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Healthcare-associated infections are a major complication of care for patients in intensive care, causing costs and additional mortality. Infection prevention practices, such as hand hygiene, have been suboptimal globally. This study aimed to explore the level of knowledge and perceptions of critical care staff regarding healthcare-associated infections as insufficient knowledge contributes to an increased burden of these infections. A nationwide survey of physicians and nurses working in intensive care units of Finnish tertiary care hospitals was conducted to gain knowledge and explore perceptions regarding the prevention of healthcare-associated infections in intensive care units. Descriptive statistics were used to describe the study data, and a mainly nonparametric method was used to compare the groups. The respondents demonstrated moderately good knowledge of hand hygiene and infection prevention, with a median of 36 correct responses (Q1, Q3: 34, 37). However, there were notable gaps in their knowledge in infection prevention regarding the routes of infection transmission, with a median score of 4 (Q1, Q3: 4, 6). Conversely, perceptions of infection prevention were generally positive. The median score for perceptions was 51 (Q1, Q3: 47, 55), but no significant association was found between perceptions and knowledge levels. The level of knowledge about healthcare-associated infections is not satisfactory. In particular, there is a lack of in-depth understanding of the mechanisms of infection transmission and prevention. Providing unit-tailored feedback on performance, along with education on the transmission mechanisms and infection prevention for healthcare workers is essential.

Early implementation of interventions at a young age fosters behaviour changes and helps to adopt behaviours that promote health. Digital technologies may help to promote the hand hygiene behaviour of children. However, there is a lack of digital feedback interventions focusing on the hand hygiene behaviour of preschool children in childhood education and care settings. This study protocol aims to describe a study that evaluates the effectiveness of a gamified live feedback intervention and explores underlying behavioural theories in achieving better hand hygiene behaviour of preschool children in early childhood education and care settings. This study will be a four-arm cluster randomized controlled trial with three phases and a twelve-month follow-up by country stratification. The sample size is 106 children of which one cluster will have a minimum number of 40 children. During the baseline phase, all groups will have automated monitoring systems installed. In the intervention phase, the control group will have no screen activity. The intervention groups will have feedback displays during the handwashing activity. Intervention A will receive instructions, and intervention B and C groups will receive instructions and a reward. In the post-intervention phase, all the groups will have no screen activity except intervention C which will receive instructions from the screen but no reward. The outcome measures will be hand hygiene behaviour, self-efficacy, and intrinsic motivation. Outcome measures will be collected at baseline, intervention, and post-intervention phases and a 12-month follow-up. The data will be analysed with quantitative and qualitative methods. The findings of the planned study will provide whether this gamified live feedback intervention can be recommended to be used in educational settings to improve the hand hygiene behaviour of preschool children to promote health. The trial is registered with ClinicalTrials.gov (registration number NCT05395988 https://clinicaltrials.gov/ct2/show/NCT05395988?term=NCT05395988&draw=2&rank=1 ).

Contagious diseases that affect young children place a great burden on them and their families. Proper hand hygiene is an important measure to reduce the disease burden, however, its implementation in day care centres is challenging. This paper introduces a digital intervention to support independent and good handwashing among young children. The intervention leverages animated instructions triggered by water and soap use, together with a symbolic reward shown to children on a screen during and immediately after handwashing. We tested the intervention in a pre-registered, cluster-randomised controlled field trial in 4 day care centres in Finland and Germany with 162 children over 42 days. The intervention increased soaping time, used as a proxy for handwashing quality, by 5.30 s (+ 62%, p < 0.001). The effect occurs immediately at the onset of the intervention and is maintained throughout the intervention phase.

Aim Evaluate the intensive care acquired infections incidence and the change over time in infection practices in one intensive care unit. Design We used an action research approach with cyclical activities. Methods Our study included two cycles with hand hygiene observation based on the WHO's five‐moments observation tool, observing hand hygiene practices, analysing the observations, and giving feedback on observations, intensive care acquired infection rates, and alcohol‐based hand rub consumption. The Revised Standards for Quality Improvement Reporting Excellence is the basis for this research report describing research aimed at improving patient safety and quality of care. Results During the study, annual alcohol‐based hand rub consumption increased by 6.7 litres per 1000 patient days and observed hand hygiene compliance improved. In the first cycle of the study, there was a decrease in critical care acquired infection rates, but the improvement was not sustainable.

