To improve the rates of central line-associated bloodstream infections in an intensive care and non-intensive care setting in a large Australian health service. Evidence-based care bundles targeting central line practices were developed and implemented using a pragmatic action research-approach. Wards recruited change facilitators to implement the bundles. Compliance and ward engagement were measured, and pre-intervention and intervention central line-related infection rates were compared. Wards showed a reduction in central line-related infections by 90% during the intervention for up to 2 years. Adherence to bundles was high in both settings. Improvements in insertion practices were observed after baseline and were sustained, with the largest improvement seen in documentation. Maintenance and removal practices showed less variation than insertion practices. Care bundles are an effective intervention to reduce central-line-related infections over a sustained period when clinician adherence is high. Care bundles can be effective in high-risk settings beyond intensive care units, including haemodialysis. Central lines were identified from local hospital data as a major contributor to health care-associated infection rates. Care bundles were implemented in high-risk settings and demonstrated sustained reductions in central-line-related infections. Care bundles are an effective intervention for health care organisations to reduce and sustain preventable infections in high-risk patient cohorts. We adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) framework. No patient or public contribution.

Injectable anticipatory medications are routinely prescribed ahead of need in many countries to help manage distressing end-of-life symptoms. However, little is known about the lived experience of patients and informal caregivers as they navigate their prescription, supply and use. To explore and map patient journeys in navigating anticipatory medication care, and to identify healthcare interactions with the greatest potential for enhancing patient and informal caregiver experiences of care. Qualitative secondary analysis of longitudinal interview data using framework analysis and patient journey mapping techniques. Adults (18+) prescribed anticipatory medications (n = 6), informal caregivers (n = 9) and health care professionals involved in their care (n = 5). Visually mapping journeys highlighted that patients and informal caregivers' experiences of anticipatory medication processes varied greatly and were influenced by the context of care. All participants appreciated access to injectable medications for future symptom control. However, journeys repeatedly highlighted suboptimal information exchange between patients, informal caregivers and healthcare professionals, regarding their purpose and threshold for use. Navigating unfamiliar and complex end-of-life medication support systems was more challenging when patients lived alone or experienced communication difficulties. Patient and informal caregiver experiences of timely symptom control could be improved by healthcare professionals having open and ongoing conversations about the role of anticipatory medications. Simplified and well-signposted routes for accessing healthcare professional advice and medication input are needed. Using journey mapping offers a novel way to visually illustrate different patient and informal caregivers lived experience and can be adapted for researching experiences of various care pathways.

Continuous quality improvement is an important endeavor for keeping clinical practice up to date with research evidence and professional guidelines for the sake of patients and the rational use of system resources. Quality clusters are a framework for quality improvement in general practice, but the effects of working in quality clusters have not been evaluated in randomized trials. The use of prostate-specific antigen (PSA) tests in general practice represents a clinically relevant area for quality improvement due to recent guideline revisions, practice variation, and concerns about overuse. The objective of this study is to evaluate the effectiveness of a quality cluster-based intervention on the use of PSA tests in general practice. The study is a cluster randomized controlled trial with an intervention group and a control group-receiving the intervention delayed-based in quality clusters in Denmark. We aim to include 50 quality clusters, each quality cluster having on average 13 general practice clinics. The intervention period is six months, and the total study period is 12months. Randomization is 1:1 to intervention and control by a computer algorithm stratified by the five Danish health regions and cluster size. The intervention includes a cluster package about prostate-specific antigen used at a quality cluster meeting with data on use of prostate-specific antigen-tests, information on clinical guidelines, videos with clinicians, reflection questions, and hand-out materials to support implementation of changes to clinical practice. The control group proceeds with cluster work as usual and will receive the intervention delayed. Data for the primary and secondary outcomes will be obtained through registries and will be assessed at the end of the trial. We anticipate that the intervention will encourage general practitioners to reflect on their use of PSA testing and adjust their practice in accordance with the clinical guidelines if needed, and that this will result in an overall reduction in the use of the test. Clinicaltrials.gov NCT06748456. Registered on 16.10.2024. https://clinicaltrials.gov/study/NCT06748456?id=NCT06748456&rank=1. Retrospectively registered.

