Comparison of hand hygiene compliance among healthcare workers in Intensive care units and wards of COVID-19: A large scale multicentric study in India

Assessing and comparing knowledge, attitude, and practices related to water, sanitation and hygiene among government and non-government school students in Gujarat: a mixed method study

BACKGROUND

Water, sanitation, and hygiene (WASH) practices are vital for health, especially among school students who can propagate messages. Comparing WASH knowledge, attitudes and practices between government and non-government schools can guide tailored interventions. This study aimed to assess and compare WASH-related knowledge, attitudes, and practices among adolescents in government versus non-government schools in Gujarat, India.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 566 students from 17 government and 17 non-government schools. Interviews using a standardized questionnaire provided quantitative data on WASH-related knowledge, attitudes, and practices. Qualitative data was gathered through focus group discussions exploring influences on student WASH behaviors. Analyses included descriptive statistics, group comparisons, multivariate regression, and thematic analysis. A value of P < 0.05 was considered significant.

RESULTS

In total, 566 students participated, with 257 (45%) from government and 309 (55%) from non-government schools. Non-government students showed significantly better knowledge of handwashing (AOR 1.9, 95% CI 1.3-2.7), fecal-oral transmission (AOR 1.8, 95% CI 1.3-2.5), open defecation (AOR 1.7, 95% CI 1.2-2.4), and menstrual hygiene (AOR 3.2, 95% CI 1.1-9.2). More non-government students had positive attitudes about safe drinking water (AOR 4.1, 95% CI 1.8-9.6), conserving water (AOR 2.0, 95% CI 1.4-2.9), cleanliness (AOR 1.8, 95% CI 1.1-2.9), investing in hygiene (AOR 5.3, 95% CI 3.1-9.2), and menstrual management (AOR 2.1, 95% CI 1.2-3.6). In practices, non-government students showed higher use of soap (AOR 1.9, 95% CI 1.3-2.8), better menstrual hygiene (AOR 5.9, 95% CI 3.2-10.9), and more sanitary defecation (AOR 2.7, 95% CI 1.8-4.0). Superior WASH outcomes were associated with older age (AOR 1.8, 95% CI 1.1-3.0), urban locality (AOR 2.3, 95% CI 1.5-3.5), higher parental education (AOR 2.1, 95% CI 1.3-3.4), and affluence (AOR 3.1, 95% CI 1.8-5.2). Qualitative data highlighted knowledge gaps, inadequate facilities, detrimental cultural beliefs, poverty, and the need for government support.

CONCLUSIONS

Disparities exist in WASH behaviors between school types, suggesting the need for tailored interventions addressing specific gaps. Schools play a critical role in cultivating proper hygiene through infrastructure provision and targeted education. Government schools may require extra support to overcome challenges related to WASH access and quality.

Knowledge, Perception, and Practices of Hand Hygiene Among Medical and Paramedical Students at a Tertiary Care Institute in Uttarakhand

BACKGROUND

Healthcare-associated infections or nosocomial infections are considered to be one of the leading causes of increased morbidity and mortality in patients. Hand hygiene is one of the simplest and most effective infection control measures to prevent nosocomial infections. Medical and paramedical students are the foundation of any healthcare system. So, induction and further training during the study period are required to build a robust healthcare system with responsible clinicians.

AIM

To access the knowledge, attitude, and practices of hand hygiene among medical and paramedical students at a tertiary care hospital in Uttarakhand.

METHODS

A cross-sectional study was done among medical and paramedical students in a tertiary care center at Dehradun, Uttarakhand. The total number of study participants was 216, surveyed through a standard WHO-hand hygiene questionnaire. The questionnaire was circulated among students through Google Forms consisting of a total of 26 questions on demographics, knowledge, perception, and practices of hand hygiene. Statistical analyses were performed using Stata software, version 11 (Stata Corp., College Station, TX, USA).

RESULTS

The overall knowledge score for hand hygiene in medical students was 16.73 whereas it was 15.17 among paramedical students. According to categories of knowledge it was found to be moderate in 48% (82 out of 147) of the medical students and 63.31% (43 out of 69) of the paramedical students. Both the groups perceived that hand hygiene is an important measure to prevent hospital-acquired infections whereas the practices were not so good in both the groups.

CONCLUSION

The present study reveals that there were knowledge gaps between medical and paramedical students regarding knowledge of hand hygiene. Overall scores were better among medical students as compared to paramedical students. Moderate knowledge scores in both groups emphasize a regular need for induction training of the students in the institute.

