The hygienic efficacy of different hand-drying methods: a review of the evidence

Emitted droplets and aerosols and their transmission when drying hands under an air-jet dryer

When drying hands with a high-speed air jet dryer, the jet impingement on hands can quickly atomize the remnant water on the hand skins into droplets and aerosols. Emission of droplets and liquid aerosols, their spatial transport and the possible inhaling exposure to the hand dryer user remain unclear. This investigation measured the jet flows from a downward air jet dryer, by the particle image velocimetry (PIV), the helium bubble trajectory analysis, and an ultrasonic anemometer. Emission of the droplets when turning over the hands, the droplet spatial motion, and their deposition on human body were photographed by a high speed camera. Concentrations of the liquid aerosols were monitored and the total emitted aerosol numbers and size spectrum were analyzed. The possible inhalation exposure to the emitted liquid aerosols was examined. It is found that number of droplets in size of 0.1 to 0.6 mm can deposit on the mouth and nose and the surrounding face. A typical hand drying process may emit approximately 105 liquid aerosols, of which 93 % are in the submicron size. A hand dryer user may inhale thousands of the emitted liquid aerosols if drying hands without wearing face mask.

Observation of Food Handlers' Hand Hygiene Behavior During Production at a Sandwich-making Factory

Effective hand hygiene is essential during food production to reduce the risk of microbiological contamination. Improper hand hygiene by food handlers can be a major contributing factor in the spread of foodborne illnesses. Self-reported behavior does not equate to actual behavior as it has the limitation of biases. Therefore, observational data are more effective at assessing the actual behavior of food handlers. Covert observation utilizing closed-circuit television (CCTV) cameras can yield reliable data. This study utilized covert observation to assess hand hygiene compliance from CCTV footage of food handlers in a sandwich-making facility. An electronic observation checklist, based upon the company's hand-hygiene protocol, was used to capture observed hand hygiene practices. A total of 588 occasions that required hand hygiene practices by food handlers (n = 12) were observed during the production of ready-to-eat (RTE) sandwiches over 16 h during two shifts. Food handlers did not wash their hands on 32% of occasions which required food hygiene practices. Of those occasions where there was an attempt to implement hand hygiene practices (n = 401), only 1% of behaviors were compliant with the company hand hygiene protocol. Observations indicated that 95% of attempts did not adhere to the recommended handwashing duration (≥20 s). Soap was not used in 4% of attempts, and hands were not wetted prior to applying soap in 16% of attempts. Additionally, 62% of attempts did not use hand sanitizer after handwashing and drying. Food handlers were observed attempting hand hygiene practices significantly more frequently (p < 0.001) when entering (89% of occasions) than exiting (8% of occasions) the production area. Findings indicate that appropriate interventions are needed to improve hand hygiene compliance of food handlers to ensure food is produced safely within the food manufacturing sector.

Hand-Washing Habits in a Sample of Spanish Soft Contact Lens Wearers

Contact lens (CL) wear is a safe method for the correction of refractive errors. However, rare, severe ocular complications may occur which may lead to visual loss. As most of these complications are related to poor patient compliance with care and maintenance instructions, resulting in the contamination of hands, CLs and accessories, it was the purpose of this study to assess hand-washing habits in a sample of Spanish soft CL wearers. Hand hygiene was explored through a self-reported online survey and via an in-office practical demonstration in a subset of those users answering the survey. A total of 198 surveys were analyzed, and 18 CL users participated in the practical demonstration. Overall, hand-washing habits were not adequate, with 35 (17.8%) and 103 (52.2%) participants reporting not always washing their hands prior to CL or storage case manipulation, respectively. While 161 (81.3%) participants dried their hands after washing, 132 of these (82.1%) used non-disposable cloth towels. Participants receiving specific hand-washing information from their practitioners (141, or 71.1%) had better hand hygiene (p < 0.05). During the practical demonstration, 13 (72.2%) participants used water and soap to wash their hands, but only 3 (16.7%) displayed correct hand washing routines. Complete patient education, as well as practical reminders at all follow-up visits, are essential to ensure better hand hygiene in order to reduce the probability of ocular complications and to guarantee safe and satisfactory CL use.

S2k-Guideline hand antisepsis and hand hygiene

The consensus-based guideline "hand antisepsis and hand hygiene" for Germany has the following sections: Prevention of nosocomial infections by hygienic hand antisepsis, prevention of surgical site infections by surgical hand antisepsis, infection prevention in the community by hand antisepsis in epidemic or pandemic situations, hand washing, selection of alcohol-based hand rubs and wash lotions, medical gloves and protective gloves, preconditions for hand hygiene, skin protection and skin care, quality assurance of the implementation of hand hygiene measures and legal aspects. The guideline was developed by the German Society for Hospital Hygiene in cooperation with 22 professional societies, 2 professional organizations, the German Care Council, the Federal Working Group for Self-Help of People with Disabilities and Chronic Illness and their Family Members, the General Accident Insurance Institution Austria and the German-speaking Interest Group of Infection Prevention Experts and Hospital Hygiene Consultants.

Appropriate Hand Drying - The Missed Step of Hand Hygiene: A Qualitative Evaluation of Hand Drying Practices among Indian Health Care Workers

Hand hygiene remains one of the most effective methods of preventing healthcare-associated infections. Hand drying is the end point of hand hygiene. Hand drying after hand hygiene is less explored, and the practice varies in different facilities. This explorative study was done to know the various hand-drying methods and practices of healthcare workers in Indian settings. This was a descriptive cross-sectional questionnaire-based observational study initiated from a tertiary care setup in Uttarakhand. Healthcare workers over 18 years of age directly involved in patient care were enrolled. A semi-structured questionnaire with both open-ended and close-ended questions was used with snowballing sampling technique. Statistical analysis was done using Statistical Package for Social Sciences (SPSS). Out of the eligible 395 respondents, 62.8% were female. The mean age of the respondents was 31.34 ± 8.44 years and average working hours were 8.87 ± 2.97 (range 4-24) hours. Only 72.7% did hand hygiene always before touching a patient. Nurses were more compliant about hand hygiene than doctors (P < 0.0001). A total of 82.8% were aware of appropriate hand-drying methods. Staff in the Intensive care unit Intensive care unit (ICU) setup were more aware of hand drying practices (P = 0.033). A total of 21.8% wiped their hands on their clothing to dry their hands. This was more in staff from paraclinical departments (P = 0.001). A total of 35.7% used handkerchiefs to dry hands. Resident doctors used handkerchiefs more than senior doctors or nursing staff (P = 0.01). A total of 49.9% of respondents spent less than 10 seconds in hand drying. Hand-hygiene knowledge is high among healthcare workers in India, but the knowledge of appropriate hand-drying practices is lacking. There is wide variation in the practice of hand drying. Better hand drying guidelines and incorporating hand drying as the essential endpoint of the hand hygiene ritual are warranted.

Effectiveness and context dependency of social norm interventions: five field experiments on nudging pro-environmental and pro-social behavior

Social norm interventions hold the potential to change people's behavior. Five field experiments (N = 1,163) examined the effects of a simple and easily realizable social norm nudge based on the social media format "Be like Bill." The nudge consisted of a stick figure named Toni that communicated descriptive and injunctive norms regarding pro-environmental or pro-social behaviors. Nudge conditions were compared to no-intervention control conditions. Experiment 1 (N = 179) focused on paper towel consumption in a women's restroom at a German university. The nudge condition used less paper towels than the control condition, d = 0.48. Experiment 2 (N = 183) replicated this result (d = 0.32) in a more diverse setting of a women's restroom at a German Christmas market. Experiment 3 (N = 250) examined differences in the effects of prescriptive (i.e., 'do-norm') versus proscriptive (i.e., 'do not-norm') social norms on paper towel consumption again in a university women's restroom. The effectiveness of both social norm nudge conditions was shown in comparison to the control condition (d = 0.46; d = 0.40), while the prescriptive and proscriptive social norm manipulations did not differ. Experiment 4 (N = 206) applied the nudging approach to the use of plastic lids in a coffee shop, where no effect was found. Finally, Experiment 5 (N = 345) focused on the pro-social behavior of mask wearing in a bakery toward the end of the Covid-19 pandemic restrictions in Germany. In the nudge condition, more visitors put on face masks compared to the control group, d = 0.39. Limitations and contextual factors regarding the applicability of our social norm nudge are discussed.

