Changes in healthcare-associated infections after the introduction of a national hand hygiene initiative

Introduction: Interventions that prevent healthcare-associated infections should lead to fewer deaths and shorter hospital stays. Cleaning hands with soap and water or alcohol rub is an effectiveway to prevent the transmission of organisms, but compliance is sometimes low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infections. Methods: We examined if the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for six types of healthcare-associated infections were examined in 38 Australian hospitals across six states. Infection categories were: bloodstream infections, centralline associated bloodstream infections, methicillin-resistant and methicillin-sensitive Staphylococcus aureus, Staphylococcus aureus bacteraemia and surgical site infections. Results: The National Hand Hygiene Initiative was associated with a statistically significant reduction in infection rates in 11 out of 23 state and infection combinations studied. There was no change in infection rates for nine combinations, and there was an increase in three infection rates in South Australia. Conclusions: The intervention was associated with reduced infection rates in many cases. The lack of improvement in nine cases may have been because they already had effective initiatives before the national initiative’s introduction.

Bridging the gap: Exploring the barriers to using economic evidence in healthcare decision making and strategies for improving uptake

Evidence from economic evaluations is often not used to inform healthcare policy despite being well regarded by policy makers and physicians. This article employs the accessibility and acceptability framework to review the barriers to using evidence from economic evaluation in healthcare policy and the strategies used to overcome these barriers. Economic evaluations are often inaccessible to policymakers due to the absence of relevant economic evaluations, the time and cost required to conduct and interpret economic evaluations, and lack of expertise to evaluate quality and interpret results. Consistently reported factors that limit the translation of findings from economic evaluations into healthcare policy include poor quality of research informing economic evaluations, assumptions used in economic modelling, conflicts of interest, difficulties in transferring resources between sectors, negative attitudes to healthcare rationing, and the absence of equity considerations. Strategies to overcome these barriers have been suggested in the literature, including training, structured abstract databases, rapid evaluation, reporting checklists for journals, and considering factors other than cost effectiveness in economic evaluations, such as equity or budget impact. The factors that prevent or encourage decision makers to use evidence from economic evaluations have been identified, but the relative importance of these factors to decision makers is uncertain.

How do Australian print media representations of child abuse and neglect inform the public and system reform?

The print media play a vital role in informing the public about child abuse and neglect. This information helps build broad support for laws and system developments that enable the state to intervene into private family lives and ensure that children are protected from maltreatment. Print media coverage usually sets the daily media agenda. It therefore influences public understandings of child abuse and neglect and what people believe should be done about it. Media impact on policy agendas should not be underestimated. This article outlines the results of a study of all major Australian newspaper stories covering abuse and neglect matters during an 18-month period in 2008–2009. A range of issues are identified concerning how well these stories inform the public about the nature of the problem and the current national reform agenda for protective systems that promotes early intervention and prevention...

Feature article coverage of Australian out-of-home care : portrayals and policy reform

Mandatory reporting is a key aspect of Australia’s approach to protecting children and is incorporated into all jurisdictions’ legislation, albeit in a variety of forms. In this article we examine all major newspaper’s coverage of mandatory reporting during an 18-month period in 2008-2009, when high-profile tragedies and inquiries occurred and significant policy and reform agendas were being debated. Mass media utilise a variety of lenses to inform and shape public responses and attitudes to reported events. We use frame analysis to identify the ways in which stories were composed and presented, and how language portrayed this contested area of policy. The results indicate that within an overall portrayal of system failure and the need for reform, the coverage placed major responsibility on child protection agencies for the over-reporting, under-reporting, and overburdened system identified, along with the failure of mandatory reporting to reduce risk. The implications for ongoing reform are explored along with the need for robust research to inform debate about the merits of mandatory reporting.

