1
|
Aboul-Enein BH, Kelly PJ, Raddi S, Keller T, Almoayad F. Effectiveness of hand hygiene campaigns and interventions across the League of Arab States: a region-wide scoping review. J Hosp Infect 2024; 147:161-179. [PMID: 38492646 DOI: 10.1016/j.jhin.2024.02.022] [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] [Received: 12/24/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/18/2024]
Abstract
Hand hygiene is a standard public health practice for limiting the spread of infectious diseases, yet they are still not routine global health behaviours. This review aimed to examine the effectiveness of various hand hygiene interventions conducted across the League of Arab States, identify gaps in the existing literature, and propose areas for future research and intervention development. A scoping review was conducted across 16 databases for relevant publications published up to and including October 2023. Forty studies met the inclusion criteria; of these, 34 were hospital-based and six community-based. Of the reviewed studies, 24 provided adequate details that would enable replication of their intervention. Eighteen of the studies used some variation of the World Health Organization's Five Moments for intervention content or assessment. More than half (N = 25) reported healthcare worker or student hand hygiene behaviours as an outcome and 15 studies also included some form of patient-centred outcomes. Six studies specified the use of theory or framework for their evaluation design or intervention content, and four studies mentioned use of local government guidelines or recommendations. Future research should focus on bridging the literature gaps by emphasizing community-based studies and integrating cultural nuances into intervention designs. Additionally, applying theoretical frameworks to hand hygiene studies could enhance understanding and effectiveness, ensuring sustainable improvements in hygiene practices across diverse settings in the League of Arab States.
Collapse
Affiliation(s)
- B H Aboul-Enein
- London School of Hygiene & Tropical Medicine, Faculty of Public Health and Policy, London, UK.
| | - P J Kelly
- Thomas Jefferson University, College of Nursing, Philadelphia, PA, USA
| | - S Raddi
- University of Bisha, College of Applied Medical Sciences, Department of Nursing, Bisha, Saudi Arabia
| | - T Keller
- New Mexico State University, School of Nursing, Las Cruces, NM, USA
| | - F Almoayad
- Princess Nourah Bint Abdulrahman University, College of Health and Rehabilitation Sciences, Department of Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Gould D, Hawker C, Drey N, Purssell E. Should automated electronic hand-hygiene monitoring systems be implemented in routine patient care? Systematic review and appraisal with Medical Research Council Framework for Complex Interventions. J Hosp Infect 2024; 147:180-187. [PMID: 38554805 DOI: 10.1016/j.jhin.2024.03.012] [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] [Received: 01/23/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
Manual hand-hygiene audit is time-consuming, labour-intensive and inaccurate. Automated hand-hygiene monitoring systems (AHHMSs) offer advantages (generation of standardized data, avoidance of the Hawthorne effect). World Health Organization Guidelines for Hand Hygiene published in 2009 suggest that AHHMSs are a possible alternative. The objective of this review was to assess the current state of the literature for AHHMSs and offer recommendations for use in real-world settings. This was a systematic literature review, and publications included were from the time that PubMed commenced until 19th November 2023. Forty-three publications met the criteria. Using the Medical Research Council's Framework for Developing and Evaluating Complex Interventions, two were categorized as intervention development studies. Thirty-nine were evaluations. Two described implementation in real-world settings. Most were small scale and short duration. AHHMSs in conjunction with additional intervention (visual or auditory cue, performance feedback) could increase hand hygiene compliance in the short term. Impact on infection rates was difficult to determine. In the few publications where costs and resources were considered, time devoted to improving hand hygiene compliance increased when an AHHMS was in use. Health workers' opinions about AHHMSs were mixed. In conclusion, at present too little is known about the longer-term advantages of AHHMSs to recommend uptake in routine patient care. Until more longer-term accounts of implementation (over 12 months) become available, efforts should be made to improve direct observation of hand hygiene compliance to improve its accuracy and credibility. The Medical Research Council Framework could be used to categorize other complex interventions involving use of technology to prevent infection to help establish readiness for implementation.
Collapse
Affiliation(s)
- D Gould
- Independent Consultant, London, UK
| | - C Hawker
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - N Drey
- School of Health & Psychological Sciences, Department of Nursing, City University, London, UK
| | - E Purssell
- Faculty of Health, Medicine and Social Care, School of Nursing and Midwifery, Anglia Ruskin University, Chelmsford, UK.
| |
Collapse
|
3
|
Minotti C, Aghlmandi S, Bielicki JA. Electronic hand hygiene monitoring tools for implementation of optimal hand sanitizing adherence in neonatal intensive care. J Hosp Infect 2024; 147:213-215. [PMID: 38447807 DOI: 10.1016/j.jhin.2024.02.018] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Affiliation(s)
- C Minotti
- Paediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland; Infectious Disease and Vaccinology, University Children's Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - S Aghlmandi
- Paediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland
| | - J A Bielicki
- Paediatric Research Centre, University Children's Hospital Basel, Basel, Switzerland; Infectious Disease and Vaccinology, University Children's Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland; Centre for Neonatal and Paediatric Infection, St George's, University of London, London, UK
| |
Collapse
|
4
|
Mbamalu O, Bonaconsa C, Surendran S, Nampoothiri V, Pennel T, Boutall A, Papavarnavas N, Singh S, Holmes A, Charani E, Mendelson M. Missed opportunities for hand hygiene at the patient's bedside: a pilot descriptive study. J Hosp Infect 2024; 147:216-218. [PMID: 38070710 DOI: 10.1016/j.jhin.2023.11.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024]
Affiliation(s)
- O Mbamalu
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - C Bonaconsa
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - S Surendran
- Health Systems and Equity, The George Institute for Global Health, New Delhi, India
| | - V Nampoothiri
- Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - T Pennel
- Chris Barnard Division of Cardiothoracic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - A Boutall
- Colorectal Unit, Groote Schuur Hospital, Cape Town, South Africa
| | - N Papavarnavas
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - S Singh
- Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - A Holmes
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - E Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - M Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
5
|
Hervé RC, Bryant C, Sutton L, Cox C, Gião MS, Keevil CW, Wilks SA. Impact of different hand-drying methods on surrounding environment: aerosolization of virus and bacteria, and transfer to surfaces. J Hosp Infect 2024; 147:197-205. [PMID: 38521417 DOI: 10.1016/j.jhin.2024.03.005] [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] [Received: 12/11/2023] [Revised: 02/27/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND In recent years, hand drying has been highlighted as a key step in appropriate hand hygiene, as moisture on hands can increase the transfer of micro-organisms from hands to surfaces and vice versa. AIM To understand bacterial and viral aerosolization following hand drying, and study the transfer of micro-organisms from hands to surfaces after drying using different methods. METHODS Groups of five volunteers had their hands pre-washed with soap, rinsed and dried, then inoculated with a concentrated mixture of Pseudomonas fluorescens and MS2 bacteriophage. Volunteers entered an empty washroom, one at a time, and rinsed their hands with water or washed their hands with soap prior to drying with a jet dryer or paper towels. Each volunteer applied one hand successively to various surfaces, while their other hand was sampled using the glove juice method. Both residual bacteria and viruses were quantified from the washroom air, surface swabs and hand samples. FINDINGS P. fluorescens and MS2 bacteriophages were rarely aerosolized while drying hands for any of the drying methods studied. Results also showed limited, and similar, transfer of both micro-organisms studied on to surfaces for all drying methods. CONCLUSION The use of jet dryers or paper towels produces low levels of aerosolization when drying hands in a washroom. Similarly, all drying methods result in low transfer to surfaces. While the coronavirus disease 2019 pandemic raised concerns regarding public washrooms, this study shows that all methods tested are hygienic solutions for dry washed hands.
Collapse
Affiliation(s)
- R C Hervé
- School of Biological Sciences, University of Southampton, Southampton, UK.
| | - C Bryant
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - L Sutton
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - C Cox
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - M S Gião
- Dyson Technology Ltd, Malmesbury, UK
| | - C W Keevil
- School of Biological Sciences, University of Southampton, Southampton, UK
| | - S A Wilks
- School of Biological Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
6
|
Iversen AM, Hansen MB, Münster M, Kristensen B, Ellermann-Eriksen S. Hand hygiene compliance in nursing home wards: the effect of increased accessibility of alcohol-based hand rub. J Hosp Infect 2024; 147:206-212. [PMID: 38521416 DOI: 10.1016/j.jhin.2024.02.027] [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] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. AIM To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). METHODS An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. FINDINGS A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and +13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (P < 0.0001). CONCLUSION Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential.
Collapse
Affiliation(s)
- A-M Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark.
| | - M B Hansen
- Konduto ApS, Sani Nudge, Copenhagen, Denmark
| | | | - B Kristensen
- National Centre of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - S Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
| |
Collapse
|
7
|
Tartari E, Garlasco J, Mezerville MHD, Ling ML, Márquez-Villarreal H, Seto WH, Simon A, Hennig TJ, Pittet D. Ten years of hand hygiene excellence: a summary of outcomes, and a comparison of indicators, from award-winning hospitals worldwide. Antimicrob Resist Infect Control 2024; 13:45. [PMID: 38637873 PMCID: PMC11027265 DOI: 10.1186/s13756-024-01399-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Hand hygiene is a crucial measure for the prevention of healthcare-associated infections (HAIs). The Hand Hygiene Excellence Award (HHEA) is an international programme acknowledging healthcare facilities for their leadership in implementing hand hygiene improvement programmes, including the World Health Organisation's Multimodal Improvement Strategy. This study aimed at summarising the results of the HHEA campaign between 2010 and 2021 and investigating the relationship between different hand hygiene parameters based on data from participating healthcare facilities. METHODS A retrospective analysis was performed on datasets from HHEA forms, including data on hand hygiene compliance, alcohol-based handrub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. Descriptive statistics were reported for each variable. The correlation between variables was inspected through Kendall's test, while possible non-linear relationships between hand hygiene compliance, ABHR consumption and HHSAF scores were sought through the Locally Estimated Scatterplot Smoothing or logistic regression models. A tree-structured partitioning model was developed to further confirm the obtained findings. RESULTS Ninety-seven healthcare facilities from 28 countries in three world regions (Asia-Pacific, Europe, Latin America) were awarded the HHEA and thus included in the analysis. HHSAF scores indicated an advanced hand hygiene promotion level (median 445 points, IQR 395-480). System change (100 [95-100] points) and institutional safety climate (85 [70-95] points) showed the highest and lowest score, respectively. In most cases, hand hygiene compliance was above 70%, with heterogeneity between countries. ABHR consumption above 20 millilitres per patient-day (ml/PD) was widely reported, with overall increasing trends. HHSAF scores were positively correlated with hand hygiene compliance (τ = 0.211, p = 0.007). We observed a positive correlation between compliance rates and ABHR consumption (τ = 0.193, p < 0.001), although the average predicted consumption was stable around 55-60 ml/PD for compliance rates above 80-85%. Logistic regression and partitioning tree analyses revealed that higher HHSAF scores were more likely in the high-ABHR consumption group at cut-offs around 57-59 ml/PD. CONCLUSION Ten years after its inception, the HHEA proves to be a valuable hand hygiene improvement programme in healthcare facilities worldwide. Consistent results were provided by the different hand hygiene indicators and the HHSAF score represents a valuable proxy measure of hand hygiene compliance.
Collapse
Affiliation(s)
- Ermira Tartari
- Faculty of Health Sciences, University of Malta, 2080, Msida, Malta.
- Infection Prevention and Control Unit, Department of Integrated Health Services, WHO Headquarters, Geneva, Switzerland.
| | - Jacopo Garlasco
- Infectious Diseases Unit, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Moi Lin Ling
- Infection Prevention and Epidemiology, Singapore General HospitalSingapore, 169608, Singapore, Singapore
| | | | - Wing-Hong Seto
- School of Public Health, WHO Collaborating Centre, The University of Hong Kong, Hong Kong, China
| | - Anne Simon
- Infection Control and Prevention, CHU Helora, Haine-Saint-Paul, Belgium
| | | | - Didier Pittet
- Faculty of Medicine & Clean Hospitals, University of Geneva, Geneva, Switzerland
| |
Collapse
|
8
|
Chen F, Xu QH. Disinfection and hand hygiene knowledge, attitude, and practices among childcare facilities staff during the COVID-19 pandemic in Anhui, China: a cross-sectional study. Front Public Health 2024; 12:1335560. [PMID: 38638484 PMCID: PMC11024235 DOI: 10.3389/fpubh.2024.1335560] [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] [Received: 11/09/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Objective This study aimed to investigate the knowledge, attitude, and practice (KAP) regarding disinfection and hand hygiene, along with associated influencing factors among childcare facilities staff during the COVID-19 pandemic in Anhui, and to provide information for developing disinfection and hand hygiene strategies for childcare facilities. Methods A web-based cross-sectional study was conducted among Anhui Province residents in China in September 2020. In this study, 60 childcare facilities in two cities of Anhui Province were selected using the convenient sampling method for questionnaires. The questionnaires were distributed through a web-based platform. The disinfection and hand hygiene KAP scores among childcare facilities staff were calculated, and their influencing factors were analyzed. The accuracy rates of knowledge, attitude, and practice of behavior were calculated and analyzed. Results A total of 1,029 participants were included in the study. The disinfection and hand hygiene knowledge, attitude and practice ranged from approximately 5 to 23, 1 to 5, 3 to 13, respectively. The score of urban areas was higher than that of rural areas. Higher education levels and more years of working were associated with higher scores. Additionally, staff who received training or supervision had higher scores than those without. The categories with the lowest knowledge accuracy rate (46.3%), lowest attitude accuracy rate (4.2%), and "always" practice rate (5.3%) among childcare facility staff were all related to the question categories concerning the appropriate range of disinfectants for use. The accuracy rates of hand hygiene knowledge and attitude among the childcare facility staff were high (83.7%-99.6%), but the "always" practice rate was in the middle range (63.0%). Conclusion The disinfection and hand hygiene knowledge among childcare facilities staff was inadequate during the COVID-19 pandemic in Anhui. Continuous implementation of education and training, particularly in rural areas, is essential. Establishing a monitoring system to assess usage effectiveness and adverse reactions in China is critical. Interventions should focus on increasing compliance with hand hygiene practices. Further research should explore the training and intervention of disinfection and hand hygiene, the safety of disinfection measures, and more operational hand hygiene methods in childcare facilities.
