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Hung IC, Chen TM, Lin JP, Tai YL, Shen TL, Lee SJ. Correction to 'Wnt5b integrates Fak1a to mediate gastrulation cell movements via Rac1 and Cdc42'. Open Biol 2020; 10:200058. [PMID: 32183619 PMCID: PMC7125960 DOI: 10.1098/rsob.200058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Focal adhesion kinase (FAK) mediates vital cellular pathways during development. Despite its necessity, how FAK regulates and integrates with other signals during early embryogenesis remains poorly understood. We found that the loss of Fak1a impaired epiboly, convergent extension and hypoblast cell migration in zebrafish embryos. We also observed a clear disturbance in cortical actin at the blastoderm margin and distribution of yolk syncytial nuclei. In addition, we investigated a possible link between Fak1a and a well-known gastrulation regulator, Wnt5b, and revealed that the overexpression of fak1a or wnt5b could cross-rescue convergence defects induced by a wnt5b or fak1a antisense morpholino (MO), respectively. Wnt5b and Fak1a were shown to converge in regulating Rac1 and Cdc42, which could synergistically rescue wnt5b and fak1a morphant phenotypes. Furthermore, we generated several alleles of fak1a mutants using CRISPR/Cas9, but those mutants only revealed mild gastrulation defects. However, injection of a subthreshold level of the wnt5b MO induced severe gastrulation defects in fak1a mutants, which suggested that the upregulated expression of wnt5b might complement the loss of Fak1a. Collectively, we demonstrated that a functional interaction between Wnt and FAK signalling mediates gastrulation cell movements via the possible regulation of Rac1 and Cdc42 and subsequent actin dynamics.
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Affiliation(s)
- I-Chen Hung
- Department of Life Science, National Taiwan University, No. 1, Roosevelt Road, Section 4, Taipei 10617, Taiwan
| | - Tsung-Ming Chen
- Department of Life Science, National Taiwan University, No. 1, Roosevelt Road, Section 4, Taipei 10617, Taiwan.,Department of Plant Pathology and Microbiology, National Taiwan University, No. 1, Roosevelt Road, Section 4, Taipei 10617, Taiwan.,Department and Graduate Institute of Aquaculture, National Kaohsiung Marine University, Kaohsiung, Taiwan
| | - Jing-Ping Lin
- Department of Plant Pathology and Microbiology, National Taiwan University, No. 1, Roosevelt Road, Section 4, Taipei 10617, Taiwan
| | - Yu-Ling Tai
- Department of Plant Pathology and Microbiology, National Taiwan University, No. 1, Roosevelt Road, Section 4, Taipei 10617, Taiwan
| | - Tang-Long Shen
- Department of Plant Pathology and Microbiology, National Taiwan University, No. 1, Roosevelt Road, Section 4, Taipei 10617, Taiwan.,Center for Biotechnology, National Taiwan University, Taipei, Taiwan
| | - Shyh-Jye Lee
- Department of Life Science, National Taiwan University, No. 1, Roosevelt Road, Section 4, Taipei 10617, Taiwan.,Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.,Center for Biotechnology, National Taiwan University, Taipei, Taiwan.,Center for Systems Biology, National Taiwan University, Taipei, Taiwan
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Hung IC, Chang HY, Cheng A, Chen MW, Chen AC, Ting L, Lai YH, Wang JT, Chen YC, Sheng WH. Implementation of human factors engineering approach to improve environmental cleaning and disinfection in a medical center. Antimicrob Resist Infect Control 2020; 9:17. [PMID: 31988745 PMCID: PMC6966902 DOI: 10.1186/s13756-020-0677-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Inadequate hospital cleaning may contribute to cross-transmission of pathogens. It is important to implement effective cleaning for the safe hospital environment. We conducted a three-phase study using human factors engineering (HFE) approach to enhance environmental cleanliness. Methods This study was conducted using a prospective interventional trial, and 28 (33.3%) of 84 wards in a medical center were sampled. The three-phases included pre-intervention analysis (Phase 1), implementing interventions by HFE principles (Phase 2), and programmatic analysis (Phase 3). The evaluations of terminal cleaning and disinfection were performed using the fluorescent marker, the adenosine triphosphate bioluminescence assay, and the aerobic colony count method simultaneously in all phases. Effective terminal cleaning and disinfection was qualified with the aggregate outcome of the same 10 high-touch surfaces per room. A score for each high-touch surface was recorded, with 0 denoting a fail and 10 denoting a pass by the benchmark of the evaluation method, and the total terminal cleaning and disinfection score (TCD score) was a score out of 100. Results In each phase, 840 high-touch surfaces were collected from 84 rooms after terminal cleaning and disinfection. After the interventions, the TCD score by the three evaluation methods all showed significant improved. The carriage incidence of multidrug-resistant organism (MDRO) decreased significantly from 4.1 per 1000 patient-days to 3.6 per 1000 patient-days (P = .03). Conclusion The HFE approach can improve the thoroughness and the effectiveness of terminal cleaning and disinfection, and resulted in a reduction of patient carriage of MDRO at hospitals. Larger studies are necessary to establish whether such efforts of cleanliness can reduce the incidence of healthcare-associated infection.
