Reducing Blood Culture Contamination Rates: Introduction of a Combined Education and Skin Antisepsis Intervention.

Background. Blood culture contamination (BCC) is an important quality concern in clinical microbiology as it can lead to unnecessary antimicrobial therapy in patients and increased workload for laboratory scientists. The Clinical Laboratory and Standards Institute recommend BCC rates to be <3 % and recently updated guidelines have set a new goal of 1 %. The aim of this project was to design and implement interventions to reduce BCC rates at our institution. Methods. We introduced a combined education and skin antisepsis intervention in a large Model 4 academic teaching hospital in the South of Ireland. BD ChloraPrep skin antisepsis applicators (2 % chlorhexidine gluconate/70 % isopropyl alcohol), licensed for use for blood culture specimen collection, were introduced, replacing Clinell (2 % chlorhexidine gluconate/70 % isopropyl alcohol) wipes. In addition, a multimodal education programme was designed and delivered. This consisted of a video demonstrating the recommended blood culture specimen collection technique using the new applicators as well as simulation training for all interns. The video was uploaded to the intranet as an educational resource available to all staff. Results. The interventions were implemented in July 2022 and BCC rates pre- and post-intervention were calculated. The average BCC rate for the 12 months preceding the intervention (July 2021 to July 2022) was 2.56 % with highest rates in the Emergency Department. This compared to an average rate of 2.2 % in the 12 months post-intervention (July 2022 to July 2023). In comparing the two rates the reduction in BCC rates between the two periods was not statistically significant (P=0.30). Conclusion. Overall BCC rates reduced but the difference between the two periods did not reach statistical significance. The resource-intensive nature of providing regular and timely feedback of contamination rates and the larger impact of in-person education and training over virtual modalities may explain the modest reduction. Further investments in these areas, particularly in the Emergency Department, will be necessary to further reduce rates in line with new recommendations.

Kinetic Insights into Bridge Cleavage Pathways in Periodic Mesoporous Organosilicas.

Bridging functionalities in periodic mesoporous organosilicas (PMOs) enable new functionalities for a wide range of applications. Bridge cleavage is frequently observed during anneals required to form porous structures, yet the mechanism of these bridge cleavages has not been completely resolved. Here, these chemical transformations and their kinetic pathways on sub-millisecond timescales induced by laser heating are revealed. By varying anneal times and temperatures, the transformation dynamics of bridge cleavage and structural transformations and their activation energies are determined. The structural relaxation time for individual reactions and their effective local heating time are determined and compared, and the results directly demonstrate the manipulation of different molecules through kinetic control of the sequence of reactions. By isolating and understanding the earliest stage of structural transformations, this study identifies the kinetic principles for new synthesis and post-processing routes to control individual molecules and reactions in PMOs and other material systems with multi-functionalities.

Developing an e-learning curriculum to educate healthcare staff in the acute hospital setting about autism.

When attending acute hospital settings, autistic children and adults rely on health professionals and ancillary staff to interact with them appropriately to facilitate accurate diagnoses and management of health concerns. Health outcomes for autistic people are adversely affected by comorbidities as well as difficulties in accessing and navigating acute healthcare environments. These factors demonstrate a need to develop targeted education for healthcare staff working in the acute hospital setting. This article discusses the background to the project, including the results of a literature review that highlighted some of the difficulties this patient group experiences in accessing health care. It discusses the development and evaluation of an e-learning education programme for healthcare staff working in an acute hospital setting using Kern et al's (1998) six-step approach to curriculum development. Staff reported a desire to learn more about autism and how to make patient consultations and experiences more accessible and productive. It was acknowledged that there are many undiagnosed autistic adults navigating the acute health system and it is anticipated that the e-learning programme will assist staff in identifying and meeting their needs. During research with an autism advocacy group, there was a clear recommendation for the use of the term 'autistic person' rather than 'person with autism', which is reflected in the resulting education programme and this article.

Autonomous materials synthesis via hierarchical active learning of nonequilibrium phase diagrams.

Autonomous experimentation enabled by artificial intelligence offers a new paradigm for accelerating scientific discovery. Nonequilibrium materials synthesis is emblematic of complex, resource-intensive experimentation whose acceleration would be a watershed for materials discovery. We demonstrate accelerated exploration of metastable materials through hierarchical autonomous experimentation governed by the Scientific Autonomous Reasoning Agent (SARA). SARA integrates robotic materials synthesis using lateral gradient laser spike annealing and optical characterization along with a hierarchy of AI methods to map out processing phase diagrams. Efficient exploration of the multidimensional parameter space is achieved with nested active learning cycles built upon advanced machine learning models that incorporate the underlying physics of the experiments and end-to-end uncertainty quantification. We demonstrate SARA's performance by autonomously mapping synthesis phase boundaries for the Bi2O3 system, leading to orders-of-magnitude acceleration in the establishment of a synthesis phase diagram that includes conditions for stabilizing δ-Bi2O3 at room temperature, a critical development for electrochemical technologies.

Optical Identification of Materials Transformations in Oxide Thin Films.

Recent advances in high-throughput experimentation for combinatorial studies have accelerated the discovery and analysis of materials across a wide range of compositions and synthesis conditions. However, many of the more powerful characterization methods are limited by speed, cost, availability, and/or resolution. To make efficient use of these methods, there is value in developing approaches for identifying critical compositions and conditions to be used as a priori knowledge for follow-up characterization with high-precision techniques, such as micrometer-scale synchrotron-based X-ray diffraction (XRD). Here, we demonstrate the use of optical microscopy and reflectance spectroscopy to identify likely phase-change boundaries in thin film libraries. These methods are used to delineate possible metastable phase boundaries following lateral-gradient laser spike annealing (lg-LSA) of oxide materials. The set of boundaries are then compared with definitive determinations of structural transformations obtained using high-resolution XRD. We demonstrate that the optical methods detect more than 95% of the structural transformations in a composition-gradient La-Mn-O library and a Ga2O3 sample, both subject to an extensive set of lg-LSA anneals. Our results provide quantitative support for the value of optically detected transformations as a priori data to guide subsequent structural characterization, ultimately accelerating and enhancing the efficient implementation of micrometer-resolution XRD experiments.

Acute surgical wound-dressing procedure: Description of the steps involved in the development and validation of an observational metric.

The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound-dressing procedure using aseptic non-touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six-stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound-dressing procedure performance. Video recordings of acute surgical wound-dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound-dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound-dressing procedure in both simulated and clinical practice contexts.