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Ly AN, McDavid K, Craig C, Maheia D, Gongora Y, Medley A, Morey F, Manzanero R, Morazan G, Lino A, Romero V, Blanco R, Ishida K, Lozier M, Murray KO. Water, Sanitation, and Hygiene Infrastructure and Resources in Schools in Belize during the COVID-19 Pandemic, 2021-2023. Int J Environ Res Public Health 2024; 21:470. [PMID: 38673382 PMCID: PMC11050648 DOI: 10.3390/ijerph21040470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Access to water, sanitation, and hygiene (WASH) resources in schools is critical for disease prevention and control, especially during public health emergencies. In Belize, systematic, national data on WASH in schools are needed to inform public health decisions and interventions. From December 2021 to January 2022, a national survey was sent electronically to government and government-aided primary and secondary schools in Belize (N = 308) to gather information on WASH services. From the survey, 12 pilot schools were selected based on the highest self-reported need for WASH resources to participate in additional evaluation and intervention, which included environmental nudges, supplemental supply provision, and hand hygiene education. To understand how the progression of the COVID-19 pandemic may have influenced hand hygiene, facility assessments to evaluate access to hand hygiene resources were conducted in person when most schools reopened for face-to-face learning during the pandemic (March 2022) and 15 months later (June 2023). Among the schools participating in the national survey (N = 221), 55% reported times when water was not available at the schools. Almost 9 in 10 schools (89%) had a functional handwashing station, and 47% reported always having soap for handwashing. Between baseline and follow-up at the 12 pilot schools, we observed decreases in the proportion of functional handwashing access points (-11%), functional handwashing access points accessible for individuals with disabilities (-17%) and small children (-29%), and functional alcohol-based hand rub dispensers (-13%). Despite the ongoing COVID-19 pandemic, we observed gaps in WASH resources in schools in Belize during the onsite assessments at the pilot schools. Schools should be encouraged and provided with WASH resources to maintain vigilance for disease control measures.
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Affiliation(s)
- Anh N. Ly
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave, Houston, TX 77030, USA
| | - Kelsey McDavid
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Christina Craig
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Dian Maheia
- Belize Ministry of Education, Culture, Science, and Technology, West Block Independence Plaza, Belmopan, Belize
| | - Yolanda Gongora
- Belize Ministry of Education, Culture, Science, and Technology, West Block Independence Plaza, Belmopan, Belize
| | - Alexandra Medley
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Francis Morey
- Belize Ministry of Health and Wellness, East Block Building, National Assembly, Bliss Parade, Belmopan, Belize
| | - Russell Manzanero
- Belize Ministry of Health and Wellness, East Block Building, National Assembly, Bliss Parade, Belmopan, Belize
| | - Gerhaldine Morazan
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave, Houston, TX 77030, USA
| | - Allison Lino
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave, Houston, TX 77030, USA
| | - Vickie Romero
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave, Houston, TX 77030, USA
| | - Rosalva Blanco
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave, Houston, TX 77030, USA
| | - Kanako Ishida
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Matthew Lozier
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
- United States Public Health Service, 1101 Wootton Parkway, Suite 300, Rockville, MD 20852, USA
| | - Kristy O. Murray
- Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, 1102 Bates Ave, Houston, TX 77030, USA
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Guerrero-Soler M, Gras-Valentí P, Gómez-Sotero IL, Platas-Abenza G, Silva-Afonso RDF, Benito-Miralles CM, Fuster-Pérez M, Cartagena-Llopis L, Sánchez-Valero M, Sánchez-Payá J, Chico-Sánchez P. Impact of COVID-19 on the degree of compliance with hand hygiene: a repeated cross-sectional study. Epidemiol Infect 2024; 152:e69. [PMID: 38557427 DOI: 10.1017/s0950268824000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Hand hygiene (HH) is the paramount measure used to prevent healthcare-associated infections. A repeated cross-sectional study was undertaken with direct observation of the degree of compliance on HH of healthcare personnel during the SARS-CoV-2 pandemic. Between, 2018-2019, 9,083 HH opportunities were considered, and 5,821 in 2020-2022. Chi squared tests were used to identify associations. The crude and adjusted odds ratios were used along with a logistic regression model for statistical analyses. Compliance on HH increased significantly (p < 0.001) from 54.5% (95% CI: 53.5, 55.5) to 70.1% (95% CI: 68.9, 71.2) during the COVID-19 pandemic. This increase was observed in four of the five key moments of HH established by the World Health Organization (WHO) (p < 0.05), except at moment 4. The factors that were significantly and independently associated with compliance were the time period considered, type of healthcare-personnel, attendance at training sessions, knowledge of HH and WHO guidelines, and availability of hand disinfectant alcoholic solution in pocket format. Highest HH compliance occurred during the COVID-19 pandemic, reflecting a positive change in healthcare-personnel's behaviour regarding HH recommendations.
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Affiliation(s)
- Maria Guerrero-Soler
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Paula Gras-Valentí
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Isel Lilibeth Gómez-Sotero
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Guillermo Platas-Abenza
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Raissa de Fátima Silva-Afonso
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carmen-María Benito-Miralles
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Marina Fuster-Pérez
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Lidia Cartagena-Llopis
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María Sánchez-Valero
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Sánchez-Payá
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pablo Chico-Sánchez
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
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Liu HL, Liu YL, Sun FY, Li ZC, Tan HY, Xu YC. Hand Hygiene among Anesthesiologists and Microorganisms Contamination in Anesthesia Environments: A Single-Center Observational Study. Biomed Environ Sci 2022; 35:992-1000. [PMID: 36443252 DOI: 10.3967/bes2022.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the baseline levels of microorganisms' growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital. METHODS This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital. Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination. RESULTS Microorganisms' growth results showed that 20% (5/25) of anesthesiologists' hands carried microorganisms (> 10 CFU/cm 2) before patient contact began. Female anesthesiologists performed hand hygiene better than did their male counterparts, with fewer CFUs ( P = 0.0069) and fewer species ( P = 0.0202). Our study also found that 55.6% (5/9) of ready-to-use operating rooms carried microorganisms (> 5 CFU/cm 2). Microorganisms regrowth began quickly (1 hour) after disinfection, and increased gradually over time, reaching the threshold at 4 hours after disinfection. Staphylococcus aureus was isolated from the hands of 20% (5/25) of anesthesiologists and 33.3% (3/9) of operating rooms. CONCLUSION Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene, daily cleaning rate of the operating room may be insufficient, and we would suggest that there should be a repeat cleaning every four hours.
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Affiliation(s)
- Hong Lei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China;Graduate School, Capital Medical University, Beijing 100069, China
| | - Ya Li Liu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China;Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing 100730, China
| | - Fang Yan Sun
- Infection Control Department, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China
| | - Zong Chao Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Hong Yu Tan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education, Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ying Chun Xu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Beijing 100730, China;Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases (BZ0447), Beijing 100730, China
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Verkola M, Järvelä T, Järvinen A, Jokelainen P, Virtala A, Kinnunen PM, Heikinheimo A. Infection prevention and control practices of ambulatory veterinarians: A questionnaire study in Finland. Vet Med Sci 2021; 7:1059-1070. [PMID: 33645926 PMCID: PMC8294370 DOI: 10.1002/vms3.464] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 02/02/2021] [Accepted: 02/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Veterinarians face the risk of contracting zoonotic pathogens. Infection prevention and control (IPC) guidelines stress the importance of proper hand hygiene and personal protective equipment (PPE) to prevent transmission of these pathogens. OBJECTIVES We aimed to assess how ambulatory livestock and equine veterinarians follow IPC guidelines, when working on farms and in stables. METHODS We studied hygiene practices of livestock and equine ambulatory veterinarians (n = 129) in Finland. A web-based questionnaire was used to obtain demographic information and information regarding hand-hygiene facilities and practices, use and cleaning of PPE and cleaning of medical equipment. RESULTS According to 66.9% of the respondents, hand-washing facilities were often adequate on livestock farms, but only 21.4% reported that this was the case in stables (p < .001). While 75.0% reported washing their hands or using hand sanitizer always before moving on to the next farm, only 42.5% reported doing this before moving on to the next stables (p < .001). Universal protective coat or coverall use was more common in livestock practice than in equine practice (91.6% vs. 27.7%, p < .001). Stethoscope cleaning was reported to happen less frequently than once a week by 30.0% of the respondents. CONCLUSIONS Finnish veterinarians' self-reported IPC adherence was far from uniform. IPC was more commonly followed in ambulatory livestock practice perhaps facilitated by better hand-washing facilities on farms than in stables. The study suggests that education of veterinarians is still needed and that hand-washing facilities need to be improved even in a high-income country.
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Affiliation(s)
- Marie Verkola
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Terhi Järvelä
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Asko Järvinen
- Department of Infectious DiseasesInflammation CenterHelsinki University Central Hospital and University of HelsinkiHUSFinland
| | - Pikka Jokelainen
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
- Laboratory of ParasitologyDepartment of BacteriaInfectious Disease PreparednessStatens Serum InstitutCopenhagen SDenmark
| | | | | | - Annamari Heikinheimo
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
- Finnish Food AuthoritySeinäjokiFinland
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de Arriba-Fernández A, Molina-Cabrillana MJ, Serra Majem L. [Evolution of adherence to hand hygiene in health care professionals in a third level hospital in relation to the SARS-CoV-2 pandemic]. Rev Esp Quimioter 2021; 34:214-219. [PMID: 33829723 PMCID: PMC8179943 DOI: 10.37201/req/150.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/20/2021] [Accepted: 02/22/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital Universitario Insular de Gran Canaria with respect to previous years. METHODS Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated. RESULTS Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05). CONCLUSIONS In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.
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Affiliation(s)
- A de Arriba-Fernández
- Alejandro de Arriba-Fernández, Universidad de Las Palmas de Gran Canaria. Paseo Blas Cabrera Felipe "Físico", 310, Las Palmas Gran Canaria. Spain.
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6
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Huang F, Armando M, Dufau S, Florea O, Brouqui P, Boudjema S. COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices. J Hosp Infect 2021; 111:27-34. [PMID: 33716086 PMCID: PMC7948529 DOI: 10.1016/j.jhin.2021.03.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has affected healthcare workers (HCWs) in their clinical practice. HCWs were challenged with new guidelines and practices to protect themselves from occupational risks. AIM To determine whether hand hygiene behaviour by real-time measurement was related to the dynamic of the epidemic, and the type of patient being cared for in France. METHODS This study used an automated hand hygiene recording system to measure HCW hand hygiene on entry to and exit from patient rooms throughout the COVID-19 pandemic. The correlation between hand hygiene compliance and COVID-19 epidemiological data was analysed. Analysis of variance was performed to compare compliance rate during the different periods of the epidemic. FINDINGS HCW hand hygiene rate on room entry decreased over time; on room exit, it increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, then rebounded by 2.82% during the second wave of the epidemic. Hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic; conversely, hand hygiene on room entry did not depend on the trend of the epidemic, nor on nursing of COVID-19 patients, and it decreased over time. CONCLUSION HCWs modified their behaviours to face the risk propensity of the pandemic. However, to improve the poor compliance at room entry, reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary; disinfection of gloving hands might solve this issue.
