Bacteriological Aspects of Hand Washing: A Key for Health Promotion and Infections Control

Hand-to-surface bacterial transfer and healthcare-associated infections prevention: a pilot study on skin microbiome in a molecular biology laboratory

Background

Healthcare-associated infections (HAIs) are a major global public health problem, contributing significantly to patient morbidity and mortality. This study analyses differences in type and amounts of bacteria transferred from volunteers' dominant palm to two healthcare-relevant surfaces (glass and laminate table), both before and after hand washing with water and antibacterial soap. The aim was to understand hand-to-surface microbial contamination and support the development of HAI prevention strategies.

Methods

Microbial DNA was extracted and sequenced to identify bacteria species. Taxonomic and statistical analyses were performed to evaluate bacterial diversity and abundance across the experimental groups.

Results

The results confirmed greater bacteria abundance and species richness on palm compared to surfaces, with a significant reduction after hand washing, especially on glass. Taxa analysis highlighted the increased persistence of Gram-negative HAIs-related bacteria on laminate surface, while Gram-positive opportunistic bacteria were more abundant on palms and glass surface. Beta diversity confirmed significant differences in microbial composition between the groups, highlighting the importance of bacteria-surface characteristics in designing preventive measures.

Conclusion

Despite some limitations, our study emphasizes the importance of microbiological surveillance for all opportunistic bacteria with pathogenic potential. These findings can contribute to more effective guidelines for surface disinfection and hand washing, key elements in preventing HAIs.

Hair removal with a clipper and microbial colonisation prior to knee arthroplasty: a randomised controlled trial

Background

Despite the widely reported success of knee arthroplasty, studies show that 1.6-3 % of patients undergo revision within the first postoperative year predominantly due to infection. Preoperative skin preparation may potentially decrease the bacterial load and consequently, the risk of periprosthetic joint infections. The effects of hair removal on prosthetic joint infection are inconsistent. Our primary aim was to investigate if hair removal with a clipper influenced skin colonisation and bacterial composition.

Methods

Forty Caucasian male participants who were planned to undergo knee arthroplasty, (mean age 63.8 years), were included. Patients were randomised to hair removal in a within-person study design. As a control, the opposite leg of the patient was used. Swabs were collected prior to hair removal (baseline), immediately after hair removal (Day 0), and with follow-up after one and seven days.

Results

The intervention showed significant decrease in mean log colony-forming units per. cm2 from baseline 2.97 to 2.67 (P<0.01) immediately after hair removal and sustained at Day 1 (P=0.01). At Day 7, the mean was non-significant compared to baseline. The control group did not show any decrease of skin microbiota at follow-up on Day 0, 1 or 7.No significant differences within the bacterial composition were found between the intervention and control leg at baseline among the six most prevalent detected bacterial species: Staphylococcus epidermidis, Micrococcus luteus, S. hominis, S. capitis, S. haemolyticus and S. aureus. The study did not find any changes in the bacterial composition over time.

Conclusion

Hair removal with a clipper within 24 hours prior to surgery causes a significant non-selective reduction in skin colonisation.

Impact of the coronavirus disease 2019 pandemic on the diversity of notifiable infectious diseases: a case study in Shanghai, China

The outbreak of coronavirus disease 2019 (COVID-19) has not only posed significant challenges to public health but has also impacted every aspect of society and the environment. In this study, we propose an index of notifiable disease outbreaks (NDOI) to assess the impact of COVID-19 on other notifiable diseases in Shanghai, China. Additionally, we identify the critical factors influencing these diseases using multivariate statistical analysis. We collected monthly data on 34 notifiable infectious diseases (NIDs) and corresponding environmental and socioeconomic factors (17 indicators) from January 2017 to December 2020. The results revealed that the total number of cases and NDOI of all notifiable diseases decreased by 47.1% and 52.6%, respectively, compared to the period before the COVID-19 pandemic. Moreover, the COVID-19 pandemic has led to improved air quality as well as impacted the social economy and human life. Redundancy analysis (RDA) showed that population mobility, particulate matter (PM2.5), atmospheric pressure, and temperature were the primary factors influencing the spread of notifiable diseases. The NDOI is beneficial in establishing an early warning system for infectious disease epidemics at different scales. Furthermore, our findings also provide insight into the response mechanisms of notifiable diseases influenced by social and environmental factors.