Preparing schools for future pandemics: Insights on water, sanitation and hygiene solutions from the Brazilian school reopening policies

Post-COVID-19, schools urgently need to enhance infection control and prevention (IPC) measures, including water, sanitation, and hygiene (WASH), to prepare for future outbreaks and pandemics. Particularly in Brazil, that is of particular concern, as students are still recovering from the 20th longest school closure in the world. Hence, the current study had two goals: (i) to describe WASH solutions outlined in policies released at the federal, state, and capital city levels in Brazil during the COVID-19 pandemic for the safe reopening of schools and (ii) to discuss their potential to enhance school's capacity to remain operational during a new pandemic or outbreak. With a qualitative exploratory approach, we performed content analysis to discuss the direction (what, where, how and for whom?) of 66 public policies by integrating four frameworks. Solutions were discussed in the light of the principles of human rights and the human rights to water and sanitation, international guidelines for WASH and IPC in schools and the Sphere minimum standards for humanitarian aid. One hundred and fifty-nine solutions, spanning five thematic areas and five population groups, including software and hardware interventions, were compiled for potential use in Brazil and beyond. While suggested solutions have the potential to provide a cleaner and safer learning environment, it is essential to exercise caution when implementing these measures and adapt them to the specific circumstances of each school.

Prevalence and determinants of hand hygiene behavior among Indian population: a systematic review and meta-analysis

Despite a global call to action, many deaths occur yearly in developing nations from contagious diseases due to poor sanitation and hygiene. Although hand hygiene (HH) behavior was critical in preventing the COVID-19 pandemic, the sustainability of such practices is still questionable. Therefore, the current systematic review and meta-analysis investigated the prevalence and determinants of HH behavior among the Indian population (PROSPERO registration ID: CRD42022344961). Systematic searches on electronic databases, including ScienceDirect, Scopus, Web of Science, JSTOR, PubMed, and Google Scholar, targeted qualitative and quantitative studies that report HH behaviors in India. Pooled effect sizes were calculated with the inverse-variance method using random-effects models, acknowledging the study heterogeneity. Out of 1053 studies, 15 studies that met eligibility criteria were included in the qualitative synthesis. Among them, five studies were included in the meta-analyses. The overall prevalence of HH before food was 55% (95% CI = 31-78), and after the toilet was 84% (95% CI = 65-96). Subgroup analysis showed that before-food HH prevalence pre- and post-COVID-19 was 61% and 36%, respectively, whereas after-toilet HH prevalence was 91% and 74%, respectively. Meta-regression revealed statistically non-significant results for COVID-19 status. While it could not adequately explain the heterogeneity of the 'before-food prevalence' studies (Adj. R2 = - 34.80%), it did account for more than 19% in 'after-toilet prevalence' (Adj. R2 = 19.72%). This systematic review highlights various demographic, psychosocial, and environmental determinants of HH behavior. The results offer the potential for a deeper comprehension of the key factors influencing HH in India and could find implications for developing viable interventions. This aids in planning efficient promotional campaigns to enhance personal hygiene and control infectious diseases in the nation.

Copper oxide particle emission and the spread in a public washroom from a high-speed jet air dryer

The high-speed jet discharged by hand dryers with brushed motors may release hazardous particles. In this study, the particles released from the hand dryer were trapped using high-efficiency particulate air filters for chemical composition analysis in a small test room. A manikin was placed to mimic a user standing in front of the dryer. Number and mass concentrations of the released particles were measured to estimate the particle emission rates and inhalation exposure. The particle emission rate reached 2.64 × 106 particles/s when starting the dryer. The released particles were found to contain a copper element, subsequently extrapolated to copper oxide. Secondly, in the large test room, jet airflows were measured using a three-dimensional ultrasonic anemometer. The results revealed that the horizontally placed palms caused the discharged jets to bend toward the human body, resulting in an upward motion of the air into the breathing zone. After running the dryer for 30 s, the peak mass concentration in the breathing zone for particles with a less than 2.5-μm diameter was 13.1 µg/m3. Installing high-efficiency particulate air filters to the air outlets of hand dryers was found to be effective in minimizing the exposure to CuO.

Synthesising the evidence for effective hand hygiene in community settings: an integrated protocol for multiple related systematic reviews

INTRODUCTION

Despite evidence for the efficacy and effectiveness of hand hygiene in reducing the transmission of infectious diseases, there are gaps in global normative guidance around hand hygiene in community settings. The goal of this review is to systematically retrieve and synthesise available evidence on hand hygiene in community settings across four areas: (1) effective hand hygiene; (2) minimum requirements; (3) behaviour change and (4) government measures.

METHODS AND ANALYSIS

This protocol entails a two-phased approach to identify relevant studies for multiple related systematic reviews. Phase 1 involves a broad search to capture all studies on hand hygiene in community settings. Databases, trial registries, expert consultations and hand searches of reference lists will be used to ensure an exhaustive search. A comprehensive, electronic search strategy will be used to identify studies indexed in PubMed, Web of Science, EMBASE, CINAHL, Global Health, Cochrane Library, Global Index Medicus, Scopus, PAIS Index, WHO IRIS, UN Digital Library and World Bank eLibrary published in English from January 1980 to March 2023. The outcome of phase 1 will be a reduced sample of studies from which further screening, specific to research questions across the four key areas can be performed. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Quantitative and qualitative data will be extracted following best practices. We will assess all studies using the Mixed Method Appraisal Tool. All effect measures pertaining to review outcomes will be reported and a narrative synthesis of all studies will be presented including 'data-driven' descriptive themes and 'theory-driven' analytical themes as applicable.

ETHICS AND DISSEMINATION

This systematic review is exempt from ethics approval because the work is carried out on published documents. The findings of the reviews will be disseminated in related peer-reviewed journals.

PROSPERO REGISTRATION NUMBER

CRD42023429145.

Inclusion of Food Safety Information in Home-delivered U.K. Meal-kit Recipes

Home-delivered meal-kit recipe boxes provide consumers with fresh, measured ingredients requiring storage, preparation, and cooking by following a recipe card.Previous literature has suggested that including food safety information within recipes may positively impact behavior. Therefore, there is a need to better understand what food safety information is included on the meal-kit recipe cards. Content analysis was performed on U.K. meal-kit provider recipe cards (n = 359) obtained using citizen science methods. Although 46% of recipes referred to handwashing at the start of recipe preparation, these stated 'wash hands' with no further advice regarding hand hygiene, and half (48%) did not refer to handwashing during recipe preparation. Most recipes included produce (99%) and referred to washing fruit and vegetables (88%). For meal-kits that provided animal proteins (n = 332), 50% referred to storing ingredients in the fridge, and only one recipe referred to recommended temperatures (≤5°C). Where applicable (n = 346), food safety advice to prevent cross-contamination was present in 51% of recipes.Statements concerning cooking adequacy of animal proteins (n = 1306) included subjective cooking guidance, with 35% referring to visual assessment of color and 26% cooking duration. For best practice food safety guidance, two recipes referred to end-point temperature, and one stated to use a temperature probe. While all meal-kit providers provided some food safety-related information in reviewed recipes, information was often not sufficient to inform consumers about food safety risk-reducing behaviors in the domestic setting. Observational research is needed to understand consumer engagement with how food safety information in meal-kit recipes impacts the behavior of consumers.