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Affiliation(s)
- F Huang
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France.
| | - M Armando
- Aix Marseille Université, CNRS, Laboratory of Cognitive Psychology (UMR 7290), Marseille, France
| | - S Dufau
- Aix Marseille Université, CNRS, Laboratory of Cognitive Psychology (UMR 7290), Marseille, France
| | - O Florea
- AP-HM, IHU Méditerranée Infection, Marseille, France
| | - P Brouqui
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France; AP-HM, IHU Méditerranée Infection, Marseille, France
| | - S Boudjema
- Aix Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France
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Shin JH, Mizuno S, Okuno T, Itoshima H, Sasaki N, Kunisawa S, Kaku M, Yoshida M, Gu Y, Morii D, Shibayama K, Ohmagari N, Imanaka Y. Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals. BMC Infect Dis 2021; 21:234. [PMID: 33639873 PMCID: PMC7912490 DOI: 10.1186/s12879-021-05921-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship. METHODS We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses. RESULTS The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses. CONCLUSIONS Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Anti-Infective Agents/therapeutic use
- Antimicrobial Stewardship/methods
- Antimicrobial Stewardship/standards
- Catheter-Related Infections/drug therapy
- Catheter-Related Infections/epidemiology
- Catheter-Related Infections/prevention & control
- Cross Infection/drug therapy
- Cross Infection/epidemiology
- Cross Infection/prevention & control
- Drug Resistance, Bacterial
- Hand Hygiene/standards
- Hand Hygiene/statistics & numerical data
- Health Knowledge, Attitudes, Practice
- Hospitals, Teaching/standards
- Hospitals, Teaching/statistics & numerical data
- Humans
- Infection Control/methods
- Infection Control/standards
- Japan/epidemiology
- Personnel, Hospital/statistics & numerical data
- Pneumonia, Ventilator-Associated/drug therapy
- Pneumonia, Ventilator-Associated/epidemiology
- Pneumonia, Ventilator-Associated/prevention & control
- Practice Patterns, Physicians'/standards
- Surveys and Questionnaires
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Affiliation(s)
- Jung-Ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Seiko Mizuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Takuya Okuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Hisashi Itoshima
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Noriko Sasaki
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Mitsuo Kaku
- Division of Infectious Diseases and Infection Control, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Makiko Yoshida
- Department of Infectious Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Daiichi Morii
- Department of Infection Control and Prevention, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Norio Ohmagari
- Department of Infectious Diseases, AMR Clinical Reference Center, and Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
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Gaube S, Fischer P, Lermer E. Hand(y) hygiene insights: Applying three theoretical models to investigate hospital patients' and visitors' hand hygiene behavior. PLoS One 2021; 16:e0245543. [PMID: 33444410 PMCID: PMC7808666 DOI: 10.1371/journal.pone.0245543] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Improving hand hygiene in hospitals is the most efficient method to prevent healthcare-associated infections. The hand hygiene behavior of hospital patients and visitors is not well-researched, although they pose a risk for the transmission of pathogens. Therefore, the present study had three aims: (1) Finding a suitable theoretical model to explain patients' and visitors' hand hygiene practice; (2) Identifying important predictors for their hand hygiene behavior; and (3) Comparing the essential determinants of hand hygiene behavior between healthcare professionals from the literature to our non-professional sample. METHODS In total N = 1,605 patients and visitors were surveyed on their hand hygiene practice in hospitals. The employed questionnaires were based on three theoretical models: a) the Theory of Planned Behavior (TPB); b) the Health Action Process Approach (HAPA); and c) the Theoretical Domains Framework (TDF). Structural equation modeling was used to analyze the data. To compare our results to the determinants of healthcare workers' hand hygiene behavior, we searched for studies that used one of the three theoretical models. RESULTS Among patients, 52% of the variance in the hand hygiene behavior was accounted for by the TDF domains, 44% by a modified HAPA model, and 40% by the TPB factors. Among visitors, these figures were 59%, 37%, and 55%, respectively. Two clusters of variables surfaced as being essential determinants of behavior: self-regulatory processes and social influence processes. The critical determinants for healthcare professionals' hand hygiene reported in the literature were similar to the findings from our non-professional sample. CONCLUSIONS The TDF was identified as the most suitable model to explain patients' and visitors' hand hygiene practices. Patients and visitors should be included in existing behavior change intervention strategies. Newly planned interventions should focus on targeting self-regulatory and social influence processes to improve effectiveness.
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Affiliation(s)
- Susanne Gaube
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Peter Fischer
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Eva Lermer
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany
- FOM University of Applied Sciences for Economics & Management, Munich, Germany
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Gharpure R, Miller GF, Hunter CM, Schnall AH, Kunz J, Garcia-Williams AG. Safe Use and Storage of Cleaners, Disinfectants, and Hand Sanitizers: Knowledge, Attitudes, and Practices among U.S. Adults during the COVID-19 Pandemic, May 2020. Am J Trop Med Hyg 2020; 104:496-501. [PMID: 33377450 PMCID: PMC7866329 DOI: 10.4269/ajtmh.20-1119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/18/2020] [Indexed: 12/24/2022] Open
Abstract
Cleaning and disinfection of frequently touched surfaces and frequent hand hygiene are recommended measures to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. Since the onset of the COVID-19 pandemic, poison center calls regarding exposures to cleaners, disinfectants, and hand sanitizers have increased as compared with prior years, indicating a need to evaluate household safety precautions. An opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020. Survey items evaluated knowledge regarding use and storage of cleaners, disinfectants, and hand sanitizers; attitudes about household cleaning and disinfection; and safety precautions practiced during the prior month. We assigned a knowledge score to each respondent to quantify knowledge of safety precautions and calculated median scores by demographic characteristics and attitudes. We identified gaps in knowledge regarding safe use and storage of cleaners, disinfectants, and hand sanitizers; the overall median knowledge score was 5.17 (95% CI: 4.85-5.50; maximum 9.00). Knowledge scores were lower among younger than older age-groups and among black non-Hispanic and Hispanic respondents compared with white non-Hispanic respondents. A greater proportion of respondents expressed knowledge of safety precautions than the proportion who engaged in these precautions. Tailored communication strategies should be used to reach populations with lower knowledge of cleaning and disinfection safety. In addition, as knowledge alone did not shape individual engagement in safety precautions, health promotion campaigns may specifically emphasize the health risks of unsafe use and storage of cleaners, disinfectants, and hand sanitizers to address risk perception.
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Affiliation(s)
- Radhika Gharpure
- COVID-19 Response, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gabrielle F. Miller
- COVID-19 Response, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Candis M. Hunter
- COVID-19 Response, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy H. Schnall
- National Center for Environmental Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jasen Kunz
- COVID-19 Response, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Coletti P, Wambua J, Gimma A, Willem L, Vercruysse S, Vanhoutte B, Jarvis CI, Van Zandvoort K, Edmunds J, Beutels P, Hens N. CoMix: comparing mixing patterns in the Belgian population during and after lockdown. Sci Rep 2020; 10:21885. [PMID: 33318521 PMCID: PMC7736856 DOI: 10.1038/s41598-020-78540-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/20/2020] [Indexed: 12/24/2022] Open
Abstract
The COVID-19 pandemic has shown how a newly emergent communicable disease can lay considerable burden on public health. To avoid system collapse, governments have resorted to several social distancing measures. In Belgium, this included a lockdown and a following period of phased re-opening. A representative sample of Belgian adults was asked about their contact behaviour from mid-April to the beginning of August, during different stages of the intervention measures in Belgium. Use of personal protection equipment (face masks) and compliance to hygienic measures was also reported. We estimated the expected reproduction number computing the ratio of [Formula: see text] with respect to pre-pandemic data. During the first two waves (the first month) of the survey, the reduction in the average number of contacts was around 80% and was quite consistent across all age-classes. The average number of contacts increased over time, particularly for the younger age classes, still remaining significantly lower than pre-pandemic values. From the end of May to the end of July , the estimated reproduction number has a median value larger than one, although with a wide dispersion. Estimated [Formula: see text] fell below one again at the beginning of August. We have shown how a rapidly deployed survey can measure compliance to social distancing and assess its impact on COVID-19 spread. Monitoring the effectiveness of social distancing recommendations is of paramount importance to avoid further waves of COVID-19.
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Affiliation(s)
- Pietro Coletti
- UHasselt, Data Science Institute and I-BioStat, Hasselt, 3500, Belgium.
| | - James Wambua
- UHasselt, Data Science Institute and I-BioStat, Hasselt, 3500, Belgium
| | - Amy Gimma
- London School of Hygiene and Tropical Medicine, London, WC1E, UK
| | - Lander Willem
- University of Antwerp, Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, Antwerp, 2610, Belgium
| | - Sarah Vercruysse
- UHasselt, Data Science Institute and I-BioStat, Hasselt, 3500, Belgium
| | - Bieke Vanhoutte
- University of Antwerp, Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, Antwerp, 2610, Belgium
| | | | | | - John Edmunds
- London School of Hygiene and Tropical Medicine, London, WC1E, UK
| | - Philippe Beutels
- University of Antwerp, Centre for Health Economic Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, Antwerp, 2610, Belgium
- The University of New South Wales, School of Public Health and Community Medicine, Sydney, NSW, 2033, Australia
| | - Niel Hens
- UHasselt, Data Science Institute and I-BioStat, Hasselt, 3500, Belgium
- London School of Hygiene and Tropical Medicine, London, WC1E, UK
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11
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Czeisler MÉ, Garcia-Williams AG, Molinari NA, Gharpure R, Li Y, Barrett CE, Robbins R, Facer-Childs ER, Barger LK, Czeisler CA, Rajaratnam SM, Howard ME. Demographic Characteristics, Experiences, and Beliefs Associated with Hand Hygiene Among Adults During the COVID-19 Pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:1485-1491. [PMID: 33056951 PMCID: PMC7561087 DOI: 10.15585/mmwr.mm6941a3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Zhang S, Guo M, Wu F, Xiong N, Ma Y, Wang Z, Duan L, Chen L, Ouyang H, Jin Y. Factors associated with asymptomatic infection in health-care workers with severe acute respiratory syndrome coronavirus 2 infection in Wuhan, China: a multicentre retrospective cohort study. Clin Microbiol Infect 2020; 26:1670-1675. [PMID: 32911080 PMCID: PMC7476563 DOI: 10.1016/j.cmi.2020.08.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To describe the fraction of asymptomatic health-care workers (HCWs) in two designated hospitals for coronavirus disease 2019 (COVID-19) treatment in Wuhan and explore the factors associated with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS All HCWs in Wuhan Union Hospital and Wuhan Red Cross Hospital with either positive SARS-CoV-2 nucleic acid or positive antibody test before 18 April 2020 were included. Exposure, epidemiological and demographic information were retrospectively collected by a structured questionnaire. Medical records were also reviewed for clinical characteristics and CT images of HCWs. RESULTS As of 18 April 2020, a total of 424 HCWs were identified. Among them, 276 (65.1%) were symptomatic and 148 (34.9%) were asymptomatic. Fifty-five (19.9%) families of the symptomatic HCWs and 16 (10.8%) families of the asymptomatic HCWs were infected with SARS-CoV-2. HCWs with infected family members tended to be symptomatic (OR 2.053, 95% CI 1.130-3.730; p 0.018). Multivariable logistic regression analysis exhibited that performing tracheal intubation or extubation (OR 4.057, 95% CI 1.183-13.909; p 0.026) was associated with an increased likelihood of symptomatic SARS-CoV-2 infection, whereas consistent use of N95 respirators (OR 0.369, 95% CI 0.201-0.680; p 0.001) and eye protection (OR 0.217, 95% CI 0.116-0.404; p < 0.001) were associated with an increased likelihood of asymptomatic SARS-CoV-2 infection. CONCLUSIONS Asymptomatic SARS-CoV-2 infection in HCWs comprised a considerable proportion of HCW infections during the pandemic of COVID-19. Those who performed tracheal intubation or extubation were most likely to develop related symptoms, whereas those taking aggressive measures, including consistent use of N95 masks and eye protection, tended to be asymptomatic cases.