Adherence to radical cure for Plasmodium vivax remains a major challenge for malaria control programmes. Novel regimens, such as 7-day high-dose primaquine regimen and single-dose tafenoquine, may improve treatment adherence and antirelapse effectiveness but can increase the risk of haemolysis in individuals with glucose-6-phosphate dehydrogenase deficiency. Stakeholder (ie, policymakers, providers, patients, etc) perceptions of these risks may significantly influence the acceptability and uptake of these regimens. Understanding these perceptions is essential for policymakers to design effective communication and implementation strategies of novel radical cure strategies. Guided by qualitative methodology and a risk perception lens, this study explored P. vivax malaria stakeholders' experiences and interpretations of novel radical cure regimens. Between February and September 2023, 58 semistructured interviews and 6 focus group discussions were conducted at Arba Minch General Hospital and three health centres and health posts within the Gamo Zone of the South Ethiopia Regional State: Lante, Shecha and Shele. Participants included clinical trial staff and participants, health centre personnel, health extension workers and routine care patients. The 7-day-high-dose primaquine regimen and single-dose tafenoquine were viewed as promising solutions to the adherence challenges of the standard 14-day primaquine regimen; however, participants raised concerns about the effectiveness of the shortened treatment duration and the safety of the increased daily dose of primaquine. A risk perception lens revealed that concerns about effectiveness and safety were influenced by prior public health messaging emphasising completion of the full 14-day regimen alongside fears of overdosing and drug-induced haemolysis. Pill characteristics, including number, shape and colour as well as fears of overdosing and drug-induced haemolysis also contributed to apprehension about the safety of these regimens. Participants' perceptions of shortened radical cure regimens were shaped by concerns about effectiveness and safety, influenced by prior treatment messaging and pill characteristics such as higher dosing and pill burden. A risk perception lens can inform implementation and communication strategies for novel regimens, where addressing user perceptions alongside practical improvements, such as reducing pill burden, is essential for optimising uptake and adherence.

ABSTRACT This study examined factors influencing effective supervision of peer support specialists (PSS) integrated into medical settings. The research used a survey incorporating quantitative measures—the Brief Assessment of Recovery Capital (BARC-10), the Assessment for Collaborative Environments (ACE-15), and an adapted Quality of Supervision Scale (QSS)—as well as qualitative open-ended questions. Results indicated that quality supervision was linked with higher levels of recovery capital (mean BARC-10 score = 54.89, surpassing the remission threshold of 47) and team connectedness (mean ACE-15 score = 59.81, above previous averages). Qualitative responses emphasized the value of consistent and trusting supervisory relationships for professional development and well-being, which corresponded with improvements in client care, resource access, and ethical practice. The study outlines approaches for delivering effective supervision and its potential to strengthen recovery capital, promote workforce retention, improve team functioning, and support patient outcomes.

Alpine regions exhibit high incidence rates of cutaneous melanoma due to increased ultraviolet radiation at higher altitudes. In 2022, the "Montagna SÌ, Melanoma NO" (Mountain YES, Melanoma NO) public health campaign began promoting sun-protective behaviors in these areas. This study aims to evaluate an intervention's effectiveness 3 years after its launch and assess improvements in sun safety practices. A before-and-after comparative study was conducted by surveying a random sample of 229 Belluno residents in the Veneto Region, Italy, in 2022, and 115 of those same individuals in 2025 using a standardized questionnaire. Data on sociodemographics, phenotypic characteristics, sun exposure habits, sunscreen use, protective clothing/eyewear usage, and campaign awareness were collected. In 2025, 43% of respondents (95% CI: 33.44%-52.17%) reported being aware of the health promotion efforts. A significant increase in sunscreen application during outdoor activities lasting more than 1 hour and during skiing was detected. Nevertheless, other protective measures, such as the use of caps and sunglasses, did not demonstrate any significant improvement. The campaign was effective. It reached its target population and improved sun-protective behaviors, confirming the value of community-engaged, tailored health promotion strategies. Further initiatives are necessary to address the remaining gaps in melanoma prevention adherence.