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Affiliation(s)
- I-Chen Hung
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan
| | - Hao-Yuan Chang
- 2School of Nursing, National Taiwan University, No.1, Sec. 1, Jen Ai Rd, Taipei City, 100 Taiwan.,3Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Aristine Cheng
- 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Wen Chen
- 3Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - An-Chi Chen
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan
| | - Ling Ting
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan
| | - Yeur-Hur Lai
- 2School of Nursing, National Taiwan University, No.1, Sec. 1, Jen Ai Rd, Taipei City, 100 Taiwan.,5Department of Nursing, National Taiwan University Cancer Center, No.57, Ln. 155, Sec. 3, Keelung Rd, Taipei City, 106 Taiwan
| | - Jann-Tay Wang
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan.,4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yee-Chun Chen
- 1Center for Infection Control, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan.,4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- 4Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,6Department of Medical Education, National Taiwan University Hospital, No.7, Zhongshan S. Rd, Taipei City, 100 Taiwan
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Hung IC, Hsiao YC, Sun HS, Chen TM, Lee SJ. MicroRNAs regulate gene plasticity during cold shock in zebrafish larvae. BMC Genomics 2016; 17:922. [PMID: 27846817 PMCID: PMC5111229 DOI: 10.1186/s12864-016-3239-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/01/2016] [Indexed: 12/19/2022] Open
Abstract
Background MicroRNAs (miRNAs) are critical regulators responding to acute environmental stresses in both plants and animals. By modulating gene expression, miRNAs either restore or reconstitute a new expression program to enhance cell tolerance to stresses. Cold shock is one of the stresses that can induce acute physiological responses and transcriptional changes in aquatic creatures. Previous genomic studies have revealed many cold-affected genes in fish larvae and adults, however, the role of miRNAs in acute cold response is still ambiguous. To elucidate the regulatory roles of miRNAs in the cold-inducible responses, we performed small RNA-seq and RNA-seq analyses and found potential cold regulatory miRNAs and genes. We further investigated their interactions and involvements in cold tolerance. Results Small RNA-seq and RNA-seq identified 29 up-/26 down-regulated miRNAs and 908 up-/468 down-regulated genes, respectively, in responding to cold shock for 4 h at 18 °C. miRNA and transcriptomic analyses showed these miRNAs and mRNAs are involved in similar biological processes and pathways. Gene ontology enrichment analyses revealed the cold-induced genes were enriched in pathways, including melanogenesis, GnRH pathway, circadian rhythm, etc. We were particularly interested in the changes in circadian clock genes that affect daily metabolism. The enrichment of circadian clock genes was also observed in previous fish cold acclimation studies, but have not been characterized. To characterize the functional roles of circadian clock genes in cold tolerance, we individually overexpressed selected clock genes in zebrafish larvae and found one of the core clock genes per2 resulted in better recovery from cold shock. In addition, we validated the interaction of per2 with its associate miRNA, dre-mir-29b, which is also cold-inducible. It suggests the transcription of per2 can be modulated by miRNA upon cold shock. Conclusions Collectively, our observations suggest that miRNAs are fine turners for regulating genomic plasticity against cold shock. We further showed that the fine tuning of core clock gene per2 via its associated miRNA, dre-mir-29b, can enhance the cold tolerance of zebrafish larvae. Electronic supplementary material The online version of this article (doi:10.1186/s12864-016-3239-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- I-Chen Hung
- Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - Yu-Chuan Hsiao
- Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - H Sunny Sun
- Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, 70456, Taiwan.,Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, 70456, Taiwan
| | - Tsung-Ming Chen
- Department and Graduate Institute of Aquaculture, National Kaohsiung Marine University, Kaohsiung 81157, Taiwan.
| | - Shyh-Jye Lee
- Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan. .,Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, 10617, Taiwan. .,Center for Biotechnology, National Taiwan University, Taipei, 10617, Taiwan. .,Center for Systems Biology, Taipei, 10617, Taiwan.
