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Herzer C, Berg T, Hegemann C, Gebhardt T, Niesalla H, Senges C. The state of hand rub dispensers in healthcare settings - a multicenter assessment in 19 German healthcare facilities. Antimicrob Resist Infect Control 2024; 13:118. [PMID: 39380072 PMCID: PMC11462814 DOI: 10.1186/s13756-024-01470-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 09/19/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND Hand hygiene is one of the most important hygiene measures to prevent healthcare-associated infections. Well-functioning hand rub dispensers are the foundation of hand hygiene but are often overlooked in research. As the point of origin for hand hygiene, dispensers not only promote compliance through ease of use, but also strongly influence the amount of hand rub used per disinfection. This work investigates how dispenser types and conditions affect dispensed volumes and usability. METHODS Data from 5,014 wall-mounted or point-of-care dispensers was collected from 19 German healthcare facilities during installation of an electronic hand hygiene monitoring system, including dispenser type and dispensed hand rub volumes. Of these dispensers, 56.2% were metal dispensers, and the majority (89.5%) were wall-mounted. For one hospital, 946 wall-mounted dispensers were analyzed in detail regarding pump material, damages, functionality, cleanliness, and filling levels. RESULTS Dispensed volumes varied across and within dispenser types, ranging from 0.4 mL to 4.4 mL per full actuation, with the largest volumes generally dispensed by plastic dispensers with a preset of 1.0 to 3.0 mL per actuation. In general, most dispensers dispense more hand rub per full actuation than specified by the manufacturer. When different types of dispensers are used within a healthcare facility, vastly different volumes can be dispensed, making reliable and reproducible disinfection difficult for healthcare workers. In the detailed analysis of 946 dispensers, 27.1% had cosmetic defects, reduced performance, or were unusable, with empty disinfectant being the most common reason. Only 19.7% of working dispensers delivered their maximum volume on the first full actuation. CONCLUSION Even though several studies addressed the variability in dispensed volumes of hand hygiene dispensers, studies dealing with dispenser types and functionality are lacking, promoting the common but false assumption that different dispensers may be equivalent and interchangeable. Variability in dispensed volumes, coupled with frequent dispenser defects and maintenance issues, can be a major barrier to hand hygiene compliance. To support healthcare workers, more attention should be paid to 'dispenser compliance', selecting dispensers with similar volume ranges and proper maintenance.
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Affiliation(s)
| | | | | | | | - Heide Niesalla
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH, HARTMANN group, Hamburg, Germany
| | - Christoph Senges
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH, HARTMANN group, Hamburg, Germany.
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Senges C, Herzer C, Norkus E, Krewing M, Mattner C, Rose L, Gebhardt T, Mattner F, Niesalla H. Workflows and locations matter - insights from electronic hand hygiene monitoring into the use of hand rub dispensers across diverse hospital wards. Infect Prev Pract 2024; 6:100364. [PMID: 38601127 PMCID: PMC11004075 DOI: 10.1016/j.infpip.2024.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/28/2024] [Indexed: 04/12/2024] Open
Abstract
Background While healthcare-associated infections (HAIs) affect approximately 3.2-6.5% of hospitalised patients in the US and Europe, improving hand hygiene (HH) could reduce HAI rates. Investigating HH is time-consuming and not always objective, and comprehensive, unbiased data is needed to develop effective strategies. Using electronic tools can provide new and detailed insights on the determinants of HH. Aim To evaluate location-dependent usage of wall-mounted dispensers (WMDs) and point-of-care dispensers (POCs) using an electronic HH recording system. Methods In this retrospective study, hand rub volumes were anonymously recorded for 931,446 disinfections from 17 wards in nine German hospitals using the electronic monitoring system NosoEx®. Number of disinfections and rub volumes of WMDs/POCs by ward and room type were analysed. Findings Generally, WMDs were most prevalent. With >3 dispensers per bed and >20 disinfections per patient day, availability and use were highest in intensive care (ICU) and intermediate care (IMC), but here rub volumes from WMDs were lowest (∼2.0 mL). Although most dispensers are located in patient rooms (∼42%), they are more frequently used in hallways. In surgical ICUs, dispensers are often used in patient rooms, where contact with open wounds is common. About 3.6 mL of hand rub is used per disinfection in treatment rooms, the highest volume of all room types. Conclusion Dispenser use was dependent on location, room type, ward specialisation and workflow. Optimising the location of hand rub dispensers (HRDs)s is not the only solution to improve HH, but can help reduce inconvenience, achieve more ergonomic workflows and better meet user needs.