From Evidence Synthesis to Agile Design: Bridging the Gap Between Evidence-Based Practice and Quality Improvement.

ABSTRACTPollen analysis is a crucial tool for reconstructing past vegetation and ecosystems. Until now, pollen analysis has been a time‐consuming manual process, severely limiting the number of records an analyst can produce and their temporal resolution. Recently, automatic approaches based on artificial neural networks have shown potential for classifying multiple pollen types. These approaches performed well with clean, modern reference material, but not with real‐world fossil pollen samples from, for example lake sediments. To overcome this limitation, our TOFSI approach uses two neural networks to first detect and then classify pollen and other objects. Here, we apply the approach, for the first time, to a long lake sediment sequence at a very high resolution of 1 cm. To this end, a model has been trained to recognise 48 pollen, spore and NPP classes. Our approach performs excellently for the classes that are well represented in the training data. At the 0.5 confidence level, the automatic recognition achieves a recall and precision of at least 0.9. However, performance tends to decline for classes with fewer than ~100 training objects. We conclude that, when suitable images and model training are provided, TOFSI can accurately detect and classify multiple pollen, spores and NPP classes in lake sediment samples. The approach hence allows fully automated analysis when limited taxonomic resolution is sufficient. When full taxonomic resolution is required, TOFSI can be used in a semi‐automatic approach involving manual revision of critical objects. Both approaches substantially reduce analysis times, while the resulting count sums and, consequently, the statistical reliability of the results are often much higher. Besides improved productivity, an image‐based workflow could offer palynologists several practical improvements, including simplified student training and communication between researchers. Extended documentation and long‐term storage of results may improve the standardisation of pollen counts.

Stunting remains a major public health challenge in Indonesia’s dryland regions, where cultural and religious values influence child care practices. This study tested a culturally grounded behavior-change communication model for stunting prevention among mothers with children aged 0–23 months in West Timor. Using a quasi-experimental pretest–post-test nonequivalent control group design, 102 mothers were assigned to intervention and control groups. The intervention involved a structured cultural communication module delivered by trained religious leaders over six months. Results showed significant improvements in awareness, motivation, intention, and practice among intervention participants, supporting religiously embedded communication as an effective community-based stunting prevention strategy.

