Artificial intelligence for monitoring hand hygiene compliance in healthcare settings: A scoping review.

For more than a century, Hand hygiene (HH) has been known to be the most cost-effective hygienic method to minimize infection transmission and risk in healthcare settings. Even though 50% of healthcare-associated infections (HAIs) can be prevented with proper HH, globally 7 per 100 patients from acute-care hospitals in high-income countries (HIC) and 15 per 100 patients in low and middle-income countries (LMIC) acquire at least one HAI during their hospital stay. Even though medical healthcare students do not have the primary responsibility of providing patient care, it is necessary to train, assess, and monitor HH as their interaction with patients could lead to an increased number of HAIs. By conducting this global scoping review, we aim to summarize the global trends surrounding the knowledge, attitude, and practice (KAP) of medical healthcare students regarding HH, and how it affects patient safety. We followed the five stages of Arksey and O'Malley's Scoping Review Methodology. The literature search was done in three databases, specifically, EMBASE, Web of Science, and PubMed. Original published research in credible journals in English conducted between 2012 and 2023 discussing HH amongst medical healthcare students all over the world were included. Twenty-three studies were included in the final analysis. The overall knowledge of medical students regarding HH was low, with some studies reporting scores as low as 10.1%. However, the attitude towards HH was generally positive, with mean scores ranging from 55% to 93%. Notably, nursing students and females exhibited better attitudes and self-reported HH practices. Furthermore, studies indicated that providing training on HH resulted in an increase in positive attitudes towards and improved practices of HH. By focusing on training and facilitating improved HH practices, future generations of doctors and nurses can contribute to minimizing HAIs and enhancing patient safety. Standardized approaches and comprehensive data collection are crucial for implementing effective HH interventions.

Background Artificial intelligence (AI) offers significant opportunities to improve the field of implementation science by supporting key activities such as evidence synthesis, contextual analysis, and decision-making to promote the adoption and sustainability of evidence-based practices. This living scoping review aims to: (1) map applications of AI in implementation research and practice; (2) identify evaluation approaches, reported outcomes, and potential risks; and (3) synthesize reported research gaps and opportunities for advancing the use of AI in implementation science. Methods This scoping review will follow the Joanna Briggs Institute (JBI) methodology and the Cochrane guidance for living systematic reviews. A living scoping review is warranted to keep up with the rapid changes in AI and its growing use in implementation science. We will include empirical studies, systematic reviews, grey literature, and policy documents that describe or evaluate applications of AI to support implementation science across the steps of the Knowledge-to-Action (KTA) Model. AI methods and models of interest include machine learning, deep learning, natural language processing, large language models, and related technologies and approaches. A search strategy will be applied to bibliographic databases (MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, Web of Science), relevant journals, conference proceedings, and preprint servers. Two reviewers will independently screen studies and extract data on AI characteristics, specific implementation task according to the KTA Model, evaluation methods, outcome domains, risks, and research gaps. Extracted data will be analyzed descriptively and synthesized narratively using a mapping approach aligned with the KTA Model. Discussion This living review will consolidate the evidence base on how AI is applied across the spectrum of implementation science. It will inform researchers, policymakers, and practitioners seeking to harness AI to improve the adoption, scale-up, and sustainability of evidence-based interventions, while identifying areas for methodological advancement and risk mitigation. Review registration Open Science Framework, May 2025: https://doi.org/10.17605/OSF.IO/2Q5DV

