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.
Deep endometriosis transvaginal ultrasound (DE TVS) is accurate in the detection of ovarian and DE; however, realisation of its full potential and utilisation remains variable. As such, patients may require a two-step approach (diagnostic followed by therapeutic laparoscopy) or laparoscopy by a surgeon who is unaware of disease extent and may not have the appropriate skill level. We believe the economic impact of a two-step approach on the healthcare system is significant. We aim to compare the economic costs of two diagnostic models of care of patients with potential endometriosis. The conventional model (M1) includes the basic pelvic ultrasound and diagnostic laparoscopy. The novel model (M2) includes the DE TVS. Estimates for endometriosis prevalence and severity were drawn from local Australian hospital data. The study utilised a hypothetical population of 1000 patients visiting a public gynecology clinic for signs and symptoms of endometriosis. A Markov model (figure 1) with a 12-month time horizon was built to estimate the change to government, health service and patient costs with the adoption of the DE TVS compared to standard diagnostic methods. Probabilistic sensitivity analysis was conducted to capture the uncertainty in the information used to populate the models. The total annual cost of novel model (M2) is $12,547,724.03AUD (£6,826,673.63GBP), cheaper than the conventional model (M1), which cost $13,472,161.67AUD (£7,329,620.15GBP). Supporting information can be found in the online version of this abstract Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
In Sri Lanka, there is some evidence that the likelihood of breastfeeding initiation varies by exposure to Baby-Friendly Hospital Initiative [BFHI]-compliant care and mode of birth. Globally, there is some evidence that exposure to mother-baby skin-to-skin contact (BFHI Step 4) is lower in caesarean section births. Therefore, we aimed to determine how breastfeeding initiation varies by mode of birth in Sri Lanka, and the extent to which women's exposure to BFHI practices explains any associations found. A cross-sectional survey was conducted with women with a live baby across four government hospitals in Sri Lanka. Quantitative data were collected through participant interviews and extraction from medical records. Associations between BFHI practices, breastfeeding initiation, mode of birth, and women's characteristics were assessed using binary logistic regression analysis applied in mediation and moderated mediation models. Women who received care compliant with Steps 4 and 6 of BFHI, regardless of their mode of birth, were more likely to initiate breastfeeding within the first hour after birth. BFHI Step 4 partially and completely mediated the effect of planned caesarean section and emergency caesarean section, respectively, on breastfeeding initiation within one hour of birth. Further, exposure to BFHI Step 6 partially mediated the effect of emergency caesarean section on breastfeeding initiation within one hour of birth. Women's age, pre-pregnancy BMI, parity status, and ethnic group significantly influenced the relationship between planned or emergency caesarean section, exposure to Step 4 or Step 6 of BFHI, and breastfeeding initiation within one hour of birth. Specifically, being primiparous strengthened the likelihood that having a planned caesarean section decreased women's exposure to BFHI Step 4; and having a pre-pregnancy BMI of 23-27.49 kg/m2 weakened the likelihood that planned caesarean section decreased exposure to BFHI Step 4. Improving compliance with mother-baby skin-to-skin contact (BFHI Step 4) and no supplementation (BFHI Step 6) is critical for Sri Lankan health services to support all women to establish breastfeeding initiation within one hour of birth, as these practices attenuate the negative effect of caesarean section on breastfeeding initiation.
Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses' beliefs associated with performing hand hygiene guided by the World Health Organization's (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses' decisions to perform hand hygiene according to the recently implemented national guidelines. Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia. Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings. The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses' hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses' hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient's surroundings continues to be reported as the most neglected opportunity for compliance.
The term 'economic determinants of health and disease' is often assumed to mean the association between increasing wealth and better health. However, examining the concept in detail provides opportunities to understand how economics can inform decisions that address inequities. Decisions need to be made about how to spend resources to address all types of inequities, not only access to healthcare, and thus maximise the welfare of society. Economics seeks to understand the choices made by people, governments and other organisations, and uses this information to predict the effect of intervention. As the focus of economics is on the welfare society, there is an inextricable link between the social and economic determinants of health...
Maternity services have limited formalised guidance on planning new services such as midwifery group practice for vulnerable women, for example women with a history of substance abuse (alcohol, tobacco and other drugs), mental health challenges, complex social issues or other vulnerability. Continuity of care through midwifery group practice is mostly restricted to women with low-risk pregnancies and is not universally available to vulnerable women, despite evidence supporting benefits of this model of care for all women. The perception that midwifery group practice for vulnerable women is a high-risk model of care lacking in evidence may have in the past, thwarted implementation planning studies that seek to improve care for these women. We therefore aimed to identify the barriers and enablers that might impact the implementation of a midwifery group practice for vulnerable women.A qualitative context analysis using the Consolidated Framework for Implementation Research was conducted at a single-site tertiary health facility in Queensland, Australia. An interdisciplinary group of stakeholders from a purposeful sample of 31 people participated in semi-structured interviews. Data were analysed using manual and then Leximancer computer assisted methods. Themes were compared and mapped to the Framework.Themes identified were the woman's experience, midwifery workforce capabilities, identifying "gold standard care", the interdisciplinary team and costs. Potential enablers of implementation included perceptions that the model facilitates a relationship of trust with vulnerable women, that clinical benefit outweighs cost and universal stakeholder acceptance. Potential barriers were: potential isolation of the interdisciplinary team, costs and the potential for vicarious trauma for midwives.There was recognition that the proposed model of care is supported by research and a view that clinical benefits will outweigh costs, however supervision and support is required for midwives to manage and limit vicarious trauma. An interdisciplinary team structure is also an essential component of the service design. Attention to these key themes, barriers and enablers will assist with identification of strategies to aid successful implementation. Australian maternity services can use our results to compare how the perceptions of local stakeholders might be similar or different to the results presented in this paper.
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