Effect of handwashing on the reduction of Escherichia coli on children's hands in an urban slum Indonesia

Poor hand hygiene practice has been linked to an increase in the number of infections among children in urban slums. Hands are considered an intersection for bacterial transmission, but it is unclear whether the handwashing technique affects bacteria elimination. This study investigated the effect of handwashing on the concentration of Escherichia coli (E. coli) and factors related to its reduction among children in an urban slum in Bandung, Indonesia. We observed handwashing and conducted repeated hand swabs before and after handwashing among 137 participants. The mean E. coli concentration on the hands decreased after handwashing, with a higher reduction in E. coli count among students who used soap and had soap contact for more than 10 s during handwashing. Cleaning in-between fingers, using soap, soap contact for more than 10 s, and drying hands with a single-use towel were effective factors for reducing E. coli concentration after handwashing (p < 0.05). More than half of the swab samples (59%) tested positive for E. coli after handwashing, indicating that the children's handwashing technique was not effective in completely removing E. coli from the hands. Moreover, sustained and consistent handwashing practice as a daily behavior in children would maximize the effect.

Effect of Drinking Water Salt Content on the Interaction between Surfactants and Bacteria

Sodium dodecyl sulfate (SDS) is a common surfactant used in various hygienic products. Its interactions with bacteria were studied previously, but the three-way interaction between surfactants, bacteria, and dissolved salts in the context of bacterial adhesion has not been studied. Here, we examined the combined effects of SDS (at concentrations typical of everyday hygienic activities) and salts, sodium chloride, and calcium chloride (at concentrations typically found in tap water) on the adhesion behavior of the common opportunistic pathogen Pseudomonas aeruginosa. We found that bacterial adhesion in the absence of SDS was dependent on the cation concentration rather than the total ionic strength and that combined treatment with several millimolar NaCl and SDS can increase bacterial adhesion. The addition of low concentrations of SDS (2 mM) to tens to hundreds millimolar concentrations of NaCl, typical of systems that suffer seawater incursion, reduced bacterial adhesion dramatically. Combined treatment with Ca+2 (in concentrations typical of those found in hard water) and SDS produced a small increase in total adhesion but a dramatic increase in the strength of adhesion. We conclude that the type and concentration of salts in water can have a considerable effect on the efficacy of soap in reducing bacterial adhesion and should be taken under consideration in critical applications. IMPORTANCE Surface-adhering bacteria are a reoccurring problem in many settings, including households, municipal water systems, food production facilities, and hospitals. Surfactants, and specifically sodium dodecyl sulfate (also known as SDS/SLS), are commonly used to remove bacterial contamination, but data regarding the interaction of SDS with bacteria and especially the effects of water-dissolved salts on this interaction are lacking. Here, we show that calcium and sodium ions can dramatically affect the efficacy of SDS on bacterial adhesion behavior and conclude that salt concentrations and ion species in the water supply should be considered in SDS applications.

Promoting COVID-19 prevention strategies in student dormitory setting: A qualitative study

OBJECTIVE

To explore the risk perceptions and COVID-19 prevention practices of dormitory residents in Indonesia. Participants: Nineteen dormitory residents, 3 staff and 1 dormitory manager were recruited from the Saint Theresa Avila student dormitory. Methods: This qualitative study used individual interviews and framework analysis. Results: Generally, the study confirms that there is a gap between risk perception and COVID-19 prevention practices among dormitory residents. There are barriers in accessing hand washing facilities and in complying with COVID-19 prevention protocols including not wearing masks, not following quarantine procedures and visiting friends' rooms. Conclusion: Dormitory managers and staff should repeatedly remind residents to wear masks and maintain safe distance through sending short messages on dormitory social media groups. In addition to psychological assistance and basic supplies during self-quarantine, providing sanitizer and installing posters detailing the hand-washing steps are essential at each hand-washing facility in the dormitory.

Recommendations for hand hygiene in community settings: a scoping review of current international guidelines

BACKGROUND

Hand hygiene is an important measure to prevent disease transmission.

OBJECTIVE

To summarise current international guideline recommendations for hand hygiene in community settings and to assess to what extent they are consistent and evidence based.

ELIGIBILITY CRITERIA

We included international guidelines with one or more recommendations on hand hygiene in community settings-categorised as domestic, public or institutional-published by international organisations, in English or French, between 1 January 1990 and 15 November 2021.

DATA SOURCES

To identify relevant guidelines, we searched the WHO Institutional Repository for Information Sharing Database, Google, websites of international organisations, and contacted expert organisations and individuals.

CHARTING METHODS

Recommendations were mapped to four areas related to hand hygiene: (1) effective hand hygiene; (2) minimum requirements; (3) behaviour change and (4) government measures. Recommendations were assessed for consistency, concordance and whether supported by evidence.

RESULTS

We identified 51 guidelines containing 923 recommendations published between 1999 and 2021 by multilateral agencies and international non-governmental organisations. Handwashing with soap is consistently recommended as the preferred method for hand hygiene across all community settings. Most guidelines specifically recommend handwashing with plain soap and running water for at least 20 s; single-use paper towels for hand drying; and alcohol-based hand rub (ABHR) as a complement or alternative to handwashing. There are inconsistent and discordant recommendations for water quality for handwashing, affordable and effective alternatives to soap and ABHR, and the design of handwashing stations. There are gaps in recommendations on soap and water quantity, behaviour change approaches and government measures required for effective hand hygiene. Less than 10% of recommendations are supported by any cited evidence.

CONCLUSION

While current international guidelines consistently recommend handwashing with soap across community settings, there remain gaps in recommendations where clear evidence-based guidance might support more effective policy and investment.

Assessment of the effect of hand dryers used in shopping malls on hand hygiene

BACKGROUND

Hand drying is one of the most important factors affect hand hygiene. This study was conducted to investigate the effect of hand dryers used in the restrooms located on the food court floors in shopping malls in Turkey on hand hygiene.

METHODS

Hands were washed for at least 20 seconds by following hygienic hand washing procedures of the World Health Organization. Swab samples were taken from the wet hands after hand washing, then from the dry hands, which were dried under the hand dryers and from the air blowing part of the hand dryers. Samples were cultured on agar plates that were directly exposed to the air-blowing part of the hand dryers.

RESULTS

It was found that total coliform bacteria were 0.000 colony-forming unit (CFU)/petri in wet and dried hand, 3.437 CFU/petri in blown air and 5.250 CFU/petri in swab samples. Staphylococcus aureus was found to be 0.125, 64.125, 26.375, and 388.750 CFU/petri, respectively. Total bacteria count was found to be 0.687, 48.750, 35.625, and 595.000 CFU/petri, respectively. S. aureus and the total bacterial load were higher in the blower outlet of the hand dryers than washed hand, blown air and dried hand (P < .05). The bacteria count in the unfiltered hand dryers was higher than that in the filtered hand dryers (P < .05).

CONCLUSIONS

Using hand dryers would negatively affect hand hygiene even if hands were washed following hygienic hand washing procedures.

Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study

BACKGROUND

The practice of hand washing is an effective way to prevent contamination and disease transmission. Following the COVID-19 pandemic, hand washing has become increasingly important. Therefore, this qualitative study aimed to understand barriers to hand hygiene compliance among healthcare workers during the COVID-19 pandemic.

MATERIALS AND METHODS

Twenty-five healthcare workers from intensive care units were sampled using purposive sampling in a qualitative content analysis study. Data were collected through a semi-structured interview and field notes. Based on the Lundman and Graneheim approach, the data were analyzed. COREQ checklist was used to report the research.

RESULTS

According to the findings, there are three main categories of barriers to hand hygiene practice: barriers related to individuals (including two subcategories of lack of knowledge of healthcare workers and healthcare workers' improper attitude), barriers related to management (including two subcategories of wrong behavioral patterns and unsuitable training and planning), and barriers related to organizations (including four subcategories of heavy workloads, improperly designed wards, a lack of equipment, and lack of quality equipment).

CONCLUSIONS

This research indicates that hand washing practice increased during the COVID-19 pandemic. Nevertheless, some barriers persist, resulting in a decline in hand washing compliance among health care workers. This finding can help managers and policymakers remove barriers to hand washing compliance and improve healthcare workers' adherence to hand washing.

Environmental and Behavioral Factors Associated With Handwashing With Soap After Defecation in a Rural Setting of 2 Districts of the Jimma Zone, Ethiopia

BACKGROUND

Handwashing with soap can prevent the spread of fecal oral microbes in the home environment. Despite the lack of water and for a variety of reasons, soap-based handwashing is not practiced in developing countries after defecation.