Purpose This viewpoint examines how changing social norms and evolving organisational culture in healthcare, particularly within clinical laboratories and quality management systems, have reshaped conceptions of acceptable practice. Drawing a parallel with cultural reckonings in reality TV, the paper contends that healthcare's progression from “that is how it was done” to “this is how we improve” reflects not simply procedural updating but a deeper cultural transformation. Using the New Zealand (NZ) clinical lab sector as a case study, it explores how structural reform, accreditation systems, workforce change and safety reporting mechanisms have collectively redefined the normative landscape, making a shift from hierarchy to psychological safety and from compliance-driven to value-driven quality approaches. Design/methodology/approach This viewpoint synthesises concepts from organisational sociology, quality improvement literature and healthcare safety research. The discussion integrates theoretical perspectives (e.g. Mannion and Davies on organisational culture, Edmondson on psychological safety and Westrum's safety culture taxonomy) with empirical developments from the NZ context. The case study draws on doctoral research, accreditation history, legislative analysis under the Health Practitioners Competence Assurance (HPCA) Act 2003, workforce studies and Health Quality and Safety Commission documentation. Findings Healthcare organisations experience sustained normative change. Practices once considered routine are increasingly viewed as inconsistent with contemporary expectations of safety and equity. This shift reflects a broader movement from compliance-driven models toward value-driven quality cultures. The NZ lab sector illustrates these dynamics. Structural reform altered governance arrangements; accreditation institutionalised expectations of quality; protected reporting mechanisms supported psychological safety; workforce change introduced new values; and mandatory reporting embedded systematic safety surveillance. Key themes include the centrality of psychological safety for learning, the influence of leadership behaviour in cultural change and the importance of structural interventions that reinforce professional values. Cultural transformation emerges as both a quality imperative and an ethical progression. Research limitations/implications As a conceptual viewpoint, the article synthesises existing literature and policy development rather than presenting primary empirical data. While the NZ case offers a rich illustration, findings may not be directly transferable to systems with different regulatory and funding arrangements. Further research should integrate organisational culture metrics into quality assessment frameworks, examine how cultural variables influence improvement outcomes and explore interactions between structural reform and professional agency over time. Practical implications Sustainable quality improvement requires attention to culture as well as procedure. Creating psychological safety demands intentional leadership behaviours. Accreditation and regulatory bodies should consider cultural indicators alongside compliance measures. Structured reporting mechanisms, generationally responsive workforce strategies and protected quality assurance (QA) activities can strengthen learning environments. The NZ experience suggests that legislative design can embed safety culture institutionally. Social implications Normative evolution in healthcare reflects broader societal shifts in expectations of dignity, safety and accountability. Just as public tolerance for exploitation or humiliation in media has diminished, healthcare systems are increasingly oriented toward transparency, equity and psychological safety. Professional norms do not develop in isolation; they evolve alongside changing social values. Healthcare organisations therefore both respond to and contribute to wider moral progress. Originality/value This viewpoint offers three contributions. First, it introduces a novel parallel between media-based cultural reckoning and normative change in healthcare. Second, it presents an integrated account of structural reform, accreditation development, protected reporting and workforce transformation within the NZ lab sector as a cohesive case study in organisational culture change. Third, it synthesises organisational sociology, safety and quality improvement scholarship to argue that the shift from “that's how it was done” to “this is how we improve” reflects substantive normative evolution within healthcare practice.

Artificial intelligence (AI) is increasingly encroaching on domains traditionally reserved for humans, including moral judgment. This trend has sparked heated debates, with both strong concerns and optimism about its implications. To contribute to this discourse, this research examines how individuals respond when AI participates in moral evaluations of cyberbullying incidents. We conducted an experiment employing 3 (Reviewer cue: human vs. AI vs. collaboration) × 2 (Roles in cyberbullying incident: victim vs. bystander) between-subjects design. Findings show that the AI reviewer cue indirectly increased perceived decision compliance, report efficacy, and future report intention by activating positive machine heuristics. However, negative machine heuristics did not mediate the effects of AI reviewer cues on perceived report efficacy and future report intention. Human-AI collaboration did not differ significantly from either AI-only or human-only reviewer cues. In addition, although the interaction effect was not significant, planned contrasts suggest that victims may be more likely to perceive the AI reviewer as lacking contextual understanding, whereas bystanders may view it as more objective. This highlights the challenges of using AI-driven judgment in sensitive areas such as cyberbullying, emphasizing the need for practical improvements to enhance reporting systems.

Paediatric regional anaesthesia (RA) is a safe and effective modality for peri-operative pain management, associated with improved outcomes and reduced opioid use. However, utilisation remains variable, and defining appropriate benchmarks is challenging. We conducted a 28-day retrospective audit of RA practice in a tertiary paediatric centre. All anaesthesiologist-performed regional blocks were recorded. Surgical cases not typically amenable to RA were excluded. The primary outcome was the proportion of patients receiving RA, with secondary analysis excluding unsuitable procedures. A total of 491 patients underwent surgery, of whom 94 (19.1%) received RA, increasing to 20.8% following case exclusion. A total of 117 blocks were performed, comprising 86 peripheral (73.5%) and 31 central (26.5%) blocks. Peripheral techniques included 42 lower limb (35.9%), 30 truncal/craniofacial (25.6%), and 14 upper limb (12.0%) blocks. Central blocks included 15 caudal (12.8%), 10 epidural (8.5%), and 6 paravertebral (5.2%) blocks. RA utilisation in our institution is consistent with European data. These findings establish a local benchmark and support ongoing audit and quality improvement in paediatric anaesthesia practice.