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Affiliation(s)
- Christoph Senges
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| | | | | | - Marco Krewing
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
| | - Clara Mattner
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
- Institute of Rural Studies, Johann Heinrich von Thünen Institute, Braunschweig, Germany
| | - Leonard Rose
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
| | | | - Frauke Mattner
- Chair for Hygiene and Environmental Medicine, University Witten-Herdecke, Cologne Clinics, Cologne, Germany
| | - Heide Niesalla
- HARTMANN SCIENCE CENTER, BODE Chemie GmbH a company of the HARTMANN GROUP, Hamburg, Germany
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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] [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.
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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
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Starrett WG, Arbogast JW, Parker AE, Wagner PT, Mahrer SE, Christian V, Lane BL, Cheek VL, Robbins GA, Boyce JM, Polenakovik H. The effect of a prospective intervention program with automated monitoring of hand hygiene performance in long-term and acute-care units at a Veterans Affairs medical center. Infect Control Hosp Epidemiol 2024; 45:207-214. [PMID: 37649167 PMCID: PMC10877535 DOI: 10.1017/ice.2023.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/17/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To measure the impact of an automated hand hygiene monitoring system (AHHMS) and an intervention program of complementary strategies on hand hygiene (HH) performance in both acute-care and long-term care (LTC) units. DESIGN Prospective, nonrandomized, before-and-after intervention study. SETTING Single Veterans Affairs Medical Center (VAMC), with 2 acute-care units and 6 LTC units. METHODS An AHHMS that provides group HH performance rates was implemented on 8 units at a VAMC from March 2021 through April 2022. After a 4-week baseline period and 2.5-week washout period, the 52-week intervention period included multiple evidence-based components designed to improve HH compliance. Unit HH performance rates were expressed as the number of dispenses (events) divided by the number of patient room entries and exits (opportunities) × 100. Statistical analysis was performed with a Poisson general additive mixed model. RESULTS During the 4-week baseline period, the median HH performance rate was 18.6 (95% CI, 16.5-21.0) for all 8 units. During the intervention period, the median HH rate increased to 21.6 (95% CI, 19.1-24.4; P < .0001), and during the last 4 weeks of the intervention period (exactly 1 year after baseline), the 8 units exhibited a median HH rate of 25.1 (95% CI, 22.2-28.4; P < .0001). The median HH rate increased from 17.5 to 20.0 (P < .0001) in LTC units and from 22.9 to 27.2 (P < .0001) in acute-care units. CONCLUSIONS The intervention was associated with increased HH performance rates for all units. The performance of acute-care units was consistently higher than LTC units, which have more visitors and more mobile veterans.
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Affiliation(s)
- W. Grant Starrett
- Dayton Veterans Affairs Medical Center, Dayton, Ohio, USA
- Division of Infectious Diseases, Department of Medicine, Wright State University, Dayton, Ohio, USA
| | | | - Albert E. Parker
- Center for Biofilm Engineering, Montana State University, Bozeman, Montana, USA
- Department of Mathematical Sciences, Montana State University, Bozeman, Montana, USA
| | | | | | | | | | | | | | | | - Hari Polenakovik
- Dayton Veterans Affairs Medical Center, Dayton, Ohio, USA
- Division of Infectious Diseases, Department of Medicine, Wright State University, Dayton, Ohio, USA
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Nakayama A, Yamaguchi I, Okamoto K, Maesaki S. Targeted Infection Control Practices in Japanese Hospitals for Multidrug-Resistant Organisms: Guidance From the Public Health Center. Cureus 2023; 15:e50680. [PMID: 38229815 PMCID: PMC10791020 DOI: 10.7759/cureus.50680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction The study conducted by the Kawaguchi City Public Health Center (PHC) in 2023 on hospital infection control (IC) programs revealed that hospitals can improve their IC programs if the PHC provides training sessions (TSs) that have numerical effects. In this study, we expected that we could help hospitals develop their IC practices by providing targeted guidance. This study aimed to clarify targeted guidance on IC practices and TS programs to develop hospitals'hospitals' IC programs on multidrug-resistant organisms (MDROs) by examining hospitals'hospitals' IC programs in reference to the study conducted in 2023 and other case reports. Methods In June 2022, the Kawaguchi City PHC conducted TSs for 19 hospitals and eight affiliated (AFs) clinics with beds, providing guidelines and practices on infection control (IC) for MDROs. After the TSs, we sent a questionnaire to these hospitals and affiliated clinics. The questionnaire inquired about current and planned IC policies, hand hygiene compliance programs (HHCPs), the usefulness of the TSs conducted by the PHC, and IC programs that the facilities intended to implement or develop in the future. This study examined the relationship between the perceived usefulness of the information provided and the IC programs planned for development, referencing a study conducted in 2023 and other case reports. Results Seventeen hospitals and six AFs with beds responded to the survey, yielding an 85.2% response rate. IC policies for methicillin-resistant Staphylococcus aureus (MRSA) were prepared by 21 hospitals (91.3%), whereas only five hospitals (21.7%) had prepared IC policies for carbapenem-resistant Enterobacteriaceae. Regarding HHCPs, an increase in the availability of alcohol-based hand sanitizer was identified by 17 hospitals (73.9%), while 13 hospitals (56.5%) reported using posters or symbols, 12 hospitals (52.2%) reported using TS and hand sanitizers, and nine hospitals (39.1%) assessed HH compliance and provided feedback. Furthermore, nine hospitals (39.1%) identified HHCPs and Environmental Cleaning (EC) for carbapenemase-producing Enterobacteriaceae (CPE) as useful information. There was a statistically significant association between TSs on HHCPs and the development of new HHCPs (p = 0.027). Additionally, information on EC for CPE was significantly associated with the development of staff cohorting strategies (p = 0.007). However, TS programs were not significantly connected to EC, nor were TSs to be developed. Conclusion The PHC should advise hospitals to assess if their HHCPs effectively contribute to improving HH compliance. It is essential for the PHC to furnish hospitals with resources and information that aid in the development of EC training. Additionally, the PHC should support the creation of specific and effective TS programs focused on EC or TS development. Conducting surveys to identify barriers to implementing staff cohorting strategies is also recommended. We propose that TS programs should include quantifiable data on HHCPs and EC, such as.