Artificial intelligence (AI) offers significant opportunities to improve the field of implementation science by supporting key activities such as evidence synthesis, contextual analysis, and decision-making to promote the adoption and sustainability of evidence-based practices. This living scoping review aims to: (1) map applications of AI in implementation research and practice; (2) identify evaluation approaches, reported outcomes, and potential risks; and (3) synthesize reported research gaps and opportunities for advancing the use of AI in implementation science. This scoping review will follow the Joanna Briggs Institute (JBI) methodology and the Cochrane guidance for living systematic reviews. A living scoping review is warranted to keep up with the rapid changes in AI and its growing use in implementation science. We will include empirical studies, systematic reviews, grey literature, and policy documents that describe or evaluate applications of AI to support implementation science across the steps of the Knowledge-to-Action (KTA) Model. AI methods and models of interest include machine learning, deep learning, natural language processing, large language models, and related technologies and approaches. A search strategy will be applied to bibliographic databases (MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, Web of Science), relevant journals, conference proceedings, and preprint servers. Two reviewers will independently screen studies and extract data on AI characteristics, specific implementation task according to the KTA Model, evaluation methods, outcome domains, risks, and research gaps. Extracted data will be analyzed descriptively and synthesized narratively using a mapping approach aligned with the KTA Model. This living review will consolidate the evidence base on how AI is applied across the spectrum of implementation science. It will inform researchers, policymakers, and practitioners seeking to harness AI to improve the adoption, scale-up, and sustainability of evidence-based interventions, while identifying areas for methodological advancement and risk mitigation. Open Science Framework, May 2025: https://doi.org/10.17605/OSF.IO/2Q5DV.

ObjectivesThe purpose of this review is to identify the theoretical framework of implementation science in the intensive care unit (ICU), the determinants affecting implementation results, the intervention guided by a theoretical framework and the assessment of implementation effectiveness based on implementation science to guide further advancement of the implementation of evidence in the field of ICU.DesignThe scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) Scoping Review Methodology Group’s guidance and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The study protocol was registered with the International Prospective Registry of Systematic Reviews on 15 December 2024 (registration number: CRD42024614246).Data sourcesWe searched the following databases and sources: PubMed, Web of Science, Cochrane Library and EBSCO.Eligibility criteriaWe included studies exploring the implementation science in the ICU that were published in English language.Data extraction and synthesisTwo researchers conducted the literature search by referring to the search strategies, and one researcher removed duplicates using EndNote. Two independent investigators screened the retrieved studies based on their titles and abstracts using eligibility criteria. Subsequently, the same two researchers conducted a full-text screening.Results13 articles were included: 8 qualitative studies, 3 mixed studies, 1 quasi-experimental study and 1 prospective observational study. Regarding the implementation of the theoretical framework for research, seven studies applied the consolidated framework for implementation research (CFIR), two studies applied the research implementation in health services framework (i-PARIHS) and one each of the research into the translating research into practice model, the exploration, preparation, implementation, sustain, the reach, effectiveness, adoption, implementation and maintenance model and the behaviour change wheel. The CFIR was the most applied in the ICU, followed by the i-PARIHS. The literature demonstrated how implementation science is used and how it can reduce the gap between evidence and practice.ConclusionStrategies to support the implementation of accelerated evidence-based practice in the ICU are important, and more researchers need to conduct implementation science studies of the ICU to facilitate the translation of evidence and improve the quality of nursing practice in the future.

OBJECTIVE. To determine the impact of known observers on hand hygiene performance in inpatient care units with differing baseline levels of hand hygiene compliance. Observational study. Three inpatient care units, selected on the basis of past hand hygiene performance, in a hospital where hand hygiene observation and feedback are routine. Three infection control practitioners (ICPs) and a student intern observed hospital staff. Beginning in late 2005, the 3 ICPs, who were well known to the hospital staff, performed frequent, regular observations of hand hygiene in all 3 inpatient care units of the hospital, as part of routine surveillance. During the study period (January-May 2007), a student intern who was unknown to the hospital staff also performed observations of hand hygiene in the 3 inpatient care units. The rates of hand hygiene compliance observed by the 3 ICPs were compared with those observed by the student intern. The 3 ICPs observed 332 opportunities for hand hygiene during 15 observation periods, and the student intern observed 355 opportunities during 19 observation periods. The overall rate of hand hygiene compliance observed by the ICPs was 65% (ie, in 215 of the 332 opportunities, the performance of proper hand hygiene by hospital staff was observed), and the overall rate of hand hygiene compliance observed by the student intern was 58% (ie, in 207 of the 355 opportunities, the performance of proper hand hygiene by hospital staff was observed) (P=.1 ). Both the ICPs and the student intern were able to distinguish between inpatient care units with a high rate of hand hygiene compliance (hereafter referred to as high-performing units) and those with a low rate (hereafter referred to as low-performing units). However, in the 2 high-performing units, the ICPs observed significantly higher compliance rates than did the student intern, whereas in the low-performing unit, both the ICPs and the student intern measured similarly low rates of hand hygiene compliance. Recognized observers are associated with higher rates of hand hygiene compliance, even in a healthcare setting where such observations have become routine. This effect (ie, the Hawthorne effect) is more pronounced in high-performing units and insignificant in low-performing units. The use of unrecognized observers may be important for verifying high performance but is probably unnecessary for documenting poor performance. Moreover, the Hawthorne effect may be a useful tool for sustaining and improving hand hygiene compliance.