Collapse
Affiliation(s)
| | - Qing Hua Xu
- Anhui Center for Disease Control and Prevention, Hefei, Anhui, China
| |
Collapse
|
9
|
Thom KA, Rock C, Robinson GL, Reisinger HR, Baloh J, Chasco E, Liang Y, Li S, Diekema DJ, Herwaldt LA, Johnson JK, Harris AD, Perencevich EN. Alcohol-based decontamination of gloved hands: A randomized controlled trial. Infect Control Hosp Epidemiol 2024; 45:467-473. [PMID: 37994538 PMCID: PMC11007359 DOI: 10.1017/ice.2023.243] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/06/2023] [Accepted: 10/09/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE The gold standard for hand hygiene (HH) while wearing gloves requires removing gloves, performing HH, and donning new gloves between WHO moments. The novel strategy of applying alcohol-based hand rub (ABHR) directly to gloved hands might be effective and efficient. DESIGN A mixed-method, multicenter, 3-arm, randomized trial. SETTING Adult and pediatric medical-surgical, intermediate, and intensive care units at 4 hospitals. PARTICIPANTS Healthcare personnel (HCP). INTERVENTIONS HCP were randomized to 3 groups: ABHR applied directly to gloved hands, the current standard, or usual care. METHODS Gloved hands were sampled via direct imprint. Gold-standard and usual-care arms were compared with the ABHR intervention. RESULTS Bacteria were identified on gloved hands after 432 (67.4%) of 641 observations in the gold-standard arm versus 548 (82.8%) of 662 observations in the intervention arm (P < .01). HH required a mean of 14 seconds in the intervention and a mean of 28.7 seconds in the gold-standard arm (P < .01). Bacteria were identified on gloved hands after 133 (98.5%) of 135 observations in the usual-care arm versus 173 (76.6%) of 226 observations in the intervention arm (P < .01). Of 331 gloves tested 6 (1.8%) were found to have microperforations; all were identified in the intervention arm [6 (2.9%) of 205]. CONCLUSIONS Compared with usual care, contamination of gloved hands was significantly reduced by applying ABHR directly to gloved hands but statistically higher than the gold standard. Given time savings and microbiological benefit over usual care and lack of feasibility of adhering to the gold standard, the Centers for Disease Control and Prevention and the World Health Organization should consider advising HCP to decontaminate gloved hands with ABHR when HH moments arise during single-patient encounters.Trial Registration: NCT03445676.
Collapse
Affiliation(s)
- Kerri A. Thom
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Clare Rock
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Gwen L. Robinson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Jure Baloh
- Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Emily Chasco
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Shanshan Li
- MassMutual Data Science, Springfield, Massachusetts
| | | | | | - J. Kristie Johnson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Anthony D. Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
10
|
Haenen A, Huis A, Teerenstra S, Liefers J, Bos N, Voss A, de Greeff S, Hulscher M. Effect and Process Evaluation of an Intervention to Improve Hand Hygiene Compliance in Long-Term Care Facilities. J Am Med Dir Assoc 2024; 25:591-598. [PMID: 37549888 DOI: 10.1016/j.jamda.2023.06.020] [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] [Received: 03/03/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVES This study evaluated the effect of a tailored, multifaceted improvement strategy on hand hygiene compliance in long-term care facilities (LTCFs). We also performed a process evaluation to explore the mechanisms through which our strategy brought about change. DESIGN We conducted a stepped-wedge cluster-randomized controlled trial with a sequential rollout of the improvement strategy to all participating LTCFs. The strategy consisted of education, training, reminders, observation sessions (including feedback), and team meetings (including feedback). SETTING AND PARTICIPANTS The study included nursing professionals from 14 LTCFs (23 wards) in the Netherlands. METHODS Hand hygiene compliance was observed during 5 measurement periods using WHO's "Five Moments for Hand Hygiene." Multilevel analyses and corresponding tests were completed on an intention-to-treat basis. RESULTS The absolute intervention effect of overall hand hygiene compliance (primary outcome measure) was 13% (95% CI 9.3-16.7, P < .001), adjusted for time and clustering. The adjusted absolute effect was 23% (95% CI 7-39, P < .002) before a clean and aseptic procedure, 18% (95% CI 10-26, P < .001) after touching a resident, 14% (95% CI 7-22, P < .003) before touching a resident, 10% (95% CI 5-15, P < .001) after contact with body fluid, and 1% (95% CI -11 to 13, P = .8) after touching a resident's surroundings. With the exception of leadership, participants at LTCFs with more exposure to the intervention components showed statistically significantly more improvement than those at facilities with lower exposure scores. CONCLUSIONS AND IMPLICATIONS Our strategy was successful in improving hand hygiene compliance. LTCFs with more team members exposed to the different intervention components, demonstrated a greater effect from the intervention. To strengthen the impact of our intervention, we recommend that future improvement strategies provide more support to managers to ensure they are better equipped to take on their leadership roles and enable their teams to improve and maintain hand hygiene compliance.
Collapse
Affiliation(s)
- Anja Haenen
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands; National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control/Epidemiology and Surveillance Unit, Bilthoven, the Netherlands.
| | - Anita Huis
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Steven Teerenstra
- Department for Health, Evidence, Section Biostatistics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janine Liefers
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nynke Bos
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sabine de Greeff
- Department of Antimicrobial Resistance and Healthcare Associated Infections, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marlies Hulscher
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| |
Collapse
|
11
|
Tartari E, Bellissimo-Rodrigues F, Pires D, Fankhauser C, Lotfinejad N, Saito H, Suchomel M, Kramer A, Allegranzi B, Boyce J, Sax H, Stewardson AJ, Pittet D. Updates and future directions regarding hand hygiene in the healthcare setting: insights from the 3rd ICPIC alcohol-based handrub (ABHR) task force. Antimicrob Resist Infect Control 2024; 13:26. [PMID: 38424571 PMCID: PMC10905912 DOI: 10.1186/s13756-024-01374-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose threats to global health. Effective hand hygiene is essential for preventing HAIs and the spread of AMR in healthcare. We aimed to highlight the recent progress and future directions in hand hygiene and alcohol-based handrub (ABHR) use in the healthcare setting. In September 2023, 42 experts in infection prevention and control (IPC) convened at the 3rd International Conference on Prevention and Infection Control (ICPIC) ABHR Taskforce in Geneva, Switzerland. The purpose of this meeting was to provide a synthesis of recent evidence and formulate a research agenda on four critical areas for the implementation of effective hand hygiene practices: (1) ABHR formulations and hand rubbing techniques, (2) low-resource settings and local production of ABHR, (3) hand hygiene monitoring and technological innovations, and (4) hand hygiene standards and guidelines.
Collapse
Affiliation(s)
- Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | | | - Daniela Pires
- National Institute of Health and Care Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | - Nasim Lotfinejad
- Infection Control Program and WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine. Faculty of Medicine, Institute of Global Health, . Mariana University Yokohama Seibu Hospital, University of Geneva, Geneva, Switzerland
| | - Miranda Suchomel
- Institute of Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - John Boyce
- J.M. Boyce Consulting, LLC, Hyde Park, NY, USA
| | - Hugo Sax
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew J Stewardson
- Department of Infectious Diseases, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia
| | - Didier Pittet
- Clean Hospitals, Geneva, Switzerland.
- Faculty of Medicine & Clean Hospitals, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
12
|
Dekker M, van Mansfeld R, Borgert M, Maaskant J, Paulus F, Seller A, Jongerden IP. The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study. Antimicrob Resist Infect Control 2024; 13:23. [PMID: 38419094 PMCID: PMC10903006 DOI: 10.1186/s13756-024-01378-5] [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] [Received: 08/17/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The application of hand hygiene (HH) and the use of non-sterile gloves (NSG) in daily care is highly intertwined. We aimed (1) to assess the combined application of HH and NSG among nurses and (2) to explore determinants that influence their ability to combine both measures in their care. METHODS In a multi-methods study, we combined direct observations of care episodes with semi-structured interviews with nurses in two affiliated university hospitals. Topics were based on Flottorp's checklist of determinants of practice. RESULTS In total, we observed 205 care episodes and interviewed 10 nurses. Observations revealed that the combination of NSG and HH was correctly applied in 19% of care episodes in which a single procedure was executed, and in 2% of care episodes in which multiple procedures were performed. From the interviews, we found determinants that influenced compliance, covered mainly by three out of seven of Flottorp's checklist domains. Nurses indicated that their knowledge of protocols was limited to HH and protocols were hardly ever actively consulted; visual reminders within their workplace were used as sources of information. Nurses' behavior was primarily influenced by their ability to operationalize this information and their ability to integrate both infection prevention measures into their care. The intention to apply and combine HH and NSG use was influenced by their risk assessment of cross-contamination, by the urge to self-protect and gut feeling. The feasibility to execute HH and NSG protocols is influenced by the urgency and the complexity of the care episode. CONCLUSIONS The combined correct application with HH and NSG measures by nurses is low. Nurses are instructed in a fragmented way while in the day to day care HH and NSG use are highly intertwined. Operationalization and simplification of infection prevention protocols, in which instructions on both infection prevention measures are fused, should be considered. Strategies to improve practice should consider the power of habit and nurses urge to self-protect.
Collapse
Affiliation(s)
- Mireille Dekker
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
| | - Rosa van Mansfeld
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Marjon Borgert
- Amsterdam UMC, Department of Intensive Care, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jolanda Maaskant
- Amsterdam UMC, Department of Internal Medicine, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Frederique Paulus
- Amsterdam UMC, Department of Intensive Care, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Annamarike Seller
- Department of Human Resources, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Research Center for Health Economics, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Societal participation & Health, Amsterdam, the Netherlands
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Irene P Jongerden
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Roopashree MR. To Analyze and Evaluate the Rate of Compliance of Hand Hygiene Practices in a Tertiary Care Hospital: Initiation of Quality Improvement Program and Clinical Audit. Hosp Top 2024; 102:52-60. [PMID: 38264864 DOI: 10.1080/00185868.2024.2302599] [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: 01/25/2024]
Abstract
INTRODUCTION Health care as a service organization is associated with hospital-acquired infection which is drawing attention. There are concerns raised by patients, attenders, stake holders, insurers, government agencies, and regulatory bodies. The study aims to evaluate the awareness and the rate of compliance with hand hygiene. METHODS The audit methodology implemented is a concurrent medical record audit. The period of the audit was conducted for 6 months. A random sampling method was incorporated. The sample size was determined as 20% of the staff had been involved. RESULTS The Total average level of awareness of hand hygiene and adherence to policy is 93.6%. The average of all the 3 categories of compliance at 5 levels of hand hygiene in percentage is 82.3%. DISCUSSION Hand hygiene practices if stringently implemented will minimize the cross-transmission of infection in health care facilities. By knowing the awareness level and compliance level are measured with standardized training modules. APPLICATIONS Create awareness on hand hygiene and provide training with respect to the effectiveness of implementation. Incorporate hand hygiene steps as well as in the audit process. CONCLUSIONS There is a requirement for training with respect to the effectiveness of the implementation of the techniques. The level of care and quality of services can be made better by incorporating quality improvement programs (QIPs). By regular audits, we can raise the service quality and benchmark it.
Collapse
|
14
|
Stones C, Ai W, Rutter S, Madden A. Hand Hygiene Messaging Design in the Workplace: Views From the Workforce-Introduction. HERD 2024; 17:49-63. [PMID: 37728087 PMCID: PMC10704885 DOI: 10.1177/19375867231195646] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
AIMS The study aimed to (1) discover workers' attitudes toward the use of novel video screens to improve hand sanitization in the workplace and (2) discover what workers' preferences are for hand hygiene (HH) messaging style and tone and reasons for their preferences. BACKGROUND Practicing good HH in non-medical office settings is vital to curb the spread of a range of common and infectious diseases. Despite this, workers are rarely consulting in the construction of HH messages. The qualitative views of users can provide us with the "why" rather than the "what" and can highlight areas of cynicism, concern and overall attitudes to HH. METHODS A survey was completed by 520 UK workers concerning attitudes and views toward HH messaging and the use of a video-based hand sanitizer unit. Analysis consisted of both qualitative and quantitative methods. RESULTS Workers were skeptical toward the use of digital technologies within HH interventions, and there were misgivings about the role that video could play. Results demonstrated a strong preference for positive and supportive messages. Educational and trustworthy qualities were well rated. Messages that emphasized surveillance, previously successful in a clinical setting, or guilt, were not well received. Visual approaches that utilized serious illustration were valued. CONCLUSION This study highlights how consulting workers before the design of HH initiatives is important in guiding the design process. The resultant user-centered criteria promotes the use of positive, motivational, thought-provoking, surprising, and visual approaches to HH messaging.
