138 HINIC: Hand Hygiene – Improving NICU Infection Control
Bibliographic record
Abstract
Reducing nosocomial infections in hospitals is important. The complex environment of the neonatal intensive care unit (NICU) demands an extra Moment of Hand Hygiene as implemented by Public Health Ontario. As such, precautionary measures surrounding hand hygiene have been implemented, including a bare-below-the-elbow (BBE) guideline and the moments of hand hygiene (MHH). We sought out to observe adherence and identify barriers to adherence to the MHH and BBE guidelines in the NICU. This is a cross-sectional study that took place from March through August 2018 in the NICU. We observed adherence to the MHH and BBE guidelines for 24 one-hour shifts. We describe adherence overall, as well as stratified by the moment, the body part (i.e. finger, hand, wrist, and forearm), the type of participant (e.g. doctor, nurse, family member) and the time of day (e.g. day vs. night shift). Subsequently, we administered online and in-person questionnaires to healthcare providers and patient families, respectively, to assess knowledge of these guidelines and barriers to adherence. We found Moments 1A and 2 least often adhered to (51% and 50%, respectively). We found forearm violations the most common BBE violation (56% adherence rate). 24 healthcare providers completed the questionnaire. 18/24 (75%), 16/24 (67%), and 16/24 (67%) agreed or strongly agreed that skin irritation, forgetfulness, and the busy NICU environment are barriers to adhering to the MHH. 15/23 (65%) and 13/23 (57%) agreed or strongly agreed that forgetfulness and the lack of a secure location to store jewellery and other valuables are barriers to adhering to the BBE guideline. 27 family members completed the questionnaire, of which 25 (93%), 24 (89%), 23 (85%), and 23 (85%) agreed or strongly agreed that hand hygiene equipment is available at the NICU, bedside, well labeled, and is constantly filled, respectively. There is a variation in adherence to the various MHH and the BBE guidelines when stratified by moment and by body part. Patient familes and healthcare providers have differing opinions on barriers to adherence. Families noted few barrier while healthcare providers commonly identified time constraints, the busy NICU environment, forgetfulness, skin irritation, lack of a secure location to secure jewellery, and patient family members not being comfortable commenting as potential barriers.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.026 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".