Making the fun stop : youth justice reform in Queensland

In 2013 the newly elected conservative Liberal National Party government instigated amendments to the Youth Justice Act 1992 (Qld). Boot camps replaced court ordered youth justice conferencing. In 2014 there were more drastic changes, including opening the Children’s Court proceedings to the public, permitting publication of identifying information of repeat offenders, removing the principle of ‘detention as a last resort’, facilitating prompt transferral of 17 year olds to adult prisons and instigating new bail offences and mandatory boot camp orders for recidivist motor vehicle offenders in Townsville. This article compares these amendments to the legislative frameworks in other jurisdictions and current social research. It argues that these amendments are out of step with national and international best practice benchmarks for youth justice. Early indications are that Indigenous children are now experiencing increased rates of unsentenced remand. The article argues that the government’s policy initiatives are resulting in negative outcomes and that early and extensive evaluations of these changes are essential.

Speaking too soon : the sabotage of bail reform in New South Wales

Within just over one month of coming into operation in May 2014, the new Bail Act 2013 (NSW), a product of long-term law reform consideration, was reviewed and then amended after talk-back radio ‘shock jock’ and tabloid newspaper outcry over three cases. This article examines the media triggers, the main arguments of the review conducted by former New South Wales (NSW) Attorney General John Hatzistergos, and the amendments, with our analysis of the judicial interpretation of the Act thus far providing relevant background. We argue that the amendments are premature, unnecessary, create complexity and confusion, and, quite possibly, will have unintended consequences: in short, they are a mess. The whole process of reversal is an example of law and order politics driven by the shock jocks and tabloid media, the views of which, are based on fundamental misconceptions of the purpose of bail and its place in the criminal process, resulting in a conflation of accusation, guilt and punishment. Other consequences of the review and amendments process recognised in this article include the denigration of judicial expertise and lack of concern with evidence and process; the disproportionate influence of the shock jocks, tabloids and Police Association of NSW on policy formation; the practice of using retired politicians to produce ‘quick fix’ reviews; and the political failure to understand and defend fundamental legal principles that benefit us all and are central to the maintenance of a democratic society and the rule of law. The article concludes with some discussion of ways in which media and political debate might be conducted to produce more balanced outcomes.

Nothing new in Indigenous reform agenda

Indigenous leader Pat Dodson – who revealed he has met Prime Minister Tony Abbott only once, and then in passing – said last week that removal of frontline services from Indigenous organisations working towards Closing the Gap in Indigenous health “would seem counter intuitive to any fair-minded Australian”. But that, he said in this Age OpEd, has been the result of the Federal Government’s much-awaited Indigenous Advancement Strategy...

EFL teachers' professional dilemmas with moral curriculum reform in Indonesia

This project explored how EFL teachers working in different sectors in Indonesia experienced moral education reform. Teachers working in either state schools or Islamic private schools were interviewed and their classes were observed. The thesis indicated that systemic investment in teachers' professionalism contributed to teachers' emerging dilemmas and their resolutions. Teachers in the better resourced state sector reported more dilemmas related to the implementation of the reform and resolved these dilemmas by using professional judgement, while teachers in the less resourced sector reported dilemmas related to their context and failed to implement the curriculum.

Electronic medical record systems in Saudi Arabia: Knowledge and preferences of healthcare professionals

Background The use of Electronic Medical Record (EMR) systems is increasing internationally, though developing countries, such as Saudi Arabia, have tended to lag behind in the adoption and implementation of EMR systems due to several barriers. The literature shows that the main barriers to EMR in Saudi Arabia are lack of knowledge or experience using EMR systems and staff resistance to using the implemented EMR system. Methods A quantitative methodology was used to examine health personnel knowledge and acceptance of and preference for EMR systems in seven Saudi public hospitals in Jeddah, Makkah and Taif cities. Results Both English literacy and education levels were significantly correlated with computer literacy and EMR literacy. Participants whose first language was not Arabic were more likely to prefer using an EMR system compared to those whose first language was Arabic. Conclusion This study suggests that as computer literacy levels increase, so too do staff preferences for using EMR systems. Thus, it would be beneficial for hospitals to assess English language proficiency and computer literacy levels of staff prior to implementing an EMR system. It is recommended that hospitals need to offer training and targeted educational programs to the potential users of the EMR system. This would help to increase English language proficiency and computer literacy levels of staff as well as staff acceptance of the system.