Collapse
Affiliation(s)
| | - Wenbo Ai
- Royal College of Art, London, United Kingdom
| | - Sophie Rutter
- Information School, Sheffield University, London, United Kingdom
| | - Andrew Madden
- Information School, Sheffield University, London, United Kingdom
| |
Collapse
|
15
|
Boyce JM. Current issues in hand hygiene. Am J Infect Control 2023; 51:A35-A43. [PMID: 37890952 DOI: 10.1016/j.ajic.2023.02.003] [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] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Multiple aspects of hand hygiene have changed in recent years. METHODS A PubMed search was conducted to identify recent articles about hand hygiene. RESULTS The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. CONCLUSIONS Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
Collapse
Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
| |
Collapse
|
16
|
Siebers C, Mittag M, Grabein B, Zoller M, Frey L, Irlbeck M. Hand hygiene compliance in the intensive care unit: Hand hygiene and glove changes. Am J Infect Control 2023; 51:1167-1171. [PMID: 37044262 DOI: 10.1016/j.ajic.2023.04.007] [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] [Received: 07/28/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Hand disinfection (HD) is known to be the single most effective prevention measure to avoid nosocomial infections, but the compliance rate (CR) remains low. The aim of this study was to determine the incidence of HD opportunities and the CR during the treatment of critically ill patients. One special focus was on glove usage to determine whether gloves were substituted for HD. METHODS This is a single-blinded direct observation of employees of an.ßintensive care unit. One specially educated observer recorded all hand hygiene indications over a period of 21 8-hour shifts as well as performed HD and study of glove use behavior. RESULTS Over a period of 168.ßhours, 2,036 HDs should be performed during the care for 1 intensive care unit patient. In total, only 690 HDs occurred, resulting in a CR of 33.9%. With regard to the nurses, there was an HD opportunity around the clock every 6.ßminutes on average. About 17% of the total working time would have to be applied for 100% correct hand hygiene application. Donning or changing of gloves took place in 38.2% of all indications for HD. CONCLUSIONS Our results show that HD opportunities occur in high frequency during the treatment of critically ill patients. The compliance with HD remains too low, even when a 100% CR seems to be unachievable. Improvements should focus on aseptic procedures, combining the lowest CR with the highest procedural risk for the patient. The Healthcare Personal (HCP) uses gloves when an HD opportunity occurs. Implementing glove disinfection strategies in daily routine might help optimize patient care.
Collapse
Affiliation(s)
- Christian Siebers
- Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University, Munich, Germany; Department of Anaesthesiology and Intensive Care, Hospital of Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany.
| | - Martin Mittag
- Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Beatrice Grabein
- Department of Clinical Microbiology and Hospital Hygiene, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Michael Zoller
- Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Lorenz Frey
- Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| | - Michael Irlbeck
- Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
17
|
Park SY, Park S, Lee E, Jeong YS, Kim JH, Oh SM, Cheong S, Park H, Jo S, Kim TH. Steady amelioration of institutional hand hygiene behavior among health care personnel after 12-year consistent intervention. Am J Infect Control 2023; 51:1023-1027. [PMID: 36736385 DOI: 10.1016/j.ajic.2023.01.009] [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] [Received: 10/28/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Institutional hand hygiene (HH) behavior is difficult to monitor and improve consistently, especially over long periods. This study aimed to investigate the long-term effects of HH promotion activities. METHOD We launched the HH promotion team in 2010 and conducted interventions including goal setting, observation and feedback, education, reward incentives, and accountability. Optimal HH compliance rates were calculated based on adherence to all 6-step HH technique and appropriate time recommended by the World Health Organization. HH and optimal HH compliance were calculated over 12 years. Poisson regression analysis was used to determine the trend in HH compliance according to year. RESULTS In 2010, HH and optimal HH compliance were 59.7% and 15.6%, respectively. HH compliance increased by 83.9% in 2013 and remained over 75%. HH compliance increased significantly, with a relative risk (RR) of 1.014 (95% CI 1.002-1.025, P = .018). Optimal HH compliance increased by 67.8% in 2013 and remained over 60%, except in 2016 (58.8%) and 2019 (59.8%). Optimal HH compliance increased with RR 1.033 (95% CI 0.991-1.076, P = .123). DISCUSSION HH and optimal HH compliance increased significantly over the 12 years when subgroup analysis was performed by job category. CONCLUSIONS HH promotion team activities improved and maintained optimal HH compliance among HCWs.
Collapse
Affiliation(s)
- Se Yoon Park
- Department of Hospital Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea; Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea; Centers for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Republic of Korea
| | - Suyeon Park
- Department of Biostatistics, Soonchunhyang University Seoul Hospital, Republic of Korea; Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
| | - Yeon Su Jeong
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin Hwa Kim
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sun Mi Oh
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Sojin Cheong
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Hyein Park
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - SoYea Jo
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
18
|
Bilgin H, Sili U, Pazar N, Kucuker I, Kepenekli E, Yanar MA, Memisoglu A, Ozek E, Adhikari NK, Pinto R, Korten V. Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study. Am J Infect Control 2023; 51:1028-1033. [PMID: 36603809 DOI: 10.1016/j.ajic.2022.12.011] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). METHODS AND MATERIALS This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. RESULTS We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). CONCLUSION In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.
Collapse
Affiliation(s)
- Huseyin Bilgin
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Uluhan Sili
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nazli Pazar
- Infection Prevention and Control, Marmara University Hospital, Istanbul, Turkey
| | - Isil Kucuker
- Infection Prevention and Control, Marmara University Hospital, Istanbul, Turkey
| | - Eda Kepenekli
- Department of Pediatric Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Meral Agirman Yanar
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Asli Memisoglu
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Eren Ozek
- Department of Neonatal Intensive Care Unit, Marmara University School of Medicine, Istanbul, Turkey
| | - Neill Kj Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Volkan Korten
- Department of Infectious Diseases and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
19
|
Rüfenacht S, Kohler P, Kuhn R, Flury D, Widmer AF, Schlegel M. Impact of the coronavirus disease 2019 (COVID-19) pandemic on the adherence to hand hygiene practice in hospitals-Data from a Swiss national surveillance system. Infect Control Hosp Epidemiol 2023; 44:1522-1525. [PMID: 36624690 PMCID: PMC10507510 DOI: 10.1017/ice.2022.308] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 01/11/2023]
Abstract
In >100,000 observations across Swiss acute-care hospitals, hand hygiene (HH) adherence significantly increased during the first coronavirus disease 2019 (COVID-19) wave. However, despite persisting COVID-19 activity, HH adherence returned to prepandemic levels over a 2-year observation period. These results indicate that training and support remains challenging.
Collapse
Affiliation(s)
- Susanne Rüfenacht
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Philipp Kohler
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Rolf Kuhn
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Domenica Flury
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | | | - Matthias Schlegel
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | | |
Collapse
|
20
|
Dassler K, Zurfluh K, Stephan R, Willi B. Educational intervention to improve infection prevention and control practices in four companion animal clinics in Switzerland. J Hosp Infect 2023; 139:121-133. [PMID: 37302754 DOI: 10.1016/j.jhin.2023.06.002] [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] [Received: 04/13/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Infection prevention and control (IPC) practices vary among companion animal clinics, and outbreaks with carbapenemase-producing Enterobacterales (CPE) have been described. AIM To investigate the effect of an IPC intervention (introduction of IPC protocols, IPC lectures, hand hygiene campaign) in four companion animal clinics. METHODS IPC practices, environmental and hand contamination with antimicrobial-resistant micro-organisms (ARM) and hand hygiene (HH) were assessed at baseline, and 1 and 5 months after the intervention. RESULTS Median IPC scores (% maximum score) improved from 57.8% (range 48.0-59.8%) to 82.9% (range 81.4-86.3%) at 1-month follow-up. Median cleaning frequency assessed by fluorescent tagging increased from 16.7% (range 8.9-18.9%) to 30.6% (range 27.8-52.2%) at 1-month follow-up and 32.8% (range 32.2-33.3%) at 5-month follow-up. ARM contamination was low in three clinics at baseline and undetectable after the intervention. One clinic showed extensive contamination with ARM including CPE before and after the intervention (7.5-16.0% ARM-positive samples and 5.0-11.5% CPE-positive samples). Mean HH compliance improved from 20.9% [95% confidence interval (CI) 19.2-22.8%] to 42.5% (95% CI 40.4-44.7%) at 1-month follow-up and 38.7% (95% CI 35.7-41.7%) at 5-month follow-up. Compliance was lowest in the pre-operative preparation area at baseline (11.8%, 95% CI 9.3-14.8%) and in the intensive care unit after the intervention (28.8%, 95% CI 23.3-35.1%). HH compliance was similar in veterinarians (21.5%, 95% CI 19.0-24.3%) and nurses (20.2%, 95% CI 17.9-22.7%) at baseline, but was higher in veterinarians (46.0%, 95% CI 42.9-49.1%) than nurses (39.0%, 95% CI 36.0-42.1%) at 1-month follow-up. CONCLUSION The IPC intervention improved IPC scores, cleaning frequency and HH compliance in all clinics. Adapted approaches may be needed in outbreak situations.
Collapse
Affiliation(s)
- K Dassler
- Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - K Zurfluh
- Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | - R Stephan
- Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | - B Willi
- Clinic for Small Animal Internal Medicine, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
21
|
Huang W, Huang J, Wang G, Lu H, He M, Wang W. A Pilot Study of Deep Learning Models for Camera based Hand Hygiene Monitoring in ICU. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-5. [PMID: 38083035 DOI: 10.1109/embc40787.2023.10341146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Hand hygiene is key to preventing cross-infections in the Intensive Care Unit (ICU). Monitoring of hand washing activities can effectively increase the compliance of clinicians to hand hygiene. In this paper, we explored the feasibility of recognizing clinicians' hand-washing activities using a clinical dataset recorded in ICU using CCTV cameras. We benchmarked three types of hand hygiene detection methods on the dataset with the aim of identifying the 7-step hand washing procedure defined by WHO. Experimental results show that our approach achieves 97% average accuracy for personalized and 67% for generalized modeling. Preliminary results indicate that hand hygiene recognition is subject-dependent, and thus cross-subject modeling or subject-adaptive learning should be used to enhance generalization. The feasibility and challenges of CCTV-camera-based hand hygiene recognition are discussed. The results may contribute to design a hand hygiene scoring and alert system as part of the IoT system in hospitals. The hospital data and code are available at https://github.com/SunnySideUp11/ICU-MH-20.
Collapse
|
22
|
Deryabina A, Aiypkhanova A, Juvashev A, Alimbetov K, Tekebayev K, Kassa G, Howard AA. Core components of infection prevention and control programs at the facility level in Kazakhstan: key challenges and opportunities. Antimicrob Resist Infect Control 2023; 12:59. [PMID: 37349829 PMCID: PMC10286477 DOI: 10.1186/s13756-023-01264-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/04/2022] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Kazakhstan is developing a National Roadmap to strengthen its Infection Prevention and Control (IPC), but until recently has lacked a country-wide facility-level assessment of IPC performance gaps. METHODS In 2021, the World Health Organization (WHO)'s IPC Core Components and Minimal Requirements were assessed at 78 randomly selected hospitals across 17 administrative regions using adapted WHO tools. The study included site assessments, followed by structured interviews with 320 hospital staff, validation observations of IPC practices, and document reviews. RESULTS All hospitals had at least one dedicated IPC staff member, 76% had IPC staff with any formal IPC training; 95% established an IPC committee and 54% had an annual IPC workplan; 92% had any IPC guidelines; 55% conducted any IPC monitoring in the past 12 months and shared the results with facility staff, but only 9% used monitoring data for improvements; 93% had access to a microbiological laboratory for HAI surveillance, but HAI surveillance with standardized definitions and systematic data collection was conducted in only one hospital. Adequate bed spacing of at least 1 m in all wards was maintained in 35% of hospitals; soap and paper towels were available at the hand hygiene stations in 62% and 38% of hospitals, respectively. CONCLUSIONS Existing IPC programs, infrastructure, IPC staffing, workload and supplies present within hospitals in Kazakhstan allow for implementation of effective IPC. Development and dissemination of IPC guidelines based on the recommended WHO IPC core components, improved IPC training system, and implementation of systematic monitoring of IPC practices will be important first steps towards implementing targeted IPC improvement plans in facilities.