COVID-19 infections among health care workers at a university hospital in Jeddah, Saudi Arabia

BACKGROUND

The objective of this study was to describe the prevalence, characteristics, and risk factors of coronavirus disease-2019 (COVID-19) infection among health care workers (HCWs) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

METHODS

A prospective cross-sectional study of HCWs confirmed to have COVID-19 infection from March 1, 2020 to December 31, 2022.

RESULTS

A total of 746 HCWs were diagnosed with COVID-19. Patients' age ranged from 22 to 60 years with a mean ± standard deviation of 37.4 ± 8.7 years. The infection was community-acquired in 584 (78.3%) HCWs. The vast majority (82.6%) of the infected HCWs had no comorbidities. Nurses (400/746 or 53.6%) represented the largest professional group, followed by physicians (128/746 or 17.2%), administrative staff (125/746 or 16.8%), respiratory therapists (54/746 or 7.2%), and physiotherapists (39/746 or 5.2%). Symptoms included fever (64.1%), cough (55.6%), sore throat (44.6%), headache (22.9%), runny nose (19.6%), shortness of breath (19.0%), fatigue (12.7%), body aches (11.4%), diarrhea (10.9%), vomiting (4.4%), and abdominal pain (2.8%). Most (647 or 86.7%) patients were managed as outpatients. Four (0.5%) HCWs died.

CONCLUSIONS

HCWs face a dual risk of SARS-CoV-2 infection, both from community exposure and within the hospital setting. Comprehensive infection control strategies are needed to protect HCWs both inside and outside the hospital environment.

Reduction in diarrhea cases following implementation of COVID-19 hand hygiene interventions in Ghana: A causal impact analysis

BACKGROUND

The human hand has constant contact with the environment, hence requires regular hand hygiene. Hand hygiene has gained recognition because of the COVID-19 pandemic and is a largely effective, affordable preventive measure against infectious diseases. This study used both national and sub-national analyses to evaluate the effect of COVID-19 handwashing guidelines on instances of diarrhea in Ghana.

METHODS

Data on diarrhea cases spanning February 2018 and March 2022 were retrieved from the District Health Information Management System (DHIMS 2) using a data extraction guide. The data were summarized using descriptive statistics. The difference in diarrhea cases between the pre-COVID-19 and COVID-19 periods was measured using a two-sample t-test across Ghana's 16 administrative areas. Causal Impact package in R statistical software was employed to determine the impact of the introduction of COVID-19 hand hygiene protocols on diarrheal disease.

RESULTS

A total of 5,645,533 diarrheal cases reported between February 2018 and March 2022 through the routine MIS (DHIMS2) were examined. Fifty-three percent of the cases occurred before the introduction of the hand hygiene protocol. Descriptive statistics indicated a statistically significant decrease in average diarrheal cases during the hand hygiene implementation era (13,463 cases reduction, p<0.001). Sub-national analyses revealed significant reductions in various regions: Greater Accra, Ashanti, Ahafo, Central, Eastern, Northern, Upper East, Upper West, and Volta (p<0.05). Causal impact analysis confirmed 11.0% nationwide reduction in diarrheal cases attributed to the COVID-19 hand hygiene protocols (p<0.001).

CONCLUSION

This study underscores the effectiveness of COVID-19 hand hygiene protocols in reducing diarrheal morbidity in Ghana, with varying regional impacts. These findings advocate for the sustenance of investments and commitments made at the COVID hand hygiene protocols, particularly in this era where the pandemic appears controlled.

Hand hygiene with interventions: an observational study from a tertiary care institute over 2 years

Background

Appropriate adherence to hand hygiene (HH) practices by health care workers (HCWs) reduces the transmission of pathogens and subsequently the incidence of hospital acquired infections (HAIs), in health care settings. Strict monitoring and auditing of this simple and cost-effective intervention is very important, as it significantly contributes in reducing the HAIs.

Material and methods

A retrospective observational study, evaluating the HH audits from June 2021 till May 2023 in a tertiary health care facility in North India. HH audits were conducted in the ICUs and wards daily, by the trained infection control nurses (ICNs), using direct observation method based on World health organization (WHO) hand hygiene observational forms. HH total adherence (HHTAR), partial adherence (HHPAR) and complete adherence rate (HHCAR) were analyzed in Microsoft Excel sheet. HHTAR rates were compared among different profession, moments and the month wise trend was also observed over the period.

