Cost-effectiveness of a national initiative to improve hand hygiene compliance using the outcome of healthcare associated staphylococcus aureus bacteraemia

Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia.

Mobile phone use while driving : an investigation of the beliefs influencing drivers’ hands-free and hand-held mobile phone use.

This study explored the psychological influences of hands-free and hand-held mobile phone use while driving. Participants were 796 Australian drivers aged 17 to 76 years who owned mobile phones. A cross-sectional survey assessed frequency of calling and text messaging while driving (overall, hands-free, hand-held) as well as drivers’ behavioural, normative, and control beliefs relating to mobile phone use while driving. Irrespective of handset type, 43% of drivers reported answering calls while driving on a daily basis, followed by making calls (36%), reading text messages (27%), and sending text messages (18%). In total, 63.9% of drivers did not own hands-free kits and, of the drivers that owned hand-free kits, 32% did not use it most or all of the time. Significant differences were found in the behavioural, normative, and control beliefs of frequent and infrequent users of both types of handset while driving. As expected, frequent users reported more advantages of, more approval from others for, and fewer barriers that would prevent them from, using either a hands-free or a hand-held mobile phone while driving than infrequent users. Campaigns to reduce mobile phone use while driving should attempt to minimise the perceived benefits of the behaviour and highlight the risks of this unsafe driving practice.

Prehistoric hand stencils at Fern Cave, North Queensland (Australia): environmental and chronological implications of Raman spectroscopy and FT-IR imaging results

Raman spectroscopy and FT-IR imaging analyses of cave wall pigment samples from north Queensland (Australia) indicate that some hand stencils were undertaken during a dry environmental phase indicating late Holocene age. Other, earlier painting episodes also took place during dry environmental periods of the terminal Pleistocene and/or early Holocene. These results represent a rare opportunity to attain chronological information for rock art in conditions where insufficient carbon is present for radiocarbon dating.

Machine recognition of hand-drawn circuit diagrams

An application of image processing techniques to recognition of hand-drawn circuit diagrams is presented. The scanned image of a diagram is pre-processed to remove noise and converted to bilevel. Morphological operations are applied to obtain a clean, connected representation using thinned lines. The diagram comprises of nodes, connections and components. Nodes and components are segmented using appropriate thresholds on a spatially varying object pixel density. Connection paths are traced using a pixel-stack. Nodes are classified using syntactic analysis. Components are classified using a combination of invariant moments, scalar pixel-distribution features, and vector relationships between straight lines in polygonal representations. A node recognition accuracy of 82% and a component recognition accuracy of 86% was achieved on a database comprising 107 nodes and 449 components. This recogniser can be used for layout “beautification” or to generate input code for circuit analysis and simulation packages

Evaluating the economics of the Australian National Hand Hygiene Initiative

The National Hand Hygiene Initiative, implemented in Australia in 2009, is currently being evaluated for effectiveness and cost-effectiveness by a multidisciplinary team of researchers. Data from a wide range of sources are being harvested to address the research questions. The data are observational and appropriate statistical and economic modelling methods are being used. Decision makers will be provided with new knowledge about how hand hygiene interventions should be organised and what investment decisions are justified. This is novel research and the authors are unaware of any other evaluation of hand hygiene improvement initiatives. This paper describes the evaluation currently underway.

Validation of a new hand-held electronic data capture method for continuous monitoring of subjective appetite sensations

Background When large scale trials are investigating the effects of interventions on appetite, it is paramount to efficiently monitor large amounts of human data. The original hand-held Electronic Appetite Ratings System (EARS) was designed to facilitate the administering and data management of visual analogue scales (VAS) of subjective appetite sensations. The purpose of this study was to validate a novel hand-held method (EARS II (HP® iPAQ)) against the standard Pen and Paper (P&P) method and the previously validated EARS. Methods Twelve participants (5 male, 7 female, aged 18-40) were involved in a fully repeated measures design. Participants were randomly assigned in a crossover design, to either high fat (>48% fat) or low fat (<28% fat) meal days, one week apart and completed ratings using the three data capture methods ordered according to Latin Square. The first set of appetite sensations was completed in a fasted state, immediately before a fixed breakfast. Thereafter, appetite sensations were completed every thirty minutes for 4h. An ad libitum lunch was provided immediately before completing a final set of appetite sensations. Results Repeated measures ANOVAs were conducted for ratings of hunger, fullness and desire to eat. There were no significant differences between P&P compared with either EARS or EARS II (p > 0.05). Correlation coefficients between P&P and EARS II, controlling for age and gender, were performed on Area Under the Curve ratings. R2 for Hunger (0.89), Fullness (0.96) and Desire to Eat (0.95) were statistically significant (p < 0.05). Conclusions EARS II was sensitive to the impact of a meal and recovery of appetite during the postprandial period and is therefore an effective device for monitoring appetite sensations. This study provides evidence and support for further validation of the novel EARS II method for monitoring appetite sensations during large scale studies. The added versatility means that future uses of the system provides the potential to monitor a range of other behavioural and physiological measures often important in clinical and free living trials.