[Characterization of infectious conjunctivitis in a fourth-level care center, Bogota, Colombia]

Objective

The purpose of this study is to describe the characteristics of the populations that consulted to the emergency service due to conjunctivitis from March 1 of 2019 to March 1 of 2021 and evaluate the frequency of presentation of contagious ocular pathologies like is the case of bacterial conjunctivitis.

Methods

A descriptive cross-sectional study was conducted in a historical cohort in the Department of Surgery, Ophthalmology Unit of the Hospital Universitario San Ignacio, Bogotá D.C. from March 2019 to March 1, 2021. The study included patients with a diagnosis of bacterial conjunctivitis and patients with a diagnosis of superinfected viral conjunctivitis, and excluded all patients with a positive result for COVID-19 and patients with symptoms suggestive of SARS-infectionCoV-2. Of the patients, 629 met the selection criteria.

Results

Between March 2019 and April 2020, 534 consultations were registered in the emergency department of the ophthalmology unit, and from April 24, 2020 (when resolution 666 on biosecurity measures started) until March 2021, 95 consultations were registered. The majority of the patients presented with viral conjunctivitis, followed by superinfected viral conjunctivitis, and bacterial conjunctivitis.

Conclusion

We hypothesize that biosecurity measures such as isolation, frequent hand washing, and the use of face masks could explain the marked reduction in cases of infectious conjunctivitis in the community.

Outbreak of Candida parapsilosis fungemia in an intensive care unit during a COVID surge: an epidemic within a pandemic

We sought to investigate epidemiology, risk factors, clinical features, and outcome of the C. parapsilosis blood stream infection (BSI) outbreaks observed during the first surges of COVID-19 pandemic in our population. Retrospective, monocentric observational study in the 24 bed intensive care unit (ICU) of a tertiary care medical center in northern Italy, from 2019 to 2021 first 5 months. 2030 patients were enrolled, of whom 239 were COVID-19 positive. The total incidence of Candida-BSI was 41.9 per 1000 admissions, with two outbreaks during 2020 spring and winter's COVID surges. The total numbers of C. parapsilosis BSI cases are 94, of which 21 during the first outbreak and 20 during the second. In our population, COVID-19 was strongly associated with C. parapsilosis BSI (OR 4.71, p < 0.001), as well as continuous renal replacement therapy (CRRT) (OR 3.44, p = 0.001), prolonged antibiotic therapy (OR 3.19, p = 0.004), and delayed infusion sets replacements (OR 2.76, p = 0.015). No statistically significant association was found between Candida-BSI episodes and mortality, when adjusted for other known outcome risk factors. COVID surges undermined the infectious control measures in our ICU, leading to two outbreak of C. parapsilosis BSI. A stricter, thorough management of intravascular devices and infusion set is crucial in prevention of catheter related BSI, and awareness must be kept high, especially in emergencies circumstances, such as the ongoing COVID-19 pandemic.

The impact of COVID-19 pandemic on hand hygiene adherence among pediatric physicians, in Saudi Arabia

Introduction

The hand hygiene practice (HHP) is the most effective and simplest preventive measure to reduce the risk of infection. HHP is more relevant among pediatric physicians in the context of the COVID-19 pandemic since, children are more vulnerable to infection. Therefore, assessment of the COVID-19 impact on HHP could be useful in minimizing lethal virus transmission from pediatric physicians to patients and vice versa.