OBJECTIVE

The objective of the study was to determine the environmental and behavioral factors associated with hand washing with soap after defecation of respondents with children under the age of 5 years in a rural setting.

METHODS

Data used were taken from 756 households with children under the age of 5 that participated in a cross-sectional study conducted from July 22 to August 9, 2018, in 2 selected districts in the Jimma Zone, Southwest Ethiopia. It included post-defecation hand washing with soap and other variables such as sociodemographic information, environmental and behavioral factors. Stata version 16 was used to analyze the data. We use binary logistic regression models. To declare statistical significance, a P-value of less than .05 with an adjusted odds ratio and a confidence interval of 95% was used.

RESULTS

The prevalence of soap-based post defecation hand washing practices among respondents was 64.4%. Hand washing practice after defecation with soap has a significant association with having more than 1 child under 5 years of age (AOR = 1.60; 95% CI: 1.05-2.45), households living with cattle (AOR = 2.00; 95% CI: 1.30-3.07), use of unimproved latrine (AOR = 0.55; 95%CI: 0.31-0.98), with the presence of feces in the compound of the households interviewed (AOR = 7.08; 95% CI: 4.07-12.35) and regular cleaning water containers before filling drinking water (AOR = 2.16; 95% CI: 1.13-4.15).

CONCLUSIONS

Most of the study participants washed their hands with soap after defecation. The presence of feces in the compound, having more than 1 child, living with cattle, and cleaning water containers routinely before filling drinking water all enhanced post-defecation handwashing with soap. However, when using unimproved latrines, respondents' post-defecation handwashing behavior with soap may be significantly reduced.

Cross-Sectional Study to Evaluate Knowledge on Hand Hygiene in a Pandemic Context with SARS-CoV-2

Background and Objectives: The basis of any infection control program is hand hygiene (HH). The aim of this study was to investigate knowledge of HH among medical students. Materials and Methods: Students were randomly selected from two Romanian universities and a cross-sectional, questionnaire-based study was conducted between January and May 2021. The answers regarding demographic data and knowledge concerning the methods, the time and the antiseptics used for HH were collected. The selection of the study group was made according to selection criteria in accordance with ethical issues. A descriptive statistical analysis was performed, and a chi-square test was used for data comparison, with a cut-off point of 0.05 for statistical significance. Results: The results indicated that the attitude of the students towards the practice of HH improved significantly. Most students believe that simple HH can control infections. Significant differences were found by the year of study in terms of the hand surfaces included and recommended duration (p < 0.05). Conclusions: In conclusion, the study shows that most respondents have sufficient knowledge on HH, meaning that a higher compliance is required to control infections. The indicated reasons of non-compliance with HH are emergencies and other priorities.

Transmission of COVID-19 and other infectious diseases in public washrooms: A systematic review

BACKGROUND

The risk of infectious disease transmission in public washrooms causes concern particularly in the context of the COVID-19 pandemic. This systematic review aims to assess the risk of transmission of viral or bacterial infections through inhalation, surface contact, and faecal-oral routes in public washrooms in healthcare and non-healthcare environments.

METHODS

We systematically reviewed environmental sampling, laboratory, and epidemiological studies on viral and bacterial infection transmission in washrooms using PubMed and Scopus. The review focused on indoor, publicly accessible washrooms.

RESULTS

Thirty-eight studies from 13 countries were identified, including 14 studies carried out in healthcare settings, 10 in laboratories or experimental chambers, and 14 studies in restaurants, workplaces, commercial and academic environments. Thirty-three studies involved surface sampling, 15 air sampling, 8 water sampling, and 5 studies were risk assessments or outbreak investigations. Infectious disease transmission was studied in relation with: (a) toilets with flushing mechanisms; (b) hand drying systems; and (c) water taps, sinks and drains. A wide range of enteric, skin and soil bacteria and enteric and respiratory viruses were identified in public washrooms, potentially posing a risk of infection transmission. Studies on COVID-19 transmission only examined washroom contamination in healthcare settings.

CONCLUSION

Open-lid toilet flushing, ineffective handwashing or hand drying, substandard or infrequent surface cleaning, blocked drains, and uncovered rubbish bins can result in widespread bacterial and/or viral contamination in washrooms. However, only a few cases of infectious diseases mostly related to faecal-oral transmission originating from washrooms in restaurants were reported. Although there is a risk of microbial aerosolisation from toilet flushing and the use of hand drying systems, we found no evidence of airborne transmission of enteric or respiratory pathogens, including COVID-19, in public washrooms. Appropriate hand hygiene, surface cleaning and disinfection, and washroom maintenance and ventilation are likely to minimise the risk of infectious disease transmission.

Hand Hygiene Compliance and Associated Factors among Healthcare Workers in Ethiopia: A Systematic Review and Meta-Analysis

Background

Promoting hand hygiene compliance should be a priority for health authorities and all healthcare facilities at all levels. Therefore, this systematic review and meta-analysis aimed to provide a pooled estimate of hand hygiene compliance and associated factors among healthcare professionals in Ethiopia.

Methods

PubMed, Science Direct, EMBASE, the Google search engine, and Google Scholar were used to retrieve studies that were eligible for the study. The searches included all studies published in English prior to July 2021. Using a structured data extraction format, two authors independently extracted the required data. STATA Version 16 software has been used for statistical analysis. To measure the heterogeneity of the studies, the Cochrane Q-test statistics and I2 test were used. Because of the significant heterogeneity, a random-effects model was used.

Results

The pooled hand hygiene compliance among healthcare workers in Ethiopia was 38% (95% CI: 0.16-0.59). According to the study's subgroup analysis, Addis Ababa City administration health workers had the highest hand hygiene compliance, at 73% (95% CI: 0.50-0.96), while SNNP regional state had the lowest, at 9% (95% CI: 0.05-0.13). Presence of hand hygiene promotion (OR: 2.14, 95% CI: 1.04-3.24), towel/tissue paper availability (OR: 3.97, 95% CI: 2.09-5.86), having a positive attitude toward hand hygiene (OR: 1.79, 95% CI: 1.28-2.30), having good knowledge about hand hygiene (OR: 3.45, 95% CI: 1.26-5.64), and being trained for hand hygiene (OR:4.97, 95% CI:1.81-8.14) were significantly associated with hand hygiene compliance.

Conclusion

In this analysis, hand hygiene compliance among healthcare workers in Ethiopia was less than half. Providing hand hygiene promotion, towel/tissue paper presence, having a positive attitude toward hand hygiene, having good knowledge about hand hygiene, and being trained for hand hygiene were important variables for the increment of hand hygiene compliance.

What is the risk of acquiring SARS-CoV-2 from the use of public toilets?

Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.

Soap, water, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): an ancient handwashing strategy for preventing dissemination of a novel virus

Public Health Agencies worldwide (World Health Organization, United States Centers for Disease Prevention & Control, Chinese Center for Disease Control and Prevention, European Centre for Disease Prevention and Control, etc.) are recommending hand washing with soap and water for preventing the dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. In this review, we have discussed the mechanisms of decontamination by soap and water (involving both removal and inactivation), described the contribution of the various components of formulated soaps to performance as cleansers and to pathogen inactivation, explained why adherence to recommended contact times is critical, evaluated the possible contribution of water temperature to inactivation, discussed the advantages of antimicrobial soaps vs. basic soaps, discussed the differences between use of soap and water vs. alcohol-based hand sanitizers for hand decontamination, and evaluated the limitations and advantages of different methods of drying hands following washing. While the paper emphasizes data applicable to SARS-CoV-2, the topics discussed are germane to most emerging and re-emerging enveloped and non-enveloped viruses and many other pathogen types.