The hygienic efficacy of different hand-drying methods : a review of the evidence

The transmission of bacteria is more likely to occur from wet skin than from dry skin; therefore, the proper drying of hands after washing should be an integral part of the hand hygiene process in health care. This article systematically reviews the research on the hygienic efficacy of different hand-drying methods. A literature search was conducted in April 2011 using the electronic databases PubMed, Scopus, and Web of Science. Search terms used were hand dryer and hand drying. The search was limited to articles published in English from January 1970 through March 2011. Twelve studies were included in the review. Hand-drying effectiveness includes the speed of drying, degree of dryness, effective removal of bacteria, and prevention of cross-contamination. This review found little agreement regarding the relative effectiveness of electric air dryers. However, most studies suggest that paper towels can dry hands efficiently, remove bacteria effectively, and cause less contamination of the washroom environment. From a hygiene viewpoint, paper towels are superior to electric air dryers. Paper towels should be recommended in locations where hygiene is paramount, such as hospitals and clinics.

Hand-held monocular SLAM in thermal-infrared

Thermal-infrared imagery is relatively robust to many of the failure conditions of visual and laser-based SLAM systems, such as fog, dust and smoke. The ability to use thermal-infrared video for localization is therefore highly appealing for many applications. However, operating in thermal-infrared is beyond the capacity of existing SLAM implementations. This paper presents the first known monocular SLAM system designed and tested for hand-held use in the thermal-infrared modality. The implementation includes a flexible feature detection layer able to achieve robust feature tracking in high-noise, low-texture thermal images. A novel approach for structure initialization is also presented. The system is robust to irregular motion and capable of handling the unique mechanical shutter interruptions common to thermal-infrared cameras. The evaluation demonstrates promising performance of the algorithm in several environments.

Properties of hand-made clay balls used as a novel filter media

Filtration using granular media such as quarried sand, anthracite and granular activated carbon is a well-known technique used in both water and wastewater treatment. A relatively new prefiltration method called pebble matrix filtration (PMF) technology has been proved effective in treating high turbidity water during heavy rain periods that occur in many parts of the world. Sand and pebbles are the principal filter media used in PMF laboratory and pilot field trials conducted in the UK, Papua New Guinea and Serbia. However during first full-scale trials at a water treatment plant in Sri Lanka in 2008, problems were encountered in sourcing the required uniform size and shape of pebbles due to cost, scarcity and Government regulations on pebble dredging. As an alternative to pebbles, hand-made clay pebbles (balls) were fired in a kiln and their performance evaluated for the sustainability of the PMF system. These clay balls within a filter bed are subjected to stresses due to self-weight and overburden, therefore, it is important that clay balls should be able to withstand these stresses in water saturated conditions. In this paper, experimentally determined physical properties including compression failure load (Uniaxial Compressive Strength) and tensile strength at failure (theoretical) of hand-made clay balls are described. Hand-made clay balls fired between the kiln temperatures of 875oC to 960oC gave failure loads of between 3.0 kN and 7.1 kN. In another test when clay balls were fired to 1250oC the failure load was 35.0 kN compared to natural Scottish cobbles with an average failure load of 29.5 kN. The uniaxial compressive strength of clay balls obtained by experiment has been presented in terms of the tensile yield stress of clay balls. Based on the effective stress principle in soil mechanics, a method for the estimation of maximum theoretical load on clay balls used as filter media is proposed and compared with experimental failure loads.

ACE research vignette 022 : family business succession : when death takes a hand

This series of research vignettes is aimed at sharing current and interesting research findings from our team of international Entrepreneurship researchers. In this vignette, Dr. Mervyn Morris considers the impact on family business operations due to the sudden and unexpected death of a key family member.

Silver Gelatin Print: A group exhibition curated by Karen Milder that investigates and captures the traditional processes using photograms, liquid emulsion, toning, hand-colouring and film. Part of the Queensland Festival of Photography 4 (QFP4).

Pillar of salt: (3 hand-applied silver gelatin photographs) Statement: For women moving into new experiences and spaces, loss and hardship is often a price to be paid. These courageous women look back to things they have overcome in order to continue to grow.