BackgroundArtificial intelligence (AI) offers significant opportunities to improve the field of implementation science by supporting key activities such as evidence synthesis, contextual analysis, and decision-making to promote the adoption and sustainability of evidence-based practices. This living scoping review aims to: (1) map applications of AI in implementation research and practice; (2) identify evaluation approaches, reported outcomes, and potential risks; and (3) synthesize reported research gaps and opportunities for advancing the use of AI in implementation science.MethodsThis scoping review will follow the Joanna Briggs Institute (JBI) methodology and the Cochrane guidance for living systematic reviews. A living scoping review is warranted to keep up with the rapid changes in AI and its growing use in implementation science. We will include empirical studies, systematic reviews, grey literature, and policy documents that describe or evaluate applications of AI to support implementation science across the steps of the Knowledge-to-Action (KTA) Model. AI methods and models of interest include machine learning, deep learning, natural language processing, large language models, and related technologies and approaches. A search strategy will be applied to bibliographic databases (MEDLINE, Embase, CINAHL, PsycINFO, IEEE Xplore, Web of Science), relevant journals, conference proceedings, and preprint servers. Two reviewers will independently screen studies and extract data on AI characteristics, specific implementation task according to the KTA Model, evaluation methods, outcome domains, risks, and research gaps. Extracted data will be analyzed descriptively and synthesized narratively using a mapping approach aligned with the KTA Model.DiscussionThis living review will consolidate the evidence base on how AI is applied across the spectrum of implementation science. It will inform researchers, policymakers, and practitioners seeking to harness AI to improve the adoption, scale-up, and sustainability of evidence-based interventions, while identifying areas for methodological advancement and risk mitigation.Review registrationOpen Science Framework, May 2025:https://doi.org/10.17605/OSF.IO/2Q5DV

Innovative Surveillance and Execution of the World Health Organization's 5 Moments of Hand Hygiene in an Acute-care Hospital