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Affiliation(s)
- Ayako Nakayama
- Department of Administration, Kawaguchi Public Health Center, Kawaguchi City, JPN
| | - Ichiro Yamaguchi
- Department of Environmental Health, National Institute of Public Health, Saitama, JPN
| | - Koji Okamoto
- Department of Administration, Kawaguchi Public Health Center, Kawaguchi City, JPN
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, JPN
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Dick A, Sterr CM, Dapper L, Nonnenmacher-Winter C, Günther F. Tailored positioning and number of hand rub dispensers: the fundamentals for optimized hand hygiene compliance. J Hosp Infect 2023; 141:71-79. [PMID: 37660889 DOI: 10.1016/j.jhin.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Availability of alcohol-based hand rub (ABHR) dispensers at positions adapted to the work flow of healthcare workers (HCWs) is decisive in order to carry out indication-based hand rubbing. Although requirements and guidelines regarding the positioning of ABHR dispensers are in place, scientific evidence is often lacking. METHODS In order to analyse the impact of the location and number of ABHR dispensers on hand hygiene performance, additional dispensers were systematically placed in patient rooms in a surgical 38-bed ward at Marburg University Hospital, Germany to complement the existing dispenser locations. ABHR use was monitored continuously before and after complementation using the NosoEx hand hygiene monitoring system. The ward had 53 dispensers before the intervention and 82 dispensers after the intervention. RESULTS The addition of dispensers increased ABHR consumption across the entire ward. Before the intervention, mean consumption was 20.6 mL/patient-day, whereas mean consumption after the intervention was 25.3 mL/patient-day. Depending on the combination of dispenser locations, consumption increased through targeted supplementation in patient rooms. The presence of two or three dispensers per patient room resulted in significantly greater ABHR consumption compared with one dispenser per patient room. The preferred location combinations were entrance-front bed-back bed and entrance-foot end. CONCLUSION ABHR consumption can be increased significantly by optimizing the position and number of dispensers. The outstanding factors are visibility and integrability of dispenser use into the work flow; in particular, a dispenser should be positioned in the entrance area. Recommendations should be optimized with regard to the required number and location of dispensers in patient rooms.
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Affiliation(s)
- A Dick
- Division of Infection Control and Hospital Epidemiology, Marburg University Hospital, Marburg, Germany
| | - C M Sterr
- Division of Infection Control and Hospital Epidemiology, Marburg University Hospital, Marburg, Germany
| | - L Dapper
- Division of Infection Control and Hospital Epidemiology, Marburg University Hospital, Marburg, Germany
| | - C Nonnenmacher-Winter
- Division of Infection Control and Hospital Epidemiology, Marburg University Hospital, Marburg, Germany
| | - F Günther
- Division of Infection Control and Hospital Epidemiology, Marburg University Hospital, Marburg, Germany.
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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] [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.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
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Siju J, Anagboso U, Vernet E, Moss M, Javaid W, Cassano K. Implementation of a quality improvement project using the patient as the observer to improve hand hygiene compliance in ambulatory care practices. J Hosp Infect 2023; 140:34-39. [PMID: 37562594 DOI: 10.1016/j.jhin.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Monitoring hand hygiene compliance in the ambulatory setting remains a challenge because a healthcare trained observer loses line of sight once the examination room door closes. This quality improvement project focused on the implementation of a hand hygiene compliance improvement programme that is amenable to the routines and work flows of the ambulatory setting. METHODS After a review of the literature, nursing leadership and infection prevention implemented the 'patient as the observer' hand hygiene programme across 32 ambulatory practices. RESULTS Patients completed 281,000 observations with an overall compliance rate of ≥90%. The average overall compliance rate by role was 91% for providers, 89% for nurses, and 91% for medical assistants/technicians/others. A 92% compliance average was noted 'before caring for you' and 89% 'after caring for you' for providers, 90% and 87% for nurses, and 92% and 89% for medical assistants/technicians/others. DISCUSSION This study demonstrated that the implementation of a hand hygiene compliance improvement programme using the patient as the observer can be adopted successfully in the ambulatory setting. CONCLUSION Hand hygiene compliance can be monitored effectively in the ambulatory setting with the involvement of the patient as the observer.