Method

The present cross-sectional, electronically self-administered supplement based survey study was conducted among different professional levels of pediatric physicians involving consultants, specialists, and residents. The supplement includes information related to demography, knowledge, awareness, preventive measures, demonstration and practice of HHP. The information was collected and summarized on a Microsoft excel sheet before being imported to SPSS for statistical analysis.

Results

Of the total (N = 404) pediatric physicians, 56.68% male, 43.06% belongs to 25–35 years, 42.32% were consultants, 98.01% respondents were familiar with five moments of HHP. Further, HHP immediately before touching patients (99.26%), clean/aseptic procedure (95.04%), after body fluid exposure (72.28%), after touching patients (98.01%), after touching surrounding of patients (74.75%) may prevent germ transmission to patients whereas HHP after touching patients (98.27%), before clean/aseptic procedure (67.57%), after exposure to immediate surroundings of patients (97.02%) may prevent germ transmission to pediatric physicians. Rubbing hands is preferred before palpation of abdomen (74.25%), before giving injection (56.68%), after removing gloves (61.88%), after making a patient's bed (47.80%), while washing of hands preferred after emptying bedpan (67.82%) and after visible exposure to blood (84.40%), 92.57% believed gloves can't replace HHP, posters display at point of care as reminders (95.30%), received frequent HHP education (82.92%), 50.49% do not need HHP reminder, 51.73% preferred alcohol based sanitizer, 53.46% facilitate daily morning huddle, HHP >10 times per day before COVID-19 (24.62%) while in COIVID-19 (56.44%). HPP is the most effective way to prevent the spread (98.01%) of microbes because it kills germs (90.35%), health care associated infections is the major (38.06%) cause of germ transmission, 86.88% will be remains committed to HHP even after pandemic. In comparison to residents and specialists, consultants gave more importance (p = 0.02) to HHP and were more adherent during (p = 0.007) and even after (p = 0.001) COVID-19 pandemic.

Conclusion

Assessing knowledge of pediatric physician, awareness, and adherence to hand hygiene measures could be helpful to reduce the contact transmission of lethal viruses to patients and vice versa. Further increase in the awareness, knowledge and education of HHP are required in order to maximize its utilization.

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The hand hygiene practice (HHP) is the most effective and simplest preventive measure to reduce the risk of infection.

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Of the total (N = 404) pediatric physicians, 56.68% male, 43.06% belongs to 25–35 years, 42.32% were consultants, 98.01% respondents were familiar with five moments of HHP.

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Assessing knowledge of pediatric physician, awareness, and adherence to hand hygiene measures could be helpful to reduce the contact transmission of lethal viruses to patients and vice versa.

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.

Exploring infection prevention and control knowledge and beliefs in the Solomon Islands using Photovoice

Healthcare associated infections are the most common complication of a person's hospital stay. Contemporary infection prevention and control programs are universally endorsed to prevent healthcare associated infections. However, western biomedical science on which contemporary infection prevention and control is based, is not the only way that staff and patients within healthcare settings understand disease causation and/or disease transmission. This results paper reports on one aspect of a study which ascertains perceptions of disease transmission and how these influence infection prevention and control practice at Atoifi Adventist Hospital Solomon Islands. Photovoice was used as the primary data collection method with staff and patients. The germ theory and hospital hygiene processes were only one of many explanations of disease transmission at the hospital. Many social, cultural and spiritual influences played an important role in how people understood disease to be transmitted. Although infection prevention and control models based on western science continue to form the premise of reducing healthcare associated infections in Solomon Islands and locations across the globe, local social, cultural and spiritual beliefs need to be considered when planning and implementing infection prevention and control programs to ensure success.