Guidelines for Reopening a Nation in a SARS-CoV-2 Pandemic: A Path Forward

Background and Objectives: Action, not fear, is the path forward in the coronavirus infectious disease 2019 (COVID-19) pandemic. Since early 2020, the world's nations have faced conundrums over severe acute respiratory syndrome corona virus type 2 (SARS-CoV-2) infections resulting in COVID-19 resulting in national closures, and thus, a clear understandable plan that nations can implement is required to reopen. The healthcare benefits of reopening a nation more likely than not exceed the benefits of continued pandemic-related closure. Pandemic-related closures have resulted in countless delayed or avoided urgent care evaluations. Furthermore, routine care of acute and chronic illnesses, including evaluations, diagnoses, and treatments, has also been delayed. Isolation, loss of income, and fear have resulted in mental health conditions or exacerbated existing conditions. The magnitude of untoward ramifications is unknown and may ultimately represent an inestimable degree of danger and morbidity, and even death. The pandemic of SARS-CoV-2 has created an atmosphere of fear of COVID-19 that has directly and indirectly injured the world's population. Since this has resulted in increasing morbidity and mortality, creating economic chaos, and near systemic collapse of educational systems with no well described plan forward, it is the purpose of this study to provide guidelines that provide a path forward to safely open a nation. Physicians often equipped by their education, training, and experiences across disciplines are uniquely positioned to comprehend, coordinate, and teach other physicians, business owners, and municipal and government leaders from guidelines. As such, physicians may take the lead in a path forward to reopening a nation, including opening businesses, educational facilities, and religious establishments, while minimizing the risk of SARS-CoV-2 infection. Materials and Methods: Reviews of the literature among the disciplines of environmental air, sanitation, social interaction, medical testing, vaccination, protection, and disease prevention and safety allowed for the conceptualization and eventual genesis of identifiable interventions which either reduce the viral load in the environment or inactivate the virus from replication. Each of the guidelines was selected based on the principle that it involved the elimination or inactivation of the viral particle. With a reduction in viral load or inactivation of replication, the implementation of these guidelines is expected to allow for reopening a nation with an increased level of safety. Results: The guidelines identified, including air exchange (ventilation), air filtration, personal protective filtering devices (masks), hand hygiene, social distancing, screening and testing, vaccines, high-risk patient protection, medical management, and adjunctive therapies, are described and referenced. Conclusions: In that the pandemic is primarily a public health issue, the path forward is best coordinated by local, regional, and national physicians. Many physicians with a breadth of experiences are uniquely positioned to coordinate the implementation of these interdisciplinary guidelines. Using these guidelines as a planned, coordinated action, not fear, is a path forward. Nations have a decision to make: closuring versus opening.

Adherence to food hygiene and personal protection recommendations for prevention of COVID-19

Background

Several actions in the realm of public policies and programs have been implemented worldwide to prevent and control the spread of COVID-19. As Brazil and many parts of the world are marked by regional, cultural, and social inequalities, risk communication and assimilation of protection recommendations by the public may be erratic, hampering the proper measurement of their effectiveness.

Scope and approach

Even though transmission of SARS-CoV-2 by foods is unlikely, this work aimed to evaluate the population's adherence to the recommended food hygiene and personal protection measures to prevent COVID-19. An online survey containing questions on food hygiene and personal protection was publicly disseminated via internet and social networks. Data from 3000 respondents were collected and discussed herein.

Key findings and conclusions: Most respondents adopted the recommended hygienic and personal protection measures to avoid contamination with SARS-CoV-2. However, some important flaws were detected, such as lack of use of face masks when in public places (6%), improper hand washing and sanitizing (10–12%) and use of incorrect products for food or environment cleaning and sanitization (28%), indicating that adequate risk communication and preventive recommendations must continue in order to avoid contamination with the coronavirus. The heighten awareness with food hygiene during the pandemic may have an enduring positive effect on food safety.

Reducing the risk of infection to patients and staff during gynaecological outpatient and ambulatory appointments

This chapter explores ways to reduce the risk of severe acute respiratory syndrome coronavirus-2 transmission to women and staff within gynaecology outpatient clinics. The likely routes of transmission are discussed, namely through droplets, aerosols and fomites. Using the 'hierarchy of control' categories, elimination, substitution, engineering, administration and personal protective equipment, practical strategies for modifying virus exposure are presented. The management of specific clinical conditions are reviewed based on advice prepared by the specialist societies in conjunction with each other and the Royal College of Obstetricians and Gynaecologists. The need to maintain at least a minimal level of gynaecological services is recognised and that this should provide safe, equitable and effective care. Ways to reduce clinic attendance are discussed with the substitution of face-to-face with remote consultations and when this is relevant. Current recommendations for ambulatory procedures, which include colposcopy and hysteroscopy, are considered so that best use is made of reduced resources.

Relationship between hand hygiene behavior and Staphylococcus aureus colonization on cell phones of nurses in the intensive care unit

Background

Healthcare-Associated Infections (HAIs) are infections that often occur in hospitals with Staphylococcus aureus as the primary cause. Staphylococcus aureus is usually found on nurses' hands and easily transferred by contact. Cell phones can be a convenient medium for transmitting bacteria. Accordingly, hand washing is one of the effective ways to prevent the transmission of Staphylococcus aureus.

Objective

This study aimed to determine the relationship between hand hygiene behavior and the colonization of Staphylococcus aureus on cell phones of nurses in the intensive care unit of the academic hospital.

Methods

This was an observational study with a cross-sectional design conducted from December 2019 to January 2020. The observations of hand hygiene behaviors were performed on 37 nurses selected using total sampling. Colonization of bacteria on each nurses' cell phone was calculated by swabbing the cell phones' surface. Colony counting was done using the total plate count method. Spearman Rank test and Mann Whitney test were used for data analysis.

Results

The nurses' hand hygiene behavior was 46.06%. Staphylococcus aureus colonization was found on 18.2% of the nurses' cell phones. However, there was no significant relationship between the nurses' hand hygiene behavior and the colonization of Staphylococcus aureus on their cell phones.

Conclusion

The hand hygiene behavior of nurses was still low, and there was evidence of Staphylococcus aureus colonization on their cell phones. As there was no relationship between the nurses' hand hygiene behavior with the colonization of Staphylococcus aureus on the cell phones, further research is needed to determine if there is an increase or decrease in colonization before and after regular observations.

Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature

Numerous studies are published on the benefits of electric hand dryers vs paper towels (PT) for drying hands after washing. Data are conflicting and lacking key variables needed to assess infection risks. We provide a rapid scoping review on hand-drying methods relative to hygiene and health risks. Controlled vocabulary terms and keywords were used to search PubMed (1946-2018) and Embase (1947-2018). Multiple researchers independently screened abstracts for relevance using predetermined criteria and created a quality assessment scoring system for relative study comparisons. Of 293 papers, 23 were included in the final analysis. Five studies did not compare multiple methods; however, 2 generally favoured electric dryers (ED); 7 preferred PT; and 9 had mixed or statistically insignificant results (among these, 3 contained scenarios favourable to ED, 4 had results supporting PT, and the remaining studies had broadly conflicting results). Results were mixed among and within studies and many lacked consistent design or statistical analysis. The breadth of data does not favour one method as being more hygienic. However, some authors extended generalizable recommendations without sufficient scientific evidence. The use of tools in quantitative microbial risk assessment is suggested to evaluate health exposure potentials and risks relative to hand-drying methods. We found no data to support any human health claims associated with hand-drying methods. Inconclusive and conflicting results represent data gaps preventing the advancement of hand-drying policy or practice recommendations.