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Affiliation(s)
- Shuai Zhang
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengfei Guo
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Feng Wu
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China; Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yanling Ma
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhihui Wang
- Department of Scientific Research, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Limin Duan
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lan Chen
- Hospital Infection-Control Department, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Haixia Ouyang
- Department of Human Resources, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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13
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Or PPL, Wong BYM, Chung JWY. To investigate the association between the health literacy and hand hygiene practices of the older adults to help them fight against infectious diseases in Hong Kong. Am J Infect Control 2020; 48:485-489. [PMID: 32037202 PMCID: PMC7132680 DOI: 10.1016/j.ajic.2019.12.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/14/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Proper hand hygiene helps prevent infectious diseases, while health literacy plays a critical role in preventive health behaviors. It remains unclear as to why proper hand hygiene practices cannot be sustained and what role health literacy plays in older adults fight against infectious diseases. METHODS A convenience sample of 433 old adults aged 65 and above was recruited. Their hygiene practices and health literacy were evaluated using a structured questionnaire adopted from the Centre for Health Protection and the Chinese version of the HLS-Asia-Q questionnaire. RESULTS The percentage distribution of the hand hygiene performance, from always to never, was 18%-10%. A majority 63.28% (274) of them were classified as having inadequate health literacy (0-25), while a meager 1.62% (7) of them as having excellent health literacy (42.01-50). The Spearman correlation showed a significant positive relationship (P < 0.05) between the participants' health literacy and their hand hygiene practices. CONCLUSIONS Health literacy and hand hygiene are positively related in helping the older adults fight against infectious diseases. To sustain proper hand hygiene practices is to provide frequent hand hygiene training to the older adults.
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Affiliation(s)
- Peggy Pui-Lai Or
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong.
| | - Bonny Yee-Man Wong
- Li Ka Shing Faculty of Medicine, School of Public Health, The University of Hong Kong, Hong Kong
| | - Joanne Wai-Yee Chung
- Department of Health and Physical Education, The Education University of Hong Kong, Tai Po, Hong Kong
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14
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Diefenbacher S, Sassenrath C, Tatzel J, Keller J. Evaluating healthcare workers' hand hygiene performance using first-person view video observation in a standardized patient-care scenario. Am J Infect Control 2020; 48:496-502. [PMID: 32334725 DOI: 10.1016/j.ajic.2019.11.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/17/2019] [Accepted: 11/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Monitoring healthcare workers' (HCWs) hand hygiene (HH) performance is recommended for improving compliance. Observer biases challenge data validity, thus supplemental approaches such as video observation are needed to complement monitoring. METHODS We investigate first-person view (FPV) video observation during simulated standardized patient care handling a catheter in a study with 71 HCWs. HH performance was evaluated for (1) all HH opportunities and (2) a subset of opportunities required in an ideal work sequence, hereafter core opportunities. HCWs' acceptance of FPV video observation and usability judgments were assessed. RESULTS Compliance level for core HH opportunities (M = 43.5%) was significantly higher than compliance considering all opportunities (M = 30.4%, t(70) = 8.493, P < .001). Reducing HH opportunities to core opportunities would significantly increase compliance levels from the observed average of 30.4% to 44.9% (t(70) = 12.822, P < .001). Overall, both usability ratings and acceptance of the body camera were promising. DISCUSSION FPV video observation in simulated standardized patient care provides new instruments to evaluate HH performance beyond mere compliance rates. Our results emphasize the role of optimizing workflow in order to improve HCW's HH compliance. CONCLUSIONS FPV video observation in a standardized patient care simulation is feasible and offers information for HH interventions that target actual deficiencies.
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Affiliation(s)
| | | | - Johannes Tatzel
- Department of Social Psychology, Ulm University, Ulm, Germany
| | - Johannes Keller
- Department of Social Psychology, Ulm University, Ulm, Germany
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15
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Lee MH, Lee GA, Lee SH, Park YH. A systematic review on the causes of the transmission and control measures of outbreaks in long-term care facilities: Back to basics of infection control. PLoS One 2020; 15:e0229911. [PMID: 32155208 PMCID: PMC7064182 DOI: 10.1371/journal.pone.0229911] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 02/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The unique characteristics of long-term care facilities (LTCFs) including host factors and living conditions contribute to the spread of contagious pathogens. Control measures are essential to interrupt the transmission and to manage outbreaks effectively. AIM The aim of this systematic review was to verify the causes and problems contributing to transmission and to identify control measures during outbreaks in LTCFs. METHODS Four electronic databases were searched for articles published from 2007 to 2018. Articles written in English reporting outbreaks in LTCFs were included. The quality of the studies was assessed using the risk-of-bias assessment tool for nonrandomized studies. FINDINGS A total of 37 studies were included in the qualitative synthesis. The most commonly reported single pathogen was influenza virus, followed by group A streptococcus (GAS). Of the studies that identified the cause, about half of them noted outbreaks transmitted via person-to-person. Suboptimal infection control practice including inadequate decontamination and poor hand hygiene was the most frequently raised issue propagating transmission. Especially, lapses in specific care procedures were linked with outbreaks of GAS and hepatitis B and C viruses. About 60% of the included studies reported affected cases among staff, but only a few studies implemented work restriction during outbreaks. CONCLUSIONS This review indicates that the violation of basic infection control practice could be a major role in introducing and facilitating the spread of contagious diseases in LTCFs. It shows the need to promote compliance with basic practices of infection control to prevent outbreaks in LTCFs.
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Affiliation(s)
- Min Hye Lee
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, South Korea
| | - Gyeoung Ah Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Seong Hyeon Lee
- College of Nursing, Seoul National University, Seoul, South Korea
| | - Yeon-Hwan Park
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, South Korea
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16
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Erasmus V, Otto S, De Roos E, van Eijsden R, Vos MC, Burdorf A, van Beeck E. Assessment of correlates of hand hygiene compliance among final year medical students: a cross-sectional study in the Netherlands. BMJ Open 2020; 10:e029484. [PMID: 32054622 PMCID: PMC7045092 DOI: 10.1136/bmjopen-2019-029484] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify the factors that influence the hand hygiene compliance of final year medical students, using a theoretical behavioural framework. DESIGN Cross-sectional survey assessing self-reported compliance and its behavioural correlates. SETTING Internships of medical students in the Netherlands. PARTICIPANTS 322 medical students of the Erasmus Medical Center were recruited over a period of 12 months during the Public Health internship, which is the final compulsory internship after an 18-month rotation schedule in all major specialities. PRIMARY AND SECONDARY OUTCOME MEASURES Behavioural factors influencing compliance to hand hygiene guidelines were measured by means of a questionnaire based on the Theory of Planned Behaviour and Social Ecological Models. Multiple linear regression analysis was used to identify the effect of including attitudes, social norms, self-efficacy, knowledge, risk perception and habit on hand hygiene compliance. RESULTS We included 313 students in the analysis (response rate 97%). The behavioural model explained 40% of the variance in self-reported compliance (adjusted R2=0.40). Hand hygiene compliance was strongly influenced by attitudes (perceived outcomes of preventive actions), self-efficacy (perception of the ability to perform hand hygiene at the clinical ward) and habit, but was not associated with knowledge and risk perception. CONCLUSIONS Targeting medical students' behaviour should focus on the empowerment of these juniors and provide them with evidence on the health benefits of prevention, rather than increasing their factual knowledge of procedures. Clinical teaching environments could help them form good patient safety habits during this vital phase of their career.
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Affiliation(s)
- Vicki Erasmus
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Suzie Otto
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Emmely De Roos
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC Rotterdam, Rotterdam, Zuid-Holland, Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Ed van Beeck
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
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17
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Cooke RPD, Corke C. Staff surveys will unlock the key to better hand hygiene performance. Lancet Infect Dis 2020; 20:167-168. [PMID: 32006503 DOI: 10.1016/s1473-3099(19)30688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/22/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Richard P D Cooke
- Department of Medical Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK.
| | - Charlotte Corke
- Department of Medical Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
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18
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Bull T, Corley A, Lye I, Spooner AJ, Fraser JF. Cannula and circuit management in peripheral extracorporeal membrane oxygenation: An international survey of 45 countries. PLoS One 2019; 14:e0227248. [PMID: 31887197 PMCID: PMC6936833 DOI: 10.1371/journal.pone.0227248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 12/15/2019] [Indexed: 01/05/2023] Open
Abstract
Effective and safe practices during extracorporeal membrane oxygenation (ECMO) including infection precautions and securement of lines (cannulas and circuits) are critical to prevent life-threatening patient complications, yet little is known about the practices of bedside clinicians and data to support best practice is lacking. Therefore, the aim of this study was to identify and describe common line-related practices for patients supported by peripheral ECMO worldwide and to highlight any gaps for further investigation. An electronic survey was conducted to examine common line practices for patients managed on peripheral ECMO. Responses were obtained from 45 countries with the majority from the United States (n = 181) and United Kingdom (n = 32). Standardised infection precautions including hand hygiene, maximal barrier precautions and skin antisepsis were commonplace for cannulation. The most common antisepsis strategies included alcohol-based chlorhexidine gluconate (CHG) for cannula insertion (53%) and maintenance (54%), isopropyl alcohol on circuit access ports (39%), and CHG-impregnated dressings to cover insertion sites (36%). Adverse patient events due to line malposition or dislodgement were reported by 34% of respondents with most attributable to ineffective securement. Centres 'always' suturing peripheral cannula sites were more likely to experience a cannula adverse event than centres that 'never' sutured (35% [95% CI 30, 41] vs 0% [95% CI 0, 28]; Chi-square 4.40; p = 0.04) but this did not meet the a priori significance level of <0.01. An evidence-based guideline would be beneficial to improve ECMO line management according to 78% of respondents. Evidence gaps were identified for antiseptic agents, dressing products and regimens, securement methods, and needleless valves. Future research addressing these areas may provide opportunities for consensus guideline development and practice improvement.
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Affiliation(s)
- Taressa Bull
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Queensland, Australia
| | - Amanda Corley
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Queensland, Australia
| | - India Lye
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Queensland, Australia
| | - Amy J. Spooner
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Queensland, Australia
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital and University of Queensland, Chermside, Queensland, Australia
- Adult Intensive Care Services, The Prince Charles Hospital, Chermside, Queensland, Australia
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19
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Goedken CC, Livorsi DJ, Sauder M, Vander Weg MW, Chasco EE, Chang NC, Perencevich E, Reisinger HS. "The role as a champion is to not only monitor but to speak out and to educate": the contradictory roles of hand hygiene champions. Implement Sci 2019; 14:110. [PMID: 31870453 PMCID: PMC6929350 DOI: 10.1186/s13012-019-0943-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Implementation science experts define champions as "supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization." Many hospitals use designated clinical champions-often called "hand hygiene (HH) champions"-typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term "HH champion" and how they define the role. METHODS An ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes. RESULTS A total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role. CONCLUSIONS Healthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance-and differentiate it from the role of a "compliance auditor." Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.