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Affiliation(s)
- J Siju
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA.
| | - U Anagboso
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
| | - E Vernet
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
| | - M Moss
- Infection Prevention and Control, Mount Sinai Health System, New York, USA
| | - W Javaid
- Infection Prevention and Control, Mount Sinai Health System, New York, USA
| | - K Cassano
- Ambulatory Care Nursing, Mount Sinai Health System, New York, USA
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Armstrong-Novak J, Juan HY, Cooper K, Bailey P. Healthcare Personnel Hand Hygiene Compliance: Are We There Yet? Curr Infect Dis Rep 2023; 25:1-7. [PMID: 37361491 PMCID: PMC10213575 DOI: 10.1007/s11908-023-00806-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/28/2023]
Abstract
Purpose of Review Poor hand hygiene is well documented as a factor in healthcare-associated infections and excellent rates of hand hygiene remains elusive. Recent Findings There is increased use of universal or increased gloving to minimize hand contamination, but its use does not replace hand hygiene opportunities. There is significant interest in electronic hand hygiene monitoring systems, but they are not without their unique issues. Behavioral psychology remains a significant factor in motivating hand hygiene behaviors; even in COVID-19, hand hygiene rates initially improved but trended down back to baseline while still dealing with the pandemic. Summary More emphasis should be placed on the how to properly perform hand hygiene and why it is so important, as well as the role of gloves, is needed. Continued investment and awareness of their status as role models from both system leadership and senior healthcare providers are needed.
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Affiliation(s)
| | - Hui Yu Juan
- Virginia Commonwealth University Health System, Richmond, VA USA
| | - Kaila Cooper
- Virginia Commonwealth University Health System, Richmond, VA USA
| | - Pamela Bailey
- Prisma Health Midlands, Columbia, SC USA
- University of South Carolina School of Medicine, 2 Medial Park, Suite 205, Columbia, SC 29203 USA
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Kim JH, Kwok KO, Huang Z, Poon PKM, Hung KKC, Wong SYS, Chan EYY. A longitudinal study of COVID-19 preventive behavior fatigue in Hong Kong: a city with previous pandemic experience. BMC Public Health 2023; 23:618. [PMID: 37004041 PMCID: PMC10064631 DOI: 10.1186/s12889-023-15257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/10/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND In addition to high vaccination levels, COVID-19 control requires uptake and continued adherence to personal hygiene and social distancing behaviors. It is unclear whether residents of a city with successive experience in worldwide pandemics such as SARS, would quickly adopt and maintain preventive behaviors. METHODS A population-based, longitudinal telephone survey was conducted between in first local wave of the COVID-19 pandemic (April 2020) and third local wave (December 2020) (n = 403). The study examined factors associated with personal hygiene and social distancing behavior fatigue, as measured by reduced adherence. RESULTS Over 9 months, face mask use increased (96.5-100%, p < 0.001). Although habitual hand hygiene remained unchanged (92.0%), blue collar workers and non-working individuals showed higher risk of hand hygiene fatigue. There was a decline (p < 0.05) in avoidance of social gatherings (81.1 to 70.7%), avoidance of public places (52.9-27.5%) and avoidance of international travel (81.9-77.4%) even with rising caseloads. Lowered perception of COVID-19 disease severity was associated with decreased avoidance of social gatherings and public places while lower education was associated with decline in avoidance of social gatherings. CONCLUSION Even in regions with past pandemic experience, maintaining social distancing behaviors during a protracted pandemic remains a major public health challenge.
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Affiliation(s)
- Jean H Kim
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhe Huang
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Paul Kwok-Ming Poon
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Kevin Kei Ching Hung
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China
- Accident & Emergency Medicine Academic Unit, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Emily Ying Yang Chan
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong SAR, China.
- GX Foundation, Hong Kong, China.