Background Up to 35% of nurses’ working time is spent on care documentation. We describe the evaluation of a system aimed at assisting nurses in documenting patient care and potentially reducing the documentation workload. Our goal is to enable nurses to write or dictate nursing notes in a narrative manner without having to manually structure their text under subject headings. In the current care classification standard used in the targeted hospital, there are more than 500 subject headings to choose from, making it challenging and time consuming for nurses to use. Methods The task of the presented system is to automatically group sentences into paragraphs and assign subject headings. For classification the system relies on a neural network-based text classification model. The nursing notes are initially classified on sentence level. Subsequently coherent paragraphs are constructed from related sentences. Results Based on a manual evaluation conducted by a group of three domain experts, we find that in about 69% of the paragraphs formed by the system the topics of the sentences are coherent and the assigned paragraph headings correctly describe the topics. We also show that the use of a paragraph merging step reduces the number of paragraphs produced by 23% without affecting the performance of the system. Conclusions The study shows that the presented system produces a coherent and logical structure for freely written nursing narratives and has the potential to reduce the time and effort nurses are currently spending on documenting care in hospitals.

Objectives: To examine the association between work hours, work stress, and collaboration among the ward personnel, and the risk of hospital-associated infection among patients. Design: Cross-sectional data on hospital infections were collected between March and June 2004. These data were linked with wardlevel responses to a personnel survey collected during the same time period. Setting: Medical records of patients in 60 non-psychiatric bed wards in 6 Finnish hospitals. Participants: One thousand ninety-two patients and 1159 staff survey responses. Measurements: Prevalence surveillance was performed by 4 infection control nurses, using standard criteria. Data on several potential risk factors for infection were collected: sex, age, patient type (surgical vs. other), hospital type (university vs. regional hospital), unit type, number of patients in the ward, exposure to invasive devices, International Classification of Diseases version 10 diagnosis, chemotherapy, radiotherapy, and use of corticosteroids. Staff working conditions were measured by survey scales. Results: Ninety-nine cases (9.1%) of hospital-associated infection were found. Multilevel logistic regression analyses, adjusted for hospital factors and patient-related risk factors, showed that long work hours among staff were associated with increased risk of infection [odds ratio (OR) 2.74, 95% confidence interval (CI): 1.07-7.04]. Other staff-related correlates of infection were high work stress, as indicated by high imbalance between efforts and rewards (OR: 2.47; 95% CI: 1.38-4.42), low trust between work unit members (OR: 2.37; 95% CI: 1.27-4.43), injustice in the distribution of work (OR: 1.81; 95% CI: 1.04-3.16), and poor collaboration between ward supervisors (OR: 2.46; 95% CI: 1.38-4.38). Conclusions: Long work hours, high work stress, and poor collaboration among the ward staff are associated with hospital-associated infection among patients.

BackgroundHealthcare-associated infections are a major complication of care for patients in intensive care, causing costs and additional mortality. Infection prevention practices, such as hand hygiene, have been suboptimal globally. This study aimed to explore the level of knowledge and perceptions of critical care staff regarding healthcare-associated infections as insufficient knowledge contributes to an increased burden of these infections.MethodsA nationwide survey of physicians and nurses working in intensive care units of Finnish tertiary care hospitals was conducted to gain knowledge and explore perceptions regarding the prevention of healthcare-associated infections in intensive care units. Descriptive statistics were used to describe the study data, and a mainly nonparametric method was used to compare the groups.ResultsThe respondents demonstrated moderately good knowledge of hand hygiene and infection prevention, with a median of 36 correct responses (Q1, Q3: 34, 37). However, there were notable gaps in their knowledge in infection prevention regarding the routes of infection transmission, with a median score of 4 (Q1, Q3: 4, 6). Conversely, perceptions of infection prevention were generally positive. The median score for perceptions was 51 (Q1, Q3: 47, 55), but no significant association was found between perceptions and knowledge levels.ConclusionsThe level of knowledge about healthcare-associated infections is not satisfactory. In particular, there is a lack of in-depth understanding of the mechanisms of infection transmission and prevention. Providing unit-tailored feedback on performance, along with education on the transmission mechanisms and infection prevention for healthcare workers is essential.