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Affiliation(s)
- Cassie Cunningham Goedken
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
| | - Daniel J. Livorsi
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
| | - Michael Sauder
- Department of Sociology, University of Iowa, 140 Seashore Hall West, Iowa City, IA 52242 USA
| | - Mark W. Vander Weg
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
- Department of Psychological and Brain Sciences, University of Iowa, W311 Seashore Hall, Iowa City, IA 52242-1407 USA
| | - Emily E. Chasco
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
| | - Nai-Chung Chang
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132 USA
| | - Eli Perencevich
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, 601 Hwy 6 West, Iowa City, 52246 USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, 375 Newton Rd, Iowa City, IA 52242 USA
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Lawson A, Vaganay-Miller M. The Effectiveness of a Poster Intervention on Hand Hygiene Practice and Compliance When Using Public Restrooms in a University Setting. Int J Environ Res Public Health 2019; 16:ijerph16245036. [PMID: 31835651 PMCID: PMC6950365 DOI: 10.3390/ijerph16245036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022]
Abstract
Background: Most research on hand hygiene compliance in community settings indicates that compliance is poor. It is not conclusive as to whether poster interventions are effective at improving compliance. Methods: An independent, self-designed poster intervention was installed in one set of male and female public restrooms in a university campus in the UK. The hand hygiene practice and compliance of the university population was measured via indirect observation over a 60 day period. Results: During the pre-intervention observation period, 51.09% of the university population practiced basic hand hygiene compliance (washed hands with water, soap and dried afterwards), and 7.88% practiced adequate hand hygiene compliance (washed hands with water and soap for 20 s or more and dried afterwards for 20 s or more). During the post-intervention observation period, 55.39% of the university population were observed practicing basic hand hygiene compliance, and 7.97% practicing adequate hand hygiene compliance. Gender differences revealed that more females practiced basic hand hygiene in the post-intervention observation period (62.81%) than during the pre-intervention period (49.23%) and this was statistically significant (χ2 = 13.49, p = < 0.01). Discussion: The poster intervention had a limited effect on improving the basic and adequate hand hygiene compliance of the general population when using public restrooms. The use of independent, self-designed posters to improve hand hygiene practice and compliance is largely ineffective in the short term and should be used with caution in future intervention strategies.
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Wilson AM, Reynolds KA, Canales RA. Estimating the effect of hand hygiene compliance and surface cleaning timing on infection risk reductions with a mathematical modeling approach. Am J Infect Control 2019; 47:1453-1459. [PMID: 31331717 DOI: 10.1016/j.ajic.2019.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Quantitative tools are needed to relate infection control interventions to infection risk reductions. METHODS A model for predicting virus concentrations on hands was used to predict rotavirus, rhinovirus, and influenza A virus doses. Variability in behaviors, transfer efficiencies for various contact types, and surface areas of contact were included. Dose-response curves were used to relate estimated doses to infection risks. Percent reductions from baseline in average rotavirus, rhinovirus, and influenza A virus dose and infection risk were calculated for interventions. RESULTS Baseline average infection risks for rotavirus, rhinovirus, and influenza A virus were 0.43, 0.20, and 5.51 × 10-6, respectively. One and 2 cleaning events decreased average viral infection risks by 6.98%-17.06% and 13.95%-34.66%, respectively. A 15% increase in hand compliance decreased average infection risks by 6.98%-20.51%. A 15% increase in hand hygiene compliance paired with 2 cleaning events decreased average infection risks by 20.93%-47.55%. DISCUSSION This study demonstrates the infection risk benefits of combined interventions. CONCLUSIONS Models such as the one in this study could be used to optimize timing and frequency of cleaning events and to create hand hygiene compliance goals to achieve infection risk targets.
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Affiliation(s)
- Amanda M Wilson
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ.
| | - Kelly A Reynolds
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Robert A Canales
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
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Evans EW, Redmond EC. Video observation of hand-hygiene compliance in a manufacturer of ready-to-eat pie and pastry products. Int J Environ Health Res 2019; 29:593-606. [PMID: 30569758 DOI: 10.1080/09603123.2018.1558183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/07/2018] [Indexed: 06/09/2023]
Abstract
Food-handler hand-hygiene can be a contributory factor for food-borne illness. Cognitive data (knowledge/attitudes/self-reported practices), while informative, are not indicative of behaviour, and are subject to biases. Consequently, observation of behaviour is superior to survey data. However, researcher presence in direct observation increases reactivity, whereas video observation gives comprehensive analysis over a longer period, furthermore, familiarity reduces reactivity. Although video observation has been used to assess food safety at retail/foodservice, this valuable method is under-utilized in food-manufacturing environments. For the study, footage (24 h) was reviewed to assess compliance in a food-manufacturing site with company protocol. Video observation of food-handlers entering production (n = 674) was assessed; upon 70 occasions no attempt to implement hand-hygiene was observed. Of attempted hand-hygiene practices (n = 604), only 2% implemented compliant practices. Although 78% of attempts utilized soap, only 42% included sanitizer. Duration ranged from 1 to 69 s (Median 17 s). The study provides hand-hygiene data in an area that observational data is seldom captured.
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Affiliation(s)
- Ellen W Evans
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University , Cardiff , Wales
| | - Elizabeth C Redmond
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University , Cardiff , Wales
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Brink AJ, Messina AP, Maslo C, Swart K, Chunnilall D, van den Bergh D. Implementing a multi-faceted framework for proprietorship of hand hygiene compliance in a network of South African hospitals: leveraging the Ubuntu philosophy. J Hosp Infect 2019; 104:404-413. [PMID: 31738987 DOI: 10.1016/j.jhin.2019.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/21/2019] [Accepted: 11/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Given the lack of hospital-wide ownership and shortage of nurses, the ideal model for large-scale implementation of hand hygiene (HH) behaviour change in low- and middle-income countries is unknown. AIM The aim of the multi-modal strategy was to engender hospital accountability for HH compliance. METHODS The quasi-experimental study was conducted in 50 South African hospitals (November 2015 to July 2017) and involved five overlapping phases: executive governance and corporate behaviour change; group-wide systematic situational analysis; development of an electronic-assisted direct-observed data collection and analysis application; launch and implementation; and accountable governance. Measurement of intra- and inter-hospital variance to six HH opportunities was calculated and data compliance dashboards were e-mailed weekly to hospital leadership teams to provide feedback of recorded HH compliance and behaviour to frontline teams. Baseline comparison (July 2016) of compliance was compared versus post-implementation (July 2017). FINDINGS Baseline HH compliance of ≤60% was documented for 16% (8/50) of hospitals, whereas overall, 48% (24/50) of hospitals demonstrated a significant improvement (P < 0.01). Over the 13-month observation period, 523,422 observations were recorded with a mean rate of 277 ± 223 observations per 1000 patient-days. The group mean composite compliance improved by 7.8% (P < 0.01) from 77.4% ± 12.8 to 85.2% ± 8.8 between July 2016 and July 2017, respectively. CONCLUSION Implementation of a multi-faceted HH model in a large, diverse group of South African hospitals translated into changes in the organizational systems and accountability, standardized HH compliance management and feedback that led to HH proprietorship.
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Affiliation(s)
- A J Brink
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - A P Messina
- Division of Pharmacy, Netcare Hospitals Ltd, Johannesburg, South Africa; Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Maslo
- Division of Infection Control, Netcare Hospitals Ltd, Johannesburg, South Africa
| | - K Swart
- Division of Infection Control, Netcare Hospitals Ltd, Johannesburg, South Africa
| | - D Chunnilall
- Division of Pharmacy, Netcare St Augustine's Hospital, Durban, South Africa
| | - D van den Bergh
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Vander Weg MW, Perencevich EN, O’Shea AMJ, Jones MP, Vaughan Sarrazin MS, Franciscus CL, Goedken CC, Baracco GJ, Bradley SF, Cadena J, Forrest GN, Gupta K, Morgan DJ, Rubin MA, Thurn J, Bittner MJ, Reisinger HS. Effect of Frequency of Changing Point-of-Use Reminder Signs on Health Care Worker Hand Hygiene Adherence: A Cluster Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1913823. [PMID: 31642930 PMCID: PMC6820039 DOI: 10.1001/jamanetworkopen.2019.13823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Although hand hygiene (HH) is considered the most effective strategy for preventing hospital-acquired infections, HH adherence rates remain poor. OBJECTIVE To examine whether the frequency of changing reminder signs affects HH adherence among health care workers. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial in 9 US Department of Veterans Affairs acute care hospitals randomly assigned 58 inpatient units to 1 of 3 schedules for changing signs designed to promote HH adherence among health care workers: (1) no change; (2) weekly; and (3) monthly. Hand hygiene rates among health care workers were documented at entry and exit to patient rooms during the baseline period from October 1, 2014, to March 31, 2015, of normal signage and throughout the intervention period of June 8, 2015, to December 28, 2015. Data analyses were conducted in April 2018. INTERVENTIONS Hospital units were randomly assigned into 3 groups: (1) no sign changes throughout the intervention period, (2) signs changed weekly, and (3) signs changed monthly. MAIN OUTCOMES AND MEASURES Hand hygiene adherence as measured by covert observation. Interrupted time series analysis was used to examine changes in HH adherence from baseline through the intervention period by group. RESULTS Among 58 inpatient units, 19 units were assigned to the no change group, 19 units were assigned to the weekly change group, and 20 units were assigned to the monthly change group. During the baseline period, 9755 HH opportunities were observed at room entry and 10 095 HH opportunities were observed at room exit. During the intervention period, a total of 15 855 HH opportunities were observed at room entry, and 16 360 HH opportunities were observed at room exit. Overall HH adherence did not change from baseline compared with the intervention period at either room entry (4770 HH events [48.9%] vs 3057 HH events [50.1%]; P = .14) or exit (6439 HH events [63.8%] vs 4087 HH events [65.2%]; P = .06). In units that changed signs weekly, HH adherence declined from baseline at room entry (-1.9% [95% CI, -2.7% to -0.8%] per week; P < .001) and exit (-0.8% [95% CI, -1.5% to 0.1%] per week; P = .02). No significant changes in HH adherence were observed in other groups. CONCLUSIONS AND RELEVANCE The frequency of changing reminder signs had no effect on HH rates overall. Units assigned to change signs most frequently demonstrated worsening adherence. Considering the abundance of signs in the acute care environment, the frequency of changing signs did not appear to provide a strong enough cue by itself to promote behavioral change. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02223455.