ABSTRACT This scoping review focuses on the concept of teacher research in primary and secondary education, a practice increasingly acknowledged for its impact on teaching and professional development. Despite teacher research’s recognised advantages, consensus on its definition is lacking, and several barriers hinder teachers’ involvement in research. This review aims at examining how teacher research is conceptualised in the literature, identifying its characteristics, and analysing the factors that affect its implementation. The study adhered to an established methodological framework for conducting scoping reviews and the PRISMA-ScR reporting guidelines. Following a systematic search in three databases, the included publications were synthesised through thematic synthesis and ideal-type analysis. The findings reveal that teacher research is mainly conceived as a situated and reflective activity focused on the immediate improvement of teaching practices. This review offers useful insights to guide future educational policies and support the integration of teacher research into everyday teaching.

Improving epilepsy knowledge, attitudes & practices among primary health care providers: findings from a pre-post intervention study in Central India.

BackgroundDespite the importance of quality improvement in advancing patient care and safety, there is limited literature describing structured, practical, and co-designed quality improvement education.ObjectiveThis study aimed to (1) describe how learner co-design was operationalized within Kern’s 6-step curriculum development framework to develop a quality improvement workshop for medical students and resident physicians, (2) evaluate preworkshop and postworkshop changes in learners’ self-reported understanding of and confidence in quality improvement, and (3) explore participants’ attitudes toward quality improvement and their perceptions of the workshop’s relevance to future practice.MethodsUsing Kern’s 6-step curriculum development model, informed by Kolb’s Experiential Learning Theory, we co-designed a 1-day quality improvement workshop with medical students and resident physicians. To address objective 1, the workshop development process was guided by a literature review and a targeted needs assessment. To address objective 2, we used a mixed methods pre-post educational evaluation design. The workshop incorporated expert-led lectures, small-group project design exercises, and peer presentations addressing audit methodology, ethical considerations, and practical implementation. Preworkshop and postworkshop surveys assessed changes in participants’ self-reported understanding of quality improvement concepts, confidence, and attitudes using 10-point Likert scales. Quantitative data were analyzed using the Wilcoxon matched-pairs signed-rank and Fisher exact tests. Semistructured interviews explored participants’ experiences and helped to explain their quantitative responses. Interview transcripts were analyzed using thematic analysis.ResultsFindings from the literature review and targeted needs assessment identified gaps in practical quality improvement education related to project design, implementation, and ethical considerations, which informed workshop co-design. In total, 31 learners attended the workshop, and 77.4% (24/31) completed preworkshop and postworkshop surveys. There was a significant improvement in participants’ understanding of the Plan-Do-Study-Act cycle (preworkshop median score 2.0, IQR 1.0‐2.8 vs postworkshop median score 4.0, IQR 4.0‐5.0; P<.001). Confidence in engaging in quality improvement projects improved significantly (preworkshop median score 4.5, IQR 2.3‐7.0 vs postworkshop median score 7.5, IQR 6.3‐8.0; P=.004). Self-reported knowledge of additional methodologies, including Six Sigma, Lean, and root cause analysis, also improved significantly. Participants rated the workshop highly (median score 9.5 out of 10). Qualitative findings indicated that participants perceived improved capability in project planning, greater ethical awareness, and stronger motivation to apply learning in clinical practice. These findings reflect self-reported learning experiences rather than objectively verified skill development.ConclusionsLearner co-design was successfully integrated within Kern’s curriculum development framework to develop a practical quality improvement workshop informed by identified learner needs. Participation in the workshop was associated with improved self-reported understanding, confidence, and positive perceptions of relevance and usefulness. Future research should examine longer-term outcomes and evaluate adaptation across broader educational settings.

