Identifying interventions to improve hand hygiene compliance in the intensive care unit through co-design with stakeholders

Background: Despite the effectiveness of hand hygiene (HH) for infection control, there is a lack of robust scientific data to guide how HH can be improved in intensive care units (ICUs). The aim of this study is to use the literature, researcher, and stakeholder opinion to explicate potential interventions for improving HH compliance in the ICU, and provide an indication of the suitability of these interventions. Methods: A four-phase co-design study was designed. First, data from a previously completed systematic literature review was used in order to identify unique components of existing interventions to improve HH in ICUs. Second, a workshop was held with a panel of 10 experts to identify additional intervention components. Third, the 91 intervention components resulting from the literature review and workshop were synthesised into a final list of 21 hand hygiene interventions. Finally, the affordability, practicability, effectiveness, acceptability, side-effects/safety, and equity of each intervention was rated by 39 stakeholders (health services researchers, ICU staff, and the public). Results: Ensuring the availability of essential supplies for HH compliance was the intervention that received most approval from stakeholders. Interventions involving role models and peer-to-peer accountability and support were also well regarded by stakeholders. Education/training interventions were commonplace and popular. Punitive interventions were poorly regarded. Conclusions: Hospitals and regulators must make decisions regarding how to improve HH compliance in the absence of scientific consensus on effective methods. Using collective input and a co-design approach, the guidance developed herein may usefully support implementation of HH interventions that are considered to be effective and acceptable by stakeholders.

Identifying interventions to improve hand hygiene compliance in the intensive care unit through co-design with stakeholders

Background: Despite the effectiveness of hand hygiene (HH) for infection control, there is a lack of robust scientific data to guide how HH can be improved in intensive care units (ICUs). The aim of this study is to use the literature, researcher, and stakeholder opinion to explicate potential interventions for improving HH compliance in the ICU, and provide an indication of the suitability of these interventions. Methods: A four-phase co-design study was designed. First, data from a previously completed systematic literature review was used in order to identify unique components of existing interventions to improve HH in ICUs. Second, a workshop was held with a panel of 10 experts to identify additional intervention components. Third, the 91 intervention components resulting from the literature review and workshop were synthesised into a final list of 21 hand hygiene interventions. Finally, the affordability, practicability, effectiveness, acceptability, side-effects/safety, and equity of each intervention was rated by 39 stakeholders (health services researchers, ICU staff, and the public). Results: Ensuring the availability of essential supplies for HH compliance was the intervention that received most approval from stakeholders. Interventions involving role models and peer-to-peer accountability and support were also well regarded by stakeholders. Education/training interventions were commonplace and popular. Punitive interventions were poorly regarded. Conclusions: Hospitals and regulators must make decisions regarding how to improve HH compliance in the absence of scientific consensus on effective methods. Using collective input and a co-design approach, the guidance developed herein may usefully support implementation of HH interventions that are considered to be effective and acceptable by stakeholders.

Virtual Collaboration in Academia

More nurses and nurse educators today are working distantly in different geographic locations from others, and this includes working from home or satellite locations (Poulsen & Ipsen, 2017). Can we work collaboratively in a purely distance relationship? In academia, collaboration between colleagues is common and often mandated. Being able to engage with others in a collegial manner is necessary, and in some instances the relationship may be purely virtual. This revolution in cognitive capability uses long-distance interactive technology and the structure of professional learning communities. Successful group collaboration is driven by high expectations, shared goals, professionalism, and peer accountability. Such collaboration may be viewed as involving a nonlinear theory of change, with multiple factors influencing processes and outcomes. Factors impacting success include academic considerations (professional goals, disciplinary expertise), nonacademic issues (personal preferences, financial factors), and the development of a culture of trust and collective leadership. Practical strategies to implement such virtual collaboration are discussed.

Good Governance in the Development of Network Codes for the EU Internal Electricity Market

This article aims to contribute to the further development of the governance structure of the internal energy market by evaluating the process of the development of network codes, that is, the technical rules governing access to – and functioning of the cross border electricity grid, against principles of good governance. It finds that the governance structure does not sufficiently ensure responsiveness to stakeholder input. This is due to a lack of legal accountability mechanisms, which are only insufficiently complemented by means of political-, social-, vertical administrative- and peer-accountability. Legal accountability mechanisms are insufficient to guarantee adequate responsiveness to stakeholder input, due to rigid standing criteria for direct actions at the European Court of Justice against network codes adopted as delegated acts by the Commission. Moreover, there is insufficient possibility of judicial review as regards the roles of various network members in the development of network codes, in particular regarding soft law instruments used by ACER and ENTSO-E. Hence, their factual influence on the technical rules adopted as network codes is not appropriately met by legal accountability mechanisms that would ensure their stakeholder responsiveness. While current means of political-, social-, vertical administrativeand peer-accountability may improve responsiveness to stakeholder input, a thorough analysis of the network code development process shows that they are too weak to meet a level as required by principles of good governance. This lack of accountability also leads to a lack of participation and openness. This article argues that alternative accountability mechanisms need to be strengthened in a way that adapts the present system of accountability mechanisms to the flexible means of exercising authority through network governance. In particular, it advocates a greater role for stakeholder committees as well as ACER in the development of network codes.

Effects of Anonymity and Accountability During Online Peer Assessment

A 2´2 experiment was conducted to determine the effects of anonymity (anonymous vs. named) and peer-accountability (more-accountable vs. less-accountable) on peer over-marking, and on the criticality and quality of peer comments during online peer assessment. Thirty-six graduate students in a Web-based education research methods course were required to critique two published research articles as a part of their course. Peer assessment was carried out on the first critique. Students were randomly assigned to one of the four groups. Peer assessors were randomly assigned three students’ critiques to assess. Peer assessors and the students being assessed were from the same group. Peer assessors assigned a numeric mark and commented on students’ critiques. The four main results were: First, significantly fewer peer assessors over-marked (i.e., assigned a higher mark relative to the instructor) in the anonymous group as compared to the named group (p < .04). Second, peer assessors in the anonymous group provided a significantly higher number of critical comments (i.e., weaknesses) as compared to the named group (p < .01). Third, peer assessors in the named groupand the more-accountable group made a significantly higher number of quality comments (i.e., cognitive statements indicating strengths and weakness along with reasoned responses and suggestions for improvement), compared to the peer assessors in the anonymous group and the less-accountable group (p < .01). Lastly, the students’ responses to the questionnaire indicated that they found the peer assessment process helpful. This study suggests that in online peer assessment, the anonymity and the degree of peer-accountability affect peer marking and comments.