Detecting hand washing activity among activities of daily living and classification of WHO hand washing techniques using wearable devices and machine learning algorithms

During COVID-19, awareness of proper hand washing has increased significantly. It is critical that people learn the correct hand washing techniques and adopt good hand washing habits. Hence, this study proposes using wearable devices to detect hand washing activity among other daily living activities (ADLs) and classify steps proposed by the World Health Organization (WHO). Two experiments were conducted with 16 participants, aged from 20 to 31. The first experiment was hand washing following WHO regulation (ten participants), and the second experiment was performing eight ADLs (eight participants). All participants wore two wearable devices equipped with accelerometers and gyroscopes; one on each wrist. Four machine learning classifiers were compared in classifying hand washing steps in the leave-one-subject-out (LOSO) mode. The SVM model with Gaussian kernel achieved the best performance in classifying 11 washing hands steps, with an average F1-score of 0.8501. When detected among the other ADLs, hand washing following WHO regulation obtained the F1-score of 0.9871. The study demonstrates that wearable devices are feasible to detect hand washing activity and the hand washing techniques as well. The classification results of getting the soap and rubbing thumbs are low, which will be the main focus in the future study.

Cross-cultural adaptation and validation of the caregiver contribution to self-care of chronic illness inventory in China: a cross-sectional study

OBJECTIVE

Caregiver contribution (CC) is important for the self-care behaviors of chronic disease individuals, as it could enhance patient outcomes. Therefore, it is necessary to assess this CC by using a good validity and reliability instrument. The Caregiver Contribution to Self-Care Chronic Illness Inventory (CC-SC-CII) was designed to assess CC to self-care behaviors of patients with chronic illness in Italy. However, it was unclear whether this tool had sound psychometrics properties in the context of Chinese culture. Therefore, we performed the cross-cultural adaption of the CC-SC-CII and we tested its psychometric properties among Chinese caregivers of patients with chronic disease.

DESIGN

A cross-sectional observational design.

SETTINGS

Participants were recruited from communities and institutions in Pingdingshan, Henan Province, China.

PARTICIPANTS

301 caregivers of care recipients with chronic disease completed the Chinese version of the CC-SC-CII (C-CC-SC-CII).

PRIMARY AND SECONDARY OUTCOME MEASURES

The content validity index of items (I-CVI), the scale content validity index-average (S-CVI/Ave), exploratory factor analysis, confirmatory factor analysis (CFA), internal consistency and item analysis were tested.

RESULTS

The range of I-CVI was between 0.833 and 1.00, and the score of S-CVI was 0.991. In CFA, the C-CC to self-care monitoring scale had satisfactory fit indices. However, the C-CC to self-care maintenance and management scales had unsupported fit indices. The reliability coefficients of C-CC-SC-CII were 0.792, 0.880 and 0.870 for its three scales. Item-total correlations were all over 0.590. Test-retest reliability showed that the range of intraclass correlation coefficients was from 0.728 to 0.783.

CONCLUSION

The C-CC-SC-CII has sound psychometrics characteristics and is a culturally appropriate and reliable instrument for assessing CC to the self-care behaviours of patients with chronic disease in China.

Compliance with hygiene practices among healthcare workers at an academic hospital emergency department

Introduction

Healthcare-associated infections (HCAIs) are an important contributor to patient morbidity and mortality. Healthcare workers (HCWs) hands are the chief mode of transmission of HCAIs. The emergency centre (EC) is frequently the first point of contact for patients within the health care system. The aim of this study is to determine compliance with hygiene practices among healthcare workers at a tertiary hospital EC.

Methods

Hygiene practices of staff were observed over a six-week period. Data pertaining to compliance rates with hand cleansing and other hygiene practices was collected. Consent was obtained retrospectively to avoid influencing participant behaviour.

Results

From a total of 477 potential hygiene opportunities, compliance with hand hygiene was only 34.4% (n = 164). Hand cleansing with an alcohol-based hand rub was observed in 87 (26.7%) of the 326 (68.3%) opportunities where it was indicated, while handwashing with soap and water was observed in 35 (23.2%) of the 151 opportunities where this was indicated. Compliance to each of the six steps of handwashing ranged between 62.2% and 83.5%, with there being a gradual deterioration in compliance from step one through to step six. Compliance with ‘bare below the elbows’ was observed in 242 (50.7%) opportunities while disposable surgical gloves were worn on 85 (44.7%) of the 190 opportunities where this was indicated.