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Affiliation(s)
- Mark W. Vander Weg
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City
| | - Eli N. Perencevich
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City
- Department of Epidemiology, University of Iowa, Iowa City
| | - Amy M. J. O’Shea
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City
| | - Michael P. Jones
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Biostatistics, University of Iowa, Iowa City
| | - Mary S. Vaughan Sarrazin
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City
| | - Carrie L. Franciscus
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
| | - Cassie Cunningham Goedken
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
| | | | | | - Jose Cadena
- South Texas Veterans Health Care System, San Antonio
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio
| | | | | | | | | | - Joseph Thurn
- Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Marvin J. Bittner
- Nebraska-Western Iowa Veterans Affairs Health Care System, Omaha, Nebraska
| | - Heather Schacht Reisinger
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
- Department of Internal Medicine, University of Iowa, Iowa City
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RISSO F, MINGHETTI D, MARIANI M, SERVELI S, PARODI A, LA MASA D, CASTAGNOLA E, RAMENGHI L. Behaviours monitoring and infection control in neonatal intensive care unit: how to improve ourselves? J Prev Med Hyg 2019; 60:E226-E228. [PMID: 31650058 PMCID: PMC6797888 DOI: 10.15167/2421-4248/jpmh2019.60.3.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/27/2019] [Indexed: 11/16/2022]
Abstract
Introduction Healthcare-associated infections are important events in neonatal
intensive care unit. Hand hygiene is considered one of the most important procedures
to control these complications. Methods Healthcare workers procedures for patient’s approaching were
directly monitored from February to April 2018 in the Neonatal
Intensive Care Unit of Istituto Giannina Gaslini, Genoa, Italy. Number and type of total contacts with patients or “patient unit”
(e.g.: ventilator, monitor, isolette) were recorded as well as
errors related to lack of hand hygiene after and before performing
procedures. Results A total of 1,040 actions were observed on patient or patient
unit: 560 actions by nursing staff, 240 by residents and 240 by
consultants. The most common misbehaviour was the “double touch” in
nursing staff (30%), “glasses, hair or nose” in residents (35%), and
“double touch” and “glasses hair or nose” in consultants (25% and
23% respectively). Conclusions Extemporaneous contact is the more frequent potential “high risk”
moment for transmission of healthcare associated infections in
NICU.
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Affiliation(s)
| | | | - M. MARIANI
- IRCCS Istituto Giannina
Gaslini, Genova, Italy
| | - S. SERVELI
- IRCCS Istituto Giannina
Gaslini, Genova, Italy
| | - A. PARODI
- IRCCS Istituto Giannina
Gaslini, Genova, Italy
| | - D. LA MASA
- IRCCS Istituto Giannina
Gaslini, Genova, Italy
| | - E. CASTAGNOLA
- IRCCS Istituto Giannina
Gaslini, Genova, Italy
- Correspondence: Elio Castagnola, Infectious
Diseases Unit, Istituto Giannina Gaslini - Ospedale Pediatrico IRCCCS,
largo G. Gaslini 5, 16147 Genova, Italy - Tel. +39 010
56362428 - Fax +39 010 3733450 - E-mail:
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Benudis A, Stone S, Sait AS, Mahoney I, Price LL, Moreno-Koehler A, Anketell E, Doron S. Pitfalls and Unexpected Benefits of an Electronic Hand Hygiene Monitoring System. Am J Infect Control 2019; 47:1102-1106. [PMID: 31005345 DOI: 10.1016/j.ajic.2019.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND No single strategy is more effective than proper hand hygiene (HH) in reducing the spread of nosocomial infections. Unfortunately, health care worker compliance with HH is imperfect. We sought to improve HH compliance using an electronic hand hygiene monitoring system (EHHMS) in 2 units to collect unbiased data and provide feedback. METHODS In this prospective, quasi-experimental study, the Hyginex EHHMS was installed in 2 units at Tufts Medical Center. Ninety-one bracelets were assigned, and electronic data were collected over 8 months. Human observations continued. We compared HH compliance as measured by human observation before, during, and after EHHMS implementation. Pre- and post-implementation surveys were distributed to staff. RESULTS The number of electronically captured HH compliance observations was small due to infrequent bracelet use after month 2 of the intervention. HH compliance, as determined by human observation, increased by an average of 1.3 percentage points per month (P = .0005). Survey responses revealed negative attitudes about the EHHMS before and after its implementation. CONCLUSIONS Despite poor EHHMS participation and negative attitudes toward its implementation, HH compliance, as measured by human observation, significantly improved. Hospitals considering implementing an EHHMS should look to refine the intervention to encourage health care worker participation.
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Affiliation(s)
- Abigail Benudis
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA
| | - Samuel Stone
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA
| | - Afrah S Sait
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA; King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ian Mahoney
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA
| | - Lori Lyn Price
- Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | | | - Eric Anketell
- Patient Care Services, Tufts Medical Center, Boston, MA
| | - Shira Doron
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA.
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Lenglet A, van Deursen B, Viana R, Abubakar N, Hoare S, Murtala A, Okanlawon M, Osatogbe J, Emeh V, Gray N, Keller S, Masters P, Roolvink D, Davies J, Hickox K, Fotso A, Bil K, Ikenna Nwankwo C, Ahmad B, Caluwaerts A, Lessard I, Dimeglio S, Malou N, Kanapathipillai R, McRae M, Wong S, Hopman J. Inclusion of Real-Time Hand Hygiene Observation and Feedback in a Multimodal Hand Hygiene Improvement Strategy in Low-Resource Settings. JAMA Netw Open 2019; 2:e199118. [PMID: 31411711 PMCID: PMC6694391 DOI: 10.1001/jamanetworkopen.2019.9118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/13/2019] [Indexed: 12/21/2022] Open
Abstract
Importance Hand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings. Objective To pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data. Design, Setting, and Participants This prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018. Exposures Multimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time. Main Outcomes and Measures Hand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene. Results A total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]). Conclusions and Relevance This study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Amsterdam, the Netherlands
- Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | | | | | | | | | | | | | - Vera Emeh
- Médecins Sans Frontières, Abuja, Nigeria
| | - Nell Gray
- Médecins Sans Frontières, London, United Kingdom
| | - Sara Keller
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Pete Masters
- Médecins Sans Frontières, London, United Kingdom
| | - Duco Roolvink
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Jane Davies
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Kaci Hickox
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | - Karla Bil
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | | | | | | | | | | | - Nada Malou
- Médecins Sans Frontières, Geneva, Switzerland
- Médecins Sans Frontières, Paris, France
| | - Rupa Kanapathipillai
- Médecins Sans Frontières, Geneva, Switzerland
- Médecins Sans Frontières, Paris, France
| | - Melissa McRae
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Sidney Wong
- Médecins Sans Frontières, Amsterdam, the Netherlands
| | - Joost Hopman
- Médecins Sans Frontières, Amsterdam, the Netherlands
- Radboud University Medical Centre, Nijmegen, the Netherlands
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Smiddy MP, Murphy OM, Savage E, Browne JP. The influence of observational hand hygiene auditing on consultant doctors' hand hygiene behaviors: A qualitative study. Am J Infect Control 2019; 47:798-803.e1. [PMID: 30711350 DOI: 10.1016/j.ajic.2018.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/19/2018] [Accepted: 12/19/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Compliance with hand hygiene guidelines reduces the risk of health care-associated infection, yet doctors are less compliant than other health care workers. Use of observational hand hygiene auditing with targeted individualized feedback was implemented, with improved hand hygiene of consultant doctors; however, the factors that influenced this were not explained by previous quantitative data. The aim was to explore consultant doctors' opinions about the influence of observational hand hygiene auditing with individualized feedback on hand hygiene behavior. METHODS Using the Theoretical Domains Framework, we conducted 12 semi-structured in-depth interviews with consultant doctors who experienced the observational hand hygiene audit and feedback intervention. Data were analyzed using a thematic analysis approach. RESULTS Analysis identified 8 domains of the Theoretical Domains Framework, with 5 dominant domains: (1) behavioral regulation: receiving written individualized audit feedback positively influenced practice; (2) knowledge: provision of specific individualized feedback improved performance; (3) reinforcement: audit highlighted substandard practices; (4) social professional role and identity: audit reports triggered profession-associated competitive motivation; and (5) environmental context and resources: auditing was perceived to be synonymous with strong organizational safety culture. CONCLUSIONS In this study, provision of individualized targeted feedback was a critical component of observational hand hygiene auditing.
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Affiliation(s)
- Maura P Smiddy
- School of Public Health, University College Cork, Cork, Ireland.
| | - Olive M Murphy
- Infection Prevention and Control Team, Bon Secours Hospital, Cork, Ireland
| | - Eileen Savage
- Catherine McCauley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John P Browne
- School of Public Health, University College Cork, Cork, Ireland
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29
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Oppong TB, Yang H, Amponsem-Boateng C, Duan G. Hand Hygiene Habits of Ghanaian Youths in Accra. Int J Environ Res Public Health 2019; 16:ijerph16111964. [PMID: 31163599 PMCID: PMC6603880 DOI: 10.3390/ijerph16111964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 11/16/2022]
Abstract
The human palm has been identified as one of the richest habitats for human microbial accommodation making hand hygiene essential to primary prevention of infection. Since the hand is in constant contact with fomites which have been proven to be mostly contaminated, building hand hygiene habits is essential for the prevention of infection. This research was conducted to assess the hand hygiene habits of Ghanaian youths in Accra. This study used a survey as a quantitative method of research. The findings of the study revealed that out of the 254 participants who fully answered the questionnaire, 22% had the habit of washing their hands after outings while only 51.6% had the habit of washing their hands after using the bathroom. However, about 60% of the participants said they sometimes ate with their hands while 28.9% had the habit of eating with the hand very often, a situation that put them at risk of infection from their hands since some participants had poor handwashing habits; prompting the need for continuous education on hand hygiene.
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Affiliation(s)
- Timothy B Oppong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
| | - Haiyan Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
| | - Cecilia Amponsem-Boateng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
| | - Guangcai Duan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan 450001, China.
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Hilt N, Hulscher MEJL, Antonise-Kamp L, OldeLoohuis A, Voss A. Current practice of infection control in Dutch primary care: Results of an online survey. Am J Infect Control 2019; 47:643-647. [PMID: 30616933 DOI: 10.1016/j.ajic.2018.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Good infection prevention is an important aspect of quality of medical care. The aim was to evaluate infection prevention and control (IPC) performance among Dutch general practitioners (GPs). METHODS Based on the current national IPC guidelines for GPs, a self-administered anonymous online questionnaire was developed and sent to GPs in the Nijmegen region of the Netherlands. Thirty-two questions were constructed to survey characteristics of GPs' offices and assess current performance of IPC measures. RESULTS One hundred questionnaires were included in our analysis. The preferred method of hand hygiene was soap and water (56%) versus alcohol-based handrub (44%). The cleaning of nondisposable, noncritical, semicritical, and critical instruments was consistent with national guideline recommendations or superior to them in 100%, 49%, and 97% of cases, respectively. An average of 57% of GPs reported environmental cleaning frequencies that were compliant with the national guidelines or superior to them. Personal protective equipment was available in 62% of GPs' practices but used in only 25% of home visits to patients. CONCLUSIONS Not all national IPC guidelines seem to be followed to the fullest extent. The current situation indicates there is room for potential improvement regarding implementation of IPC measures in GPs' offices. Area-specific guidelines and continuous medical education regarding IPC may help improve the situation.