Collapse
Affiliation(s)
- Anna Deryabina
- Mailman School of Public Health, ICAP at Columbia University, 34/1 Samal-3, 050051, Almaty, Kazakhstan.
| | | | - Almat Juvashev
- Mailman School of Public Health, ICAP at Columbia University, 34/1 Samal-3, 050051, Almaty, Kazakhstan
| | - Kuanysh Alimbetov
- National Centre for Public Health of the Ministry, Astana, Kazakhstan
| | - Kanat Tekebayev
- National Centre for Public Health of the Ministry, Astana, Kazakhstan
| | - Getachew Kassa
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
| | - Andrea A Howard
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
| |
Collapse
|
23
|
MacLeod C, Braun L, Caruso BA, Chase C, Chidziwisano K, Chipungu J, Dreibelbis R, Ejemot-Nwadiaro R, Gordon B, Esteves Mills J, Cumming O. Recommendations for hand hygiene in community settings: a scoping review of current international guidelines. BMJ Open 2023; 13:e068887. [PMID: 37344109 PMCID: PMC10314431 DOI: 10.1136/bmjopen-2022-068887] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 03/17/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Hand hygiene is an important measure to prevent disease transmission. OBJECTIVE To summarise current international guideline recommendations for hand hygiene in community settings and to assess to what extent they are consistent and evidence based. ELIGIBILITY CRITERIA We included international guidelines with one or more recommendations on hand hygiene in community settings-categorised as domestic, public or institutional-published by international organisations, in English or French, between 1 January 1990 and 15 November 2021. DATA SOURCES To identify relevant guidelines, we searched the WHO Institutional Repository for Information Sharing Database, Google, websites of international organisations, and contacted expert organisations and individuals. CHARTING METHODS Recommendations were mapped to four areas related to hand hygiene: (1) effective hand hygiene; (2) minimum requirements; (3) behaviour change and (4) government measures. Recommendations were assessed for consistency, concordance and whether supported by evidence. RESULTS We identified 51 guidelines containing 923 recommendations published between 1999 and 2021 by multilateral agencies and international non-governmental organisations. Handwashing with soap is consistently recommended as the preferred method for hand hygiene across all community settings. Most guidelines specifically recommend handwashing with plain soap and running water for at least 20 s; single-use paper towels for hand drying; and alcohol-based hand rub (ABHR) as a complement or alternative to handwashing. There are inconsistent and discordant recommendations for water quality for handwashing, affordable and effective alternatives to soap and ABHR, and the design of handwashing stations. There are gaps in recommendations on soap and water quantity, behaviour change approaches and government measures required for effective hand hygiene. Less than 10% of recommendations are supported by any cited evidence. CONCLUSION While current international guidelines consistently recommend handwashing with soap across community settings, there remain gaps in recommendations where clear evidence-based guidance might support more effective policy and investment.
Collapse
Affiliation(s)
- Clara MacLeod
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Laura Braun
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Bethany A Caruso
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Claire Chase
- Water and Sanitation Program, World Bank Group, Washington, District of Columbia, USA
| | - Kondwani Chidziwisano
- Department of Environmental Health and WASHTED, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Jenala Chipungu
- Social and Behavioural Science Department, Center for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Robert Dreibelbis
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Regina Ejemot-Nwadiaro
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Bruce Gordon
- Water, Sanitation, Hygiene and Health Unit, WHO, Geneva, Switzerland
| | | | - Oliver Cumming
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| |
Collapse
|
24
|
Saito H, Okamoto K, Fankhauser C, Tartari E, Pittet D. Train-the-Trainers in hand hygiene facilitate the implementation of the WHO hand hygiene multimodal improvement strategy in Japan: evidence for the role of local trainers, adaptation, and sustainability. Antimicrob Resist Infect Control 2023; 12:56. [PMID: 37296481 PMCID: PMC10250848 DOI: 10.1186/s13756-023-01262-8] [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] [Received: 03/30/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND "Train-the-Trainers in hand hygiene" (TTT) is a standardized training to train infection prevention and control (IPC) practitioners with the aim to promote hand hygiene in health care according to the World Health Organization (WHO) multimodal improvement strategy. Little is known in the literature about the sustained impact of hand hygiene and IPC trainings adapted locally. The aim of this study is to describe the impact of three TTT courses conducted annually in Japan on the adoption of the WHO multimodal improvement strategy by local IPC practitioners who became a "trainer" after their first TTT participation as a "trainee". METHODS Three TTT courses were conducted annually from 2020 to 2022 in Japan. A team "TTT-Japan" composed of more than 20 IPC practitioners who completed their first TTT participation adapted the original TTT program to reflect the local healthcare context in Japan, and subsequently convened the 2nd and 3rd TTTs. Pre- and post-course evaluations and post-course satisfaction surveys of the course participants were conducted to assess improvement in knowledge on hand hygiene and perception towards the course, respectively. Attitude and practice surveys of the TTT-Japan trainers were conducted to assess their perception and experience in hand hygiene promotion. The Hand Hygiene Self-Assessment Framework (HHSAF), a validated tool created by WHO to monitor the capacity of hand hygiene promotion at facility level, was applied at TTT-Japan trainers' facilities to compare results before and after trainers' engagement. We applied inductive thematic analysis for qualitative analyses of open-ended survey questions of the trainers' attitude and practice surveys, and the Wilcoxon Sign Rank test for quantitive comparisons of pre- and post-data for the surveys and HHSAF. RESULTS 158 Japanese healthcare workers participated in three TTT courses, the majority of whom (131, 82.9%) were nurses. Twenty-seven local trainers were involved in 2nd and 3rd TTTs. The scores of pre- and post-course evaluations significantly improved after the course (P < 0.001) and the improvement was consistent across all three TTTs. Post-course satisfaction survey showed that over 90% of the participants reported that the course met their expectations and that what they learned in the courses would be useful for their practice. Trainers' attitude and practice survey showed that more than three quarters (76.9%) of the trainers reported that their experience as a trainer had a positive impact on their practice at their own facilities. Qualitative analysis of the trainers' attitude and practice survey revealed that trainers appreciated continuous learning as a trainer, and group effort to promote hand hygiene as the TTT-Japan team. The HHSAF institutional climate change element at the trainers' facilities significantly improved after their engagement as a trainer (P = 0.012). CONCLUSIONS TTTs were successfully adapted and implemented in Japan, leading to sustained hand hygiene promotion activities by local trainers over three years. Further research is warranted to assess the long-term impact on local hand hygiene promotion in different settings.
Collapse
Affiliation(s)
- Hiroki Saito
- Department of Emergency and Critical Care Medicine, St. Marianna University Yokohama Seibu Hospital, 1197-1, Yasashi-Cho, Asahi-Ku, Yokohama, Kanagawa, Japan.
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland.
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Carolina Fankhauser
- Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | - Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Didier Pittet
- Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
| |
Collapse
|
25
|
Tsao H, Macdonald R, Dwyer D, Harper T, Rutz D, Sutherland J. Prolonged length of stay is associated with reduced hand hygiene compliance in the emergency department: A single centre retrospective study. Emerg Med Australas 2023; 35:213-217. [PMID: 36184077 DOI: 10.1111/1742-6723.14097] [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] [Received: 06/26/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether patient flow factors in the ED such as prolonged length of stay are associated with hand hygiene (HH) compliance. METHODS We conducted a retrospective study at an urban district hospital utilising available data from January 2018 to December 2021. Compliance to the World Health Organization five moments of HH expressed as percentage of total moments observed were collated every 2 months. Patient flow measures including proportion of patients referred or discharged within 4 h (LOS4), proportion of patients with ED length of stay >24 h (LOS24) and total number of patient presentations, were obtained for each 2-month periods. The association between these patient flow measures and HH compliance was examined using Pearson's correlation (P < 0.05). RESULTS The results showed a moderate and significant association between rates of HH compliance and LOS24 (r = -0.48, P = 0.025). That is, lower proportion of patients with ED length of stay >24 h was associated with improved HH compliance. There was no significant correlation between HH compliance and LOS4 (r = 0.38, P = 0.085) or total number of ED presentations (r = -0.30, P = 0.17). CONCLUSIONS The findings show that prolonged ED length of stay may explain, at least partly, lower rates of HH compliance. Improvements in ED HH compliance should also include strategies that enhance patient flow.
Collapse
Affiliation(s)
- Henry Tsao
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Rachel Macdonald
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Damien Dwyer
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - Tracey Harper
- Infection Control, Redland Hospital, Brisbane, Queensland, Australia
| | - Dominik Rutz
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| | - John Sutherland
- Emergency Department, Redland Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
26
|
Durant DJ, Fallwell N, Martinez L, Gonzalez A, Guerrazzi-Young C. A Free Mobile Application Improves the Efficiency of Hand Hygiene Observation Collection: Experiences at a Pediatric Hospital in South Texas. Jt Comm J Qual Patient Saf 2023; 49:111-119. [PMID: 36517340 DOI: 10.1016/j.jcjq.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Hand hygiene (HH) is the most important means of reducing hospital-acquired infections. However, compliance at health care facilities remains deficient. A process improvement study was conducted at a 191-bed, pediatric hospital in South Texas evaluating a free mobile application for HH surveillance, compared to traditional pen-and-paper methods. Using a series of Plan-Do-Study-Act (PDSA) cycles, the application was piloted on a small scale and then trialed facilitywide from June to November 2021. The number of HH audits was compared to the preceding period using percentage change analysis. The mobile application resulted in 7,388 HH observations collected, compared with 3,082 previously, representing a 140% increase. Two staff roles in the process (data entry and analysis) were eliminated, as observations were pushed directly to the infection preventionist, eliminating approximately eight hours of staff time monthly. The application enabled almost real-time updates to the HH surveillance dashboard and improved the detailedness of the data as more variables were collected during each HH observation. This is a practical alternative for innovating HH observation compared with more sophisticated and expensive HH surveillance technology.
Collapse
|
27
|
Neumark Y, Bar-Lev A, Barashi D, Benenson S. A feasibility study of the use of medical clowns as hand-hygiene promoters in hospitals. PLoS One 2022; 17:e0279361. [PMID: 36548383 PMCID: PMC9778928 DOI: 10.1371/journal.pone.0279361] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Healthcare-acquired infections (HAI) pose vast health and economic burdens. Proper hand-hygiene is effective for reducing healthcare-acquired infections (HAI) incidence, yet staff compliance is generally low. This study assessed the feasibility, acceptability and preliminary effect of employing medical clowns to enhance hand-hygiene among physicians and nurses. Staff perception of the intervention and its impact on hand-hygiene was assessed via self-report questionnaires. Nearly 1,500 hand-hygiene compliance observations were conducted in accordance with WHO guidelines before, during and after the intervention. In each of three hospitals in Israel, two departments were selected-one in which medical clowns routinely operate and one clown-naive department. Professional medical clowns acted as hand-hygiene promoters employing humorous tactics to encourage hand-sanitizing based on the WHO "5 Moments" model. The clown appeared in each department seven times during the 2-week intervention phase. Pre-intervention hand-hygiene compliance ranged from just over 50% to 80% across hospitals and departments. Overall, about 70% of nurses (N = 132) and 80% of physicians (N = 49) felt the intervention improved personal and departmental hand-hygiene, with large inter-department variation. Pre- to post-intervention hand-hygiene compliance increased by 4% -25% (3.5-14.8 percentage points) in four departments, three of which had low baseline compliance levels. Results of this feasibility study suggest that employing medical clowns as hand-hygiene promoters as a novel approach toward HAI prevention is feasible and welcome by hospital staff.
Collapse
Affiliation(s)
- Yehuda Neumark
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| | - Adina Bar-Lev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Shmuel Benenson
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
28
|
Boyce JM, Martinello RA. Pilot study of using thermal imaging to assess hand hygiene technique. Am J Infect Control 2022; 50:1208-1211. [PMID: 36116677 DOI: 10.1016/j.ajic.2022.07.015] [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] [Received: 05/13/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Currently, there is no standard method for assessing hand hygiene (HH) technique. We explored the use of thermal imaging to determine if alcohol-based sanitizer (ABHS) has been applied to fingertips and thumbs, areas often missed by healthcare personnel. METHODS A FLIR thermal camera attached to an iPhone with FLIR app was used to obtain thermal images of volunteers' dominant hand before and after performing HH with an ABHS. Temperature readings of the mid-palm area, and tips of 3rd finger and thumb were recorded before and at multiple time points after hand hygiene. RESULTS In 11 of 12 volunteers, thermal images revealed significant decreases in mid-palm, finger and thumb temperatures after performing HH (P < .01 for all sites), confirming visual assessment of coverage. When HH was performed without including the thumb, a lack of colorimetric change in the thumb was visible. For persons with "cold" fingers at baseline, assessing ABHS coverage of the fingers was more difficult. CONCLUSIONS Thermal imaging of HH performance shows promise for assessing HH technique. Additional studies involving a larger number of persons under varying conditions are needed to establish if thermal imaging can be a practical modality for teaching or monitoring HH technique.