Conclusion

Compliance with hygiene practices among EC HCWs is suboptimal. Various strategies including ongoing systematic training and regular audits may improve overall hygiene practices among EC staff.

Has the COVID 19 Virus Changed Adherence to Hand Washing among Healthcare Workers?

The aim of the study was to assess adherence to hand washing by healthcare workers (HCWs) and its variations over time in hospital wards. We wanted to check whether the pandemic had changed the behavior of HCWs. The study was conducted between 1 January 2015, and 31 December 2020. The HCWs were observed to assess their compliance with the Five Moments for Hand Hygiene. We described the percentage of adherence to World Health Organization (WHO) guidelines stratified per year, per specialty areas, per different types of HCWs. We also observed the use of gloves. Descriptive data were reported as frequencies and percentages. We observed 13,494 hand hygiene opportunities. The majority of observations concerned nurses who were confirmed as the category most frequently involved with patients. Hospital's global adherence to WHO guidelines did not change in the last six years. During the pandemic, the rate of adherence to the procedure increased significantly only in Intensive Care Unit (ICU). In 2020, the use of gloves increased in pre-patient contact. The hand-washing permanent monitoring confirmed that it is very difficult to obtain the respect of correct hand hygiene in all opportunities, despite the ongoing pandemic and the fear of contagion.

Narrative review of non-pharmaceutical behavioural measures for the prevention of COVID-19 (SARS-CoV-2) based on the Health-EDRM framework

INTRODUCTION

Non-pharmaceutical measures to facilitate a response to the COVID-19 pandemic, a disease caused by novel coronavirus SARS-CoV-2, are urgently needed. Using the World Health Organization (WHO) health emergency and disaster risk management (health-EDRM) framework, behavioural measures for droplet-borne communicable diseases and their enabling and limiting factors at various implementation levels were evaluated.

SOURCES OF DATA

Keyword search was conducted in PubMed, Google Scholar, Embase, Medline, Science Direct, WHO and CDC online publication databases. Using the Oxford Centre for Evidence-Based Medicine review criteria, 10 bottom-up, non-pharmaceutical prevention measures from 104 English-language articles, which published between January 2000 and May 2020, were identified and examined.

AREAS OF AGREEMENT

Evidence-guided behavioural measures against transmission of COVID-19 in global at-risk communities were identified, including regular handwashing, wearing face masks and avoiding crowds and gatherings.

AREAS OF CONCERN

Strong evidence-based systematic behavioural studies for COVID-19 prevention are lacking.

GROWING POINTS

Very limited research publications are available for non-pharmaceutical measures to facilitate pandemic response.

AREAS TIMELY FOR RESEARCH

Research with strong implementation feasibility that targets resource-poor settings with low baseline health-EDRM capacity is urgently needed.

COVID-19 and hand hygiene: the vital importance of hand drying

The significance of hand hygiene for preventing the transmission of microorganisms and reducing the spread of infection has been brought into sharp focus following the global coronavirus (COVID-19) pandemic. In the months since the initial outbreak, international public health campaigns and practitioner education has concentrated on hand washing and hand sanitising, with very little reference to hand drying, if any at all. However, hand drying is integral to effective hand hygiene, and is important in controlling the spread of microorganisms and maintaining healthy skin integrity. This research commentary will focus on two issues of importance with regards to hand drying: microbial transmission and skin irritation, with implications for healthcare practitioners and practice considered. It is argued that a more holistic approach to hand hygiene must be the ambition if health professional and public behaviour is to become embedded and sustained.