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Affiliation(s)
- Nataliya Hilt
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, Groningen, The Netherlands.
| | - Marlies E J L Hulscher
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Laura Antonise-Kamp
- National Coordination Centre for Communicable Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Alfons OldeLoohuis
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Clinical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands; REshape Center for Innovation, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Meng M, Sorber M, Herzog A, Igel C, Kugler C. Technological innovations in infection control: A rapid review of the acceptance of behavior monitoring systems and their contribution to the improvement of hand hygiene. Am J Infect Control 2019; 47:439-447. [PMID: 30527285 DOI: 10.1016/j.ajic.2018.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hand hygiene is crucial for preventing nosocomial infections; however, adherence rates need further attention. Prevention of nosocomial infections through regular hand hygiene monitoring and feedback is recommended by the World Health Organization. Technology holds the potential for achieving this goal. The aim of this study was to assess the influence of technological behavior monitoring innovations on hand hygiene adherence and their acceptance by healthcare professionals. METHODS A rapid review of the literature was conducted. A literature search was performed in electronic databases (Cochrane Library, Scopus, PubMed, CINAHL, PsycINFO, PsycARTICLES, PSYNDEX) and via citation tracking in November 2017. Records were screened for eligibility. Included studies were analyzed and synthesized in a narrative, tabular way. RESULTS Overall, 2,426 studies were identified, and 12 were included. Findings indicated that behavior monitoring technology improves hand hygiene adherence, resulting in adherence increases between 6.40%-54.97%. The majority of systems provided real-time feedback. Factors influencing acceptance of technology by healthcare professionals include transparency and confidentiality, user attitude and environment, device function, and device usability. CONCLUSIONS Recognizing the importance of hand hygiene adherence, active communication between behavior monitoring technology and healthcare workers seems to mediate improvement in sustainable hand hygiene adherence behavior.
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Affiliation(s)
- Michael Meng
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Michaela Sorber
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Christoph Igel
- Educational Technology Lab, German Research Center for Artificial Intelligence, Berlin, Germany
| | - Christiane Kugler
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Vasudevan RS, Mojaver S, Chang KW, Maisel AS, Frank Peacock W, Chowdhury P. Observation of stethoscope sanitation practices in an emergency department setting. Am J Infect Control 2019; 47:234-237. [PMID: 30415805 DOI: 10.1016/j.ajic.2018.08.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stethoscopes harbor pathogens that can be transferred to patients when proper sanitary measures are not taken. Our aim was to assess medical provider stethoscope cleaning and hand hygiene in an emergency department setting. METHODS The frequency and methods of stethoscope cleaning during and after provider-patient encounters were observed anonymously in an emergency department of the VA San Diego Healthcare System. RESULTS Among the total of 426 encounters, 115 (26.9%) involved the use of a personal stethoscope. In 15 of these 115 encounters (13.0%), the provider placed a glove over the stethoscope before patient contact. In 13 of these 115 encounters (11.3%), the provider cleaned the stethoscope with an alcohol swab after patient interaction. Stethoscope hygiene with water and a hand towel before patient interaction was observed in 5 of these 115 encounters (4.3%). Hand sanitizer use or handwashing was observed in 213 of the 426 encounters (50.0%) before patient interaction. Gloves were used before patient interaction in 206 of these 426 encounters (48.4%). Hand sanitizer or handwashing was used in 332 of the 426 encounters (77.9%) after patient interaction. CONCLUSIONS Rates of stethoscope and hand hygiene performance were lower than expected. Further investigation of stethoscope contamination and the associated risk of nosocomial infection are needed. Perhaps clearer guidelines on proper stethoscope cleaning would reduce this risk.
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Affiliation(s)
- Rajiv S Vasudevan
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA.
| | - Sean Mojaver
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Kay-Won Chang
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - Alan S Maisel
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, TX
| | - Punam Chowdhury
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA; Department of Emergency Medicine, VA San Diego Healthcare System, La Jolla, CA
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Smith JD, Corace KM, MacDonald TK, Fabrigar LR, Saedi A, Chaplin A, MacFarlane S, Valickis D, Garber GE. Application of the Theoretical Domains Framework to identify factors that influence hand hygiene compliance in long-term care. J Hosp Infect 2018; 101:393-398. [PMID: 30594611 DOI: 10.1016/j.jhin.2018.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Healthcare worker (HCW) hand hygiene compliance is key to patient safety; however, compliance is suboptimal. Nevertheless hand hygiene compliance is not well studied in the long-term care setting. AIM To apply a behaviour change framework, the Theoretical Domains Framework (TDF), to identify modifiable facilitators and barriers for HCW hand hygiene compliance in long-term care settings. METHODS HCW hand hygiene compliance facilitators and barriers were examined using a questionnaire for HCWs from long-term care homes in Ontario, Canada. The questionnaire was informed by the TDF, which is based on a synthesis of constructs from a number of relevant psychological theories of behaviour change. FINDINGS Barriers identified from the questionnaire aligned with the TDF domain environmental context and resources (time pressure, workload, and environmental controls). Facilitators identified from questionnaire results aligned with the TDF domains social/professional role and identity (it is what is expected of HCWs), and beliefs about consequences (risk of transmission of micro-organisms to self or others). CONCLUSION There are several barriers to hand hygiene compliance that persist in long-term care. A behaviour change theory-informed framework such as the TDF can be helpful to identify those barriers. This study identified several key behavioural constructs aligned with the TDF that can be targeted when developing novel hand hygiene interventions.
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Affiliation(s)
- J D Smith
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - K M Corace
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - T K MacDonald
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - L R Fabrigar
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - A Saedi
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - A Chaplin
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - S MacFarlane
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - D Valickis
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada
| | - G E Garber
- Infection Prevention and Control, Public Health Ontario, Toronto, ON, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital Research Institute, Ottawa, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Livorsi DJ, Goedken CC, Sauder M, Vander Weg MW, Perencevich EN, Reisinger HS. Evaluation of Barriers to Audit-and-Feedback Programs That Used Direct Observation of Hand Hygiene Compliance: A Qualitative Study. JAMA Netw Open 2018; 1:e183344. [PMID: 30646239 PMCID: PMC6324430 DOI: 10.1001/jamanetworkopen.2018.3344] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Audit and feedback based on direct observation is a common strategy to improve hand hygiene compliance, but the optimal design and delivery of this intervention are poorly defined. OBJECTIVE To describe barriers encountered by audit-and-feedback programs for hand hygiene across acute care hospitals within the Veterans Health Administration. DESIGN, SETTING, AND PARTICIPANTS A qualitative study was conducted at a geographically diverse convenience sample of 10 acute care hospitals within the Veterans Health Administration. Participants included 108 infection prevention team personnel and frontline staff. All data were collected between June 30, 2014, and March 18, 2015. Data were analyzed between September 6, 2017, and January 5, 2018. MAIN OUTCOMES AND MEASURES Barriers to audit and feedback for hand hygiene compliance were evaluated. Semistructured interviews of key personnel were performed through site visits at 6 locations and telephone interviews with 4 sites. Focus groups were conducted with frontline staff. Interviews and focus groups were audio recorded and transcribed. All transcripts were analyzed using thematic content analysis. RESULTS Overall, 108 individuals participated in the study. Semistructured interviews were conducted with 38 individuals, who were predominantly infection prevention team members. Focus group interviews were conducted with 70 frontline hospital staff members. Surveillance activities at all 10 sites made use of a variety of staff members with the intention of covertly collecting direct observations on hand hygiene compliance. Monitoring programs were challenging to maintain because of constraints on time and personnel. Both auditors and frontline staff expressed skepticism about the accuracy of compliance data based on direct observations. Auditors expressed concern about the Hawthorne effect, while frontline staff were worried that their compliance was not visible to auditors. In most hospitals, approaches to monitoring hand hygiene compliance produced friction between frontline staff and infection prevention teams. The feedback process for audit results did not consistently reach frontline staff and, in many hospitals, did not seem to facilitate improvement efforts. CONCLUSIONS AND RELEVANCE Auditing hand hygiene compliance with direct observation was problematic across these acute care hospitals. Auditing was perceived to collect inaccurate data and created tension with frontline staff, and the feedback process did not appear to encourage positive change. Strategies are needed to collect more reliable hand hygiene data and facilitate multidisciplinary collaboration toward improved compliance.
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Affiliation(s)
- Daniel J. Livorsi
- Center for Comprehensive Access Delivery & Research, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Cassie Cunningham Goedken
- Center for Comprehensive Access Delivery & Research, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | | | - Mark W. Vander Weg
- Center for Comprehensive Access Delivery & Research, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City
| | - Eli N. Perencevich
- Center for Comprehensive Access Delivery & Research, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
| | - Heather Schacht Reisinger
- Center for Comprehensive Access Delivery & Research, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City
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Öncü E, Vayısoğlu SK, Lafcı D, Yıldız E. An evaluation of the effectiveness of nursing students' hand hygiene compliance: A cross-sectional study. Nurse Educ Today 2018; 65:218-224. [PMID: 29604605 PMCID: PMC7115509 DOI: 10.1016/j.nedt.2018.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/04/2018] [Accepted: 02/20/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Emine Öncü
- Community Health Nursing Department, Faculty of Nursing, Mersin University, Mersin, Turkey.
| | | | - Diğdem Lafcı
- Fundementals of Nursing Department, Faculty of Nursing, Mersin University, Mersin, Turkey
| | - Ebru Yıldız
- Fundementals of Nursing Department, Faculty of Nursing, Mersin University, Mersin, Turkey
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Lastinger A, Gomez K, Manegold E, Khakoo R. Use of a patient empowerment tool for hand hygiene. Am J Infect Control 2017; 45:824-829. [PMID: 28768590 DOI: 10.1016/j.ajic.2017.02.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patient empowerment is recognized as an important component of a multimodal strategy to improve hand hygiene adherence. We examined the attitudes of adult patients and parents of pediatric patients toward a new patient empowerment tool (PET) at our hospital. We also surveyed physicians to determine their perceptions about the PET. METHODS A cross-sectional survey was performed of hospitalized children's parents and adult patients in a 531-bed tertiary care teaching hospital in West Virginia. Surveys were anonymous and self-administered. A separate survey was administered via e-mail to resident and attending physicians from the departments of internal medicine, pediatrics, and family medicine. RESULTS Most parents and adult patients felt it was their role to speak up if a provider did not perform hand hygiene, but a smaller number actually felt comfortable using the PET. Only 54.9% of physicians felt that patients should be involved in reminding providers to perform hand hygiene. Overall, physicians indicated that they would prefer a patient to use words rather than the PET to remind them to perform hand hygiene. CONCLUSIONS In our study, parents and adult patients supported use of the PET, but physicians were less supportive. As the patient empowerment movement grows, we should work to improve physician acceptance of patient involvement if it is to be successful.
