Lifestyle Medicine And Health Research Centre
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Browsing Lifestyle Medicine And Health Research Centre by Author "Allen, Michelle"
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Item Changes in Knowledge and Attitudes of Hospital Environmental Services Staff: The Researching Effective Approaches to Cleaning in Hospitals (REACH) Study(2018-09-01) Hall, Lisa; Graves, Nicholas; Paterson, David L.; Gericke, Christian A.; Riley, Thomas V.; Halton, Kate; Gardner, Anne; Page, Katie; Allen, Michelle; Farrington, Alison; White, Nicole; Mitchell, Brett G.Background
The Researching Effective Approaches to Cleaning in Hospitals (REACH) study tested a multimodal cleaning intervention in Australian hospitals. This article reports findings from a pre/post questionnaire, embedded into the REACH study, that was administered prior to the implementation of the intervention and at the conclusion of the study.
Methods
A cross-sectional questionnaire, nested within a stepped-wedge trial, was administered. The REACH intervention was a cleaning bundle comprising 5 interdependent components. The questionnaire explored the knowledge, reported practice, attitudes, roles, and perceived organizational support of environmental services staff members in the hospitals participating in the REACH study.
Results
Environmental services staff members in 11 participating hospitals completed 616 pre- and 307 post-test questionnaires (n = 923). Increases in knowledge and practice were seen between the pre-and post-test questionnaires. Minimal changes were observed in attitudes regarding the role of cleaning and in perceived organizational support.
Conclusion
To our knowledge, this is the first study to report changes in knowledge, attitudes, and perceived organizational support in environmental services staff members, in the context of a large multicenter clinical trial. In this underexplored group of hospital workers, findings suggest that environmental services staff members have a high level of knowledge related to cleaning practices and understand the importance of their role.
Item Effectiveness of a Structured, Framework-Based Approach to Implementation: The Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial(2020-02-18) Gardner, Anne; Graves, Nicholas; Gericke, Christian A.; Riley, Thomas V.; Halton, Kate; Page, Katie; Mitchell, Brett G.; Farrington, Alison; Allen, Michelle; White, Nicole; Hall, LisaBackground
Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-based approach to implement and quantitatively evaluate the implementation of evidence-based practice change in hospital cleaning.
Design/methods
The Researching Effective Approaches to Cleaning in Hospitals (REACH) trial was a pragmatic, stepped-wedge randomised trial of an environmental cleaning bundle implemented in 11 Australian hospitals from 2016 to 2017. Using a structured multi-step approach, we adapted the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to support rigorous and tailored implementation of the cleaning bundle intervention in eleven diverse and complex settings. To evaluate the effectiveness of this strategy we examined post-intervention cleaning bundle alignment calculated as a score (an implementation measure) and cleaning performance audit data collected using ultraviolet (UV) gel markers (an outcome measure).
Results
We successfully implemented the bundle and observed improvements in cleaning practice and performance, regardless of hospital size, intervention duration and contextual issues such as staff and organisational readiness at baseline. There was a positive association between bundle alignment scores and cleaning performance at baseline. This diminished over the duration of the intervention, as hospitals with lower baseline scores were able to implement practice change successfully.
Conclusion
Using a structured framework-based approach allows for pragmatic and successful implementation of clinical trials across diverse settings, and assists with quantitative evaluation of practice change.
Item Environmental Cleaning Research: Participating in the REACH Study(2016-11-01) Mitchell, Brett G.; Hall, Lisa; Allen, Michelle; Farrington, AlisonBackground: The Researching Effective Approaches to Cleaning in Hospitals(REACH) study is a partnership project funded by the National Health and Medical Research Council (NHMRC). It aims to evaluate the effectiveness and cost-effectiveness of a novel cleaning bundle intervention. Eleven major Australian hospitals are participating in this research, with the trial component running from May 2016 until July 2017.
Methods: The REACH trial uses a stepped wedge study design. This design ensures each trial site receives an eight week control period, followed by a randomly allocated intervention period between 20 and 50 weeks. Participation in such a major research activity requires a significant commitment from each trial hospital. To ensure this commitment is sustainable, the REACH study team will maintain a high level of contact with each site. Local site teams will also be a key aspect of conducting the research. During the pre-trial phase a research team will be established at each hospital. This team will include an infection prevention and control practitioner and an environmental services lead. Additional site team members will reflect local context and team structure. Site teams will assist with administrative activities for the trial, data collection and importantly, the effective engagement of environmental services staff.
Results and Conclusion: The local site team will be essential for successful implementation of the REACH research activities. Examples of site teams’ composition and activities will be showcased to highlight diversity and the value of strong collaboration in supporting behaviour change and quality improvement initiatives
Item Researching Effective Approaches to Cleaning in Hospitals: Protocol of the REACH Study, A Multi-Site Stepped-Wedge Randomised Trial(2016-03-24) Graves, Nicholas; Paterson, David L.; Gericke, Christian A.; Riley, Thomas V.; Dancer, Stephanie; Bailey, Emily; Havers, Sally; Gardner, Anne; Page, Katie; Allen, Michelle; Halton, Kate; Barnett, Adrian G.; Mitchell, Brett G.; Farrington, Alison; Hall, LisaBackground: The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices.
Methods/design: The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital
Discussion: Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals.
Item Variation in Hospital Cleaning Practice and Process in Australian Hospitals: A Structured Mapping Exercise(2017-12-01) Graves, Nicholas; Paterson, David L.; Gericke, Christian A.; Riley, Thomas V.; Dancer, Stephanie; Page, Katie; Halton, Kate; Barnett, Adrian G.; Hall, Lisa; Gardner, Anne; Allen, Michelle; Farrington, Alison; Mitchell, Brett G.Background: The purpose of this paper is to highlight the range of cleaning practices and processes in 11 Australian hospitals and to discuss the challenges this variation poses to the implementation of clinical trials or changes to hospital cleaning practices.
Methods: A cross-sectional study design was used to determine cleaning practices and processes in hospitals participating in the ‘Researching Effective Approaches to Cleaning in Hospitals’ (REACH) study. A standardised template and approach was used to collect information. Data collection activities included structured on-site discussions, a review of hospital practices and a document review of policy and procedural documents related to cleaning.
Results: Variations in the auditing process used to evaluate environmental cleanliness, cleaning practices, product use, training and communication pathways available to cleaning staff were identified. There was also variation in workforce structure and responsibilities for cleaning.
Conclusion: This paper is the first to describe the differences in cleaning practices between Australian hospitals. The variations identified present a number of challenges for the conduct of research and have important implications for both monitoring of and standards for cleanliness. These challenges include implementing a practice change or cleaning study where hospitals have different processes, practices and structures.