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Huang YS, Chen YC, Chen ML, Cheng A, Hung IC, Wang JT, Sheng WH, Chang SC. Comparing visual inspection, aerobic colony counts, and adenosine triphosphate bioluminescence assay for evaluating surface cleanliness at a medical center. Am J Infect Control 2015; 43:882-6. [PMID: 25952617 DOI: 10.1016/j.ajic.2015.03.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Environmental cleaning is essential in reducing microbial colonization and health care-associated infections in hospitals. However, there is no consensus for the standard method to assess hospital cleanliness, and comparisons of newer methodology, such as adenosine triphosphate bioluminescence assay, with the traditional methods are limited. METHODS A prospective study was conducted at a medical center between January 2013 and August 2013. In each selected room, 10-12 high-touch surfaces were sampled before and after terminal cleaning. The adequacy of cleaning was evaluated by visual inspection, aerobic colony counts (ACCs), and adenosine triphosphate (ATP) bioluminescence assay. RESULTS Eighty-five environmental surfaces from 8 rooms were evaluated by all 3 methods. The overall inadequacy defined by visual inspection, ACC, and ATP level was 11.8%, 20.0%, and 50.6% before cleaning and 4.7%, 5.9%, 21.2% after cleaning, respectively. A correlation between the ACC and ATP was found (r = 0.285, P < .001) using log10 values. Using ACCs <2.5 colony forming units/cm(2) as the cutoff for cleanliness, the ATP assay had better sensitivity than visual inspection (63.6% vs 27.3%). The receiver operating characteristics of the ATP assay indicated that the optimal ATP cutoff value was estimated to be 5.57 relative light units/cm(2). CONCLUSION ATP bioluminescence assay is a sensitive and rapid tool in evaluating the quality of terminal cleaning. We emphasize the value of using a quantitative method to monitor environmental cleaning at hospitals.
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Pan SC, Chen E, Tien KL, Hung IC, Sheng WH, Chen YC, Chang SC. Assessing the thoroughness of hand hygiene: "seeing is believing". Am J Infect Control 2014; 42:799-801. [PMID: 24767574 DOI: 10.1016/j.ajic.2014.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 01/09/2023]
Abstract
The thoroughness of hand hygiene (HH) was evaluated using a simulation method in which health care workers (HCWs) rubbed their hands with a fluorescent substance, washed with water, and placed their hands under an ultraviolet detector to identify areas missed. Most residue points were located in the tips of the nails (38.6%), followed by fingertips (17.4%). This stress-free "seeing is believing" program can encourage HCWs' active participation in sustaining the HH culture of health care institutions.
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Pan SC, Lai TS, Tien KL, Hung IC, Chie WC, Chen YC, Chang SC. Medical students' perceptions of their role as covert observers of hand hygiene. Am J Infect Control 2014; 42:231-4. [PMID: 24581012 DOI: 10.1016/j.ajic.2013.09.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 09/27/2013] [Accepted: 09/30/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Medical students served as covert observers of hand hygiene (HH) compliance by health care workers (HCWs) during a recent 1-year study at a teaching hospital in Taiwan. This report describes the students' experience and their views of the major factors that led to good or poor compliance. METHODS Nine upper class medical students received a basic course in HH and attended a workshop using World Health Organization standard training materials. A standardized observation tool was used to collect data on HH performance by the HCWs. On completion of the study, structured face-to-face interviews were conducted to assess the students' experiences. RESULTS The medical students observed a total of 17,742 HH opportunities during the study period. Eight of the 9 students participated in the poststudy interviews. Overall, the students believed that they had gained considerable knowledge of the attitudes regarding HH compliance by nurses, physicians, and surgeons according to each of the 5 HH indications. Based on their experience, they recommended that compliance could be improved by ensuring an adequate supply of HH products and by promoting role modeling in the ward, reminding, education in small groups, and objective structured clinical examinations. CONCLUSIONS The opportunity for medical students to serve as covert observers broadened their knowledge of how infections are transmitted in hospitals and of the barriers that must be overcome to improve HCWs' HH compliance.
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Affiliation(s)
- Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tai-Shuan Lai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Pei-Hu Branch, Taipei, Taiwan
| | - Kuei-Lien Tien
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Chen Hung
- Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chu Chie
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Center of Infection Control, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
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Abstract
The lateral line is a mechanosensory system in fish and amphibians to detect local water flow and pressure. Development of the posterior lateral line (PLL) originates from the migrating PLL primordium (PLLP). The PLLP deposits neuromasts on the trunk during migration to the tail. Molecular dissection revealed that PLL development is associated with genes mediating cell adhesion, morphogenesis, neurogenesis and development, but the regulatory signaling network is far from completion. To further investigate candidate regulatory genes for lateral line development, we found using whole-mount in situ hybridization that calnexin, an endoplasmic reticular (ER) calcium-binding protein gene, is expressed in PLL neuromasts. Knockdown of calnexin using antisense morpholino oligonucleotides resulted in a dose-dependent reduction in neuromasts and hair cells of the PLL. Using a transgenic claudin b:gfp line, we observed a notably reduced PLLP size, but no significant migration defect in calnexin morphants. Finally, we discovered that the reduced PLLP is associated with a reduction in cell proliferation and an increase in ER stress-dependent apoptosis. These results suggest that calnexin is essential for neuromast formation during lateral line development in the zebrafish.