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SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:355-376. [PMID: 36751708 PMCID: PMC10015275 DOI: 10.1017/ice.2022.304] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Cai H, Garcia A, Polivka B, Spreckelmeyer K, Yang FM. Visibility and Accessibility of Hand Hygiene Stations and Fatigue Among Nurses Working in Long-Term Care (LTC) During the COVID-19 Pandemic. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:24-37. [PMID: 36691318 DOI: 10.1177/19375867221149126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Evaluate the relationship between nurses' perception of the long-term care (LTC) environment, specifically having visible and accessible hand hygiene stations (HHS), and nurses' fatigue during the COVID-19 pandemic. BACKGROUND LTC nurses experience not only heavy workloads and fatigue but also a high risk of infection during the COVID-19 pandemic. Few studies have evaluated the relationship between safety measures such as having visible and accessible HHS and nurses' fatigue. METHODS The cross-sectional COVID-19 Impact on Nurses Study (COINS) was an online survey distributed to members of the American Association of Post-Acute Care Nursing through the REDCap survey platform, between June 1, 2020, and January 31, 2021. Logistic regression modeling was conducted to identify the relationship between nurses' perception of having visible and accessible HHS and fatigue among LTC nurses. RESULTS The majority of LTC nurse respondents (78.35%) reported having moderate to very severe fatigue. Nurses who reported not having enough visible and accessible HHS in their work environment have statistically significantly higher odds (odds ratio [OR] = 0.37, 95% confidence interval [CI] [0.20, 0.70], p = .002) of reporting experiencing moderate to very severe fatigue compared to nurses who perceived there was adequate HHS. The logistic regression is significant while controlling for sociodemographic differences, guilt for family and patients, support from work, and confidence in the future of LTC. CONCLUSIONS This study reveals the LTC environment that incorporates better considerations of more visible and accessible HHS might mitigate nurses' fatigue during the pandemic. A conceptual framework has been proposed for future studies.
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Affiliation(s)
- Hui Cai
- Department of Architecture, University of Kansas, Lawrence, KS, USA
| | - Amy Garcia
- University of Kansas School of Nursing, Kansas City, KS, USA
| | - Barbara Polivka
- University of Kansas School of Nursing, Kansas City, KS, USA
| | | | - Frances M Yang
- University of Kansas School of Nursing, Kansas City, KS, USA
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Mastering the art of persuasion during a pandemic. Nature 2022; 610:S34-S36. [DOI: 10.1038/d41586-022-03354-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Sandbøl SG, Glassou EN, Ellermann-Eriksen S, Haagerup A. Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic. Am J Infect Control 2022; 50:719-723. [PMID: 35367321 PMCID: PMC8966111 DOI: 10.1016/j.ajic.2022.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Healthcare workers' (HCWs) adherence to hand hygiene is vital in combatting COVID-19 in hospitals. We aimed to investigate HCWs hand hygiene compliance before and during the COVID-19 pandemic and hypothesised that hand hygiene compliance would increase during the pandemic. METHODS We conducted a prospective observational study in three medical departments at the Regional Hospital of West Jutland, Denmark from April 2019 to August 2020. A total of 150 HCWs participated before the COVID-19 pandemic and 136 during the pandemic. Hand hygiene observations were assessed using an automated hand hygiene monitoring system. Students unpaired t-test was used to assess differences in hand hygiene compliance rates in each department. RESULTS Comparison analyses showed, that hand hygiene compliance in department A and B was significantly higher before the COVID-19 pandemic than during the pandemic; a 7% difference in department A and a 5% difference in department B. For department C, the total hand hygiene compliance was unchanged during the pandemic compared to before. CONCLUSION The COVID-19 pandemic did not raise hand hygiene compliance. Further studies are needed to verify these findings and further identify barriers to hand hygiene compliance among HCWs.