Keyboard Contamination in Intensive Care Unit: Is Cleaning Enough? Prospective Research of In Situ Effectiveness of a Tea Tree Oil (KTEO) Film

After the SARS-CoV-2 pandemic, disinfection practices and microbial load reduction have become even more important and rigorous. To determine the contamination of keyboard surface and the relative risk to transfer healthcare-associated pathogens to susceptible patients, as it frequently happens in Intensive Care Unit (ICU), a standard keyboard (SK), a cleanable keyless keyboard (KK) with smooth surface and a standard keyboard coated with a 3 M Tegaderm^® film added with active essential oil (tea tree oil) (KTEO) were tested. S. aureus, including MRSA strains, were detected in ICU, with values ranging from 15% to 57%. Gram negative strains belonging to the Enterobacteriaceae family were also found with values ranging from 14% to 71%. Similar Gram positive and Gram negative strains were found on all surfaces, but with low percentage, and only environmental bacteria were detected using the settling plates method. The Microbial Challenge Test performed on KTEO showed high rates of decrease for all the pathogens with statistical significance both at 24 and 48 h (p = 0.003* and p = 0.040*, respectively). Our results suggest that the use of KTEO may be a feasible strategy for reducing the transmission of pathogens in health care setting and may be complementary to surface cleaning protocols.

Detection of bacterial pathogens in the hands of rural school children across different age groups and emphasizing the importance of hand wash

Introduction

Contaminated hands remain the mainstay cause of infection in children. Infections like diarrhoea and pneumonia were found to be common among children who have limited knowledge on the importance of hand wash. The present study was aimed to assess the relationship between the bacterial load sampled from the hands of school children and their routine hand wash practice methods.

Methods

Samples were collected from both the hands of 200 rural school children. Bacterial colonies isolated from the swabs were identified by standard microbiological procedures. Questionnaire was provided to gather matrix of routine hand wash practice from the subjects. Proper handwashing technique was demonstrated to children.

Results

More than 95% of the children harbored commensal like CoNS and Aerobic spore formers. Other pathogenic bacteria isolated include Acinetobacter species (36.5%), Pseudomonas species 4% (15), Enterococcus species (2%), Klebsiella species (3.5%), Flavobacterium species (1.7%), Escherichia coli (2%), and Enterobacter species (0.75%). It was found that the male children harbored more bacteria in their hands when compared to female population. Bacterial population like Pseudomonas species, Klebsiella species and Enterococcus species were predominant in the hands of children belonging to 7-10 years of age whereas Acinetobacter species, Escherichia coli and Flavobacterium species were slightly higher among 11-15 years of age. This information corresponds to the poor hand washing practices among the children.

Conclusions

It can thus be concluded from our study that simple handwashing practices can efficiently reduce the transmission of pathogenic bacteria from our hands and greatly reduce the transmission of infection.

Perceptual and cognitive determinants of tactile disgust

Tactile cues are said to be potent elicitors of disgust and reliable markers of disease. Despite this, no previous study had explored what the full range of tactile properties are that cue disgust, nor how interpretation of these sensations influences disgust. To answer these questions, participants were asked to touch nine objects, selected to cover the range of tactile properties, and evaluate their sensory, affective, and risk-based characteristics (primarily how sick they thought the object would make them). Object contact was manipulated in four ways, with participants randomly allocated to corresponding groups-one that could see the objects (i.e., the control) and three that could not (i.e., the blind groups). To manipulate disease risk interpretation of the objects, labelling was used on the blind groups, with one receiving Disgust-Labels, one True-Labels and one no labels. Disgust was strongly associated with sticky and wet textures, and moderately with viscous, cold, and lumpy textures, suggesting adherence-to-skin may predict disgust. The participants in the disgust-labelled condition had the highest disgust ratings, and this was mediated by their increased sickness belief and fear of the objects. Object identification was poor when labels or visual cues were absent. Our findings suggest that tactile disgust may reflect a bottom-up sensory component-skin adhesion-moderated by judgements of disease-related threat.