Linking scientific evidence and decision making : A case study of hand hygiene interventions

We consider how data from scientific research should be used for decision making in health services. Whether a hand hygiene intervention to reduce risk of nosocomial infection should be widely adopted is the case study. Improving hand hygiene has been described as the most important measure to prevent nosocomial infection. 1 Transmission of microorganisms is reduced, and fewer infections arise, which leads to a reduction in mortality2 and cost savings.3 Implementing a hand hygiene program is itself costly, so the extra investment should be tested for cost-effectiveness.4,5 The first part of our commentary is about cost-effectiveness models and how they inform decision making for health services. The second part is about how data on the effectiveness of hand hygiene programs arising from scientific studies are used, and 2 points are made: the threshold for statistical inference of .05 used to judge effectiveness studies is not important for decision making,6,7 and potentially valuable evidence about effectiveness might be excluded by decision makers because it is deemed low quality.8 The ideas put forward will help researchers and health services decision makers to appraise scientific evidence in a more powerful way.

Cryotherapy for docetaxel-induced hand and nail toxicity: Randomised control trial

Purpose This study investigated the efficacy and safety of cryotherapy, in the form of frozen gel gloves, in relation to docetaxel-induced hand and fingernail toxicities. Patients and methods After piloting with 21 patients, a consecutive series sample of patients (n=53) prescribed docetaxel every three weeks, for a minimum of three cycles, was enrolled in this randomised control trial. Participants acted as their own control, with the frozen gel glove worn on one randomised hand for 15 minutes prior to infusion, for the duration of the infusion, and for 15 minutes of after completion of treatment. Hand and nail toxicities were evaluated by two blinded assessors according to CTCAE.v4 criteria. To assess the potential for cross-infection of multi-use gloves, microbial culture and sensitivity swabs were taken of each glove at every tenth use. Results Of the 53 participants enrolled in the main study, 21 provided evaluable data. There was a 60% withdrawal rate due to patient discomfort with the intervention. The mean incidence and severity of toxicities in all evaluable cycles in control and intervention hands respectively were erythroderma Grade 1 (5%/5%); nail discolouration Grade 1 (81%/67%); nail loss Grade 1 (19%/19%) and nail ridging Grade 1 (57%/57%). No significant differences were determined between hand conditions in terms of time to event, nor in terms of toxicity in gloved and non-gloved hands. Conclusion While cryotherapy in the form of frozen gloves for the cutaneous toxicities associated with docetaxel is safe, its limited efficacy, patient discomfort and some logistical issues preclude its use in our clinical setting.

Silk purse, sow’s ear : transforming second-Hand clothing into luxury fashion through craft practice

There is more apparel being created than ever before in history. The unsustainable production of materials and the clothing and textile waste that contributes annually to landfill, an estimated 500 000 tonnes of clothing per year in the UK (Gray, 2012) are significant issues inspiring the practice of Australian fashion designers, Carla van Lunn and Carla Binotto. While the contemporary fashion industry is built upon a production and consumption model that is younger than the industrial revolution, the traditions of costume, craft, and bodily adornment are ancient practices. Binotto and van Lunn believe that the potential for sustainable fashion practice lies outside the current industrial manufacturing model. This case study will discuss their fashion label, Maison Briz Vegas, and examine how recycling and traditional craft practices can be used to address the problem of clothing waste and offer an alternative idea of value in fashion and materials, addressing the indicative conference theme, Craft as Sustainability Activism in Practice. “Maison Briz Vegas”, a play on the notion of French luxury and the designers’ new world and sub-tropical home town, Brisbane, is an experimental and craft-based fashion label that uses second-hand cotton T-shirts and wool sweaters as primary materials to create designer fashion. The first collection, titled “The Wasteland”, was conceived and created in Paris in 2011, where designer Carla van Lunn had been living and working for several years. The collection was inspired by the precariousness of the global economy and concerns about climate change. The mountains of discarded clothing found at flea markets provided a textile resource from which van Lunn created a recycled hand-crafted fashion collection with an activist message and was shown to buyers and press during Paris Fashion Week. The label has since become a collaboration with fellow Australian designer Carla Binotto. The craft processes employed in Maison Briz Vegas’ up-cycled fashion collections include original hand block-printing, hand embroidery, quilting and patchwork. Taking an artisanal and slow approach, the designers work to create a hand touched imperfect style in a fashion market flooded with digital printing and fast mass-produced garments. The recycling extends to garment fastenings and embellishments, with discarded jar lids and bottle tops being used as buttons and within embroidery. This process transforms the material and aesthetic value of cheap and generic second-hand clothing and household waste. Maison Briz Vegas demonstrates the potential for craft and design to be an interface for environmental activism within the world of fashion. Presenting garments that are both high-design and thoughtfully recycled in a significant fashion context, such as Paris Fashion Week, Maison Briz Vegas has been able to engage a high-profile luxury fashion audience which has not traditionally considered sustainable or eco practices as relevant or desirable in themselves. The designers are studying how to apply their production model on a greater scale in order to fill commercial orders and reach a wider audience whilst maintaining the element of bespoke, limited edition, and slow hand-craft within their work.

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

Background. Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly 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 infection. Methods. We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time. Results. The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates. Conclusions. The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative’s introduction or because infection rates were already low and could not be further reduced.