The effect of a hand hygiene intervention on infections in residents of nursing homes: a cluster randomized controlled trial

BACKGROUND

The primary goal of hand hygiene is to reduce infectious disease rates. We examined if a nursing home's participation in a hand hygiene intervention resulted in residents having fewer healthcare associated infections (HAIs) when compared to nursing homes without the hand hygiene intervention.

METHODS

This study is a part of a cluster randomized controlled trial (RCT) in 33 nursing homes to improve hand hygiene (HANDSOME). The incidence of five illnesses was followed over 13 months: gastroenteritis, influenza-like illness, pneumonia, urinary tract infections and infections from methicillin-resistant Staphylococcus aureus (MRSA). Incidence rates per study arm were reported for baseline (October-December 2016) and two follow-up periods (January-April 2017, May-October 2017). HAI rates were compared in a Poisson multilevel analysis, correcting for baseline differences (the baseline infection incidence and the size of the nursing home), clustering of observations within nursing homes, and period in the study.

RESULTS

There was statistically significantly more gastroenteritis (p < 0.001) and statistically significantly less influenza-like illness (p < 0.01) in the intervention arm when compared to the control arm. There were no statistically significant differences or pneumonia, urinary tract infections, and MRSA infections in the intervention arm when compared to the control arm. In a sensitivity analysis, gastroenteritis was no longer statistically significantly higher in the intervention arm (p = 0.92).

CONCLUSIONS

As in comparable studies, we could not conclusively demonstrate the effectiveness of an HH intervention in reducing HAIs among residents of nursing homes, despite the use of clearly defined outcome measures, a standardized reporting instrument, and directly observed HH in a multicenter cluster RCT. Trial registration Netherlands Trial Register, trial NL6049 (NTR6188). Registered October 25, 2016, https://www.trialregister.nl/trial/6049 .

Is there an adequate alternative to commercially manufactured face masks? A comparison of various materials and forms

BACKGROUND

There is a worldwide shortage of medical-grade face masks. Donning masks can play an important role in curbing the spread of SARS-CoV-2.

AIM

To conclude whether there is an effective mask for the population to wear in public that could easily be made during a medical face mask shortage using readily available materials.

METHODS

We determined the effectiveness of readily available materials and models for making a face mask. The outcomes were compared with N95/FFP2/KN95 masks that entered the Netherlands in April-May 2020. Masks were tested to determine whether they filtered a minimum of 35% of 0.3-μm particles, are hydrophobic, seal on the face, are breathable, and can be washed.

FINDINGS

Fourteen of the 25 (combinations of) materials filtered at least 35% of 0.3-μm particles. Four of the materials proved hydrophobic, all commercially manufactured filters. Two models sealed the face. Twenty-two of the 25 materials were breathable at <0.7 mbar. None of the hydrophobic materials stayed intact after washing.

CONCLUSIONS

It would be possible to reduce the reproduction rate of SARS-CoV-2 from 2.4 to below one if 39% of the population would wear a mask made from ePM₁ 85% commercially manufactured filter fabric and in a duckbill form. This mask performs better than 80% of the imported N95/FFP2/KN95 masks and provides a better fit than a surgical mask. Two layers of quilt fabric with a household paper towel as filter is also a viable choice for protecting the user and the environment.