The Governance of human resources in the Vietnamese healthcare system: A critical analysis of maternity services

This thesis utilised mixed-methods study design to understand the factors that influence the translation and implementation of central human resources in health policy at the district and commune health levels. It provided recommendations for changes to enhance governance approaches to human resources for health policy implementation at local and national levels. This thesis has also contributed to the evolution of the theory on health staff motivation and performance through the description and testing of a new model, using data from a survey on 262 health staff and 43 in-depth interviews conducted in two northern mountainous provinces of Vietnam.

Gendering occupations: Persistence and resistance of gender presumptions about members of particular healthcare professions

In spite of increasing gender diversity in employment roles, presumptions persist about the gender of people employed in particular occupations. Focusing on healthcare data collected in Australia and the United Kingdom within the past decade, we use Conversation Analysis (CA) to identify how presumptions about gender are displayed within social interaction through the use of gender-specific pronouns. We show how gender-specific pronouns are asymmetrically selected on the basis of a referent’s occupations, with gender-unspecified members of traditionally male occupations (e.g. doctors) referred to with masculine pronouns and gender-unspecified members of traditionally female occupations (e.g. nurses) referred to with feminine pronouns. We also explore ways people avoid making such presumptions. Our analysis therefore reveals a state of flux in contemporary social life, with instances in which gender presumptions persist as well as attempts to employ person references that reflect contemporary social dynamics.

Integrated reporting and directors’ concerns about personal liability exposure: Law reform options

Integrated reporting () holds significant promise as a new reporting paradigm that is holistic, strategic, responsive, material, and relevant across multiple time frames. However, its uptake in Australia is being hampered by directors’ concerns about personal liability exposure, particularly for forward-looking statements that subsequently prove to be unfounded. This article seeks to illuminate the bases for these liability concerns by outlining the similarities between and the operating and financial review requirements under the Corporations Act 2001 (Cth), and the relevant grounds for liability for misleading and deceptive disclosures, and breach of directors’ duties. In light of this discussion, this article proposes four possible reform options, ranging from minor adaptations to the Framework to far-reaching reforms of the Corporations Act. As assurance is desirable to ensure that reliance can be placed on integrated reports, the development of a legal safe harbour for auditors of forward-looking information is also canvassed.

The freedom to tinker: Patent law and experimental use

This article considers the origins and the development of the defence of experimental use in patent law - the ’freedom to tinker'. It explores the impact of such an exemption upon a number of important industries - such as agriculture, biotechnology, and pharmaceutical drugs. This article takes a comparative approach in its analysis of patent law and experimental use. It highlights the competing norms, and lack of harmonization between a number of jurisdictions - including the United States, the European Union, and Australia. Section 2 provides a critique of the development of the common law defence of experimental use in the United States. It considers a series of precedents - including Roche Products Inc v Bolar Pharmaceuticals, Madey v Duke University, Integra Lifesciences I Ltd v Merck KgaA, and Applera v MJ Research. Section 3 explores the operation of patent law and experimental use in European jurisdictions. It looks at a number of significant precedents in the United Kingdom, the Netherlands, France, Italy, and Germany. Section 4 considers the policy debate in a number of forums over the defence of experimental use in Australia. It examines the controversy over Genetic Technologies Limited asking research organisations to obtain a licence in respect of its patents associated with non-coding DNA and genomic mapping. It also considers the inquiries of the Australian Law Reform Commission and the Advisory Council on Intellectual Property, as well as the impact of the TRIPS Agreement and the Australia-United States Free Trade Agreement. The conclusion contends that there is a need for a broad-based defence of experimental use for all the member states of the Organisation for Economic Co-operation and Development.