Despite widespread concern and knowledge about the need for infection prevention and control in health care, it is clear that adherence to strict infection control procedures is not always at an optimal level (El-Masri and Oldfield, 2012). Hospital Acquired Infection (HAI) may occur when these standards break down, and HAI is a commonly discussed media topic (Bates, 2012). Alarmingly, a recent outbreak of Hepatitis C in the USA, resulting from inappropriate interference by health staff with equipment (needles) (Ramer, 2012) reminds us that even when vigilant approaches are used to combat the spread of infection, the potential for contamination from blood-borne infections remains a real possibility. Blood-borne viral infections include human immunodeficiency virus (HIV), Hepatitis C virus (HCV) and Hepatitis B virus (HBV). Taking precautions alone is not sufficient; staffs need to be knowledgeable in the disease and spread of disease. It is important to note that the risk of disease spread is to both staff and patients, although most staffs are vaccinated to prevent HBV (DoHC, 2005). While discussion papers and research studies on the topics of blood-borne diseases such as HCV, HBV and HIV/Aids are reduced in number compared with the 1980s and 1990s, current literature appears to indicate that knowledge deficits exist among nurses with regard to both HCV (Frazer et al., 2011) and HIV/Aids (Delobelle et al., 2009), and education and training specifically on these topics seems to be inconsistent and in some cases minimal (Delobelle et al., 2009; Frazer et al., 2011). This editorial discusses how blood-borne viruses (BBVs) can be best prevented in the health care setting in order to highlight the need for ongoing vigilance. An increased incidence of HBV and HCV transmission in the USA is associated with unsafe medical practices (Moore et al., 2011) particularly in those persons aged over 55 (Perz et al., 2012). These two viruses are the most prevalent in the USA with an estimated 1·4 million persons chronically infected with HBV and 3·2 million persons chronically infected with HCV (Weinbaum et al., 2008). A BBV is transmitted through contact with blood or body fluids typically through sexual or household contact, intravenous drug use or other parenteral exposures (Wise et al., 2012). Within health care settings, BBV transmission occurs through direct percutaneous inoculation of infected blood via needlestick or sharps injury or by blood splashed onto broken skin or mucous membranes (Stein et al., 2003). Health care workers (HCWs) undertaking exposure-prone procedures (EPPs) are also at risk of contracting BBVs (DoHC, 2005). The average risk of occupational HIV transmissions associated with percutaneous exposure to blood is 0·32% (approximately 1 infection in 325 documented exposures to blood from HIV-infected individuals) and for mucosal exposures it is 0·03% (approximately 1 infection for each 3300) (Henderson, 2012). The risk of occupational HBV infection following a parenteral exposure from an HBV-infected source patient with circulating e antigen is between 19% and 37% (Werner and Grady, 1982). The risk of occupational infection with HCV following parenteral exposure to blood from HCV-infected source patient is estimated at 1·9% per exposure (Henderson, 2003). In 1985, following an HIV epidemic, the Centre's for Disease Control (CDC) developed recommendations for prevention of HIV transmission in health care settings known as universal precautions (UP) (CDC, 1987). Blood was identified as the single most important source of HIV and HBV (Garner and Hospital Infection Control Practices Advisory Committee, 1996). As it is impossible to identify all patients that are sero-positive to HIV, HBV or HCV, UP dictates that all patients should be regarded as a potential biohazard (Garner and Hospital Infection Control Practices Advisory Committee, 1996; DoH UK, 1998). However, body substance isolation precautions (aimed at regarding all moist and body substances as potentially infectious) are familiar to all nurses as they are in use since 1987 (Garner and Hospital Infection Control Practices Advisory Committee, 1996). CDC then produced a two tier isolation precaution system known as standard precautions (SP) (Garner and Hospital Infection Control Practices Advisory Committee, 1996; Siegel et al., 2007). The first tier is designed for the care of all patients in hospitals, regardless of diagnosis or presumed infection status. The second tier, ‘Transmission-Based Precautions’ is for patients known or suspected to be infected by a transmissible infection (Garner and Hospital Infection Control Practices Advisory Committee, 1996; Siegel et al., 2007). SP principles include hand hygiene, patient isolation, personal protective equipment (PPE), personal and environmental hygiene, appropriate management of linen and health care waste, including sharps. Hand hygiene is the most important principle to prevent the spread of infection (WHO, 2009; HPSC, 2011a, 2011b). Hand hygiene includes hand-washing with soap (or antimicrobial soap) and water or alcohol gel. It also prescribes that cuts and abrasions are covered with waterproof dressings (WHO, 2009; HPSC, 2011a, 2011b). Stein et al. (2003) illustrated that while doctors understood the importance of hand hygiene, only 7 in 10 followed it frequently in practice. Patients with a BBV should be risk assessed to determine the type of isolation required. Patients that are actively bleeding or with large open wounds require contact precaution isolation (Siegel et al., 2007). Signs alerting staff to the type of isolation should be placed on the door and appropriate PPE should be available. PPE such as gloves and/or apron are required in the event of exposure to blood or body fluids (Siegel et al., 2007). Seventy-one percent of doctors do not wear gloves when taking blood despite 83% believing it important (Stein et al., 2003). Masks are not usually necessary unless to protect from other active infectious diseases, e.g. a patient with pulmonary tuberculosis. The environment should be cleaned daily with detergent and water and disinfected in the event of blood or body fluid spill. Blood spills require appropriate action, e.g. use of spill kits with PPE; appropriate disinfection agents to kill any viruses present; disposable scoops and yellow health care waste bags. Blood spills must be managed and decontaminated to prevent persons becoming contaminated (Siegel et al., 2007). The environment and instruments can also become contaminated with blood. This can lead to infection outbreaks such as the case of podiatry instruments that were the source of an outbreak of HBV in a long-term care facility (Wise et al., 2012). Health care waste is divided into health care risk waste and health care non-risk waste (DoHC, 2010). Health care risk waste includes any item contaminated with blood. Blood-stained products must be appropriately discarded in the yellow health care risk waste stream. If blood is in liquid form, a yellow rigid spill-proof container is used. Needles and sharps should be discarded in designated sharps containers (DoHC, 2010). Needlestick injuries (NSI) or sharps injuries must be managed appropriately. US surveillance indicates more than 380 000 parenteral annual exposures to blood. This equates to nearly 1 in 10 US HCWs receiving a needlestick exposure annually (Panlilio et al., 