Collapse
Affiliation(s)
| | - Richard A Martinello
- Departments of Internal Medicine and Pediatrics (Infectious Diseases), Yale School of Medicine, Department of Infection Prevention, Yale New Haven Health, New Haven, CT
| |
Collapse
|
29
|
Price L, Gozdzielewska L, Matuluko A, Pittet D, Allegranzi B, Reilly J. Comparing the effectiveness of hand hygiene techniques in reducing the microbial load and covering hand surfaces in healthcare workers: Updated systematic review. Am J Infect Control 2022; 50:1079-1090. [PMID: 35167898 DOI: 10.1016/j.ajic.2022.02.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND This review, commissioned by the World Health Organization (WHO), examined the effectiveness of the WHO 6-step hand hygiene (HH) technique in reducing microbial load on hands and covering hand surfaces, and compared its effectiveness to other techniques. METHODS Medline, CINAHL, ProQuest, Web of Science, Mednar, and Google Scholar were searched for primary studies, published in English (1978-February 2021), evaluating the microbiological effectiveness or hand surface coverage of HH techniques in healthcare workers. Reviewers independently performed quality assessment using Cochrane tools. The protocol for the narrative review was registered (PROSPERO 2021: CRD42021236138). RESULTS Nine studies were included. Evidence demonstrated that the WHO technique reduced microbial load on hands. One study found the WHO technique more effective than the 3-step technique (P = .02), while another found no difference between these 2 techniques (P = .08). An adapted 3-step technique was more effective than the WHO technique in laboratory settings (P = .021), but not in clinical practice (P = .629). One study demonstrated that an adapted 6-step technique was more effective than the WHO technique (P = .001). Evidence was heterogeneous in application time, product, and volume. All studies were high risk of bias. CONCLUSIONS Eight studies found that the WHO 6-step technique reduced microbial load on healthcare workers' hands; but the studies were heterogeneous and further research is required to identify the most effective, yet feasible technique.
Collapse
Affiliation(s)
- Lesley Price
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| | - Lucyna Gozdzielewska
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK.
| | - Ayodeji Matuluko
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Center on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Jacqui Reilly
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
30
|
González-González R, Huertas-Jiménez MA, Ochoa-Hein E, Galindo-Fraga A, Macías-Hernández AE, De la Torre-Rosas A. Report of a Multimodal Strategy for Improvement of Hand Hygiene Compliance in a Latin American Hospital. How Far From Excellence? J Patient Saf 2022; 18:667-673. [PMID: 36170585 DOI: 10.1097/pts.0000000000000982] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to report the results of a multimodal strategy for improvement of hand hygiene (HH) compliance in a third-level hospital in Mexico. METHODS This is an epidemiological study in a public, acute care, academic, tertiary referral center from 2009 to 2019. Healthcare worker (HCW) compliance with HH was assessed after implementation of the World Health Organization multimodal strategy that included permanent and widespread access to alcohol-based hand rubs; educational activities for staff, students, patients, and relatives; reminders in healthcare areas; patient empowerment; water quality surveillance; frequent evaluation of compliance; and feedback. The primary outcome was HH compliance rate (measured by direct observation). The association of HH with healthcare-associated infections was the secondary outcome. RESULTS A total of 60,685 HH opportunities were evaluated. The HH compliance rate increased significantly from 39.83% (95% confidence interval [CI] = 38.83%-40.84%) to 64.81% (95% CI = 64.08%-65.54%), mostly due to HH compliance in World Health Organization moments 3 to 5 (r = 0.86, P = 0.001). A statistically significant inverse association was found between HH compliance rates and surgical site infection rates (incidence rate ratio = 0.9977, 95% CI = 0.9957-0.9997, P = 0.029). CONCLUSIONS A multimodal strategy in a Latin American setting showed an increase in HH compliance over 10 years of follow-up that should nonetheless be improved. An association between HH compliance and surgical site infection rates was noticed, but this did not occur with other healthcare-associated infections; this underscores the need for a comprehensive bundled approach in their prevention.
Collapse
Affiliation(s)
- Ricardo González-González
- From the Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Martha Asunción Huertas-Jiménez
- From the Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Eric Ochoa-Hein
- From the Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | - Arturo Galindo-Fraga
- From the Department of Hospital Epidemiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | | | | |
Collapse
|
31
|
Szumska E, Czajkowski P, Zablocki M, Rozkiewicz D. The Association between Hand Disinfection Techniques and Their Barriers, as Well as the "Bare below the Elbows" Concept, among Healthcare Professionals-A Study Based on a Polish Population. Int J Environ Res Public Health 2022; 19:ijerph191811781. [PMID: 36142054 PMCID: PMC9517209 DOI: 10.3390/ijerph191811781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/05/2022] [Revised: 09/05/2022] [Accepted: 09/15/2022] [Indexed: 06/01/2023]
Abstract
Hand hygiene is the most effective way to prevent nosocomial infections. Nevertheless, the hands of healthcare professionals are still the primary route of transmission of pathogens responsible for such infections. The aim of this study was to evaluate hand disinfection techniques and investigate the risk factors that may explain the improper hand disinfection techniques among healthcare workers. We selected 7544 hospital workers directly involved in patient care. We recorded data based on the questionnaires, demographic data, and the preparation of hands for disinfection, including risk factors. Correct hand disinfection was verified by COUCOU BOX, with a UV camera. Proper hand disinfection was demonstrated among 4879 (64.7%) subjects, while 2665 (35.3%) subjects disinfected their hands incorrectly. In most places of work, nurses properly disinfected their hands more often than the physicians, particularly in general departments (62.1% vs. 69.2%; p = 0.0019). We observed that long nails and artificial/polished nails were more often observed in the group of nurses than in the group of physicians (7.3% vs. 4.7%, respectively; p = 0.0006 and 19.3% vs. 10.1%; p = 0.0000), while an inverse relationship was found in relation to watches (24.0% vs. 12.0%; p = 0.0000) and long sleeves (24.4% vs. 8.1%; p = 0.0000). Incorrect and less effective hand hygiene among some groups of hospital workers is still present. Therefore, the continuation of education actions concerned with hand hygiene among healthcare workers is needed.
Collapse
Affiliation(s)
- Emilia Szumska
- Medilab Sp. z o. o., Niedzwiedzia 60, 15-531 Bialystok, Poland
| | - Przemyslaw Czajkowski
- Clinical Research Centre, Medical University of Bialystok, Jana Kilinskiego 1, 15-089 Bialystok, Poland
| | - Michal Zablocki
- Medilab Sp. z o. o., Niedzwiedzia 60, 15-531 Bialystok, Poland
| | - Dorota Rozkiewicz
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland
| |
Collapse
|
32
|
Ahmadipour M, Dehghan M, Ahmadinejad M, Jabarpour M, Mangolian Shahrbabaki P, Ebrahimi Rigi Z. Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study. Front Public Health 2022; 10:968231. [PMID: 36062108 PMCID: PMC9433968 DOI: 10.3389/fpubh.2022.968231] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/28/2022] [Indexed: 01/25/2023] Open
Abstract
Background The practice of hand washing is an effective way to prevent contamination and disease transmission. Following the COVID-19 pandemic, hand washing has become increasingly important. Therefore, this qualitative study aimed to understand barriers to hand hygiene compliance among healthcare workers during the COVID-19 pandemic. Materials and methods Twenty-five healthcare workers from intensive care units were sampled using purposive sampling in a qualitative content analysis study. Data were collected through a semi-structured interview and field notes. Based on the Lundman and Graneheim approach, the data were analyzed. COREQ checklist was used to report the research. Results According to the findings, there are three main categories of barriers to hand hygiene practice: barriers related to individuals (including two subcategories of lack of knowledge of healthcare workers and healthcare workers' improper attitude), barriers related to management (including two subcategories of wrong behavioral patterns and unsuitable training and planning), and barriers related to organizations (including four subcategories of heavy workloads, improperly designed wards, a lack of equipment, and lack of quality equipment). Conclusions This research indicates that hand washing practice increased during the COVID-19 pandemic. Nevertheless, some barriers persist, resulting in a decline in hand washing compliance among health care workers. This finding can help managers and policymakers remove barriers to hand washing compliance and improve healthcare workers' adherence to hand washing.
Collapse
Affiliation(s)
- Maryam Ahmadipour
- Department of Pediatric, School of Medicine Afzalipour Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahlagha Dehghan
- Department of Critical Care Nursing, Facullty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehdi Ahmadinejad
- Department of Anaesthesiology, School of Medicine, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Jabarpour
- Clinical Research Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Zahra Ebrahimi Rigi
- Department of Nursing, School of Nursing and Midwifery, Iranshahr University of Medical Sciences, Iranshahr, Iran
| |
Collapse
|
33
|
Saveanu CI, Anistoroaei D, Todireasa S, Saveanu AE, Bobu LI, Bamboi I, Boronia O, Balcos C. Evaluation of the Efficiency of Hand Hygiene Technique with Hydroalcoholic Solution by Image Color Summarize. Medicina (B Aires) 2022; 58:medicina58081108. [PMID: 36013575 PMCID: PMC9413243 DOI: 10.3390/medicina58081108] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The HH (hand hygiene) technique is relatively simple. Even so, in practice there are still non-conformities regarding this aspect. Lack of knowledge or lack of compliance can be reasons for non-adherence with HH techniques. In this context, the purpose of this study was to follow the realization of the hand-washing technique with hydroalcoholic solution, applied before and after receiving the HH recommendations. Materials and Methods: A descriptive, cross-sectional study was conducted from May 2022 to June 2022. Students from a second year dental medicine class teaching in French 2021/22 “Grigore T. Popa” University of Medicine and Pharmacy in Iasi were included in the study. The approval of the ethics commission was received: No. 184/05.05.2022. The study was conducted in two stages. In the first stage, HH was performed without any recommendation. In the second stage, the antiseptic hand rubbing technique was presented following the WHO recommendations. The fluorescent Fluo-Add solution, Wood lamp for dermatology (4 × 5.5 W ultraviolet tubes with a wavelength of 360 nm), and photo camera were used. Subjects performed their HH movement before and after receiving instructions according to WHO. Images were initially taken from the backhand and palm and were finally analyzed with Image Color Summarizer. The data were analyzed by the Mann–Whitney U Test, t-test paired samples using IBM-SPSS version 26 (IBM, Armonk, NY, USA), and p ≤ 0.05 was considered statistically significant. Results: After analyzing the images, there were 70 subjects, 45.7% (32) female and 54.33% (38) male. Final average covered area of backhand was 60.89% (±17.17), 28.84:86.11, compared to 52.07% (±17.04), 9:85.23. Final average covered area for palm was 69.91% (±13.5), 31.61:93.41 compared to 59.74% (±16.64), 26.13:92.72. No statistical significance was obtained by gender. Conclusions: The study showed an improvement in hand hygiene technique without highlighting gender differences.
Collapse
Affiliation(s)
| | - Daniela Anistoroaei
- Correspondence: (D.A.); (A.E.S.); Tel.: +40-721-377-269 (D.A.); +40-0755569120 (A.E.S.)
| | | | | | | | | | | | | |
Collapse
|
34
|
Owings A, Christion L, Gilliam C, Glover B, Bhatia S, Tang L, Hakim H. Improving visitors' hand hygiene compliance in a pediatric oncology unit. Am J Infect Control 2022; 50:724-728. [PMID: 34848293 DOI: 10.1016/j.ajic.2021.11.018] [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] [Received: 09/01/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hand hygiene (HH) is the single most important method to prevent infections. We aim at improving HH compliance by visitors to a pediatric oncology unit. METHODS A performance improvement project implemented several Plan-Do-Study-Act cycles in July-November 2018. At baseline, a wall-mounted alcohol-based hand sanitizer dispenser was available at the unit entrance. Cycle 1 (visual cue), cycle 2 (visual cue plus verbal symptom screen), and cycle 3 (visual cue, symptom screen, plus HH verbal instructions) were tested. Patient care associates (PCA) positioned at the entrance implemented the cycles and recorded data about visitor's estimated age, day and time of observations, and covert HH compliance monitoring. Participating PCAs were surveyed regarding process feasibility. RESULTS Of 1230 (97%) analyzed observations; 204 (17%) were baseline, 293 (24%) in cycle 1, 374 (30%) in cycle 2, and 359 (29%) in cycle 3. The visitors' HH compliance significantly increased to 16.0%, 22.5%, and 48.5% in cycles 1, 2, and 3, respectively, from a baseline of 4.9% (P < .001). Visitors were more likely to perform HH when directly instructed (cycle 3) compared to baseline (adjusted OR = 19.77, 95% CI, 10.30-42.09, P < .001). Although the surveyed PCAs agreed the process is easy and fast, they reported few barriers. CONCLUSIONS Direct verbal instructions for HH were the most effective in improving visitors' HH compliance.
Collapse
Affiliation(s)
- Angie Owings
- Department of Infection Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Lori Christion
- Department of Nursing, St. Jude Children's Research Hospital, Memphis, TN
| | - Craig Gilliam
- Department of Infection Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Bethany Glover
- Department of Infection Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Shalini Bhatia
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Li Tang
- Department of Infection Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN
| | - Hana Hakim
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN.
| |
Collapse
|
35
|
deKay K. Clinical Issues-July 2022. AORN J 2022; 116:71-77. [PMID: 35758736 DOI: 10.1002/aorn.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/11/2022]
Abstract
Surgical hand antisepsis recommendations Key words: surgical hand scrub, alcohol-based hand rub, dry scrub, wet scrub, antimicrobial. Surgical hand rub preparation Key words: surgical hand antiseptic, hand wash, nail pick, hand hygiene, scrub personnel. Use of a closing tray Key words: clean-contaminated, isolation technique, gastrointestinal tract, wound class, wound closure. Hemostatic agent classification Key words: Class III medical devices, absorbable hemostatic agents, product classification, medical specialty panels, Code of Federal Regulations (CFR).