Results

A total of 24,740 HH opportunities were observed. The compliance rate for HHCAR, HHPAR and HHTAR were 20.3%, 41.5% and 61.4% respectively. Overall better compliance was reported from the ICUs, profession-specific compliance was highest among nurses (62.8%) and doctors (61.5%). Significant increase in adherence rate was appreciated post intervention 46.1% to 67.3%, (p value < 0.01).

Conclusions

Continuous monitoring and reinforcement with timely feedback for intervention and regular auditing is a necessity to improve and maintain the appropriate HH practices among the HCWs. Low- and middle-income countries need to focus more on this simple and promising measure to combat the increasing HAI rates.

Construction of a standardized training system for hospital infection prevention and control for new medical staff in internal medicine ICUs based on the Delphi method

In China, studies have shown nosocomial infections contribute to increased mortality rates, prolonged hospital stays, and added financial burdens for patients. Previous studies have demonstrated that effective infection control training can enhance the quality of infection control practices, particularly in intensive care unit (ICU) settings. However, there is currently no universally accepted training mode or program that adequately addresses the specific needs of ICU medical staff regarding nosocomial infection control. The objective of this study was to develop a standardized training system for preventing and controlling hospital-acquired infections among new medical staff in the internal medicine ICU. Our methodology encompassed an extensive literature review, technical interviews focusing on key events, semi-structured in-depth interviews, and two rounds of Delphi expert correspondence. We employed intentional sampling to select 16 experts for the Delphi expert consultation. Indicators were chosen based on an average importance score of >3.5 and a coefficient of variation of <0.25. The weight of each indicator was determined using the analytic hierarchy process. The efficacy of the two rounds of questionnaires was also evaluated. Our findings revealed that the questionnaires achieved a 100% effective recovery rate, with expert authority coefficients of 0.96 and 0.90. The Kendall coordination coefficients for the first-, second-, and third-level indicators in the initial round of expert consultation questionnaires were 0.440, 0.204, and 0.386 (P < 0.001), respectively. In the second round of expert consultation questionnaires, the Kendall coordination coefficients for the first, second, and third-level indicators were 0.562, 0.467, and 0.556 (P < 0.001), respectively. The final training model consisted of four first-level indicators (hospital infection prevention and control training content, training methods/forms, assessment content, and evaluation indicators), 26 second-level indicators, and 44 third-level indicators. In conclusion, the proposed standardized training system for infection prevention and control among new medical staff in the internal medicine ICU is both scientifically sound and practical, which can contribute to improved patient safety, reduced healthcare costs, and enhanced overall quality of care in internal medicine ICUs. Moreover, it can serve as a framework for future training projects.

Prevalence of vancomycin-resistant Enterococci in India between 2000 and 2022: a systematic review and meta-analysis

BACKGROUND

Vancomycin-resistant Enterococci (VRE) infections are recurrently reported in different parts of India in the last two decades. However, an up-to-date, countrywide information concerning the prevalence and the rate of VRE in India is limited and hence this study aimed to estimate the pooled prevalence of VRE in India.

METHODS

A literature search was performed using various databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed throughout. Cross-sectional studies reporting the prevalence of VRE in India from human samples whereby at least two Enterococci were isolated between 1 January 2000 and 31 December 2022 were sought for inclusion. Data were extracted and analysed using Microsoft Excel and Comprehensive Meta-analysis version 4, respectively.

RESULTS

Nineteen studies were included in the analyses. A collective total of 3683 Enterococci isolates were examined, of which 368 were VRE strains. The pooled prevalence of VRE in India was calculated at 12.4% (95% CI: 8.6-17.5; Q = 189.69; I2 = 90.51%; p = < 0.001). E. faecalis was the most frequently isolated species (1450 [39.37%]) followed by E. faecium (724 [19.66%]). Amongst the VRE strains, E. faecium was the most prevalent (214 [58.15%]) followed by E. faecalis (134 [36.41%]). An upsurge in the rate of VRE infections was observed in India over time: VRE prevalence was estimated at 4.8% between 2000 and 2010 and 14.1% between 2011 and 2020.

CONCLUSION

This study presents the most up-to-date information on the rate of VRE infections in India. Though lower than the findings for some less developed countries, VRE prevalence in India is notable and on the rise.