2004). Alarmingly, Delobelle et al.'s figure (as reported by the nurses themselves in response to survey) was as high as 7 of 10. The discrepancies in figures could be due to underreporting of NSI, which does occur in health care, and it is believed that doctors are least likely to report NSI (Stein et al., 2003). It is very important for nurses in critical care who are exposed to an NSI to perform first-aid to the injury and report to their supervisor and Occupational Health /Emergency Department. Occupational exposure should be assessed and treated accordingly, for example by immunization, hepatitis B immune globulin and post exposure chemoprophylaxis for exposure to HIV. There are also emotional effects of such exposure such as stress (Henderson, 2012) which need to be dealt with as well as financial implications. The cost of management of occupational exposures to blood and body fluids can vary from $71 to $4838 per exposure (O'Malley et al., 2007). An EU directive (2010/32/EU) was published in May 2010 (Council Directive, 2010). Its objective is to achieve the safest possible work environment for HCWs through the prevention of sharps injuries. All health care organizations must comply with this directive, which becomes legally binding on 11 May 2013 (European Biosafety Network, 2010). Perz et al. (2012) determined that unsafe injection practices account for a proportion of HBV acquisitions in health care settings (e.g. use of multi-dose vials; incorrect administration of injections resulting in microscopic quantities of blood contaminating the environment). An outbreak of HCV was identified in an outpatient's clinic where myocardial perfusion imaging was undertaken (Moore et al., 2011). It was determined that a nuclear medicine technologist routinely drew flushes of saline solution from multi-dose vials using the same needle and syringe as had previously been used to administer radiopharmaceutical doses (Moore et al., 2011). In addition, Fischer et al. (2010) highlighted HCV transmission resulting from contamination of single-use medication vials used on multiple patients during anaesthesia administration. As a consequence, more than 50 000 persons required follow-up by Public Health. This investigation highlighted breaches in aseptic technique and deficiencies in oversight within outpatient settings. BBV outbreaks have also been caused through blood glucose monitoring. Five instances of HBV in UK care homes resulted from poor infection control practice in blood glucose testing (Duffell et al., 2011). HBV outbreak was also noted in a long-stay facility where blood glucose monitoring devices were not decontaminated between patients. This resulted in HBV transmission to at least six residents (Schaffzin et al., 2012). HCV has also been transmitted by shared spring-triggered capillary blood glucose monitoring (Desenclos et al., 2001). Recently, Perz et al. (2012) identified haemodialysis as another risk factor in blood-borne pathogen transmission, while several documented cases of patient-to-patient HCV transmission via colonoscope exist (González-Candelas et al., 2010). Most occupational exposures occur on wards (36%), operating theatres account for 17% of incidents (HPA, 2008). Once a BBV is diagnosed in a health care setting, a local investigation is necessary to determine whether the infection is considered as nosocomial. Under the Infectious Disease Regulations (1981) the Department of Public Health must be notified of HBV and HCV infections. A patient notification exercise (PNE) is undertaken using ‘Guidance on the management and investigation of potential exposure to BBVs in health care setting’ (DoHC, 2005). Surveillance is a key performance indicator in the management of HCAI. Early identification of outbreaks and active surveillance of occupational exposures is also necessary. Occupational exposures include percutaneous exposures, where skin has been broken by a needle or sharp, human scratches or bites and mucotaneous exposures (HPA, 2008). Between 1997 and 2008, 3773 occupational exposures to blood or other high risk body fluids were reported to the Health Protection Agency in the UK (HPA, 2008). Feedback from surveillance and good communication informs staff of risks and of appropriate precautions. A study by Donohue et al. (2012) included recommendations such as enhanced surveillance of BBV notifications; sufficient laboratory resources; improved hospital information systems; the establishment of a national register of possible incidents of BBV transmission and that findings of investigations should be published. These would contribute to the further prevention of BBV within the health care setting. Transmission of BBVs in health care settings was believed to occur most frequently during EPPs; however, there is growing evidence of patient-to-patient transmission via other routes (Donohue et al., 2012) including deficient policies and procedures, improper hand hygiene, preparation of medication in blood processing areas, blood glucose monitoring, common-use saline bags, reuse of syringes, reuse of single-dose vials and use of multi-dose drug vials (Kermode et al., 2005; Greeley et al., 2011; Donohue et al., 2012). Perz et al. (2012) concluded that health care exposures may represent an important source of new HBV and HCV infections among older adults especially in ambulatory care settings through reduced oversight and fewer infection control resources. Strategies associated with injury prevention include avoidance of unnecessary needle use; unnecessary insertion of intravenous catheters; use of needleless or protected needle infusion systems and use of safer needles (Henderson, 2012). Health care associated infections and outbreaks of BBV have occurred in health care settings therefore it is necessary that a good infection control programme is in place (HIQA, 2009). Hand hygiene and adherence to SP are important in the prevention of spread of infections (SARI, 2005; Siegel et al., 2007). Reducing occupational exposure will reduce occupational infections with BBVs (Henderson, 2012). Education of staff is essential. Stein et al. (2003) observed the attitudes and compliance of medical staff to UP and recorded reasons for non-compliance. It concluded that while 86% of nurse's s attested to UP compliance, only 41% of doctors did. Education, monitoring, sufficient resources and disciplinary action for poor compliance are all necessary to improve infection control in hospitals (Stein et al., 2003). Although safety-engineered devices have been designed to cover sharps and eliminate all ‘after-use’ injuries, NSI still occur if these devices are used incorrectly. Thorough training and monitoring of the correct use of these safety devices is required (Perry et al., 2004). This training, together with regular education on blood-borne diseases, and infection prevention and control policies and procedures in the critical care unit lead to better management and prevention of BBV and increased safety for both staff and patients. Where direct educational update on the topics is not readily available, critical care nurses may take the initiative to perform independent learning on the topic in line with the development of their professional portfolio. Professional literature and readings on the topic are widely available and act as a good resource for the nurse looking to explore this topic within their portfolio.