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Vergara D, Loza-Rodríguez N, Acevedo F, Bustamante M, López O. Povidone-iodine loaded bigels: Characterization and effect as a hand antiseptic agent. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Foong SC, Foong WC, Tan ML, Ho JJ. Mothers' hygiene experiences in confinement centres: A cohort study. PLoS One 2022; 17:e0268676. [PMID: 35604895 PMCID: PMC9126405 DOI: 10.1371/journal.pone.0268676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Ethnic Malaysian Chinese used to observe the 1-month postpartum confinement period at home and many families would engage a traditional postpartum carer to help care for the mother and newborn. A recent trend has been the development of confinement centres (CCs) which are private non-healthcare establishments run by staff not trained in health care. Concerns about hygiene in CCs arose after infections were reported. We describe the practice of hand hygiene observed in CCs, the availability of resources for hygiene, and the prevalence of health-related problems in CCs. Methods This is a cohort study of ethnic Chinese mothers intending to breastfeed their healthy infants. They were recruited post-delivery along with a comparison group who planned to spend their confinement period at home. After their 1-month confinement period, they were contacted for a structured telephone interview about their experience. To avoid any alteration in behaviour, mothers were not told at recruitment that they had to observe hygiene practices. Multiple logistic regression was used to assess the effect of place of confinement on rates of infant health problems. Results Of 187 mothers, 88(47%) went to 27 different CCs while 99(53%) stayed at home. Response rates for the 1-month interviews were 88%(CC) versus 97%(home). Mothers in CC group stayed in one to four-bedded rooms and 92% of them had their baby sleeping separately in a common nursery described to have up to 17 babies at a time; 74% of them spent less than six hours a day with their babies; 43% noticed that CC staff had inadequate hand hygiene practices; 66% reported no hand basins in their rooms; 30% reported no soap at hand basins; 28% reported inexperienced or inadequate staff and 4% reported baby item sharing. Among the mothers staying at home, 35% employed a traditional postpartum carer for her baby; 32% did not room-in with their babies, but only 11% spent less than 6 hours a day with their babies. Of mothers who employed traditional postpartum carers, 32% did not know if their carer washed hands after changing diapers and 18% reported that their carer did not. Health problems that were probably related to infection (HPRI) like fever and cough were similar between the groups: 14%(CC) versus 14%(home) (p = 0.86). Multiple logistic regression did not show that CCs were a factor for HPRI: aOR 1.28 (95% CI 0.36 to 4.49). Three mothers reported events that could indicate transmission of infection in CCs. Conclusion We found unsatisfactory hygiene practices in CCs as reported by mothers who spent their confinement period there. Although we were not able to establish any direct evidence of infection transmission but based on reports given by the mothers in this study, it is likely to be happening. Therefore, future studies, including intervention studies, are urgently needed to establish an appropriate hygiene standard in CCs as well as the best method to implement this standard. Training CC staff with hygiene knowledge so that they can be empowered to contribute to the development of these standards would be important.
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Affiliation(s)
- Siew Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Penang, Malaysia
- * E-mail:
| | - Wai Cheng Foong
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Penang, Malaysia
| | - May Loong Tan
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Penang, Malaysia
| | - Jacqueline Judith Ho
- Department of Paediatrics, RCSI & UCD Malaysia Campus (formerly Penang Medical College), George Town, Penang, Malaysia
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Smith HS, Blumenthal-Barby JS, Chatterjee R, Hindera O, Huang A, Kothari R, Vlaev I. A Review of the MINDSPACE Framework for Nudging Health Promotion During Early Stages of the COVID-19 Pandemic. Popul Health Manag 2022; 25:487-500. [PMID: 35353613 DOI: 10.1089/pop.2021.0269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has highlighted the link between individual behavior and public health, along with the importance of evidence-based efforts to promote prosocial individual behavior. Insights from behavioral science can inform the design of effective behavior change techniques, or nudges, to influence individual behavior. The MINDSPACE framework organizes 9 behavioral science principles that can be used to guide policy design: Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments, and Ego. Using MINDSPACE as an organizing framework, this article provides a review of the literature on nudges to influence prosocial behaviors relevant during a pandemic: handwashing, avoidance of social gatherings, self-isolation and social distancing, and sharing public health messages. Additionally, empirical evidence on the use of nudges during the first several months of the COVID-19 pandemic in 2020 is summarized. Recommendations regarding the use of nudges to achieve public health policy goals during pandemics are provided. Organizational leaders, policymakers, and practitioners can use nudges to promote public health when mandates are not politically feasible or enforceable.
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Affiliation(s)
- Hadley Stevens Smith
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | | | - Ritodhi Chatterjee
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Olivia Hindera
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Angela Huang
- Internal Medicine Residency Program, University of Washington Boise, Boise, Idaho, USA
| | - Rishabh Kothari
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, United Kingdom
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18
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Akbas E, Korkmaz I, Palamar M, Barut Selver O. Shifting trends in demographic features of chemical eye injuries during COVID-19 pandemic. Int Ophthalmol 2022; 42:2127-2132. [PMID: 35013832 PMCID: PMC8745549 DOI: 10.1007/s10792-022-02211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022]
Abstract
Objectives To evaluate the etiological cause distribution in chemical eye injuries during COVID-19 pandemic. Methods In this retrospective case series, the medical records of patients, who presented with chemical eye injuries between March 30, 2020, and March 1, 2021, were evaluated and compared with the data covering 10 years before the pandemic. Results Twenty-seven eyes of twenty-three patients (19 adults, 4 children) who presented in pandemic period were included. Alcohol-based hand sanitizer was one of the two most common agents (n = 6 eyes) in the pandemic era. In the last 10 years before the pandemic, 137 eyes of 102 patients were treated for chemical eye injuries. Injuries due to alcohol-based hand sanitizer increased from 3.1 to 21.1% among all patients, and from 0 to 75% among pediatric patients during the pandemic era compared to the pre-pandemic period. The increase was statistically significant both in all patients (p = .003) and in the pediatric patient group (p = .048). Conclusion Due to COVID-19 pandemic, alcohol-based hand sanitizer use became more common. Consequently, the frequency of hand sanitizer related chemical injuries showed a 13-fold increase and the age group affected by such accidents is altered during the pandemic. Three out of four pediatric patients (75%) were injured with alcohol-based hand sanitizers, which draws attention to the fact that improperly placed hand sanitizer stations, being just at the eye level of children, can cause chemical eye injuries in the pediatric population even more.
