Hand hygiene with hand sanitizer versus handwashing: what are the planetary health consequences?

Using patients' observations to evaluate healthcare workers' alcohol-based hand rub with Pulpe'friction audits: a promising approach?

Background

Hand hygiene plays an important role in the transmission of nosocomial infections from healthcare workers (HCW) to patients. Patients could play a key role in improving hand hygiene by sharing their experience of the HCW's practices. Already in 2019, the French national mission of transversal support for actions to prevent healthcare-associated infections proposed the national "Pulpe'friction" audit, to assess HCW's reported practices, social representations, and barriers to using alcohol-based hand rubs (ABHR). This audit consisted of a positive discussion between an auditor and the HCW as well as patients, which led the HCW to declare their real practices and the barriers they faced in the field and the patients to report about the HCW's ABHR practices and the information they received about when they should perform hand hygiene.

Objective

To assess whether an association existed between HCW's reported ABHR compliance and patients' declarations about HCW's compliance in the Pulpe'friction audit data.

Methods

Data from Pulpe'friction were collected from 1st January to 31st December 2019, before the COVID-19 pandemic. Mixed linear models were performed to analyze the association between self-reporting by HCW and patients, regarding hand rubs performed by HCW prior to patient care.

Results

There was a positive association between patients' observations and HCW's declared practices regarding the frequency of with which professionals performed hand rubs before patient contact. This indicates that professional and patient statements show the same tendency. The positive association was found in hospitals for patients under 45 and over 64 years old and for paramedics, but not for physicians and not in nursing homes or long-term care facilities. Patients felt more motivated to observe and evaluate HCWs' practices if they had received information about how to correctly wash their hands.

Conclusion

Patients agreed to be involved in the evaluation or professional practices. The patients' observations were positively associated with HCWs reports. New indicators taking patients' observations into account could be interesting.

Mouthwashes: Alternatives and Future Directions

This narrative review summarises "alternative" or "natural" over-the-counter (OTC) mouthwashes not covered elsewhere in this supplement and newly emerging products, as potential mouthwashes of the future. The "natural" mouthwashes reviewed include saltwater, baking soda, coconut oil, charcoal, propolis, seaweeds, and probiotics. Other than essential oils, it is apparent that their clinical effectiveness is still under debate, but there is some evidence to suggest that propolis reduces plaque and gingivitis. This review also covers the host immune response, via novel anti-inmmunomodulant mouthwashes, such as erythropoietin to reduce inflammation with oral mucositis (OM) after radiotherapy. The emerging concept of nanoparticle-containing mouthwashes, such as iron oxide, is further discussed for OM, this agent having the potential for more targeted delivery of chemical antimicrobials. Unfortunately, there are impacts on the environment of widening mouthwash use with more new products, including increased use of packaging, antimicrobial resistance, and possible detrimental effects on marine life. Further, there are roadblocks, relating to regularly approvals and side effects, that still need to be overcome for any OTC deivered immunomodulant or nanoformulation mouthwashes. Despite these caveats, there are many new mouthwashes under development, which could help manage major oral diseases such as caries, gingivitis, and periodontal disease.

Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy

GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.

A review of HTM 01-05 through an environmentally sustainable lens

Patients deserve to be treated in a safe and clean environment with consistent standards of care every time they receive treatment. It is essential that the risk of person-to-person transmission of infections be minimised, yet it is also essential that planetary harm (and therefore public harm) is minimised with respect to resource consumption, air pollution, environmental degradation etc.In 2013, the Department of Health introduced the Health Technical Memorandum (HTM) 01-05 providing dental practices with advice on patient safety when decontaminating reusable instruments in primary care. This paper provides a commentary on HTM 01-05 and similar decontamination guidance. We believe all decontamination documents needs to reflect the so-called 'triple bottom line' - the finance, social cost and impact on the planet.The authors provide an environmental commentary on a number of items mentioned in decontamination documents, including autoclaves (including the use of helix tests), disposable paper towels, undertaking hand hygiene, using a log book, plastic bag use, the use of personal protective equipment, remote decontamination units, single use instruments, single use wipes, disinfection chemicals (for example, sodium hypochlorite) thermal disinfection and wrapping of instruments.It is hoped, in the spirit of the ever-increasing numbers of papers published to highlight how healthcare (and dentistry) could become more sustainable, that these critiques will be taken in the spirit of providing a beginning of further discussion from an environmental perspective.