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Affiliation(s)
- I-Chen Hung
- Institute of Zoology, National Taiwan University, Taipei, Taiwan, ROC
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Pan SC, Tien KL, Hung IC, Lin YJ, Yang YL, Yang MC, Wang MJ, Chang SC, Chen YC. Patient empowerment in a hand hygiene program: differing points of view between patients/family members and health care workers in Asian culture. Am J Infect Control 2013; 41:979-83. [PMID: 23706832 DOI: 10.1016/j.ajic.2013.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 02/08/2013] [Accepted: 02/08/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND "Patient empowerment" is an important component of World Health Organization hand hygiene program, but little is known about the intentions and attitude of patients/families and health care workers (HCWs) regarding this. METHODS A cross-sectional survey using questionnaires was conducted in a tertiary teaching hospital in Taiwan to assess hand hygiene knowledge and the attitudes and intentions regarding patient empowerment among patients/families and HCWs. RESULTS Among patients/families, 95.4% (329/345) had positive attitudes regarding patient empowerment; however, only 67.2% (232/345) had the positive intention to remind HCWs about hand hygiene (P < .001). Risk factors for negative intention were being female (odds ratio [OR], 1.82; 95% confidence interval [CI]: 1.08-3.03), illiteracy (OR, 3.18; 95% CI: 0.86-11.7), and being patients/families in the pediatric department (OR, 1.86; 95% CI: 0.93-3.64). Among HCWs, the difference between positive attitude (81.1%; 714/880) and positive intention regarding being reminded about hand hygiene (62.8%; 553/880) was significant (P < .001). Risk factors for negative intention were age > 25 years (OR, 3.20; 95% CI: 1.51-6.81) and a negative attitude toward patient empowerment (OR, 10.00; 95% CI: 5.88-16.67). CONCLUSION There were significant gaps between attitude and intention regarding patient empowerment both among patients/families and HCWs. Special strategies targeting women, the pediatric population, or illiterate people may help improve patient/family participation. Additionally, hand hygiene education should be incorporated into early-stage medical/nursing education to create a facilitating environment. Patients/families and HCWs cooperation is needed to promote the hand hygiene program further.
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Affiliation(s)
- Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Pan SC, Tien KL, Hung IC, Lin YJ, Sheng WH, Wang MJ, Chang SC, Kunin CM, Chen YC. Compliance of health care workers with hand hygiene practices: independent advantages of overt and covert observers. PLoS One 2013; 8:e53746. [PMID: 23341991 PMCID: PMC3544847 DOI: 10.1371/journal.pone.0053746] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/03/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Evaluation and feedback of hand hygiene (HH) compliance are important elements of the WHO multimodal strategy for hospital infection control. Overt observation is recommended, but it may be confounded by Hawthorne effect. Covert observation offers the opportunity to decrease observer bias. In this study we conducted a one year hospital-wide HH promotion program that included medical students (MS) as covert observers. METHODS HH compliance for the five WHO indications was determined by trained and validated observers. The overt observers consisted of eleven infection control nurses (ICNs) and two unit HH ambassadors (UAs) in each of 83 wards. The covert observers consisted of nine MS during their rotating clinical clerkships. Feedback was provided to department heads and staff each quarter. RESULTS Of the 23,333 HH observations 76.0% were by MS, 5.3% by ICNs and 18.7% by UAs. The annual compliance rates were MS 44.1%, ICNs 74.4% and UAs 94.1%; P<0.001. The MS found significantly lower annual compliance rates for 4/5 HH indications compared to ICNs and UAs; P<0.05. The ICNs reported significantly improvement from the first to the fourth quarter; P<0.001. This was associated with feedback from the MS of very poor compliance by nurses during the first quarter. CONCLUSIONS Based on these findings we recommend a two-pronged approach to HH programs. The role of ICNs and UAs is to educate, serve as role models, establish, sustain good HH practices and provide direct feedback. The role of the covert observers is to measure compliance and provide independent feedback.
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Affiliation(s)
- Sung-Ching Pan
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuei-Lien Tien
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Chen Hung
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Jiun Lin
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jiuh Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Hospital Planning, National Taiwan University Hospital, Taipei, Taiwan
| | - Shan-Chwen Chang
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Calvin M. Kunin
- Departments of Internal Medicine, Ohio State University, Columbus, Ohio and University of Arizona, Tucson, Arizona, United States of America
| | - Yee-Chun Chen
- Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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