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Affiliation(s)
- Allison Lastinger
- Section of Infectious Diseases, School of Medicine, West Virginia University, Morgantown, WV.
| | - Kayeromi Gomez
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV
| | - Ellen Manegold
- Department of Psychology, Eberly College of Arts and Sciences, West Virginia University, Morgantown, WV
| | - Rashida Khakoo
- Section of Infectious Diseases, School of Medicine, West Virginia University, Morgantown, WV
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Ejechi BO, Ochei OP. Bacteriological safety assessment, hygienic habits and cross-contamination risks in a Nigerian urban sample of household kitchen environment. Environ Monit Assess 2017; 189:298. [PMID: 28551887 DOI: 10.1007/s10661-017-6016-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
Urban household kitchen environment was assessed for safety by determining their levels of indicator bacteria, hygienic habits and risk of cross-contamination. Household kitchens (60) were selected in Warri Town, Nigeria, by the multi-stage sampling technique. Contact surfaces, water and indoor kitchen air were analysed for aerobic plate counts, total and faecal coliforms using Nutrient and McConkey media by swab/rinse method, membrane filtration and sedimentation methods, respectively. Hygienic habits and risk of cross-contamination were assessed with structured questionnaire which included socio-demographic variables. On the basis of median counts, the prevalence of high counts (log cfu/cm2/m3/100 mL) of aerobic plate counts (>3.0), total coliforms (>1.0) and faecal coliforms (>0) on contact surfaces and air was high (58.0-92.0%), but low in water (30.0-40.0%). Pots, plates and cutleries were the contact surfaces with low counts. Prevalence of poor hygienic habits and high risk of cross-contamination was 38.6 and 67.5%, respectively. Education, occupation and kitchen type were associated with cross-contamination risk (P = 0.002-0.022), while only education was associated with hygienic habits (P = 0.03). Cross-contamination risk was related (P = 0.01-0.05) to aerobic plate counts (OR 2.30; CL 1.30-3.17), total coliforms (OR 5.63; CL 2.76-8.25) and faecal coliforms (OR 4.24; CL 2.87-6.24), while hygienic habit was not. It can be concluded that urban household kitchens in the Nigerian setting are vulnerable to pathogens likely to cause food-borne infections.
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Affiliation(s)
- Bernard O Ejechi
- Department of Microbiology, Delta State University, P. M. B. 1, Abraka, Nigeria.
| | - Ono P Ochei
- Department of Microbiology, Delta State University, P. M. B. 1, Abraka, Nigeria
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Kingston LM, O'Connell NH, Dunne CP. Survey of attitudes and practices of Irish nursing students towards hand hygiene, including handrubbing with alcohol-based hand rub. Nurse Educ Today 2017; 52:57-62. [PMID: 28259049 DOI: 10.1016/j.nedt.2017.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/16/2016] [Accepted: 02/21/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Hand hygiene is widely recognised as the most important measure a healthcare worker can take in preventing the spread of healthcare associated infections. As a member of the healthcare team, nursing students have direct patient contact during clinical practice; hence, good hand hygiene practice among nursing students is essential. Low to moderate levels of hand hygiene knowledge and poor attitudes and practices are reported among nursing students. However, less is known about their attitudes and practices of handrubbing with ABHR, even though handrubbing is the recommended optimum practice in most situations. AIM The aim of this study was to explore attitudes and practices of hand hygiene, in particular handrubbing with alcohol-based hand rub, among nursing students in Ireland. DESIGN This survey employed a descriptive, self-report design using a questionnaire to gather data. It was administered electronically to all undergraduate nursing students (n=342) in the Department of Nursing and Midwifery at the University of Limerick, Ireland in March and April 2015. RESULTS Response rate was 66%. Attitudes towards hand hygiene were generally positive. Compliance with hand hygiene after contact with body fluid was high (99.5%) and before a clean or aseptic procedure (98.5%). However, suboptimal practices emerged, before touching a patient (85%), after touching a patient (87%) and after touching patients' surroundings (61%), with first year students more compliant than fourth year students. 16% of students were not aware of the clinical contraindications for using alcohol-based hand rub and 9% did not know when to use soap and water and when to use alcohol-based hand rub. CONCLUSION Educators and practitioners play an important role in ensuring that nursing students develop appropriate attitudes towards hand hygiene and engage in optimal handrubbing practices. Raising awareness among nursing students of their responsibility in preventing the occurrence and reducing the transmission of HCAI as an on-going endeavour is required, with the laudable aim of preventing complacency and ultimately improving patient outcomes.
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Affiliation(s)
- Liz M Kingston
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
| | - Nuala H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- Graduate Entry Medical School and Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
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Azor-Martinez E, Cobos-Carrascosa E, Seijas-Vazquez ML, Fernández-Sánchez C, Strizzi JM, Torres-Alegre P, Santisteban-Martínez J, Gimenez-Sanchez F. Hand Hygiene Program Decreases School Absenteeism Due to Upper Respiratory Infections. J Sch Health 2016; 86:873-881. [PMID: 27866386 DOI: 10.1111/josh.12454] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 03/17/2016] [Accepted: 06/22/2016] [Indexed: 05/25/2023]
Abstract
BACKGROUND We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs). METHODS This was a randomized, controlled, and open study on a sample of 1341 children 4-12 years old, attending 5 state schools in Almería (Spain), with an 8-month follow-up. The experimental group (EG) washed their hands with soap and water, together with using hand sanitizer, and the control group followed their usual handwashing procedures. Absenteeism rates due to URIs were compared between the 2 groups through a multivariate Poisson regression analysis. The percent of days missed in both groups were compared with a z test. RESULTS Overall, 1271 cases of school absenteeism due to URIs were registered. Schoolchildren from the EG had a 38% lower risk of absenteeism due to URIs, incidence rate ratio: 0.62, 95% confidence interval: 0.55-0.70, and a decrease in absenteeism of 0.45 episodes/child/academic year, p < .001. Pupils missed 2734 school days due to URIs and the percentage of days absent was significantly lower in the EG, p < .001. CONCLUSIONS Use of hand sanitizer plus handwashing with soap accompanied by educational support is an effective measure to reduce absenteeism due to URIs.
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Affiliation(s)
- Ernestina Azor-Martinez
- Distrito Sanitario, Atención Primaria Almería, España, C) Haza de Acosta S/N 04009, Almería, Spain
| | - Elena Cobos-Carrascosa
- Servicio de Pediatría, Hospital Torrecárdenas, Almería, España, C) Ramon y Cajal N° 11 Villanueva Mesia 18369, Granada, Spain
| | | | - Carmen Fernández-Sánchez
- Servicio de Farmacia Hospital Torrecardenas, C) Hermandad de Donantes de Sangre S/N, CP 04009, Almería, Spain
| | - Jenna M Strizzi
- Roger Williams University, 1 Old Ferry Rd, Bristol, RI 02809
| | - Pilar Torres-Alegre
- Unidad de Formación, e Investigación Distrito Almería España, C) Pablo Neruda 2, portal 12, 6° 1, 04009, Almería, Spain
| | | | - Francisco Gimenez-Sanchez
- Servicio de Pediatría, Hospital Torrecárdenas, Almería, España, C) Pepe Isbert 55, 04007, Almería. Spain
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Kovacs-Litman A, Wong K, Shojania KG, Callery S, Vearncombe M, Leis JA. Do physicians clean their hands? Insights from a covert observational study. J Hosp Med 2016; 11:862-864. [PMID: 27378510 DOI: 10.1002/jhm.2632] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 11/09/2022]
Abstract
Physicians are notorious for poor hand hygiene (HH) compliance. We wondered if lower performance by physicians compared with other health professionals might reflect differences in the Hawthorne effect. We introduced covert HH observers to see if performance differences between physicians and nurses decreased and to gain further insights into physician HH behaviors. Following training and validation with a hospital HH auditor, 2 students covertly measured HH during clinical rotations. Students rotated off clinical services every week to increase exposure to different providers and minimize risk of exposing the covert observation. We compared covertly measured HH compliance with data from overt observation by hospital auditors during the same time period. Covert observation produced much lower HH compliance than recorded by hospital auditors during the same time period: 50.0% (799/1597) versus 83.7% (2769/3309) (P < 0.0002). The difference in physician compliance between hospital auditors and covert observers was 19.0% (73.2% vs 54.2%); for nurses this difference was much higher at 40.7% (85.8% vs 45.1%) (P < 0.0001). Physician trainees showed markedly better compliance when attending staff cleaned their hands compared with encounters when attending did not (79.5% vs 18.9%; P < 0.0002). Our study suggests that traditional HH audits not only overstate HH performance overall, but can lead to inaccurate inferences about performance by professional groupings due to relative differences in the Hawthorne effect. We suggest that future improvement efforts will rely on more accurate HH monitoring systems and strong attending physician leadership to set an example for trainees. Journal of Hospital Medicine 2015;11:862-864. © 2015 Society of Hospital Medicine.
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Affiliation(s)
- Adam Kovacs-Litman
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Wong
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Kaveh G Shojania
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Callery
- Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mary Vearncombe
- Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jerome A Leis
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Divsion of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Paccha B, Neira-Ramirez V, Gibbs S, Torremorell M, Rabinowitz PM. Swine Worker Precautions During Suspected Outbreaks of Influenza in Swine. JOURNAL OF ENVIRONMENTAL HEALTH 2016; 78:22-45. [PMID: 27263180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
To assess the behavior and precautions that swine workers take during suspected influenza outbreaks in swine, six commercial swine farms in the Midwest U.S. region were visited when influenza outbreaks were suspected in herds during the fall/winter of 2012-2013. Use of personal protective equipment (PPE) and type of task performed by swine workers were recorded based on farm representative reports. Between one to two workers were working on the day of each visit and spent approximately 25 minutes performing work-related tasks that placed them in close contact with the swine. The most common tasks reported were walking the aisles (27%), handling pigs (21%), and handling equipment (21%). The most common PPE were boots (100%), heavy rubber gloves (75%), and dedicated nondisposable clothing (74%). Use of N95 respirators was reported at three farms. Hand hygiene practices were common in most of the farms, but reportedly performed for only 20% to 25% of tasks.
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Sakihama T, Honda H, Saint S, Fowler KE, Kamiya T, Sato Y, Iuchi R, Tokuda Y. Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers. J Hosp Med 2016; 11:199-205. [PMID: 26427035 DOI: 10.1002/jhm.2491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 07/15/2015] [Accepted: 08/05/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Though hand hygiene is an important method of preventing healthcare-associated infection, we found suboptimal hand hygiene adherence among healthcare workers in 4 diverse Japanese hospitals (adherence rates of 11%-25%). OBJECTIVE Our goal was to assess multimodal hand hygiene intervention coupled with a contest to improve hand hygiene adherence. SETTING A total of 3 to 4 inpatient wards in 3 Japanese hospitals. DESIGN Pre-post intervention study. INTERVENTION The intervention was a multimodal hand hygiene intervention recommended by the World Health Organization that was tailored to each facility. The hospital with the highest adherence after the intervention was given $5000 US dollars and a trophy, provided by an American coinvestigator unaffiliated with any of the Japanese hospitals. MEASUREMENT We tracked hand hygiene adherence rates before patient contact for each unit and hospital and compared these to pre-intervention adherence rates. RESULTS We observed 2982 postintervention provider-patient encounters in 10 units across 3 hospitals. Hand hygiene adherence rates were improved overall after the intervention (18% pre- to 33% postintervention; P < 0.001), but postintervention adherence rates varied considerably: hospital A + 29%, B + 5%, C + 8%. Hospital A won the contest with 40% adherence after the intervention. CONCLUSIONS Using a novel contest coupled with a multimodal intervention successfully improved hand hygiene rates among Japanese healthcare workers. Given the overall low rates, however, further improvement is necessary.