BackgroundFuzzy logic has been progressively investigated as a viable alternative to traditional statistical and machine learning methods in health care modeling, especially in environments marked by uncertainty, nonlinearity, and missing information. Although its use in prediction, classification, and risk stratification is well established, its application to explicit causal inference remains limited, varied, and methodologically premature.ObjectiveThis systematic review aimed to examine how fuzzy logic frameworks have been used to address causal questions in health care, focusing on their methodological characteristics, comparative performance, and degree of integration with formal causal inference approaches.MethodsA systematic search across 6 databases (PubMed, Web of Science, ScienceDirect, SpringerLink, Scopus, and IEEE Xplore) identified peer-reviewed studies published between 2014 and 2025 that applied fuzzy modeling in health care settings with explicit or implicit causal objectives. The review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines and used a modified PICO (population, intervention, comparator, and outcome) framework for study selection. Data were extracted on the health care domain, fuzzy method, comparator use, and causal framing. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) checklist and the PROBAST+AI tool, according to study design.ResultsA total of 37 studies met the inclusion criteria. The most frequently applied approaches were fuzzy inference systems, fuzzy cognitive maps, and neuro-fuzzy models, with applications spanning infectious diseases, cancer, cardiovascular health, mental health, and occupational health. Fourteen studies included comparator models; among these, 5 reported superior performance of fuzzy approaches, 3 showed comparable results, and 6 lacked sufficient detail for a robust comparison. Only 2 studies explicitly implemented formal causal inference frameworks, while most relied on predictive or associative modeling with implicit causal assumptions. Overall, the risk of bias was moderate to high.ConclusionsFuzzy logic offers interpretability and flexibility well suited to complex health care problems, yet its application to explicit causal inference remains fragmented. Greater methodological transparency, systematic benchmarking, and integration with formal causal designs—such as counterfactual and target trial frameworks—are required to establish fuzzy logic as a robust paradigm for causal inference in health care.

