tag:blogger.com,1999:blog-8066238290370557389.post9117364013516651101..comments2024-03-20T04:44:15.540-05:00Comments on Controversies in Hospital Infection Prevention: Searching for an Optimal Hand Hygiene BundleDan Diekemahttp://www.blogger.com/profile/10231929371552334184noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-8066238290370557389.post-58387211806662102992013-11-26T22:35:07.303-06:002013-11-26T22:35:07.303-06:00One other thing about our goofy little paper. It ...One other thing about our goofy little paper. It was among (just barely) the top 20 most-downloaded papers in that general medicine journal (we didn't put it in a specialty journal on purpose - we wanted regular docs and nurses to read it). This was despite the fact that we sent it all over VA to PSMs and others as an attachment... http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2006.00639.x/full<br /> neldridge202https://www.blogger.com/profile/07646837907846644263noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-78893536945889545012013-11-26T22:30:39.819-06:002013-11-26T22:30:39.819-06:00I went back and did some rereading (not retreading...I went back and did some rereading (not retreading!). It seems to me that everyone at a JCAHO (that was the name then)-accredited hospital was required as of 2004 to follow the stronger evidence parts of the 2002 CDC Hand Hygiene Guideline. In VA we wrote a special 1-page summary for the Under Secretary for Health in 2003 and had it sent out systemwide as a sort of shortcut (see page 2 of the first below). So really everything in VA after that was at all related to hand-hygiene: "my" 6 sigma study published in JGIM, Marta Render's paper on CLABSI reduction, Jain's paper on MRSA (and C diff and other infections), etc., were all confounded by this intervention to get folks to actually act on the CDC Guideline and JCAHO requirement. The memo and the newsletter guidance to VA Medical Centers are referred to at these links (I don't think I have the USH's memo anymore): http://www.slideshare.net/neldridge202/tips-hand-hygiene-dec03 and http://www.slideshare.net/neldridge202/hand-hygiene-qmic-for-leadership-021304. Trying to prevent adverse events and studying why they do or don't continue to happen is not a physics experiment that can be isolated from external forces. That said, I understand your reasons for excluding out paper. But I think it's sad because I think it contains some pretty nifty and effective tools and methods. I had major surgery this year (2013) and some of the posters we developed so many years ago for the VA were posted on the walls and doors at Johns Hopkins University Hospital. My room, almost incredibly, had one on it that I had written myself. It only occurred to me tonight that maybe my wife had set that up. But I don't think so and hope not... Our paper is at: http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2006.00361.x/full and it shows the checklist right after the fulltext of the paper - with our "nifty" not-yet-obsolete bundle - posting this version since it was excluded from your study... In general I think the premise for your study doesn't make sense in the real world. There is no optimum hand hygiene bundle. There are good ones. A good one that is actually implemented and stuck with is better than a more-perfect one than is ignored or dropped. I would defy anyone to come up with one better than the one shown in our Appendix Figure A. It's not impossible to to make a better list, but it would be hard. The downside of it is that there's a lot to do, and it's not trivial to maintain. But you don't get something for nothing...neldridge202https://www.blogger.com/profile/07646837907846644263noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-10081450702401196732013-11-20T22:27:55.829-06:002013-11-20T22:27:55.829-06:00I will have to go back and retread my own paper an...I will have to go back and retread my own paper and the attachments to answer your question! It was a long time ago. I've also posted the VHA Directive that existed 6 years prior to the one posted in the paper. That was the first one that was part of so many of the changes that were made in VA. This is the link... http://www.slideshare.net/mobile/neldridge202/vha-directive-2005-002-hand-hygiene. I think the site must be malfunctioning because it says that over 150 people looked at it tonight.neldridge202https://www.blogger.com/profile/07646837907846644263noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-73067807916700180982013-11-20T22:18:18.583-06:002013-11-20T22:18:18.583-06:00Can you explain the exact interventions that were ...Can you explain the exact interventions that were not present in the before period and were present in the after period? Were they the same in all units? For the meta-analysis, we would have to be sure that the exact bundle was implemented in a specific defined fashion in all units at a specific time. Given the provided checklist, it doesn't appear that this was the case. It appears that some parts of the bundle may have been present in the before period in some locations and not others. Is that the case?Eli Perencevichhttps://www.blogger.com/profile/05131155100606411030noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-31839809819320938212013-11-20T21:47:30.494-06:002013-11-20T21:47:30.494-06:00Wondering why this one (I'm first author) wasn...Wondering why this one (I'm first author) wasnt included. When it was published in 2006 I think it had more observations (over 4000) than any other paper. Google scholar says it's been cited 61 times so far...http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2006.00361.x/abstract. There's even a YouTube video, and it's about the VA implantation mentioned in the article...http://youtu.be/Zb_fVETGzwgneldridge202https://www.blogger.com/profile/07646837907846644263noreply@blogger.comtag:blogger.com,1999:blog-8066238290370557389.post-14330293644608674572013-11-19T21:26:44.396-06:002013-11-19T21:26:44.396-06:00Will check this out when I can get the Journal iss...Will check this out when I can get the Journal issue or PDF . Looking forward to it.neldridge202https://www.blogger.com/profile/07646837907846644263noreply@blogger.com