Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative

Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The ‘5 critical moments’ of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses’ hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-sample (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses’ hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence.

Central America: Labor Reports and Child Labor Reports Pursuant to the Trade Act of 2002, Section 2102(c)(8)-(9)

[Excerpt] These comments are in response to the “Request for Information Concerning Labor Rights in Costa Rica, El Salvador, Guatemala, Honduras and Nicaragua and their Laws Governing Exploitative Child Labor” published at 68 Fed. Reg. 19580 (April 21, 2003). This Request for Information was issued pursuant to Section 2102(c)(8) and (9) of the Trade Act of 2002, Pub. L. 107-210, which requires the President, with respect to any proposed trade agreement, to submit to Congress a “meaningful labor rights report” and a “report describing the extent to which the country or countries that are parties to the agreement have in effect laws governing exploitative child labor.”

Illegal Immigration and the U.S. Labor Market of the 1990s

Public testimony by Prof. Briggs given before the Subcommittee on Immigration and Claims of the Committee on the Judiciary, House of Representatives, April 5, 1995.

The Apparel Industry and Codes of Conduct: A Solution to the International Child Labor Problem?

This report is the third volume in ILAB’s international child labor series. It focuses on the use of child labor in the production of apparel for the U.S. market, and reviews the extent to which U.S. apparel importers have established and are implementing codes of conduct or other business guidelines prohibiting the use of child labor in the production of the clothing they sell. The report was mandated by the Omnibus Consolidated Rescissions and Appropriations Act of 1996, P.L. 104-134.

Labor Regulations and Unionization Trends: Comparative Analysis of Latin American Countries

This paper discusses the influences of labor regulations on unionization rates through the comparative analysis of Argentina, Chile and Mexico, expecting to contribute to the understanding of the determinants of unionization in Latin America. These regulations, though only one of the factors determining unionization levels, have a crucial role, their influence being at least threefold: they define entitlements to and exclusions from the right to unionize, affect union recruitment strategies and, by generating incentives and disincentives, contribute to shape individual membership decisions. After discussing historical aspects of unionization in the three countries, the analysis centers successively in two periods in which the countries compared showed both similarities and contrasts relevant to the analysis of unionization trends. In the first, the comparison is between Argentina (1976-83) and Chile (1973-89), both under military regimes that had much in common, but with contrasting unionization trends. In the second, the focus is in Argentina (1991-2001) and Mexico (1984-2000), where the reforms implemented to liberalize the economy and ensuing social-economic and labor market transformations were similar, but unionization trends differed. It is argued that, in each case, the divergent behavior of unionization, in spite of the similar economic and sociopolitical contexts, may at least partly be attributed to differences in key labor institutions.

The Municipal Budgetary Response to Changing Labor Costs: The Case of San Francisco

"This paper analyzes how expenditures of the city of San Francisco were altered in response to changes in municipal labor costs over the period 1945 through 1976. A hybrid of the "demands" and the "organizational" models of budgeting is used to measure the budgetary response to changes in the relative prices of labor inputs. Descriptive and econometric evidence reveals significant adjustments both among and within departments in reaction to changes in relative labor costs. The empirical evidence demonstrates that the city's budgetary process is guided by simple allocative rules modified by price-responsive adjustments."

Labor-Management Cooperation

[Excerpt] In analyzing labor-management cooperation, it is important to be clear on what it is not. It is not an absence of strikes or conflict. Cooperation is not synonymous with industrial peace. Cooperation may take place even when bargaining leads to work stoppages; conversely, the mere absence of strikes is no evidence that there is labor-management cooperation. In the current period, there is a tendency to equate concessionary bargaining with labor-management cooperation. Demand for and acceptance of "givebacks" reflect economic pressures and relative bargaining strength and ought not to be interpreted as evidence of a cooperative relationship.

Officer guards and inmates, including Norbert Pollock, of the Boergermoor Labor Camp; Germany.

Viehhandler (cattle dealer) Norbert Pollock of Ruethen, Westpflahlen (standing center in dark pants, white t-shirt and cap)

Damage and physiological stress to juvenile eastern rock lobster (Sagmariasus verreauxi) discarded after trapping and hand collection

Large numbers of Sagmariasus verreauxi are trapped and hand collected in Australia, but discarded due to size and quota restrictions, and under the unevaluated assumption of few impacts. To test the validity of enforced discarding, trapped and hand-collected S. verreauxi (49-143. mm carapace length - CL) were examined for external damage, placed into cages, transferred to aquaria and monitored (with controls) over three months. Haemolymph was non-repetitively sampled immediately and at one, three, and seven days to quantify stress. Most trapped (64%) and hand-collected (79%) specimens were undersized (<104. mm CL), with the latter method yielding broader ranges of sizes and moult stages. Within-trap Octopus tetricus predation caused the only mortalities (3.3%). Hand collection resulted in much greater antennae and pereopod loss than trapping (53 vs. 4%) but, compared to controls, both methods evoked benign physiological responses that resolved within a week. While most wounded S. verreauxi regenerated all or some missing appendages post-moult, their mean CLs were less than those from intact conspecifics. Simple strategies, including larger mesh sizes, and/or installing modifications to reduce bycatch in traps, careful hand collection, and appropriate release techniques might minimise impacts (including predation) to unwanted S. verreauxi, and help to control stock exploitation. © 2012 Elsevier B.V.

Haifa - Labor Sanatorium

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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.

Diabetic charcot neuroarthropathy of the hand: Clinical course, diagnosis, and treatment options

During the treatment of diabetic Charcot neuroarthropathy (CN) of the foot in two young patients, we discovered atypical alterations of their hands with loss of strength and paresthesia combined with atypical and nonhealing bone alterations and instability. Whereas CN of the foot is a serious and well-known complication of diabetes, CN of the hand is only mentioned in four articles (1–4).