Competency-based medical education, structured around the 6 core competencies of the Accreditation Council for Graduate Medical Education (ACGME), underpins postgraduate training in ACGME-International (ACGME-I)- accredited institutions. Despite its central role, limited evidence exists regarding trainees' awareness, confidence, and educational preferences related to these competencies, particularly in the Middle East. This study aimed to assess postgraduate trainees' awareness and confidence across the 6 ACGME competencies and to explore their orientation preferences at Hamad Medical Corporation, Qatar's largest ACGME-I-accredited academic center. A cross-sectional electronic survey was distributed to all postgraduate trainees at Hamad Medical Corporation. The questionnaire assessed self-reported awareness and confidence across the 6 ACGME Core Competencies, perceived emphasis during training, and preferred formats and frequency of competency-based orientation. A total of 255 trainees completed the survey. Overall confidence was high across most competency domains, particularly in medical knowledge, interpersonal and communication skills, and professionalism. Systems-based practice and practice-based learning and improvement were the least familiar and least emphasized domains. Trainees who previously received structured competency orientation reported significantly higher confidence across all domains (P < .01). Patient care (66.7%) and medical knowledge (63.9%) were perceived as highly emphasized competencies, whereas systems-based practice was least emphasized (39.2%). Most trainees (76.5%) expressed interest in competency-focused orientation, favoring annual sessions delivered through online or blended learning formats. Postgraduate trainees demonstrate strong overall awareness of ACGME-I competencies; however, notable gaps persist in systems-based practice and practice-based learning and improvement. Structured, recurring competency orientation is associated with higher trainee confidence.

ABSTRACT Faced with the dual practical challenges of global population aging and the preservation of intangible cultural heritage, ICH art education has gradually emerged as an innovative path to empower older adults and advance sustainable cultural development. Adopting a scoping review approach, this study systematically collates Chinese and international literature alongside typical practical cases, constructs a multidimensional analytical framework, and explores the internal logic of synergistic empowerment between ICH art education and the elderly. Centered on older learners, this research establishes an individual – economic – social triple-value empowerment framework, clarifying the complete operational context of older adults’ ICH participation from motivation stimulation to diversified value formation. Combining three major practical models in China – community-endogenous development, industry-education integration, and institutional platform operation – the study further refines a stepwise implementation path framed as cultural tracing – craft inheritance – innovative application. By benchmarking mature international models, including the University of the Third Age in Europe, community-based lifelong learning in Japan, and creative aging practices in Britain and the United States, this paper verifies the strong adaptability and popularization potential of the above pathway. This study improves the interdisciplinary theoretical system covering ICH art education and later-life learning. It provides cross-cultural references for policy optimization, curriculum reform and practical improvement in elderly education, and facilitates the paradigm shift of this field from passive cultural conservation to active cultural empowerment. From the perspective of lifelong learning, it also effectively broadens the connotation, boundary and practical implementation paths of elderly education.

