Unpacking nudge sensu lato: insights from a scoping review.

Nudges may play an important role in improving infection prevention and control (IPC) in hospitals. However, despite the novelty of the framework, their objectives, strategies and implementation approaches are not new. This review aims to provide an overview of the methods typically used by nudge interventions in IPC in hospitals targeting healthcare workers (HCWs). The initial search in PubMed yielded nine hits. Consequently, the search criteria were broadened and a second search was conducted, introducing 'nudge sensu lato' which incorporates insights from sources beyond the traditional nudge framework while maintaining the same objectives, strategies and approaches. During the second search, PubMed, Epistemonikos, Web of Science and PsycInfo were searched in accordance with the PRISMA guidelines. Abstracts were screened, and reviewers from an interdisciplinary team read the full text of selected papers. In total, 5706 unique primary studies were identified. Of these, 67 were included in the review, and only four were listed as nudge sensu stricto, focusing on changing HCWs' hand hygiene. All articles reported positive intervention outcomes. Of the 56 articles focused on improving hand hygiene compliance, 71.4% had positive outcomes. For healthcare equipment disinfection, 50% of studies showed significant results. Guideline adherence interventions had a 66.7% significant outcome rate. The concept of nudge sensu lato was introduced, encompassing interventions that employ strategies, methods and implementation approaches found in the nudge framework. The findings demonstrate that this concept can enhance the scientific development of more impactful nudges. This may help clinicians, researchers and policy makers to develop and implement effective nudging interventions.

COVID-19 vaccination strategy for hospital staff in Germany: a cross-sectional study in March-April 2021.

BACKGROUND: SARS-CoV-2 vaccination for healthcare workers (HCWs) started in Germany in December 2020. Hospitals had little time to prepare a vaccination strategy. AIM: To gather information on the initial vaccination strategy for HCWs from the infection control practitioners in Germany. METHODS: A cross-sectional, ethically approved questionnaire was developed, formatted as an online survey and pre-tested. Infection control practitioners responsible for hygiene/infection prevention in 987 randomly selected German hospitals were invited to participate in the survey in March and April 2021. For statistical analysis, the hospitals were categorized into two groups based on bed capacity (<500 beds: small; ≥500 beds: large). FINDINGS: One hundred out of 987 (10%) infection control practitioners completed the survey. In 80% of the participating hospitals, HCW vaccination prioritization was based on recommendations of the German standing committee on vaccination (STIKO). Even so, only 54% prioritized the vaccination of HCWs with contact to vulnerable patients, thus deviating from STIKO recommendations. HCWs with a high personal health risk were prioritized for vaccination in 24% of the hospitals. Transferring unvaccinated HCWs to an area with less infection risk was considered by 2% of large and 12% of small hospitals. CONCLUSION: Vaccination prioritization differed across hospitals and deviated from STIKO recommendations. A pandemic preparedness concept should address the potential impact of divergent strategies compared to a common approach. In addition, further studies analysing the reasons why HCWs remain unvaccinated are needed to adopt effective strategies. This is especially important against the background of facility-based compulsory vaccination.

Infection control strategies for patients and accompanying persons during the COVID-19 pandemic in German hospitals: a cross-sectional study in March-April 2021.

BACKGROUND: Patients are at risk of nosocomial COVID-19 infection. The role of accompanying persons/visitors as potential infection donors is not yet well researched, but the risk will be influenced by prevention measures recommended by infection control practitioners. AIM: To collect information about COVID-19 infection control strategies for patients and accompanying persons from infection control practitioners in German hospitals. METHODS: A cross-sectional questionnaire was developed, ethically approved, pre-tested and formatted as an online tool. Infection control practitioners in 987 randomly selected German hospitals were invited to participate in March and April 2021. For statistical analysis, the hospitals were categorized as small (0-499 beds) or large (≥500 beds). FINDINGS: One hundred surveys were completed (response rate: 10%). A higher proportion of large (71%) than small (49%) hospitals let patients decide freely whether to wear medical or FFP2 masks. Most hospitals reported spatial separation for COVID-19 patients and non-COVID-19 cases (38%) or additionally for suspected COVID-19 cases (53%). A separation of healthcare teams for these areas existed in 54% of the hospitals. Accompaniment bans were more prevalent in large (52%) than in small hospitals (29%), but large hospitals granted more exemptions. CONCLUSION: The decision as to whether to separate areas and teams seemed to depend on the hospital's structural conditions, therefore impairing the implementation of recommendations. Accompaniment regulations differ between hospital sizes and may depend on patient numbers, case type/severity and patients' requirements. In the dynamic situation of a pandemic, it can be difficult to stay up to date with findings and recommendations on infection control.