Background: Trauma, both physical and psychological, represents a pervasive public health crisis with profound implications for healthcare utilization. Trauma-Informed Care (TIC) has emerged as a systemic, organizational framework that recognizes the pervasive impact of trauma and promotes environments of healing and safety for all. Aim: This scoping review aims to map the breadth and effectiveness of TIC models as implemented and led by nursing professionals across the care continuum, from high-acuity settings like the Emergency Room to community-based Primary Care. Methods: A scoping review methodology following the Joanna Briggs Institute (JBI) framework was conducted. Five electronic databases (PubMed, CINAHL, PsycINFO, Scopus, Web of Science) were systematically searched for literature published between 2010 and 2024. Results: Findings are categorized across four key settings: Emergency/Trauma, Inpatient, Mental Health/Substance Use, and Primary Care. For nursing staff, TIC implementation is associated with decreased burnout, reduced secondary traumatic stress, increased professional self-efficacy, and improved perceived safety. Key implementation success factors include universal education, environmental modifications, and organizational leadership commitment. Conclusion: TIC is a potent, effective framework that transforms clinical encounters and workplace culture. Widespread adoption requires sustained investment in training, policy reform, and a fundamental shift toward a culture of safety and collaboration in all healthcare settings.

Assessing the effectiveness of structured teaching on knowledge of hand hygiene among healthcare workers

Despite advancements in biomedical and healthcare research, the translation of evidence into routine practice within healthcare systems often lags, perpetuating inefficiencies and disparities in care delivery. Learning health systems (LHS), which integrate internal data and external evidence for continuous improvement, hold promise for addressing these gaps. Implementation science (IS), focused on promoting the systematic uptake of evidence-based practices, offers a robust framework to drive sustainable improvements within LHS. However, the practical application of IS principles in LHS remains underexplored. This scoping review aims to systematically map the literature on the application of IS in LHS, highlighting themes, gaps and opportunities for advancing future practices. This review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews, supported by the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. The review employs a population-concept-context framework, focusing on studies engaged in LHS activities and the application of IS principles in various healthcare settings. Relevant literature will be searched across multiple databases, including OVID/Medline, Embase, Web of Science Core Collection and Health Policy Reference Center. Eligible studies will be screened, and data will be extracted and synthesised using both quantitative and qualitative methods. Key outcomes include characterising IS applications in LHS, evaluating barriers and facilitators, exploring equity integration, and identifying knowledge gaps. As this study does not involve primary data collection, ethical approval is not required. Findings will be disseminated through peer-reviewed publications and conference presentations to inform future research and practice. This protocol has been registered on the Open Science Framework (DOI: 10.17605/OSF.IO/BMQ6J).

Hand Washing

Quality Assessment and Validation of a Direct Observation Hand Hygiene Program

The Joanna Briggs Institute clinical fellowship program: a gateway opportunity for evidence-based quality improvement and organizational culture change.