Primary percutaneous coronary intervention (PPCI) is the standard of care for ST-segment elevation myocardial infarction (STEMI). Yet, data from the Middle East on long-term national trends in procedural characteristics and outcomes remain limited. This study aimed to evaluate nationwide trends in PPCI for STEMI in Qatar over nine years (2015-2023), analyzing trends of cardiovascular risk factors, presentation management, and in-hospital outcomes of STEMI cases treated with PPCI in Qatar. We examined 7,959 STEMI patients who underwent PPCI at Qatar Heart Hospital between 2015 and 2023. Descriptive statistics were presented as mean ± SD or proportions. One-way ANOVA and chi-square tests were used to assess temporal trends. Multivariate logistic regression identified risk factors associated with in-hospital mortality. A p-value ≤ 0.05 was considered significant. Annual PPCI volume increased > 50% from 820 cases in 2015 to 1,264 in 2023. The mean age was 49 years, predominantly male and non-Qatari. Cardiovascular risk factors increased significantly throughout the study, while EMS utilization rose from 63% to 77%. Radial access use increased from 57% to 84%, and intravascular ultrasound from 1.4% to 10%. Door-to-balloon time at the PPCI center declined from 60 to 45min (p = 0.001). In-hospital mortality decreased from 4.4% in 2016 to 1.5% in 2023 (p < 0.001). Predictors of in-hospital mortality included older age (OR 1.03, 95% CI 1.01-1.04), prolonged door-to-balloon time 71-80min: OR 3.49, 95% CI 1.35-9.05; 81-90min: OR 3.01, 95% CI 1.06-8.60; ≥91min: OR 3.31, 95% CI 1.36-8.08), cardiogenic shock requiring IABP (OR 12.08, 95% CI 8.30-17.60), and cardiac arrest (OR 4.76, 95% CI 3.04-7.49). This nine-year national PPCI registry demonstrates substantial improvements in access, procedural practice, and efficiency of STEMI care in Qatar, with marked decline in in-hospital mortality.

Hand hygiene is the single most effective action to prevent pathogen transmission and healthcare-associated infections. Systematically measuring hand hygiene compliance (HHC) is a fundamental requirement of any infection prevention and control program. To establish baseline HHC prevalence rates and evaluate associated glove use across all eight public hospitals in Crete, Greece, where such data are currently lacking. Accredited auditors conducted overt, direct observation in 2025 to collect data using the World Health Organization's "5 Moments" framework and the "Australian National Hand Hygiene Initiative Manual". Fully anonymized data were entered into the Hand Hygiene Compliance Application with permission from Hand Hygiene Australia. A mixed-effects logistic regression model with a nested cluster random effect at the hospital-ward-session level was used to estimate HHC proportions and their 95% confidence interval (CI). Data were collected from forty wards through 718 sessions, totaling 289 audit hours. A total of 13,359 Moments were recorded, with 4,020 being compliant (mean HHC 30%, CI 28-32%). Among healthcare workers, registered nurses demonstrated HHC of 39% (CI 36-42%), whereas specialized physicians recorded 26% (CI 21-31%). The highest compliance percentage was observed after body fluid exposure risk (53%, CI 48-57%), while the lowest was recorded before touching a patient (11%, CI 9-13%). Alcohol-based hand rub was the preferred technique (66%), yet hand hygiene was omitted in 68% of all Moments where glove use was recorded. Findings revealed suboptimal HHC, suggesting a potential association with glove use, thus allowing significant room for improvement in both practices.

This paper explores the experience of general practice nurses implementing a nurse-led social prescribing intervention to improve older people's social connectedness. Qualitative descriptive study within a multi-phase mixed methods project. Eight Australian general practice nurses working in a health connector role participated in semi-structured interviews at implementation-end (n = 8) and 12 months later (n = 5), and two focus groups, held during implementation. Interviews addressed participants' reasons for engaging in the intervention, perceptions of training, the experience of intervention delivery and sustainability. Focus groups explored participants' views of challenges and achievements. Data were analysed inductively using thematic analysis. Participants reported 'alignment between their current nursing role and the additional health connector role' regarding their scope of practice and philosophy of care. 'Preparedness to be a health connector' explained how participants' primary care nursing skills equipped them to intervene, however, additional training and resources were essential. Older people were positively impacted by the intervention, and this motivated participants to sustain elements of the intervention. With support, participants leveraged existing skills and worked to their full scope of practice. This resulted in practice improvements in caring for older people at risk of loneliness and social isolation, and professional gains for nurses. Despite challenges in sustaining the intervention as designed, participants integrated the health connector intervention into their practice within the context of their nursing role and continued this work with older people and other patient groups. Facilitating general practice nurses to undertake a social prescribing intervention had benefits for nurses and patients. Nurse-led social prescribing interventions can support older people to reactivate or maintain their social connections within the context of their health. Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist. No patient or public contribution.