Background: Despite the effectiveness of hand hygiene (HH) for infection control, there is a lack of robust scientific data to guide how HH can be improved in intensive care units (ICUs).  The aim of this study is to use the literature, researcher, and stakeholder opinion to explicate potential interventions for improving HH compliance in the ICU, and provide an indication of the suitability of these interventions. Methods: A four-phase co-design study was designed. First, data from a previously completed systematic literature review was used in order to identify unique components of existing interventions to improve HH in ICUs. Second, a workshop was held with a panel of 10 experts to identify additional intervention components. Third, the 91 intervention components resulting from the literature review and workshop were synthesised into a final list of 21 hand hygiene interventions. Finally, the affordability, practicability, effectiveness, acceptability, side-effects/safety, and equity of each intervention was rated by 39 stakeholders (health services researchers, ICU staff, and the public). Results: Ensuring the availability of essential supplies for HH compliance was the intervention that received most approval from stakeholders. Interventions involving role models and peer-to-peer accountability and support were also well regarded by stakeholders. Education/training interventions were commonplace and popular. Punitive interventions were poorly regarded. Conclusions: Hospitals and regulators must make decisions regarding how to improve HH compliance in the absence of scientific consensus on effective methods. Using collective input and a co-design approach, the guidance developed herein may usefully support implementation of HH interventions that are considered to be effective and acceptable by stakeholders.

Background: Research over the past several decades has shown an increased risk for completed suicide among people who use drugs (PWUD). However, no study to date has attempted to summarise the available literature on the variety of risk factors associated with this increased risk. This paper presents a protocol for a scoping review that aims to systematically map and synthesise the extent and nature of published, unpublished and grey literature related to risk factors for suicide among PWUD. Methods: The following six-stage methodological framework for scoping reviews proposed by Arksey and O'Malley with enhancements by Levac and colleagues will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data, (5) collating, summarising and reporting results and (6) expert consultation. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Key inclusion and exclusion criteria will be developed to guide literature screening and data charting. Three reviewers will conduct the initial screening of published, unpublished and grey literature. Identified risk factors will be collated, summarised and categorised iteratively by two independent reviewers. Stakeholder consultation will occur with experts from a national steering committee, a national advisory group, a national suicide prevention centre and a European drug monitoring centre. Conclusion: Collating and thematically categorising the various risk factors for suicide among this high-risk group will hold important implications for future research, policy and practice. The research will be disseminated through publication in a peer-reviewed academic journal and a conference presentation, and by sharing the findings with key stakeholders working within research, policy-making and professional practice contexts.