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Affiliation(s)
- Elif Akbas
- Faculty of Medicine, Department of Ophthalmology, Ege University, 35040, Izmir Bornova, Turkey
| | - Ilayda Korkmaz
- Faculty of Medicine, Department of Ophthalmology, Ege University, 35040, Izmir Bornova, Turkey
| | - Melis Palamar
- Faculty of Medicine, Department of Ophthalmology, Ege University, 35040, Izmir Bornova, Turkey
| | - Ozlem Barut Selver
- Faculty of Medicine, Department of Ophthalmology, Ege University, 35040, Izmir Bornova, Turkey.
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Economic Analysis of Perioperative Optimization. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00044-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.
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Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 62 Sonoma Lane, Middletown, CT 06457, USA.
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21
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Squire MM, Munsamy M, Lin G, Telukdarie A, Igusa T. Modeling hospital energy and economic costs for COVID-19 infection control interventions. ENERGY AND BUILDINGS 2021; 242:110948. [PMID: 33814682 PMCID: PMC7997299 DOI: 10.1016/j.enbuild.2021.110948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/13/2021] [Accepted: 03/19/2021] [Indexed: 05/10/2023]
Abstract
The study objective assessed the energy demand and economic cost of two hospital-based COVID-19 infection control interventions: negative pressure (NP) treatment rooms and xenon pulsed ultraviolet (XP-UV) equipment. After projecting COVID-19 hospitalizations, a Hospital Energy Model and Infection De-escalation Models quantified increases in energy demand and reductions in infections. The NP intervention was applied to 11, 22, and 44 rooms for small, medium, and large hospitals, while the XP-UV equipment was used eight, nine, and ten hours a day. For small, medium, and large hospitals, the annum kWh for NP rooms were 116,700 kWh, 332,530 kWh, 795,675 kWh, which correspond to annum energy costs of $11,845 ($1,077/room), $33,752 ($1,534/room), and $80,761 ($1,836/room). For XP-UV, the annum-kilowatt-hours (and costs) were 438 ($45), 493 ($50), and 548 ($56) for small, medium, and large hospitals. While energy efficiencies may be expected for the large hospital, the hospital contained more energy-intensive use rooms (ICUs) which resulted in higher operational and energy costs. XP-UV had a greater reduction in secondary COVID-19 infections in large and medium hospitals. NP rooms had a greater reduction in secondary SARS-CoV-2 transmission in small hospitals. Early implementation of interventions can result in realized cost savings through reduced hospital-acquired infections.
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Affiliation(s)
- Marietta M Squire
- Johns Hopkins University, Department of Civil and Systems Engineering, 3400 N. Charles St, Baltimore, MD 21218, USA
| | - Megashnee Munsamy
- Mangosuthu University of Technology, Mangosuthu Highway, Umlazi, Durban, South Africa
| | - Gary Lin
- Center for Disease Dynamics, Economics & Policy, Silver Spring, MD 20910, USA
| | | | - Takeru Igusa
- Johns Hopkins University, Department of Civil and Systems Engineering, 3400 N. Charles St, Baltimore, MD 21218, USA
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22
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Kuster S, Roth JA, Frei R, Meier CA, Dangel M, Widmer AF. Handrub dispensers per acute care hospital bed: a study to develop a new minimum standard. Antimicrob Resist Infect Control 2021; 10:93. [PMID: 34134772 PMCID: PMC8206889 DOI: 10.1186/s13756-021-00949-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background Accessibility to alcohol-based handrub (ABHR) dispenser is crucial to improve compliance to hand hygiene (HH), being offered as wall-mounted dispensers (ABHR-Ds), and/or pocket bottles. Nevertheless, information on the distribution and density of ABHR-Ds and their impact on HH have hardly been studied. Institutions such as the World Health Organisation or the Centers for Disease Control and Prevention do not provide guidance. The Robert-Koch-Institute (RKI) from Germany recommends an overall density of > 0.5 dispensers per patient bed. We aimed to investigate current conditions in hospitals to develop a standard on the minimal number of ABHR-D. Methods Between 07 and 09/2019, we applied a questionnaire to 178 hospitals participating in the Swissnoso National Surveillance Network to evaluate number and location of ABHR-Ds per bed in acute care hospitals, and compared the data with consumption and compliance with HH. Results 110 of the 178 (62%) hospitals provided data representing approximately 20,000 hospital beds. 83% hospitals provided information on both the total number of ABHR-Ds and patient beds, with a mean of 2.4 ABHR-Ds per bed (range, 0.4–22.1). While most hospitals (84%) had dispensers located at the room entrance, 47% reported also locations near or at the bed. Additionally, pocket-sized dispensers (100 mL) are available in 97% of hospitals. Conclusions Swiss hospitals provide 2.4 dispensers per bed, much more than governmental recommendation. The first study on the number of ABHR-Ds in hospitals may help to define a minimal standard for national and international recommendations Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00949-0.