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Affiliation(s)
- Tomoko Sakihama
- Department of Nursing, International University of Health and Welfare Graduate School, Minato-ku, Tokyo, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | - Sanjay Saint
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Toru Kamiya
- Division of General Internal Medicine & Infectious Diseases, Rakuwakai Otowa Hospital, Yamashina, Kyoto, Japan
| | - Yumiko Sato
- Division of Infection Control, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan
| | - Ritsuko Iuchi
- Division of Infection Control, Rakuwakai Otowa Hospital, Yamashina, Kyoto, Japan
| | - Yasuharu Tokuda
- Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan
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Graves N, Page K, Martin E, Brain D, Hall L, Campbell M, Fulop N, Jimmeison N, White K, Paterson D, Barnett AG. Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia. PLoS One 2016; 11:e0148190. [PMID: 26859688 PMCID: PMC4747462 DOI: 10.1371/journal.pone.0148190] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/14/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. METHODS The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012. FINDINGS No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. CONCLUSIONS The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained. The return on investment varied among the states and territories of Australia.
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Affiliation(s)
- Nicholas Graves
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Katie Page
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Martin
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Brain
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lisa Hall
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Megan Campbell
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Naomi Fulop
- Department of Applied Health Research, University College London, London, United Kingdom
| | - Nerina Jimmeison
- School of Management, Queensland University of Technology, Brisbane, Australia
| | - Katherine White
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Paterson
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Adrian G. Barnett
- Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Korzeniewski K. Prevalence of intestinal parasitic infections in the population of Central Asia on the example of inhabitants of Eastern Afghanistan. Przegl Epidemiol 2016; 70:563-573. [PMID: 28221011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Parasitic diseases of the gastrointestinal tract are a major health problem worldwide, especially in the Third World countries, where poor standards of hygiene and sanitation as well as the lack of medical care facilitate the spread of food and waterborne infections. AIM To estimate the prevalence of intestinal parasitic infections in Central Asia on the example of the population inhabiting the Ghazni Province in eastern part of the country and to assess the validity of the WHO recommended mass deworming campaign carried out in Afghanistan. Taking into consideration the fact that hundreds of thousands of immigrants from Asia and Africa have recently been flooding into Europe, it has become necessary to investigate the epidemiology of intestinal parasitoses in areas characterized by different climatic conditions and poor standards of sanitation. MATERIAL AND METHODS The study was conducted in eastern Afghanistan between November 2011 and April 2014. Parasitological examination was performed on 3 different study groups: 110 soldiers from the Afghan National Army (adults), 1,167 patients hospitalized at the Ghazni Provincial Hospital (807 children and adolescents aged 1–18 and 360 adults), and 1,869 students (7–18 years) frequenting local schools. The study involved 3,146 people including: 2,248 females and 898 males; 2,676 children and adolescents (1–18 years) and 460 adults (19–85 years). Three stool samples were collected from each study subject at the intervals of 2 to 3 days. The samples were fixed in 10% formalin and then transported by air to the Department of Epidemiology and Tropical Medicine (Military Institute of Medicine) in Poland, where they were examined by light microscopy using 3 different diagnostic methods (direct smear in Lugol’s solution, decantation with distilled water, Fülleborn’s flotation). RESULTS In total, 1,220 Afghans were found to be infected with pathogenic intestinal parasites (38.8%): 44/110 soldiers (40.0%), 322/807 hospitalized children and adolescents (39.9%), 102/360 hospitalized adults (28.3%) and 752/1869 children and adolescents frequenting local schools (40.2%). Higher infection rates were observed in children and adolescents (40.1% vs. 31.1% adults), in boys (40.8% vs. 39.9% girls), and in the adult population – in women (31.2% vs. 31.0% men). The most commonly detected intestinal parasites in all study groups were: Ascaris lumbricoides (619/3146, 19.7%), Giardia intestinalis (489/3146, 15.5%) and Hymenolepis nana (206/3146, 6.5%). SUMMARY AND CONCLUSIONS The prevalence and diversity of intestinal parasitic infections is high in the population of Central Asia. The infections caused by a wide range of nematodes, cestodes and protozoa are common among inhabitants of eastern Afghanistan. This fact suggests that the WHO-recommended deworming strategy (a single dose of 500 mg mebendazole or 400 mg albendazole) needs to be reviewed and should be replaced by targeted antiparasitic chemotherapy (albendazole, metronidazole, praziquantel), following mass screening of the local population.
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Affiliation(s)
- Krzysztof Korzeniewski
- Military Institute of Medicine in Warsaw, Department of Epidemiology and Tropical Medicine in Gdynia
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Klein F, Severijns C, Albiez D, Seljutin E, Jovanović M, Eyvazi Hesar M. The Hygiene Games. Stud Health Technol Inform 2016; 225:658-662. [PMID: 27332297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Addressing the correlation of hospital acquired infections and insufficient hand hygiene, we propose a supportive system to enhance the individual hygiene habits of health care workers. By applying gamification to incentivize health care professionals while maintaining a high standard of privacy and usability, the system focuses on technical simplicity by using concepts like bring your own device in a scaleable proof of concept implementation.
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Affiliation(s)
- Frederic Klein
- FH Aachen University of Applied Sciences, Aachen, Germany
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Schriewer A, Odagiri M, Wuertz S, Misra PR, Panigrahi P, Clasen T, Jenkins MW. Human and Animal Fecal Contamination of Community Water Sources, Stored Drinking Water and Hands in Rural India Measured with Validated Microbial Source Tracking Assays. Am J Trop Med Hyg 2015; 93:509-516. [PMID: 26149868 PMCID: PMC4559688 DOI: 10.4269/ajtmh.14-0824] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 05/23/2015] [Indexed: 11/07/2022] Open
Abstract
We examined pathways of exposure to fecal contamination of human and animal origin in 24 villages in Odisha, India. In a cross-sectional study during the monsoon season, fecal exposure via community water sources (N = 123) and in the home (N = 137) was assessed using human- and nonhuman-associated Bacteroidales microbial source tracking (MST) markers and fecal coliforms (FCs). Detection rates and marker concentrations were examined to pinpoint pathways of human fecal exposure in the public and domestic domains of disease transmission in study communities. Human fecal markers were detected much more frequently in the domestic domain (45% of households) than in public domain sources (8% of ponds; 4% of groundwater drinking sources). Animal fecal markers were widely detected in both domains (74% of ponds, 96% of households, 10% of groundwater drinking sources), indicating ubiquitous risks of exposure to animal feces and zoonotic pathogens. This study confirms an often suggested contamination link from hands to stored water in the home in developing countries separately for mothers' and children's hands and both human and animal fecal contamination. In contrast to MST markers, FCs provided a poor metric to assess risks of exposure to fecal contamination of human origin in this rural setting.
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Affiliation(s)
| | | | | | | | | | | | - Marion W. Jenkins
- *Address correspondence to Marion W. Jenkins, Department of Civil and Environmental Engineering, University of California, Davis, One Shields Avenue, Davis, CA 95618. E-mail:
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Tomar S, Lodha R, Das B, Kapil A. Hand Hygiene Compliance of Healthcare Workers in a Pediatric Intensive Care Unit. Indian Pediatr 2015; 52:620-621. [PMID: 26244961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We conducted an observational study over 11 months to assess the hand-hygiene compliance of health-care workers in a Pediatric intensive care unit. The overall compliance was 80.9%, which decreased with increase in workload (79.2% vs. 82.9%). Assessment of hand hygiene compliance helps understand the gaps in practices followed by healthcare workers, and plan effective protocols.
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Affiliation(s)
- Shilpa Tomar
- Departments of Microbiology and Pediatrics, AIIMS, New Delhi, India.
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Sahai V, Eden K, Glustein S. Hand hygiene and health care hierarchy by year of medical education. Educ Health (Abingdon) 2015; 28:148-149. [PMID: 26609017 DOI: 10.4103/1357-6283.170120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Vic Sahai
- Director of Research Institute and Business Development at Hotel Dieu Hospital; Assistant Professor, Department of Public Health Sciences, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
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Leeamornsiri S, Titawattanakul Y. Comparative Knowledge and Behavior of Contact Lens Care between Medical and Non-Medical Students. J Med Assoc Thai 2015; 98 Suppl 3:S16-S23. [PMID: 26387383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To compare knowledge and behavior of contact lens care between medical and non-medical students. MATERIAL AND METHOD Cross sectional study. Participants consisted of 200 medical students (M) and 200 non-medical students (N) who wore contact lenses within the recent one year. A structured questionnaire was filled in by subjects. RESULTS Approximately 50% of participants had been contact lens wearers for less than one year The purposes ofwearing lenses included vision correction (73.6%) and cosmetic (26.4%). Non-medical students wore color lenses significantly more than medical students. Non-medical students bought lenses from internet and markets significantly more than medical students did. For the knowledge component, the contact lens-related complications which participants can name were significantly different in both groups including allergic conjunctivitis (M: 73.2%, N: 61.3%), corneal abrasion (M: 58%, N: 36.7%), corneal ulcer (M: 61.6%, N: 45.7%), and corneal neovascularization (M: 29.8%, N: 18%). The behavior that participants had differed significantly in both groups were included rinsing lenses with tap water (M: 19.7%, N: 29.8%), and washing hands before handling lenses (M: 82.7%, N: 71%). The five common improper behaviors of lens care were similar in both groups and included wearing lenses longer than recommended, not changing lens storage solution daily, swimming while wearing lenses, using tap waterfor rising lenses and not washing hands before handling lenses. CONCLUSION Medical students had better knowledge and behavior of contact lens care than non-medical students. However, both groups ofstudents still lacked adequate knowledge and were non-compliant with contact lens care instruction.
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Hon CY, Teschke K, Shen H. Health Care Workers' Knowledge, Perceptions, and Behaviors Regarding Antineoplastic Drugs: Survey From British Columbia, Canada. J Occup Environ Hyg 2015; 12:669-677. [PMID: 25897641 DOI: 10.1080/15459624.2015.1029618] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although nurses are knowledgeable regarding the risk of exposure to antineoplastic drugs, they often do not adhere with safe work practices. However, the knowledge, perceptions, and behavior of other health care job categories at risk of exposure has yet to be determined. This study aimed to survey a range of health care workers from British Columbia, Canada about their knowledge, perceptions, and behaviors regarding antineoplastic drugs. A self-administered questionnaire was sent to participants querying the degree of contact with antineoplastics, knowledge of risks associated with antineoplastics, perceptions of personal risk, previous training with respect to antineoplastics, and safe work practices. Subjects were recruited from health care facilities in and around Vancouver. Fisher's exact tests were performed to ascertain whether there were differences in responses between job categories. We received responses from 120 participants representing seven different job categories. Pharmacists, pharmacy technicians, and nurses were more knowledgeable regarding risks than other job categories examined (statistically significant difference). Although 80% of respondents were not afraid of working with or near antineoplastics, there were concerns about the suitability of current control measures and practices employed by co-workers. Only half of respondents felt confident that they could handle all situations where there was a potential for exposure. Only one of the perception questions, self-perceived risk of exposure to antineoplastic drugs, differed significantly between job categories. Not all respondents always wore gloves when directly handling antineoplastic drugs. Further, hand hygiene was not regularly practiced after glove usage or after being in an area where antineoplastic drugs are handled. The majority of responses to questions related to safe work practices differed significantly between job categories. Our results suggest that knowledge regarding risks associated with antineoplastic drugs can be improved, especially among job categories that are not tasked with drug preparation or drug administration. There is also a gap between knowledge and compliance with glove usage and hand hygiene.Training is also recommended to improve health care workers' perceptions of the risks associated with antineoplastic drugs.
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Affiliation(s)
- Chun-Yip Hon
- a School of Occupational and Public Health, Ryerson University , Toronto , Ontario , Canada
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