Microbiological Assessment of the Different Hand Drying Methods and Washroom Environment Cross-Contamination

Proper hand drying is a fundamental part of the hand hygiene process looking at optimizing the elimination of potentially pathogenic microbes. This research compared the effectiveness of three different hand drying methods—paper towels, the use of warm air dryers in stationary hands position, and the use of air drying while hand rubbing—and their potential for cross-contamination of other users and the surrounding environment. One hundred sixty samples were collected from finger pads and palms, before and after drying. The outlet of the air dryers, air current emitted from the air dryers, and washroom environment air were also tested. The study reported that paper towels were more successful in eliminating bacteria and lead to less contamination to the washroom environment compared to the air dryers. The average number of bacteria obtained from volunteers using hand air dryer while hand rubbing was significantly higher than drying with air dryer while holding hands stationary. Plates exposed to the turned-off dryer for 5 minutes gave an average of only 25 colonies/plate, while plates exposed to the air outlet of the turned-on warm air dryers provided 292 colonies/plate. Placing Petri dishes at least one meter away from the dryer in the washroom for 30 minutes gave 72.5 colonies/plate. The current research also documented frequent contamination of public washroom environments and showed dissemination of potential pathogens, including Escherichia coli (E. coli), Klebsiella species, Bacillus cereus (B. cereus), Staphylococcus aureus (S. aureus), and coagulase-negative Staphylococci. Over 70.0% of Staphylococci were resistant to at least three antibiotics and 50.0% revealed coresistance to at least four antibiotics including penicillin, erythromycin, clindamycin, and co-trimoxazole. The method of hand drying may serve as a risk factor of cross-contamination from users to the environment and subsequent users and as reservoirs of drug-resistant bacteria in public washrooms.

The situation of infection in the elderly in Spain: a multidisciplinary opinion document

Infection in the elderly is a huge issue whose treatment usually has partial and specific approaches. It is, moreover, one of the areas where intervention can have the most success in improving the quality of life of older patients. In an attempt to give the widest possible focus to this issue, the Health Sciences Foundation has convened experts from different areas to produce this position paper on Infection in the Elderly, so as to compare the opinions of expert doctors and nurses, pharmacists, journalists, representatives of elderly associations and concluding with the ethical aspects raised by the issue. The format is that of discussion of a series of pre-formulated questions that were discussed by all those present. We begin by discussing the concept of the elderly, the reasons for their predisposition to infection, the most frequent infections and their causes, and the workload and economic burden they place on society. We also considered whether we had the data to estimate the proportion of these infections that could be reduced by specific programmes, including vaccination programmes. In this context, the limited presence of this issue in the media, the position of scientific societies and patient associations on the issue and the ethical aspects raised by all this were discussed.

Analysis of Gender-Dependent Personal Protective Behaviors in a National Sample: Polish Adolescents' COVID-19 Experience (PLACE-19) Study

During the coronavirus-19 disease (COVID-19) pandemic, the basic strategy that is recommended to reduce the spread of the disease is to practice proper hand hygiene and personal protective behaviors, but among adolescents, low adherence is common. The present study aimed to assess the gender-dependent hand hygiene and personal protective behaviors in a national sample of Polish adolescents. The Polish Adolescents’ COVID-19 Experience (PLACE-19) Study was conducted in a group of 2323 secondary school students (814 males, 1509 females). Schools were chosen based on the random quota sampling procedure. The participants were surveyed to assess their knowledge and beliefs associated with hand hygiene and personal protection, as well as their actual behaviors during the COVID-19 pandemic. The majority of respondents gave proper answers when asked about their knowledge. However, females displayed a higher level of knowledge (p < 0.05). Most of the respondents declared not leaving home, handwashing, using alcohol-based hand rub, avoiding contact with those who may be sick, and avoiding public places as their personal protective behaviors. They declared using face masks and gloves after the legal regulation requiring people to cover their nose and mouth in public places was enacted in Poland. Regarding the use of face masks and not touching the face, no gender-dependent differences were observed, while for all the other behaviors, females declared more adherence than males (p < 0.05). Females also declared a higher daily frequency of handwashing (p < 0.0001) and washing their hands always when necessary more often than males (68.2% vs. 54.1%; p < 0.0001). Males more often indicated various reasons for not handwashing, including that there is no need to do it, they do not feel like doing it, they have no time to do it, or they forget about it (p < 0.0001), while females pointed out side effects (e.g., skin problems) as the reason (p = 0.0278). Females more often declared handwashing in circumstances associated with socializing, being exposed to contact with other people and health (p < 0.05), and declared always including the recommended steps in their handwashing procedure (p < 0.05). The results showed that female secondary school students exhibited a higher level of knowledge on hand hygiene and personal protection, as well as better behaviors, compared to males. However, irrespective of gender, some false beliefs and improper behaviors were observed, which suggests that education is necessary, especially in the period of the COVID-19 pandemic.

Blowing in the wind: Bacteria and fungi are spreading from public restroom hand dryers

This study aimed to identify and quantify fungi and bacteria in the airflow of restroom hand dryers in public areas. Airflow from restroom hand dryers in 8 retail locations was tested using three types of culture media, followed by PCR and sequence analysis to identify microbial species. Both bacterial and fungal colonies were detected in all locations. The number of colonies did not vary significantly across different locations, suggesting a similar level of microbial spread by hand dryers between different types of commercial stores. Molecular analysis revealed 24 bacterial species and 40 fungal species. Of these species, 48% (31/64) have been reported to be implicated in various infections in humans, primarily those with underlying medical conditions. This study is the first to demonstrate the spread of fungi by the airflow of restroom hand dryers, and the first to show the prevalence of different fungal and bacterial species spread by restroom hand dryers in common public areas.

Too loud? Do powered hand dryers violate federal noise exposure standards?

OBJECTIVE

The aim of this study was to determine if high-powered air hand dryers produce sufficient noise to warrant concern over acoustic trauma as determined by federally established standards.

STUDY DESIGN

Prospective observational field data collection SETTING: Urban and suburban community SUBJECTS AND METHODS: Using a NIOSH developed and calibrated soundmeter app, powered hand dryers were measured throughout two metropolitan areas. Ear level measurements were performed while drying wet hands. Recorded variables included average LAeq, Time-Weighted Average, Max and Peak Levels, Noise Dose, and Projected Dose according to NIOSH and OSHA standards, and all three major weighting networks (A, C, and Z).

RESULTS

Fifty-four trials were performed at 27 locations. Average dryer run time was 28.9 s (range 14-45 s). Average LAeq (dBA), average maximum level (dBA), and average TWA (dBA) were 90.46 ± 5.32, 94.86 ± 5.73, 59.90 ± 6.80, respectively. The noise generated exceeded published manufacturer specifications. However, even with estimated cumulative daily exposure, the noise generated by these dryers did not exceed federal safety standards.

CONCLUSIONS

Air-powered hand dryers produce noise output at a level that many would find subjectively uncomfortable with some brands/models consistently producing noise in excess of 90 dBA. Nonetheless, these dryers do not produce sound exceeding NIOSH standards for noise exposure.

Community pharmacy response to infection control during COVID-19. A cross-sectional survey

Pharmacies have been practicing innovative infection control measures during COVID-19. This article seeks to explore the current activities undertaken across various community pharmacy settings in relation to the safety of the workplace environment for staff and patients.

Methods

An online cross-sectional survey was conducted in Australia during the COVID-19 outbreak from 1st to 30^th April 2020, addressing community pharmacist's awareness and response to infection and sanitation control.

Results

A total of 137 pharmacists took part in the survey. Regular cleaning took place in the pharmacy, but the use of gloves while cleaning was not regularly practice (48.18%). In addition, only 46.72% of respondents reported observing script baskets being cleaned and disinfected. About one-third (37.96%) of pharmacists were aware of the two-step cleaning and disinfecting process, with only 18.98% of pharmacist practicing such cleaning procedures. More than half of surveyed pharmacists reported having difficulty keeping up with pharmacy practice and infection control guidelines during the pandemic.

Conclusion

This study demonstrates that the majority of pharmacists are not fully aware of the proper infection control measures needed in a community pharmacy setting. Pharmacists must play a bigger role in infection control measures to ensure staff and public health safety.

Mobile phones represent a pathway for microbial transmission: A scoping review

BACKGROUND

Mobile phones have become an integral part of modern society. As possible breeding grounds for microbial organisms, these constitute a potential global public health risk for microbial transmission.

OBJECTIVE

Scoping review of literature examining microbial's presence on mobile phones in both health care (HC) and community settings.