Collapse
|
36
|
Li L, Ni K, Du X, Wu S, Zhang J, Zhou H, Hu Q, Zeng H, Sui X, Meng Q, Wang X. Assessment of the invisible blood contamination on nurses' gloved hands during vascular access procedures in a hemodialysis unit. Am J Infect Control 2022; 50:712-713. [PMID: 34963646 DOI: 10.1016/j.ajic.2021.12.009] [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] [Received: 11/30/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022]
Abstract
A prospective study was conducted to assess potential invisible blood contamination on nurses' gloved hands during vascular access procedures using the occult blood detection method in a hemodialysis unit. 60.13% (273/454) of samples tested positive for hemoglobin. These results highlighted the importance of hand hygiene and glove change during hemodialysis access care.
Collapse
Affiliation(s)
- Li Li
- Department of Disease Control and Prevention, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Kaiwen Ni
- Department of Infection Control, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuewei Du
- Department of Disease Control and Prevention, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Suzhen Wu
- Hemodialysis Center, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Jianping Zhang
- Hemodialysis Center, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Haoran Zhou
- Department of Disease Control and Prevention, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Qian Hu
- Department of Disease Control and Prevention, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Hui Zeng
- Department of Disease Control and Prevention, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Xiaofan Sui
- Department of Disease Control and Prevention, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Qinglan Meng
- Department of Disease Control and Prevention, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia
| | - Xuguang Wang
- Department of Vascular Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia.
| |
Collapse
|
37
|
de Kraker MEA, Tartari E, Tomczyk S, Twyman A, Francioli LC, Cassini A, Allegranzi B, Pittet D. Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019. Lancet Infect Dis 2022; 22:835-844. [PMID: 35202600 PMCID: PMC9132778 DOI: 10.1016/s1473-3099(21)00618-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/02/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hand hygiene is at the core of effective infection prevention and control (IPC) programmes. 10 years after the development of the WHO Multimodal Hand Hygiene Improvement Strategy, we aimed to ascertain the level of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey. METHODS From Jan 16 to Dec 31, 2019, IPC professionals were invited through email and campaigns to complete the online Hand Hygiene Self-Assessment Framework (HHSAF). A geospatial clustering algorithm selected unique health-care facilities responses and post-stratification weighting was applied to improve representativeness. Weighted median HHSAF scores and IQR were reported. Drivers of the HHSAF score were determined through a generalised estimation equation. FINDINGS 3206 unique responses from 90 countries (46% WHO Member States) were included. The HHSAF score indicated an intermediate hand hygiene implementation level (350 points, IQR 248-430), which was positively associated with country income level and health-care facility funding structure. System Change had the highest score (85 points, IQR 55-100), whereby alcohol-based hand rub at the point of care has become standard practice in many health-care facilities, especially in high-income countries. Institutional Safety Climate had the lowest score (55 points, IQR 35-75). From 2015 to 2019, the median HHSAF score in health-care facilities participating in both HHSAF surveys (n=190) stagnated. INTERPRETATION Most health-care facilities had an intermediate level of hand hygiene implementation or higher, for which health-care facility funding and country income level were important drivers. Availability of resources, leadership, and organisational support are key elements to further improve quality of care and provide access to safe care for all. FUNDING WHO, Geneva University Hospitals and Faculty of Medicine, and WHO Collaborating Center on Patient Safety, Geneva, Switzerland.
Collapse
Affiliation(s)
- Marlieke E A de Kraker
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Sara Tomczyk
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Anthony Twyman
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Laurent C Francioli
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Alessandro Cassini
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, WHO, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| |
Collapse
|
38
|
Wang C, Jiang W, Yang K, Sarsenbayeva Z, Tag B, Dingler T, Goncalves J, Kostakos V. A System for Computational Assessment of Hand Hygiene Techniques. J Med Syst 2022; 46:36. [PMID: 35522356 PMCID: PMC9076723 DOI: 10.1007/s10916-022-01817-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/11/2022] [Indexed: 10/28/2022]
Abstract
The World Health Organization (WHO) recommends a six-step hand hygiene technique. Although multiple studies have reported that this technique yields inadequate skin coverage outcomes, they have relied on manual labeling that provided low-resolution estimations of skin coverage outcomes. We have developed a computational system to precisely quantify hand hygiene outcomes and provide high-resolution skin coverage visualizations, thereby improving hygiene techniques. We identified frequently untreated areas located at the dorsal side of the hands around the abductor digiti minimi and the first dorsal interosseous. We also estimated that excluding Steps 3, 6R, and 6L from the six-step hand hygiene technique leads to cumulative coverage loss of less than 1%, indicating the potential redundancy of these steps. Our study demonstrates that the six-step hand hygiene technique could be improved to reduce the untreated areas and remove potentially redundant steps. Furthermore, our system can be used to computationally validate new proposed techniques, and help optimise hand hygiene procedures.
Collapse
Affiliation(s)
- Chaofan Wang
- School of Computing and Information Systems, The University of Melbourne, 700 Swanston St, Carlton, 3053, VIC, Australia.
| | - Weiwei Jiang
- School of Computing and Information Systems, The University of Melbourne, 700 Swanston St, Carlton, 3053, VIC, Australia
| | - Kangning Yang
- School of Computing and Information Systems, The University of Melbourne, 700 Swanston St, Carlton, 3053, VIC, Australia
| | - Zhanna Sarsenbayeva
- School of Computing and Information Systems, The University of Melbourne, 700 Swanston St, Carlton, 3053, VIC, Australia
| | - Benjamin Tag
- School of Computing and Information Systems, The University of Melbourne, 700 Swanston St, Carlton, 3053, VIC, Australia
| | - Tilman Dingler
- School of Computing and Information Systems, The University of Melbourne, 700 Swanston St, Carlton, 3053, VIC, Australia
| | - Jorge Goncalves
- School of Computing and Information Systems, The University of Melbourne, 700 Swanston St, Carlton, 3053, VIC, Australia
| | - Vassilis Kostakos
- School of Computing and Information Systems, The University of Melbourne, 700 Swanston St, Carlton, 3053, VIC, Australia
| |
Collapse
|
39
|
Wang Y, Yang J, Qiao F, Feng B, Hu F, Xi ZA, Wu W, Ni ZL, Liu L, Yuan Y. Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis. Am J Infect Control 2022; 50:563-571. [PMID: 34883162 PMCID: PMC8648372 DOI: 10.1016/j.ajic.2021.11.030] [Citation(s) in RCA: 13] [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: 08/04/2021] [Revised: 11/22/2021] [Accepted: 11/22/2021] [Indexed: 02/05/2023]
Abstract
Background Hand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures. Aim To systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic. Methods The PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I2 statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Findings Seven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%). Conclusions During the COVID-19 pandemic, the compliance of health care providers’ HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for “before contact with patients” should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.
Collapse
Affiliation(s)
- Ying Wang
- Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China; Institute of Hospital Management, Wuhan University, Wuhan, Hubei, P. R. China
| | - Jinru Yang
- Cancer Center of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Fu Qiao
- Infection Prevention and Control Department, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Bilong Feng
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China; Clinical Research Center of Hubei Critical Care Medicine, Wuhan, Hubei, P. R. China
| | - Zi-Ang Xi
- School of Architecture, Tsinghua University, Beijing, P. R. China
| | - Wenwen Wu
- School of Public Health and Management, Hubei University of Medicine, Shiyan, China
| | - Zi-Ling Ni
- School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Li Liu
- School of Architecture, Tsinghua University, Beijing, P. R. China.
| | - Yufeng Yuan
- Department of Hepatobiliary and Pancreatic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, P. R. China.
| |
Collapse
|
40
|
Garlasco J, Vicentini C, Emelurumonye IN, D'Alessandro G, Quattrocolo F, Zotti CM. Alcohol-Based Hand Rub Consumption and World Health Organization Hand Hygiene Self-Assessment Framework: A Comparison Between the 2 Surveillances in a 4-Year Region-Wide Experience. J Patient Saf 2022; 18:e658-e665. [PMID: 34520440 DOI: 10.1097/pts.0000000000000908] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Hand hygiene is essential for infection prevention. In Piedmont (Northwest Italy), hand hygiene is routinely monitored through 2 surveillance systems, the World Health Organization Hand Hygiene Self-Assessment Framework (HHSAF) and alcohol-based hand rub (ABHR) consumption. This study was aimed at (1) comparing the results of these surveillances, investigating the consistence of the 2 systems and (2) inquiring whether organizational differences among healthcare facilities significantly affected hand hygiene performances. METHODS A retrospective analysis was performed on data collected annually from 2015 to 2018 for both surveillances from 40 hospitals of the region: HHSAF score (500 points maximum) and ABHR consumption in milliliters per patient-day (mL/PD) were considered. Logistic regression models were built to evaluate possible correlations between these variables, and observations were clustered considering both variables to identify whether groups with significant differences could be discerned. A tree-structured partitioning model was used to confirm the obtained results. RESULTS A positive correlation was observed between HHSAF score and odds of belonging to the high ABHR consumption group, particularly for cutoffs set to 19 to 23 mL/PD (P = 0.033 for 23 mL/PD). Two ABHR consumption peaks were identified at approximately 10 and 22 mL/PD, corresponding to median HHSAF scores of 353.75 and 375 points, respectively. The group with better performances was mainly composed of hub hospitals (with single-hospital management). CONCLUSIONS The 2 surveillance systems are consistent, and the HHSAF score could work as a reasonable predictor of hand hygiene compliance in healthcare settings. Different management characteristics are crucial in creating a more/less favorable environment for hand hygiene compliance and infection prevention.
Collapse
Affiliation(s)
- Jacopo Garlasco
- From the Department of Public Health Sciences and Paediatrics
| | | | | | | | | | | |
Collapse
|
41
|
Schmidtke KA, Aujla N, Marshall T, Hussain A, Hodgkinson GP, Arheart KL, Birnbach DJ, Kudrna L, Vlaev I. A Crossover Randomized Controlled Trial of Priming Interventions to Increase Hand Hygiene at Ward Entrances. Front Public Health 2022; 9:781359. [PMID: 35111716 PMCID: PMC8801705 DOI: 10.3389/fpubh.2021.781359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/22/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundResearch conducted in the United States suggests that two primes (citrus smells and pictures of a person's eyes) can increase hand gel dispenser use on the day they are introduced in hospital. The current study, conducted at a hospital in the United Kingdom, evaluated the effectiveness of these primes, both in isolation and in combination, at the entry way to four separate wards, over a longer duration than the previous work.MethodsA crossover randomized controlled trial was conducted. Four wards were allocated for 6 weeks of observation to each of four conditions, including “control,” “olfactory,” “visual,” or “both” (i.e., “olfactory” and “visual” combined). It was hypothesized that hand hygiene compliance would be greater in all priming conditions relative to the control condition. The primary outcome was whether people used the gel dispenser when they entered the wards. After the trial, a follow up survey of staff at the same hospital assessed the barriers to, and facilitators of, hand hygiene compliance. The trial data were analyzed using regression techniques and the survey data were analyzed using descriptive statistics.ResultsThe total number of individuals observed in the trial was 9,811 (female = 61%), with similar numbers across conditions, including “control” N = 2,582, “olfactory” N = 2,700, “visual” N = 2,488, and “both” N = 2,141. None of the priming conditions consistently increased hand hygiene. The lowest percentage compliance was observed in the “both” condition (7.8%), and the highest was observed in the “visual” condition (12.7%). The survey was completed by 97 staff (female = 81%). “Environmental resources” and “social influences” were the greatest barriers to staff cleaning their hands.ConclusionsTaken together, the current findings suggest that the olfactory and visual priming interventions investigated do not influence hand hygiene consistently. To increase the likelihood of such interventions succeeding, future research should focus on prospectively determined mechanisms of action.
Collapse
Affiliation(s)
| | - Navneet Aujla
- Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Tom Marshall
- Primary Care Clinical Sciences Institute of Applied Health Research College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Abid Hussain
- Public Health England, Public Health Laboratory, Birmingham Heartlands Hospital, Birmingham, United Kingdom
| | - Gerard P. Hodgkinson
- Manchester Institute of Innovation Research, Alliance Manchester Business School, The University of Manchester, Manchester, United Kingdom
| | - Kristopher L. Arheart
- Division of Biostatistics, Department of Public Health Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - David J. Birnbach
- Department of Anesthesiology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States
| | - Laura Kudrna
- Institute of Applied Health, University of Birmingham, Birmingham, United Kingdom
- *Correspondence: Laura Kudrna
| | - Ivo Vlaev
- Behavioral Science Group, Warwick Business School, The University of Warwick, Coventry, United Kingdom
| |
Collapse
|
42
|
Berman L, Kavalier M, Gelana B, Tesfaw G, Siraj D, Shirley D, Yilma D. Utilizing the SEIPS model to guide hand hygiene interventions at a tertiary hospital in Ethiopia. PLoS One 2021; 16:e0258662. [PMID: 34710135 PMCID: PMC8553035 DOI: 10.1371/journal.pone.0258662] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/02/2021] [Indexed: 11/19/2022] Open
Abstract
We aimed to apply the Systems Engineering Initiative for Patient Safety (SEIPS) model to increase effectiveness and sustainability of the World Health Organization's (WHOs) hand hygiene (HH) guidelines within healthcare systems. Our cross-sectional, mixed-methods study took place at Jimma University Medical Center (JUMC), a tertiary care hospital in Jimma, Ethiopia, between November 2018 and August 2020 and consisted of three phases: baseline assessment, intervention, and follow-up assessment. We conducted questionnaires addressing HH knowledge and attitudes, interviews to identify HH barriers and facilitators within the SEIPS framework, and observations at the WHO's 5 moments of HH amongst healthcare workers (HCWs) at JUMC. We then implemented HH interventions based on WHO guidelines and results from our baseline assessment. Follow-up HH observations were conducted months later during the Covid-19 pandemic. 250 HCWs completed questionnaires with an average knowledge score of 61.4% and attitude scores indicating agreement that HH promotes patient safety. Interview participants cited multiple barriers to HH including shortages and location of HH materials, inadequate training, minimal Infection Prevention Control team presence, and high workload. We found an overall baseline HH compliance rate of 9.4% and a follow-up compliance rate of 72.1%. Drastically higher follow-up compared to baseline compliance rates were likely impacted by our HH interventions and Covid-19. HCWs showed motivation for patient safety despite low HH knowledge. Utilizing the SEIPS model helped identify institution-specific barriers that informed targeted interventions beyond WHO guidelines aimed at increasing effectiveness and sustainability of HH efforts.