Early implementation of interventions at a young age fosters behaviour changes and helps to adopt behaviours that promote health. Digital technologies may help to promote the hand hygiene behaviour of children. However, there is a lack of digital feedback interventions focusing on the hand hygiene behaviour of preschool children in childhood education and care settings. This study protocol aims to describe a study that evaluates the effectiveness of a gamified live feedback intervention and explores underlying behavioural theories in achieving better hand hygiene behaviour of preschool children in early childhood education and care settings. This study will be a four-arm cluster randomized controlled trial with three phases and a twelve-month follow-up by country stratification. The sample size is 106 children of which one cluster will have a minimum number of 40 children. During the baseline phase, all groups will have automated monitoring systems installed. In the intervention phase, the control group will have no screen activity. The intervention groups will have feedback displays during the handwashing activity. Intervention A will receive instructions, and intervention B and C groups will receive instructions and a reward. In the post-intervention phase, all the groups will have no screen activity except intervention C which will receive instructions from the screen but no reward. The outcome measures will be hand hygiene behaviour, self-efficacy, and intrinsic motivation. Outcome measures will be collected at baseline, intervention, and post-intervention phases and a 12-month follow-up. The data will be analysed with quantitative and qualitative methods. The findings of the planned study will provide whether this gamified live feedback intervention can be recommended to be used in educational settings to improve the hand hygiene behaviour of preschool children to promote health. The trial is registered with ClinicalTrials.gov (registration number NCT05395988 https://clinicaltrials.gov/ct2/show/NCT05395988?term=NCT05395988&draw=2&rank=1).

Samuli Ripatti and colleagues report a genome-wide association study for human serum metabolites using NMR of serum samples from over 8,000 Finnish individuals. They identify 31 loci associated with at least one of 216 serum metabolic measures. Nuclear magnetic resonance assays allow for measurement of a wide range of metabolic phenotypes. We report here the results of a GWAS on 8,330 Finnish individuals genotyped and imputed at 7.7 million SNPs for a range of 216 serum metabolic phenotypes assessed by NMR of serum samples. We identified significant associations ( P < 2.31 × 10 −10 ) at 31 loci, including 11 for which there have not been previous reports of associations to a metabolic trait or disorder. Analyses of Finnish twin pairs suggested that the metabolic measures reported here show higher heritability than comparable conventional metabolic phenotypes. In accordance with our expectations, SNPs at the 31 loci associated with individual metabolites account for a greater proportion of the genetic component of trait variance (up to 40%) than is typically observed for conventional serum metabolic phenotypes. The identification of such associations may provide substantial insight into cardiometabolic disorders.

Background Metabolic syndrome (MetS) is associated with premature aging, but whether this association is driven by genetic or lifestyle factors remains unclear. Methods Two independent discovery cohorts, consisting of twins and unrelated individuals, were examined ( N  = 268, aged 23–69 years). The findings were replicated in two cohorts from the same base population. One consisted of unrelated individuals ( N  = 1 564), and the other of twins ( N  = 293). Participants’ epigenetic age, estimated using blood DNA methylation data, was determined using the epigenetic clocks GrimAge and DunedinPACE. The individual-level linear regression models for investigating the associations of MetS and its components with epigenetic aging were followed by within-twin-pair analyses using fixed-effects regression models to account for genetic factors. Results In individual-level analyses, GrimAge age acceleration was higher among participants with MetS ( N  = 56) compared to participants without MetS ( N  = 212) (mean 2.078 [95% CI = 0.996,3.160] years vs. −0.549 [−1.053,−0.045] years, between-group p  = 3.5E-5). Likewise, the DunedinPACE estimate was higher among the participants with MetS compared to the participants without MetS (1.032 [1.002,1.063] years/calendar year vs. 0.911 [0.896,0.927] years/calendar year, p  = 4.8E-11). An adverse profile in terms of specific MetS components was associated with accelerated aging. However, adjustments for lifestyle attenuated these associations; nevertheless, for DunedinPACE, they remained statistically significant. The within-twin-pair analyses suggested that genetics explains these associations fully for GrimAge and partly for DunedinPACE. The replication analyses provided additional evidence that the association between MetS components and accelerated aging is independent of the lifestyle factors considered in this study, however, suggesting that genetics is a significant confounder in this association. Conclusions The results of this study suggests that MetS is associated with accelerated epigenetic aging, independent of physical activity, smoking or alcohol consumption, and that the association may be explained by genetics.