METHODS

A search (PubMed&GoogleScholar) was conducted from January 2005-December 2019 to identify English language studies. Studies were included if samples from mobile phones were tested for bacteria, fungi, and/or viruses; and if the sampling was carried out in any HC setting, and/or within the general community. Any other studies exploring mobile phones that did not identify specific microorganisms were excluded.

RESULTS

A total of 56 studies were included (from 24 countries). Most studies identified the presence of bacteria (54/56), while 16 studies reported the presence of fungi. One study focused solely on RNA viruses. Staphylococcus aureus, and Coagulase-Negative Staphylococci were the most numerous identified organisms present on mobile phones. These two species and Escherichia coli were present in over a third of studies both in HC and community samples. Methicillin-resistant S. aureus, Acinetobacter sp., and Bacillus sp. were present in over a third of the studies in HC settings.

CONCLUSIONS

While this scoping review of literature regarding microbial identification on mobile phones in HC and community settings did not directly address the issue of SARS-CoV-2 responsible for COVID-19, this work exposes the possible role of mobile phones as a 'Trojan horse' contributing to the transmission of microbial infections in epidemics and pandemics.

Using effective hand hygiene practice to prevent and control infection

Decontamination using hand hygiene remains one of the most important and effective methods for reducing healthcare-associated infections and cross-infection between patients. In 1860, Florence Nightingale wrote that nurses should wash their hands frequently throughout the day, demonstrating an early awareness of the effectiveness of this simple procedure. The COVID-19 pandemic has demonstrated that effectively applied hand hygiene is a vital intervention that can be used to prevent the spread of disease. This article details the correct procedure required for effective hand hygiene and emphasises the need for nurses to keep up to date with evidence-based guidelines. The article also outlines the differences between hand decontamination using alcohol-based hand gels and soap and water, and the complex factors that can interfere with effective hand hygiene compliance.

A behaviour change package to prevent hand dermatitis in nurses working in the National Health Service: results of a cluster randomized controlled trial

BACKGROUND

Occupational hand dermatitis poses a serious risk for nurses.

OBJECTIVES

To evaluate the clinical and cost-effectiveness of a complex intervention in reducing the prevalence of hand dermatitis in nurses METHODS: This was a cluster randomized controlled trial conducted at 35 hospital trusts, health boards or universities in the UK. Participants were (i) first-year student nurses with a history of atopic conditions or (ii) intensive care unit (ICU) nurses. Participants at intervention sites received access to a behavioural change programme plus moisturizing creams. Participants at control sites received usual care. The primary outcome was the change of prevalent dermatitis at follow-up (adjusted for baseline dermatitis) in the intervention vs. the control group. Randomization was blinded to everyone bar the trials unit to ensure allocation concealment. The trial was registered on the ISRCTN registry: ISRCTN53303171.

RESULTS

Fourteen sites were allocated to the intervention arm and 21 to the control arm. In total 2040 (69·5%) nurses consented to participate and were included in the intention-to-treat analysis. The baseline questionnaire was completed by 1727 (84·7%) participants. Overall, 789 (91·6%) ICU nurses and 938 (84·0%) student nurses returned completed questionnaires. Of these, 994 (57·6%) had photographs taken at baseline and follow-up (12-15 months). When adjusted for baseline prevalence of dermatitis and follow-up interval, the odds ratios (95% confidence intervals) for hand dermatitis at follow-up in the intervention group relative to the controls were 0·72 (0·33-1·55) and 0·62 (0·35-1·10) for student and ICU nurses, respectively. No harms were reported.

CONCLUSIONS

There was insufficient evidence to conclude whether our intervention was effective in reducing hand dermatitis in our populations. Linked Comment: Brans. Br J Dermatol 2020; 183:411-412.

Actualidades en la higiene de manos quirúrgica. Revisión de la literatura

Introducción: La higiene de manos quirúrgica, procedimiento esencial en cirugía; es una técnica que ha evolucionado y se ha ido actualizando tras el surgimiento de evidencia científica. El manual de la Organización Mundial de la Salud (OMS) publicado hace diez años es uno de los documentos que plasman cambios de esta técnica, como dejar de usar el cepillo. Sin embargo, es necesario analizar la evidencia actual con la finalidad de reconocer las nuevas tendencias de acuerdo con los resultados de las investigaciones publicadas. Objetivo: Realizar una revisión actualizada de la literatura sobre la higiene de manos quirúrgica. Desarrollo: El lavado de manos quirúrgico con cepillo es un procedimiento que se realiza en la mayoría de las instituciones hospitalarias de México; pocas han incursionado en la técnica en la que se omite el uso de cepillo. Existen diversos estudios que sustentan que el uso de cepillos debe ser erradicado debido al daño tisular que estos ocasionan. La abrasión dérmica provocada por el uso de cepillos origina que el personal se cepille las superficies de las manos y brazos por menos tiempo que el recomendado y esto a su vez impide un efecto idóneo por parte de los antisépticos. Las sustancias más recomendadas son la clorhexidina y las soluciones a base de alcohol. Conclusiones: La higiene de manos quirúrgica sin cepillo debe ser considerada debido a que disminuye costos hospitalarios, garantiza la efectividad de la descontaminación de manos, ocasiona menos lesiones dérmicas y contribuye a la reducción de las infecciones relacionadas al sitio quirúrgico.

Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study

Background

The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600-bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million.

Methods

An in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis.

Results

The facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO “5 moments” for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients’ surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70–112.88).

Conclusions

Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.

Zoonotic disease awareness survey of backyard poultry and swine owners in southcentral Pennsylvania

Owners of small backyard poultry and swine operations may be at higher risk of zoonotic diseases due to husbandry inexperience and/or a lack of knowledge. Backyard poultry and swine owners in southcentral Pennsylvania were surveyed regarding their knowledge and attitudes towards zoonotic disease prevention. One hundred and six backyard poultry and/or swine owners completed the survey (74 poultry, 15 swine, 17 both), which included questions on demographics, flock/herd characteristics, recognition of selected zoonotic diseases and clinical signs in animals, and biosecurity practices for visitors and owners. Most responded that they were aware of avian (92.2%) and swine (84.4%) influenza, and were less aware of other zoonotic diseases such as salmonellosis and brucellosis. The majority of backyard poultry and swine owners combined (62.9%) reported allowing visitors freely around their animals and did not require any special precautions. Backyard poultry and swine owners most commonly reported rarely (32.7%) or never (28.9%) wearing work gloves and never (57.1%) wearing nose/mouth coverings, such as a respirator mask, while handling animals or manure. The study findings indicated that veterinarians (61.5%) and the Internet (50.0%) are the main sources where small-scale farm producers seek animal disease information. Approximately one-third (34.9%) of the respondents reported receiving seasonal influenza vaccine. The findings of this study will be utilized to provide targeted veterinary and public health education for the prevention of zoonotic diseases in backyard farm animal settings in Pennsylvania.

E. coli recovery from antimicrobial hand towels used in rural households in Kenya

An antimicrobial towel designed for repeated use was developed to prevent recontamination of washed hands after drying. This field trial in Kenya found that nearly all antimicrobial hand towels and untreated control towels were contaminated with E. coli after household use. The antimicrobial towel did not inactivate E. coli.

A behaviour change package to prevent hand dermatitis in nurses working in health care: the SCIN cluster RCT

BACKGROUND

Although strategies have been developed to minimise the risk of occupational hand dermatitis in nurses, their clinical effectiveness and cost-effectiveness remain unclear.

OBJECTIVES

The Skin Care Intervention in Nurses trial tested the hypothesis that a behaviour change package intervention, coupled with provision of hand moisturisers, could reduce the point prevalence of hand dermatitis when compared with standard care among nurses working in the NHS. The secondary aim was to assess the impact of the intervention on participants' beliefs and behaviour regarding hand care, and the cost-effectiveness of the intervention in comparison with normal care.

DESIGN

Cluster randomised controlled trial.

SETTING

Thirty-five NHS hospital trusts/health boards/universities.

PARTICIPANTS

First-year student nurses with a history of atopic tendency, and full-time intensive care unit nurses.

