***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Meta-analytic investigations sometimes use assessment s of research quality according to a formal protocol as a tool for improving research synthesis . We asked whether a particular  quality scoring system could have a direct use in adjusting the summary estimates of a treatment difference . In an empirical study of the relation of quality scores to treatment differences in published meta-analyses of 7 groups of controlled r and omized clinical trials comprising 107 primary studies , we found no relation between treatment difference and overall quality score . We also found no relation between quality score and variation in treatment difference . The level of quality scores has increased at a rate of 9 % per decade for three decades , averaging 0.51 on a scale of 0 to 1 for the 1980s , and leaving much room for improvement . Nevertheless , attention to quality of studies by editors , review ers , and authors may be raising both the level of research done and quality of the reports BACKGROUND Little is known about the h and hygiene practice s of surgical patients . Most of the research has been directed at the health care worker , and this may discount the role that h and hygiene of the surgical patient might play in surgical site infections . METHODS A quasiexperimental , pretest/post-test study was conducted in which patients ( n = 72 ) and nurses ( n = 42 ) were interviewed to examine perceptions and knowledge about patient h and hygiene . Concurrently , observations were conducted to determine whether surgical patients were offered assistance by the nursing staff . Following an initial observation period , nursing staff received an educational session regarding general h and hygiene information and observation results . One month after the education session , patient/nurse dyads were observed for an additional 6 weeks to determine the impact of the educational intervention . RESULTS Eighty observations , 72 patient interviews , and 42 nurse interviews were completed preintervention , and 83 observations were completed postintervention . In response to the survey , more than half of patients ( n = 41 , 55 % ) reported that they were not offered the opportunity to clean their h and s , but a majority of the nursing staff reported ( n = 25 , 60 % ) that they offered patients the opportunity to clean their h and s. Prior to the educational intervention , nursing staff assisted patients in 14 of 81 h and hygiene opportunities . Following the intervention , nursing staff assisted patients 37 out of 83 opportunities ( 17.3 % vs 44.6 % , respectively , [ χ(2)1 = 13.008 , P = .0003 ] ) . CONCLUSION This study suggests that efforts to increase h and hygiene should be directed toward patients as well as health care workers OBJECTIVE To quantify the different behavioral components of healthcare workers ' motivation to comply with h and hygiene in a healthcare institution with a 10-year history of h and hygiene campaigning . DESIGN Cross-sectional study , by use of an anonymous , self-administered question naire . SETTING A 2,200-bed university teaching hospital . PARTICIPANTS A stratified r and om sample of 2,961 medical and nursing staff . RESULTS A total of 1,042 question naires ( 35.2 % ) were returned . Of the respondents , 271 ( 26.0 % ) were physicians , 629 ( 60.4 % ) were nurses , and 141 ( 13.5 % ) were nursing assistants . Overall , 1,008 respondents provided information about sex ; 718 ( 71.2 % ) of these were women . Respondents provided demographic information and data about various behavioral , normative , and control beliefs that determined their intentions with respect to performing h and hygiene . Among behavioral beliefs , the perception that healthcare-associated infections are severe for patients was highly ranked as a determinant of behavior by 331 ( 32.1 % ) of the respondents , and the perception that h and hygiene is effective at preventing these infections was ranked highly by 891 respondents ( 86.0 % ) . Among normative beliefs , perceived social pressure from patients to perform h and hygiene was ranked highly by 760 respondents ( 73.7 % ) , pressure from superiors was ranked highly by 687 ( 66.8 % ) , pressure from colleagues was ranked highly by 596 ( 57.9 % ) , and pressure from the person perceived to be most influential was ranked highly by 687 ( 68.8 % ) . Among control beliefs , the perception that h and hygiene is relatively easy to perform was rated highly by 670 respondents ( 65.1 % ) . High self-reported rates of adherence to h and hygiene ( defined as performance of proper h and hygiene during 80 % or more of h and hygiene opportunities ) was independently associated with female sex , receipt of training in h and hygiene , participation in a previous h and hygiene campaign , peer pressure from colleagues , perceived good adherence by colleagues , and the perception that h and hygiene is relatively easy to perform . CONCLUSIONS In a setting with a long tradition of h and hygiene campaigns , behavioral beliefs are strongly in favor of h and hygiene , but adherence is driven by peer pressure and the perception of high self-efficacy , rather than by reasoning about the impact of h and hygiene on patient safety . Female sex , training , and campaign exposure increased the likelihood of compliance with h and hygiene . This additional insight can help to shape future promotional activity Objective To evaluate the impact of the Cleanyourh and s campaign on rates of hospital procurement of alcohol h and rub and soap , report trends in selected healthcare associated infections , and investigate the association between infections and procurement . Design Prospect i ve , ecological , interrupted time series study from 1 July 2004 to 30 June 2008 . Setting 187 acute trusts in Engl and and Wales . Intervention Installation of bedside alcohol h and rub , material s promoting h and hygiene and institutional engagement , regular h and hygiene audits , rolled out nationally from 1 December 2004 . Main outcome measures Quarterly ( that is , every three months ) rates for each trust of hospital procurement of alcohol h and rub and liquid soap ; Staphylococcus aureus bacteraemia ( meticillin resistant ( MRSA ) and meticillin sensitive ( MSSA ) ) and Clostridium difficile infection for each trust . Associations between procurement and infection rates assessed by mixed effect Poisson regression model ( which also accounted for effect of bed occupancy , hospital type , and timing of other national interventions targeting these infections ) . Results Combined procurement of soap and alcohol h and rub tripled from 21.8 to 59.8 mL per patient bed day ; procurement rose in association with each phase of the campaign . Rates fell for MRSA bacteraemia ( 1.88 to 0.91 cases per 10 000 bed days ) and C difficile infection ( 16.75 to 9.49 cases ) . MSSA bacteraemia rates did not fall . Increased procurement of soap was independently associated with reduced C difficile infection throughout the study ( adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993 , 95 % confidence interval 0.990 to 0.996 ; P<0.0001 ) . Increased procurement of alcohol h and rub was independently associated with reduced MRSA bacteraemia , but only in the last four quarters of the study ( 0.990 , 0.985 to 0.995 ; P<0.0001 ) . Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia ( 0.86 , 0.75 to 0.98 ; P=0.02 ) and C difficile infection ( 0.75 , 0.67 to 0.84 ; P<0.0001 ) . Trust visits by Department of Health improvement teams were also associated with reduced MRSA bacteraemia ( 0.91 , 0.83 to 0.99 ; P=0.03 ) and C difficile infection ( 0.80 , 0.71 to 0.90 ; P=0.01 ) , for at least two quarters after each visit . Conclusions The Cleanyourh and s campaign was associated with sustained increases in hospital procurement of alcohol rub and soap , which the results suggest has an important role in reducing rates of some healthcare associated infections . National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections BACKGROUND H and hygiene prevents cross infection in hospitals , but compliance with recommended instructions is commonly poor . We attempted to promote h and hygiene by implementing a hospital-wide programme , with special emphasis on bedside , alcohol-based h and disinfection . We measured nosocomial infections in parallel . METHODS We monitored the overall compliance with h and hygiene during routine patient care in a teaching hospital in Geneva , Switzerl and , before and during implementation of a h and -hygiene campaign .  Seven hospital-wide observational surveys were done twice yearly from December , 1994 , to December , 1997 . Secondary outcome measures were nosocomial infection rates , attack rates of methicillin-resistant Staphylococcus aureus ( MRSA ) , and consumption of h and rub disinfectant .  FINDINGS We observed more than 20,000 opportunities for h and hygiene .  Compliance improved progressively from 48 % in 1994 , to 66 % in 1997 ( p<0.001 ) . Although recourse to h and washing with soap and water remained stable , frequency of h and disinfection substantially increased during the study period ( p<0.001 ) . This result was unchanged after adjustment for known risk factors of poor adherence . H and hygiene  improved significantly among nurses and nursing assistants , but remained poor among doctors . During the same period , overall nosocomial infection decreased ( prevalence of 16.9 % in 1994 to 9.9 % in 1998 ; p=0.04 ) , MRSA transmission rates decreased ( 2.16 to 0.93 episodes per 10,000 patient-days ; p<0.001 ) , and the consumption of alcohol-based h and rub solution  increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 ( p<0.001 ) . INTERPRETATION The campaign produced a sustained improvement in compliance with h and  hygiene  , coinciding with a reduction of nosocomial infections and MRSA transmission . The promotion of bedside , antiseptic h and rubs largely contributed to the increase in compliance The purpose of this study was to explore patient opinion about asking healthcare professionals to wash their h and s before a clinical procedure and to explore if methicillin-resistant Staphylococcus aureus ( MRSA ) status and access to patient information about infection control would influence the patients ' anxiety about asking . A descriptive survey was undertaken using a semi-structured question naire . The question naire was distributed to a r and omized convenience sample of 185 in patients across all departments of an acute NHS Trust hospital ( response rate 58.9 % ) . Spearman 's rank order and Kendall Tau-b tests were used to analyse specific correlations . Respondents were more confident than anxious about being involved in a campaign that empowered patients to ask staff to wash their h and s. Patients were more anxious to ask if their previous admission episodes were fewer , if their knowledge of MRSA was high and if there was less information about infection control available . Patients who had contracted MRSA in the past were less anxious , as they had a better underst and ing of the disease . In addition , more patients felt less anxious about asking staff to wash their h and s if staff wore a badge saying ' It 's OK to ask ' BACKGROUND A review of the literature on h and washing has documented the absence of research on the education of the patient as an intervention model for changing staff behavior regarding h and washing compliance . The primary objective of this project was to conduct a prospect i ve control study of the effect of  patient h and washing education  on staff  compliance with h and washing . METHOD A prospect i ve , controlled , 6-week intervention/control study was performed in 4 community hospitals in South Jersey . Each hospital served as its own control . Patients were educated within 24 hours of admission about the importance of asking their health care workers to wash their h and s.  Soap usage and h and washing was calculated by bed-days . Patient follow-up was conducted through telephone interviews 2 weeks after discharge . RESULTS The patient h and washing education model increased soap usage by health care workers an average of 34 % ( P = .021 ) ; this increase was consistent across hospitals regardless of the initial soap usage rates . Of the patients interviewed , 81 % read the material s provided , 57 % asked health care workers whether they had washed their h and s , and 81 % of this 57 % said they received positive responses . CONCLUSIONS For the first time , our findings document that education of patients regarding their role in monitoring h and washing compliance among health care workers can increase soap usage and h and washing and provide sustainable reinforcement of h and washing principles for health care workers This observational study measured  healthcare workers ' ( HCWs ' ) , patients ' and visitors ' h and hygiene compliance  over a 24h period in two hospital wards using the ' five moments of h and hygiene ' observation tool .  H and hygiene is considered to be the most effective measure in reducing healthcare-associated infections but studies have reported suboptimal levels of compliance . Most studies have used r and om observational time-periods for data collection and this has been criticised . We monitored a total of 823 h and hygiene opportunities ( HCW 
    Output:
    
Overall , the strategies showed promise in helping to increase patients ' intentions and /or involvement in reminding HCPs about their HH .
HCP encouragement appeared to be the most effective strategy .
A number of strategies are available to encourage patients to question HCPs about their HH .