Growth hormone and insulin-like growth factor I concentrations in bulls of various growth hormone genotypes.

A leucine/valine substitution at amino acid position 127 was identified by the polymerase chain reaction and restriction fragment length polymorphism in the bovine growth hormone gene. Genotyping was performed in 84 AI bulls of three different breeds, in which plasma concentrations of growth hormone (GH) and insulin-like growth factor I (IGF-1) were also measured. Gene frequencies of variants L (leucine) und V (valine) were 0.80/0.20 (Black and White), 0.90/0.10 (Brown), 0.71/0.29 (Simmental). Hormone concentrations were measured during different physiological conditions (normal feeding, fasting, realimentation) in the majority of animals. Generally, genotype LL was associated with higher concentrations of GH than LV. This difference was significant in Black and White bulls (P < 0.05). In contrast, IGF-1 concentrations were higher in LV than in LL animals. This was most pronounced in mature, realimented Simmental bulls. We conclude that the various GH alleles influence the circulating concentrations of GH and IGF-1.

Relationship between age, nutritional status and dairy merit with plasma profiles of growth hormone (GH) and free fatty acids (FFA) in bulls.

SUMMARY: Blood plasma levels of growth hormone (bGH) and of free fatty acids (FFA) were measured in repeated samples drawn every 15' for bHG, every 1 h for FFA one day after morning feeding and after 3 days of severe feed restriction of 7 young (< 2 years) and 14 old (> 5 years) bulls. The numerous data were condensated by the PULSAR program of Merriam and Wachter (1982) to mean level, average baseline concentration, number, average amplitude and average duration of secretory peaks. Young bulls had higher values for all of these parameters except peak duration and increased these after fast except for peak duration, baseline and integral while mature bulls reacted little to food restriction. FFA plasma levels were higher in young bulls under normal feeding when mature bulls had more frequent peaks. After feed restriction mature bulls increased the mean plasma level to the increased level of young bulls but decreased the peak frequency. The milk protein yield breeding values are related significantly to mean level, integral and the peak duration of plasma bGH levels but in different directions in young and in mature bulls. ZUSAMMENFASSUNG: Beziehungen zwischen Alter, Futterstatus, Milchzuchtwert und Plasmaspiegel von Wachstumshormon (GH) und Freien Fettsäuren (FFA) bei Stieren Blutplasmaspiegel von Wachstumshormon (GH) und Freien Fettsäuren (FFA) wurden in wiederholten Proben gemessen, die im Falle von GH alle 15 min. und im Falle von FFA jede Stunde einen Tag nach Morgenfütterung, nach drei Tagen starker Futterrestriktion bei sieben jungen (weniger als zwei Jahre) und 14 alten (über fünf Jahre) Stieren gezogen worden waren. Die zahlreichen Daten wurden mit Hilfe des Computerprogrammes von Merriam und Wachter (1982) kondensiert zu durchschnittlichen Plasmaspiegel, durchschnittliche Basiskonzentration, Zahl, durchschnittliche Amplitude und durchschnittliche Dauer von Sekretionsspitzen und Integral. Die Jungstiere hatten für alle diese Parameter höhere Werte, außer der Dauer von Sekretionsspitzen und nahmen mit Ausnahme von dieser, von Basisspiegel und Integral nach Futterrestriktion zu, während Altstiere auf diese sehr wenig reagiert haben. FFA-Plasmaspiegel waren bei jungen Stieren höher unter Normalfütterung, während alte Stiere häufiger Sekretionsspitzen zeigten. Nach Futterrestriktion steigerten Altstiere den mittleren Plasmaspiegel auf den angestiegenen Spiegel junger Stiere, aber verminderten die Häufigkeit der Sekretionsspitzen. Milchprotein-Zuchtwerte sind signifikant mit mittlerem Plasmaspiegelwert, Integral und Dauer der Sekretionsspitzen bei Plasma GH korreliert, aber in verschiedener Richtung bei jungen und bei Altstieren.