INTERVENTION

Sites were randomly allocated to be 'intervention plus' or 'intervention light'. Participants at 'intervention plus' sites received access to a bespoke online behaviour change package intervention, coupled with personal supplies of moisturising cream (student nurses) and optimal availability of moisturising cream (intensive care unit nurses). Nurses at 'intervention light' sites received usual care, including a dermatitis prevention leaflet.

MAIN OUTCOME MEASURE

The difference between intervention plus and intervention light sites in the change of point prevalence of visible hand dermatitis was measured from images taken at baseline and at follow-up.

RANDOMISATION

Fourteen sites were randomised to the intervention plus arm, and 21 sites were randomised to the intervention light arm.

BLINDING

The participants, trial statistician, methodologist and the dermatologists interpreting the hand photographs were blinded to intervention assignment.

NUMBERS ANALYSED

An intention-to-treat analysis was conducted on data from 845 student nurses and 1111 intensive care unit nurses.

RESULTS

The intention-to-treat analysis showed no evidence that the risk of developing dermatitis was greater in the intervention light group than in the intervention plus group (student nurses: odds ratio 1.25, 95% confidence interval 0.59 to 2.69; intensive care unit nurses: odds ratio 1.41, 95% confidence interval 0.81 to 2.44). Both groups had high levels of baseline beliefs about the benefits of using hand moisturisers before, during and after work. The frequency of use of hand moisturisers before, during and after shifts was significantly higher in the intensive care unit nurses in the intervention plus arm at follow-up than in the comparator group nurses. For student nurses, the intervention plus group mean costs were £2 lower than those for the comparator and 0.00002 more quality-adjusted life-years were gained. For intensive care unit nurses, costs were £4 higher and 0.0016 fewer quality-adjusted life-years were gained.

HARMS

No adverse events were reported.

LIMITATIONS

Only 44.5% of participants in the intervention plus arm accessed the behaviour change package.

CONCLUSION

The intervention did not result in a statistically significant decrease in the prevalence of hand dermatitis in the intervention plus group.

FUTURE WORK

Participants had a high level of baseline beliefs about the importance of using hand moisturisers before, during and after work. Future research should focus on how workplace culture can be changed in order for that knowledge to be actioned.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN53303171.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 58. See the NIHR Journals Library website for further project information.

Microbiological evaluation of different hand drying methods for removing bacteria from washed hands

Proper drying of hands after washing is an integral part of hand hygiene. An experimental study on 30 subjects using multiple comparisons of six hand drying methods including 1) drying on own clothes, 2) drying with one paper towel, 3) drying with two paper towels, 4) drying with a warm air dryer while holding hands stationary for 20 s, 5) drying with a warm air dryer while hand rubbing for 20 s, and 6) drying with a jet air dryer until complete dryness was achieved. It aimed to determine the effectiveness of different hand drying methods for removing bacteria from washed hands, so as to identify the optimum method using minimum resources. Our study demonstrated that the use of jet air dryers is the best method to eliminate bacteria on hands, whereas drying hands on one's own clothes is the least effective. Drying hands in a stationary position could remove more bacteria than rubbing hands when using a warm air dryer for 20 s, which mimics people's usual hand-drying practice. No significant difference in bacteria reduction was detected between the use of one or two paper towels for hand drying; therefore, using fewer resources is recommended to maintain environmental sustainability.

Evaluation of the impact of antimicrobial hand towels on hand contamination with Escherichia coli among mothers in Kisumu County, Kenya, 2011-2012

Poor hand hygiene contributes to diarrhea in developing countries. Handwashing with soap reduces diarrhea risk, but drying hands on contaminated towels can compromise the benefits of handwashing. In response to the challenge of keeping hands clean, an antimicrobial hand towel was developed and shown to be promising in the laboratory, but has not been adequately tested in the field. We evaluated the effectiveness of an antimicrobial towel in two randomized, double-blinded crossover trials among mothers with children<5 years old in 125 households in western Kenya. In trial 1, we randomly assigned mothers to use either the treated towel or an identical untreated (placebo) towel and made surprise home visits at random times once a week for three weeks. At each visit, we tested hands for Escherichia coli using sterile hand rinses, then switched towel types in the two groups and repeated three weekly rounds of E. coli testing. In crossover trial 2, we compared E. coli contamination of maternal hands immediately following three different handwashing/drying procedures: soap and water + treated towel, water only + treated towel, and soap and water + air dry. There was no statistically significant difference in the level of E. coli contamination on maternal hands by type of towel used during trial 1 (odds ratio for treated vs untreated towel: 1.14, 95% confidence interval 0.83-1.56). In trial 2, there were no significant differences in E. coli contamination of maternal hands by handwashing/drying procedure. In these trials, use of antimicrobial hand towels did not prevent E. coli contamination of mothers' hands in Kenyan households during random testing and offered no advantages over standard handwashing and drying practices. Handwashing with soap and clean water and drying with clean towels are recommended.

Epidemiological investigation on hand hygiene knowledge and behaviour: a cross-sectional study on gender disparity

Background

The hand hygiene (HH) behaviour of the general public and its effect on illnesses are issues of growing importance. Gender is associated with HH behaviour. HH efficiency is a combination of washing efficiency and hand drying, but information about the knowledge level and HH behaviour of the general public is relatively limited. The findings of this cross-sectional study can substantially contribute to the understanding on the knowledge gap and public behaviour towards HH, thereby providing information on gender-specific health promotion activities and campaigns to improve HH compliance.

Methods

An epidemiological investigation by using a cross-sectional study design on the general public was conducted either via an online platform (SurveyMonkey) or paper-and-pen methods. The hand-washing and -drying questionnaire was used for data collection.

Results

A total of 815 valid questionnaires were collected. Majority of the respondents can differentiate the diseases that can or cannot be transmitted with poor HH, but the HH knowledge of the respondents was relatively inadequate. The female respondents had a significantly better HH knowledge than male respondents. The multiple regression analysis results also indicated that females had a significantly higher knowledge score by 0.288 towards HH than males after adjusting for age and education level. Although the majority of the respondents indicated that they performed hand cleaning under different specific situations, they admitted only using water instead of washing their hands with soap. More males than females dried their hands on their own clothing, whereas more females dried their hands through air evaporation. The average time of using warm hand dryers was generally inadequate amongst the respondents.

Conclusions

Being a female, middle-aged and having tertiary education level are protective factors to improve HH knowledge. Misconceptions related to the concepts associated with HH were noted amongst the public. Self-reported practice on hand drying methods indicated that additional education was needed. The findings of this study can provide information on gender-specific health promotion activities and creative campaigns to achieve sustained improvement in HH practices.

The neglected element of hand hygiene - significance of hand drying, efficiency of different methods and clinical implication: A review

Hand hygiene is a fundamental strategy for controlling the spread of infection. Careful hand drying is integral to the process of hand hygiene, which aims to optimise the removal of potentially pathogenic microorganisms. Ineffective hand drying results in wet hands that are an infection risk increasing the potential for cross-infection, occupational contact dermatitis for healthcare practitioners, harm to patients and environmental contamination. Evidence indicates that there has been limited research regarding the significance of hand drying and the efficacy and clinical impact of different drying methods. The purpose of this review paper was to scope and evaluate the existing literature pertaining to hand drying; to examine the clinical consequences associated with wet hands for patients, healthcare practitioners and the clinical environment; to assess the efficacy of different drying methods; to consider the impact on patient safety; and to progress the research, debate and practice relating to hand drying. The methodological framework applied in this review was that of Arksey and O'Malley (2007). Twenty-one papers identified from 112 abstracts screened were included in the review. Analysis identified three primary themes emerging from the literature: (1) efficacy of hand drying methods; (2) drying method and microbial translocation, dispersion and environmental contamination; and (3) drying methods and environmental sustainability. This review highlights the equal importance of hand drying in the process of hand hygiene and suggests that the efficacy of hand drying is a critical factor in the prevention of the transfer of microorganisms to the environment, and from person to person following hand washing. In conclusion, this paper argues that greater attention needs to be given to hand drying in terms of practice, policy and research and its importance in clinical settings given greater focus.