Collapse
Affiliation(s)
- Leigh Berman
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Meredith Kavalier
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Beshea Gelana
- Department of Health Policy and Management, Jimma University, Jimma, Ethiopia
| | - Getnet Tesfaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Dawd Siraj
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Daniel Shirley
- Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Daniel Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
- Jimma University Clinical Trial Unit, Jimma University, Jimma, Ethiopia
| |
Collapse
|
43
|
Williams V, Kovacs-Litman A, Muller MP, Hota S, Powis JE, Ricciuto DR, Mertz D, Katz K, Castellani L, Kiss A, Linkenheld-Struk A, Leis JA. Impact of COVID-19 on hospital hand hygiene performance: a multicentre observational study using group electronic monitoring. CMAJ Open 2021; 9:E1175-E1180. [PMID: 34906993 PMCID: PMC8687486 DOI: 10.9778/cmajo.20210072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Reliable reports on hand hygiene performance throughout the COVID-19 pandemic are lacking as most hospitals continue to rely on direct observation to measure this quality indicator. Using group electronic hand hygiene monitoring, we sought to assess the impact of COVID-19 on adherence to hand hygiene. METHODS Across 12 Ontario hospitals (5 university and 7 community teaching hospitals), a group electronic hand hygiene monitoring system was installed before the pandemic to provide continuous measurement of hand hygiene adherence across 978 ward and 367 critical care beds. We performed an interrupted time-series study of institutional hand hygiene adherence in association with a COVID-19 inpatient census and the Ontario daily count of COVID-19 cases during a baseline period (Nov. 1, 2019, to Feb. 29, 2020), the pre-peak period of the first wave of the pandemic (Mar. 1 to Apr. 24, 2020), and the post-peak period of the first wave (Apr. 25 to July 5, 2020). We used a Poisson regression model to assess the association between the hospital COVID-19 census and institutional hand hygiene adherence while adjusting for the correlation within inpatient units. RESULTS At baseline, the rate of hand hygiene adherence was 46.0% (6 325 401 of 13 750 968 opportunities) and this improved beginning in March 2020 to a daily peak of 79.3% (66 640 of 84 026 opportunities) on Mar. 30, 2020. Each patient admitted with COVID-19 was associated with improved hand hygiene adherence (incidence rate ratio [IRR] 1.0621, 95% confidence interval [CI] 1.0619-1.0623). Increasing Ontario daily case count was similarly associated with improved hand hygiene (IRR 1.0026, 95% CI 1.0021-1.0032). After peak COVID-19 community and inpatient numbers, hand hygiene adherence declined and returned to baseline. INTERPRETATION The first wave of the COVID-19 pandemic was associated with significant improvement in hand hygiene adherence, measured using a group electronic monitoring system. Future research should seek to determine whether strategies that focus on health care worker perception of personal risk can achieve sustainable improvements in hand hygiene performance.
Collapse
Affiliation(s)
- Victoria Williams
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Adam Kovacs-Litman
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Matthew P Muller
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Susy Hota
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Jeff E Powis
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Daniel R Ricciuto
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Dominik Mertz
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Kevin Katz
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Lucas Castellani
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Alex Kiss
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Amber Linkenheld-Struk
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont
| | - Jerome A Leis
- Sunnybrook Health Sciences Centre (Williams, Linkenheld-Struk, Leis); Department of Medicine (Kovacs-Litman, Muller, Hota, Powis, Leis), University of Toronto; Division of Infectious Diseases (Muller), St. Michael's Hospital; University Health Network (Hota); Peterborough Regional Health Centre (Powis, Ricciuto), Peterborough, Ont.; Division of Infectious Diseases (Powis), Michael Garron Hospital, Toronto, Ont.; Division of Infectious Diseases (Ricciuto), Lakeridge Health, Oshawa, Ont.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; North York General Hospital (Katz), Toronto, Ont.; Sault Area Hospital (Castellani), Sault Ste Marie, Ont.; Sunnybrook Research Institute (Kiss, Leis), Toronto, Ont.
| |
Collapse
|
44
|
Liu PY, Gragnani CM, Timmerman J, Newhouse CN, Soto G, Lopez L, Spronz R, Mhaskar A, Yeganeh N, Fernandes P, Kuo AA. Pediatric Household Transmission of Severe Acute Respiratory Coronavirus-2 Infection-Los Angeles County, December 2020 to February 2021. Pediatr Infect Dis J 2021; 40:e379-e381. [PMID: 34387617 PMCID: PMC8443424 DOI: 10.1097/inf.0000000000003251] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
This brief report presents transmission rates from a prospective study of 15 households with pediatric index cases of severe acute respiratory coronavirus-2 in Los Angeles County from December 2020 to February 2021. Our findings support ongoing evidence that transmission from pediatric index cases to household contacts is frequent but can be mitigated with practicing well-documented control measures at home, including isolation, masking and good hand hygiene.
Collapse
Affiliation(s)
| | | | - Jason Timmerman
- Department of Medicine, David Geffen School of Medicine at UCLA
| | | | - Gabriela Soto
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Lizzet Lopez
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Rachel Spronz
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Aditi Mhaskar
- Department of Medicine, David Geffen School of Medicine at UCLA
| | - Nava Yeganeh
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine at UCLA
| | | | - Alice A Kuo
- Department of Pediatrics, Division of Child Health Policy, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
45
|
Takeda Y, Jamsransuren D, Makita Y, Kaneko A, Matsuda S, Ogawa H, Oh H. Inactivation of SARS-CoV-2 by Ozonated Glycerol. Food Environ Virol 2021; 13:316-321. [PMID: 34173934 PMCID: PMC8233603 DOI: 10.1007/s12560-021-09485-x] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/19/2021] [Indexed: 05/04/2023]
Abstract
We evaluated the SARS-CoV-2-inactivation activity of ozonated glycerol (OG). When a viral solution with 1% fetal bovine serum (FBS) was mixed with test solutions at a ratio of 1:19 and incubated for 20 s, OG with ozone concentrations of over 1000 ppm inactivated ≥ 94.38% of the virus. Extension of the reaction time to 1 h led to the inactivation of ≥ 99.82% of the virus (the viral titer was below the detection limit). Extension to 24 h resulted in concentrations over 200 ppm OG inactivating ≥ 99.87% of the virus (the viral titers were below the detection limit). Next, viral solutions with 1, 20, and 40% FBS were mixed with test solutions at a ratio of 1:19 and incubated for 5 min. Whereas the virucidal activity of 500 ppm OG was very limited in the presence of 1% FBS (79.47% inactivation), it increased in the presence of 20 and 40% FBS (95.13 and 97.95% inactivation, respectively; the viral titers were not below the detection limit). Meanwhile, over 1000 ppm OG inactivated ≥ 99.44% of the virus regardless of the FBS concentration (the viral titers were below the detection limit). Extension of the reaction time to 1 h led to 500 ppm OG inactivating ≥ 99.91 and ≥ 99.95% of the virus with 20 and 40% FBS, respectively (the viral titers were below the detection limit). These results suggested that OG might be useful as a virucidal agent against SARS-CoV-2.
Collapse
Affiliation(s)
- Yohei Takeda
- Research Center for Global Agromedicine, Obihiro University of Agriculture and Veterinary Medicine, 2-11 Inada, Obihiro, Hokkaido 080-8555 Japan
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, 2-11 Inada, Obihiro, Hokkaido 080-8555 Japan
| | - Dulamjav Jamsransuren
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, 2-11 Inada, Obihiro, Hokkaido 080-8555 Japan
| | - Yoshimasa Makita
- Department of Chemistry, Osaka Dental University, 8-1 Kuzuha Hanazono Hirakata, Osaka, 573-1121 Japan
| | - Akihiro Kaneko
- Department of Oral Surgery, Ikegami General Hospital, 6-1-19 Ikegami Ootaku, Tokyo, 146-8531 Japan
| | - Sachiko Matsuda
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, 2-11 Inada, Obihiro, Hokkaido 080-8555 Japan
| | - Haruko Ogawa
- Department of Veterinary Medicine, Obihiro University of Agriculture and Veterinary Medicine, 2-11 Inada, Obihiro, Hokkaido 080-8555 Japan
| | - Hourei Oh
- Center of Innovation in Dental Education, Osaka Dental University, 8-1 Kuzuha Hanazono Hirakata, Osaka, 573-1121 Japan
| |
Collapse
|
46
|
Kalin Ünüvar G, Doğanay M, Alp E. Current Infection Prevention and Control Strategies of COVID-19 in Hospitals. Turk J Med Sci 2021; 51:3215-3220. [PMID: 34289652 PMCID: PMC8771013 DOI: 10.3906/sag-2106-156] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 07/21/2021] [Indexed: 11/05/2022] Open
Abstract
Background/aim Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has been appeared first in China since December 2019. Transmission of SARS-CoV-2 occurs primarily with droplets through coughing and sneezing and also occurs through inhalation of aerosolized secretions, which travel, remain suspended in the air longer. Materials and methods Since early stages of the outbreak, COVID-19 cases have been described in healthcare workers (HCWs). However, in the early stages, the disease may be asymptomatic. This may lead to incorrect diagnosis or delayed diagnosis and may lead to the nosocomial spread of the virus. One of the most important causes of transmission among HCWs is being exposed to an aerosolized virus in a closed environment for a long time. It is possible to prevent and control the spread of COVID-19 in hospitals with outpatient treatment and triage. Results Infection control measures, including wearing surgical masks, hand hygiene, and social distance are considered essential in preventing human-to-human transmissions of SARS-CoV-2. Immediate response and practices of infection control measures are critical for saving lives during an epidemic inside and outside the hospital. Conclusion Analyzing current knowledge about the features of SARS-CoV-2 infection, screening, personal protection protocols, triage and psychological support practices for healthcare professionals can be promising in terms of controlling the infection.
Collapse
Affiliation(s)
- Gamze Kalin Ünüvar
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Doğanay
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
| | - Emine Alp
- Scientific Committee Member, Ministry of Health, Ankara, Turkey
| |
Collapse
|
47
|
Hamer DH, White LF, Jenkins HE, Gill CJ, Landsberg HE, Klapperich C, Bulekova K, Platt J, Decarie L, Gilmore W, Pilkington M, MacDowell TL, Faria MA, Densmore D, Landaverde L, Li W, Rose T, Burgay SP, Miller C, Doucette-Stamm L, Lockard K, Elmore K, Schroeder T, Zaia AM, Kolaczyk ED, Waters G, Brown RA. Assessment of a COVID-19 Control Plan on an Urban University Campus During a Second Wave of the Pandemic. JAMA Netw Open 2021; 4:e2116425. [PMID: 34170303 PMCID: PMC8233704 DOI: 10.1001/jamanetworkopen.2021.16425] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 01/15/2023] Open
Abstract
Importance The COVID-19 pandemic has severely disrupted US educational institutions. Given potential adverse financial and psychosocial effects of campus closures, many institutions developed strategies to reopen campuses in the fall 2020 semester despite the ongoing threat of COVID-19. However, many institutions opted to have limited campus reopening to minimize potential risk of spread of SARS-CoV-2. Objective To analyze how Boston University (BU) fully reopened its campus in the fall of 2020 and controlled COVID-19 transmission despite worsening transmission in Boston, Massachusetts. Design, Setting, and Participants This multifaceted intervention case series was conducted at a large urban university campus in Boston, Massachusetts, during the fall 2020 semester. The BU response included a high-throughput SARS-CoV-2 polymerase chain reaction testing facility with capacity to deliver results in less than 24 hours; routine asymptomatic screening for COVID-19; daily health attestations; adherence monitoring and feedback; robust contact tracing, quarantine, and isolation in on-campus facilities; face mask use; enhanced hand hygiene; social distancing recommendations; dedensification of classrooms and public places; and enhancement of all building air systems. Data were analyzed from December 20, 2020, to January 31, 2021. Main Outcomes and Measures SARS-CoV-2 diagnosis confirmed by reverse transcription-polymerase chain reaction of anterior nares specimens and sources of transmission, as determined through contact tracing. Results Between August and December 2020, BU conducted more than 500 000 COVID-19 tests and identified 719 individuals with COVID-19, including 496 students (69.0%), 11 faculty (1.5%), and 212 staff (29.5%). Overall, 718 individuals, or 1.8% of the BU community, had test results positive for SARS-CoV-2. Of 837 close contacts traced, 86 individuals (10.3%) had test results positive for COVID-19. BU contact tracers identified a source of transmission for 370 individuals (51.5%), with 206 individuals (55.7%) identifying a non-BU source. Among 5 faculty and 84 staff with SARS-CoV-2 with a known source of infection, most reported a transmission source outside of BU (all 5 faculty members [100%] and 67 staff members [79.8%]). A BU source was identified by 108 of 183 undergraduate students with SARS-CoV-2 (59.0%) and 39 of 98 graduate students with SARS-CoV-2 (39.8%); notably, no transmission was traced to a classroom setting. Conclusions and Relevance In this case series of COVID-19 transmission, BU used a coordinated strategy of testing, contact tracing, isolation, and quarantine, with robust management and oversight, to control COVID-19 transmission in an urban university setting.
