The role and utilisation of public health evaluations in Europe: a case study of national hand hygiene campaigns.

BACKGROUND: Evaluations are essential to judge the success of public health programmes. In Europe, the proportion of public health programmes that undergo evaluation remains unclear. The European Centre for Disease Prevention and Control sought to determine the frequency of evaluations amongst European national public health programmes by using national hand hygiene campaigns as an example of intervention. METHODS: A cohort of all national hand hygiene campaigns initiated between 2000 and 2012 was utilised for the analysis. The aim was to collect information about evaluations of hand hygiene campaigns and their frequency. The survey was sent to nominated contact points for healthcare-associated infection surveillance in European Union and European Economic Area Member States. RESULTS: Thirty-six hand hygiene campaigns in 20 countries were performed between 2000 and 2012. Of these, 50% had undergone an evaluation and 55% of those utilised the WHO hand hygiene intervention self-assessment tool. Evaluations utilised a variety of methodologies and indicators in assessing changes in hand hygiene behaviours pre and post intervention. Of the 50% of campaigns that were not evaluated, two thirds reported that both human and financial resource constraints posed significant barriers for the evaluation. CONCLUSION: The study identified an upward trend in the number of hand hygiene campaigns implemented in Europe. It is likely that the availability of the internationally-accepted evaluation methodology developed by the WHO contributed to the evaluation of more hand hygiene campaigns in Europe. Despite this rise, hand hygiene campaigns appear to be under-evaluated. The development of simple, programme-specific, standardised guidelines, evaluation indicators and other evidence-based public health materials could help promote evaluations across all areas of public health.

Nursing in a changing NHS.

In the past few weeks, I have had the privilege of attending a series of seminars exploring the themes emerging from the Mid Staffordshire Public Inquiry to date. They are highly relevant to nurses and to the future of nursing. They have explored system and professional regulation, organizational culture, board leadership, information systems, nurse training, patient experience and commissioning.

Paraneoplastic leukemoid reaction in solid tumors.

Leukemoid reaction is defined as leucocytosis >50,000/µL. When it occurs in association with a malignancy, and infection or leukemia has been ruled out, it is termed as paraneoplastic leukemoid reaction. A patient presented with fatigue, generalized weakness, and abdominal distension and was incidentally noted to have a white blood cell count of 139,000/µL. Leukemia was ruled out by peripheral smear and flow cytometry. Computed tomography-guided biopsy of thickened omentum revealed poorly differentiated metastatic carcinoma. He died 3 days after admission with a peak white blood cell count of 180,000/µL. Previous reports and pathophysiology of paraneoplastic leukemoid reaction are reviewed.

Achieving a safer health service: Part 1. Making safety a way of life.

Patient safety incidents are a major problem in the health service and it is acknowledged that blaming and reprimanding staff for actual or potential mistakes does not encourage an open and safe culture in which to work. In the first paper in a three-part series the National Patient Safety Agency's seven key to steps to achieving patient safety are discussed.

Achieving a safer health service: Part 3. Investigating root causes and formulating solutions.

The third paper in our series describes the National Patient Safety Agency's approach to investigation, root-cause analysis and significant event audit. When should an investigation be high level and when should it be low level? What does this mean, and how can lessons be translated into safety solutions in local areas? Central initiatives such as patient-safety alerts are also examined.