A baseline study of communication networks related to evidence-based infection prevention practices in an intensive care unit.

This study seeks to gain a baseline understanding of the communication network structure, content of communication, and outcomes in a medical intensive care unit experiencing higher-than-expected central line blood stream infection (CLBSI) rates. The communication network structure refers to the direction and frequency of communication on evidence-based CLBSI prevention practices across various professional subgroups and hierarchical levels in the unit, including medical faculty, nurses, residents, students, unit managers, and hospital administrators. The content of communication refers to the type of knowledge (ie, tacit vs explicit knowledge) exchanged on CLBSI prevention practices. Outcomes include (1) compliance with CLBSI prevention practices and (2) hospital-acquired CLBSI rates in the unit. Data on communication network structure and content of communication are collected using communication logs completed weekly for 4 weeks, by individual participants in each professional subgroup and hierarchical level. Outcomes are collected weekly through chart (medical record) review. Study results indicate a sparse communication network structure with minimal interaction across professional subgroups and hierarchical levels. They also indicate that primarily explicit knowledge on general infection topics is being exchanged as against tacit knowledge on specific infection prevention practices. Unit outcomes are poor, with the central line bundle score at zero during all 4 weeks. The study represents an original attempt at developing methods for measuring the communication network structure related to evidence-based infection prevention practices at the unit level. It lays a foundation for testing hypotheses related to effective communication network structures for hospital infection prevention in a larger study. More significantly, the study lays a foundation for generating concrete and context-sensitive strategies for organizational learning and improvement in the context of evidence-based practices. Such insight is critical from the perspective of evidence-based health care management.

Focus group data as a tool in assessing effectiveness of a hand hygiene campaign.

BACKGROUND: Routine handwashing has been proven to decrease incidence of health care-associated infections, including methicillin-resistant Staphylococcus aureus (MRSA), spawning numerous attempts to "advertise" its importance. However, most control measures fail to evaluate systematically the efficacy of handwashing initiatives. The purpose of this study was to implement a hand hygiene program in an academic medical center, utilizing visual cues developed with periodic input from hospital personnel. METHODS: After estimation of baseline compliance (20%), visual cues in the form of 11'' x 17'' posters were developed in a sequential fashion, based on suggestions from participants. The stepwise approach was supported by data collected via focus groups. These data were used to design target-specific messages and to understand better the benefits of utilizing participant input. RESULTS: Postexposure compliance rates indicated a modest improvement over baseline, increasing to 37% during the 12-month study. In addition, the stepwise design proved to be highly useful in guiding the intervention process. Analysis of qualitative data also elucidated numerous routes through which effective hand hygiene campaigns could be implemented. CONCLUSIONS: Through diligent observation and participant feedback, the research team was able to develop and market educational cues to meet service demands of health care professionals in a unified effort to control health care-associated infections. Future interventions should employ incremental evaluation designs supported by participant input to develop effective hand hygiene initiatives.