Collapse
Affiliation(s)
- Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
- Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- National Emerging Infectious Disease Laboratory, Boston, Massachusetts
- Precision Diagnostics Center, Boston University, Boston, Massachusetts
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Helen E. Jenkins
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Christopher J. Gill
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts
| | - Hannah E. Landsberg
- Student Health Services, Healthway, Boston University, Boston, Massachusetts
| | - Catherine Klapperich
- Precision Diagnostics Center, Boston University, Boston, Massachusetts
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Katia Bulekova
- Information Services and Technology, Boston University, Boston, Massachusetts
| | - Judy Platt
- Student Health Services, Healthway, Boston University, Boston, Massachusetts
| | - Linette Decarie
- Boston University Analytical Services & Institutional Research, Boston, Massachusetts
| | - Wayne Gilmore
- Information Services and Technology, Boston University, Boston, Massachusetts
| | - Megan Pilkington
- Boston University Analytical Services & Institutional Research, Boston, Massachusetts
| | - Trevor L. MacDowell
- Information Services and Technology, Boston University, Boston, Massachusetts
| | - Mark A. Faria
- Information Services and Technology, Boston University, Boston, Massachusetts
| | - Douglas Densmore
- Electrical and Computer Engineering, Boston University, Boston, Massachusetts
- Biological Design Center, Boston University, Boston, Massachusetts
| | - Lena Landaverde
- Student Health Services, Healthway, Boston University, Boston, Massachusetts
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts
| | - Wenrui Li
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
| | - Tom Rose
- Human Resources, Boston University, Boston, Massachusetts
| | - Stephen P. Burgay
- Office of External Affairs, Boston University, Boston, Massachusetts
| | - Candice Miller
- BU Clinical Testing Laboratory, Research Department, Boston University, Boston, Massachusetts
| | - Lynn Doucette-Stamm
- BU Clinical Testing Laboratory, Research Department, Boston University, Boston, Massachusetts
| | - Kelly Lockard
- Continuous Improvement & Data Analytics, Boston University, Boston, Massachusetts
| | - Kenneth Elmore
- Office of the Provost, Boston University, Boston, Massachusetts
| | - Tracy Schroeder
- Information Services and Technology, Boston University, Boston, Massachusetts
| | - Ann M. Zaia
- Occupational Health Center, Boston University, Boston Massachusetts
| | - Eric D. Kolaczyk
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
- Hariri Institute for Computing, Boston University, Boston, Massachusetts
| | - Gloria Waters
- Office of the Provost, Boston University, Boston, Massachusetts
- College of Health and Rehabilitation Services, Sargent College, Boston University, Boston, Massachusetts
| | - Robert A. Brown
- College of Engineering, Boston University, Boston, Massachusetts
- Office of the President, Boston University, Boston, Massachusetts
| |
Collapse
|
48
|
Rattay P, Michalski N, Domanska OM, Kaltwasser A, De Bock F, Wieler LH, Jordan S. Differences in risk perception, knowledge and protective behaviour regarding COVID-19 by education level among women and men in Germany. Results from the COVID-19 Snapshot Monitoring (COSMO) study. PLoS One 2021; 16:e0251694. [PMID: 33979413 PMCID: PMC8116045 DOI: 10.1371/journal.pone.0251694] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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: 01/30/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022] Open
Abstract
The main strategy for combatting SARS-CoV-2 infections in 2020 consisted of behavioural regulations including contact reduction, maintaining distance, hand hygiene, and mask wearing. COVID-19-related risk perception and knowledge may influence protective behaviour, and education could be an important determinant. The current study investigated differences by education level in risk perception, knowledge and protective behaviour regarding COVID-19 in Germany, exploring the development of the pandemic over time. The COVID-19 Snapshot Monitoring study is a repeated cross-sectional online survey conducted during the pandemic in Germany from 3 March 2020 (waves 1-28: 27,957 participants aged 18-74). Differences in risk perception, knowledge and protective behaviour according to education level (high versus low) were analysed using linear and logistic regression. Time trends were accounted for by interaction terms for education level and calendar week. Regarding protective behaviour, interaction terms were tested for all risk perception and knowledge variables with education level. The strongest associations with education level were evident for perceived and factual knowledge regarding COVID-19. Moreover, associations were found between low education level and higher perceived severity, and between low education level and lower perceived probability. Highly educated men were more worried about COVID-19 than those with low levels of education. No educational differences were observed for perceived susceptibility or fear. Higher compliance with hand washing was found in highly educated women, and higher compliance with maintaining distance was found in highly educated men. Regarding maintaining distance, the impact of perceived severity differed between education groups. In men, significant moderation effects of education level on the association between factual knowledge and all three protective behaviours were found. During the pandemic, risk perception and protective behaviour varied greatly over time. Overall, differences by education level were relatively small. For risk communication, reaching all population groups irrespective of education level is critical.
Collapse
Affiliation(s)
| | | | | | | | - Freia De Bock
- Federal Centre for Health Education, Cologne, Germany
| | | | | |
Collapse
|
49
|
Baye AM, Ababu A, Bayisa R, Abdella M, Diriba E, Wale M, Selam MN. Perspectives of compounding pharmacists on alcohol-based hand sanitizer production and utilization for COVID-19 prevention in Addis Ababa, Ethiopia: A descriptive phenomenology study. PLoS One 2021; 16:e0250020. [PMID: 33914768 PMCID: PMC8084187 DOI: 10.1371/journal.pone.0250020] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, the safety of patients and healthcare providers is at risk due to health care-associated infections (HCAIs). World Health Organization and the Centers for Disease Control and Prevention recommend using alcohol-based hand rub (ABHR) for hand hygiene in healthcare settings to prevent HCAIs. Irrational use of ABHR will have undesirable consequences including wastage of products, exposure of healthcare providers to infections and emergence of microbial resistance to the alcohol in hand sanitizers. This study aimed to explore the perspective and experiences of compounding pharmacists on production and utilization of ABHR solution for coronavirus disease in 2019 (COVID-19) prevention in public hospitals of Addis Ababa, Ethiopia. METHODS A descriptive qualitative study using in-depth interview of 13 key-informants serving as compounding pharmacists in public hospitals of Addis Ababa, Ethiopia, was conducted. The study participants were identified and selected by purposive sampling. All transcribed interviews were subjected to thematic analysis and transcripts were analyzed manually. FINDINGS The compounding pharmacists in this study had a mean age of 30.6 (±3.1) years and nine of the thirteen participants were men. Ten participants believed that the compounding practice in their respective sites followed the principles of good compounding practice. More than half of the participants did not believe that ABHR products were used rationally in health facilities. They argued that users did not have enough awareness when and how to use sanitizers. Most of the interviewees reported that compounding personnel had no formal training on ABHR solution production. Study participants suggested incentive mechanisms and reimbursements for experts involved in the compounding of ABHR solutions. CONCLUSION Three of the compounding pharmacists indicated that ABHR production in their setting lack compliance to good compounding practice due to inadequate compounding room, quality control tests, manpower and equipment. Despite this, most study participants preferred the in-house ABHR products than the commercially available ones. Thus, training, regular monitoring and follow-up of the hospital compounding services can further build staff confidence.
Collapse
Affiliation(s)
- Assefa Mulu Baye
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Andualem Ababu
- Pharmaceutical and Medical Equipment Directorate (PMED), Ministry of Health, Addis Ababa, Ethiopia
| | - Regasa Bayisa
- Pharmaceutical and Medical Equipment Directorate (PMED), Ministry of Health, Addis Ababa, Ethiopia
| | - Mahdi Abdella
- Pharmaceutical and Medical Equipment Directorate (PMED), Ministry of Health, Addis Ababa, Ethiopia
| | - Edessa Diriba
- Pharmaceutical and Medical Equipment Directorate (PMED), Ministry of Health, Addis Ababa, Ethiopia
| | - Minyechel Wale
- All African Leprosy, Tuberculosis Rehabilitation and Training Center (ALERT), Addis Ababa, Ethiopia
| | - Muluken Nigatu Selam
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
50
|
Abstract
BACKGROUND Annually, infections contribute to approximately 25% of the 2.8 million neonatal deaths worldwide. Over 95% of sepsis-related neonatal deaths occur in low- and middle-income countries. Hand hygiene is an inexpensive and cost-effective method of preventing infection in neonates, making it an affordable and practicable intervention in low- and middle-income settings. Therefore, hand hygiene practices may hold strong prospects for reducing the occurrence of infection and infection-related neonatal death. OBJECTIVES To determine the effectiveness of different hand hygiene agents for preventing neonatal infection in community and health facility settings. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5), in the Cochrane Library; MEDLINE via PubMed (1966 to 10 May 2019); Embase (1980 to 10 May 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 10 May 2019). We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were updated 1 June 2020. SELECTION CRITERIA We included RCTs, cross-over trials, and quasi-RCTs that included pregnant women, mothers, other caregivers, and healthcare workers who received interventions within the community or in health facility settings DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the GRADE approach to assess the certainty of evidence. Primary outcomes were incidence of (study author-defined) suspected infection within the first 28 days of life, bacteriologically confirmed infection within the first 28 days of life, all-cause mortality within the first seven days of life (early neonatal death), and all-cause mortality from the 8th to the 28th day of life (late neonatal death). MAIN RESULTS Our review included five studies: one RCT, one quasi-RCT, and three cross-over trials with a total of more than 5450 neonates (two studies included all neonates but did not report the actual number of neonates involved). Four studies involved 279 nurses working in neonatal intensive care units and all neonates on admission. The fifth study did not clearly state how many nurses were included in the study. Studies examined the effectiveness of different hand hygiene practices for the incidence of (study author-defined) suspected infection within the first 28 days of life. Two studies were rated as low risk for selection bias, another two were rated as high risk, and one study was rated as unclear risk. One study was rated as low risk for allocation bias, and four were rated as high risk. Only one of the five studies was rated as low risk for performance bias. 4% chlorhexidine gluconate (CHG) compared to plain liquid soap We are uncertain whether plain soap is better than 4% chlorhexidine gluconate (CHG) for nurses' skin based on very low-certainty evidence (mean difference (MD) -1.75, 95% confidence interval (CI) -3.31 to -0.19; 16 participants, 1 study; very low-certainty evidence). We identified no studies that reported on other outcomes for this comparison. 4% chlorhexidine gluconate compared to triclosan 1% One study compared 1% w/v triclosan with 4% chlorhexidine gluconate and suggests that 1% w/v triclosan may reduce the incidence of suspected infection (risk ratio (RR) 1.04, 95% CI 0.19 to 5.60; 1916 participants, 1 study; very low-certainty evidence). There may be fewer cases of infection in the 1% w/v triclosan group compared to the 4% chlorhexidine gluconate group (RR 6.01, 95% CI 3.56 to 10.14; 1916 participants, 1 study; very low-certainty evidence); however, we are uncertain of the available evidence. We identified no study that reported on all-cause mortality, duration of hospital stay, and adverse events for this comparison. 2% CHG compared to alcohol hand sanitiser (61% alcohol and emollients) We are uncertain whether 2% chlorhexidine gluconate reduces the risk of all infection in neonates compared to 61% alcohol hand sanitiser with regards to the incidence of all bacteriologically confirmed infection within the first 28 days of life (RR 2.19, 95% CI 1.79 to 2.69; 2932 participants, 1 study; very low-certainty evidence) in the 2% chlorhexidine gluconate group, but the evidence is very uncertain. The adverse outcome was reported as mean visual scoring on the skin. There may be little to no difference between the effects of 2% CHG on nurses' skin compared to alcohol hand sanitiser based on very low-certainty evidence (MD 0.80, 95% CI 0.01 to 1.59; 118 participants, 1 study; very low-certainty evidence). We identified no study that reported on all-cause mortality and other outcomes for this comparison. None of the included studies assessed all-cause mortality within the first seven days of life nor duration of hospital stay. AUTHORS' CONCLUSIONS: We are uncertain as to the superiority of one hand hygiene agent over another because this review included very few studies with very serious study limitations.
Collapse
Affiliation(s)
- Bankole Peter Kuti
- Department of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Tinuade A Ogunlesi
- Department of Paediatrics (Neonatal Unit), Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Olabisi Oduwole
- Department of Medical Laboratory Science, Achievers University, Owo, Nigeria
| | - Chukwudi Oringanje
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital (ITDR/P), Calabar, Nigeria
| | - Ekong E Udoh
- Department of Paediatrics, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Martin M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| |
Collapse
|