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Affiliation(s)
- Sabine Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Jan A Roth
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Reno Frei
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christoph A Meier
- Medical Director, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Internal Medicine, Clinic and Amublance of Internal Medicine, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Marc Dangel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Swissnoso, Swiss National Center for Infenction Prevention, Sulgenecstrasse 35, 3007, Bern, Switzerland.
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23
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Guellich A, Tella E, Ariane M, Grodner C, Nguyen-Chi HN, Mahé E. The face mask-touching behavior during the COVID-19 pandemic: Observational study of public transportation users in the greater Paris region: The French-mask-touch study. JOURNAL OF TRANSPORT & HEALTH 2021; 21:101078. [PMID: 33968608 PMCID: PMC8092492 DOI: 10.1016/j.jth.2021.101078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 05/18/2023]
Abstract
BACKGROUND To limit the spread of the new coronavirus disease 2019 (COVID-19), the World Health Organization recommends the use of face mask as a part of the pandemic control strategy. It has published also "best practices" in which it advises to avoid touching the mask while wearing it. This might be challenging. The purpose of this study was to investigate the frequency of mask-touching behavior in public transportation. METHODS Observational study using data collected in real life. This survey was conducted in subways and local trains of the greater Paris region, France, between May 4th and 25th, 2020. Public Transportation users were covertly observed. Demographic characteristics, type of mask and the main activity were collected by the investigator. The duration of observation, the frequency of touching face mask, hair and the uncovered area of the face were also recorded. Frequency of mask-touching per hour was determined. RESULTS One hundred eighty two persons were observed. The median of estimated age [1st and 3rd interquartile] was 35 [30;45] years and 87 (48%) were women. One hundred forty three (79%) were wearing surgical mask. The median time of observation was 8 [4;12] minutes. During this period, 87 (48%) persons touched their mask 15 [7.5;30] times per hour of whom only two (8%) have used hydroalcoholic solution to disinfect their hands. CONCLUSIONS Mask touching is frequent and is rarely followed by hand disinfection. Actions regarding mask use should be taken to improve compliance.
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Affiliation(s)
- Aziz Guellich
- Dermatology Department, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
- Primary Care Department, Université Paris-Est Créteil (UPEC), School of Medicine, Créteil, France
| | - Emilie Tella
- Dermatology Department, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
| | - Molka Ariane
- Dermatology Department, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
| | - Camille Grodner
- Dermatology Department, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
| | - Hoai-Nam Nguyen-Chi
- Dermatology Department, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
| | - Emmanuel Mahé
- Dermatology Department, Hôpital Victor Dupouy Argenteuil, Argenteuil, France
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24
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Baye AM, Ababu A, Bayisa R, Abdella M, Diriba E, Wale M, Selam MN. Alcohol-Based Handrub Utilization Practice for COVID-19 Prevention Among Pharmacy Professionals in Ethiopian Public Hospitals: A Cross-Sectional Study. Drug Healthc Patient Saf 2021; 13:37-46. [PMID: 33623439 PMCID: PMC7896735 DOI: 10.2147/dhps.s295599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/02/2021] [Indexed: 12/17/2022] Open
Abstract
Purpose Rubbing the hands with alcohol-based handrub (ABHR) is globally recommended as the preferred approach to prevent healthcare-associated infections in most routine encounters with patients, except in cases handwashing with soap and water is advised. Inappropriate utilization of ABHR could have detrimental effects, most importantly during the coronavirus disease (COVID-19) pandemic, which include exposure of healthcare professionals to healthcare-associated infections and the development of resistant microorganisms. In a hospital setting, the utilization of ABHR among frontline healthcare workers including pharmacy professionals is low. Therefore, the purpose of this study was to explore the current practice of hand rubbing among pharmacy professionals in public hospitals of Addis Ababa during the pandemic of COVID-19. Methods The study was a cross-sectional study using a self-reported questionnaire conducted among pharmacy professionals in public hospitals found in Addis Ababa from 10th May to 9th June, 2020 to recognize ABHR utilization rate. Data were collected on a sample of 384 pharmacy professional by a self-administered questionnaire. Data analysis was done using software for the statistical package for social science version 25.0. To identify the significant predictors of ABHR utilization practice bivariable and multivariable logistic regressions were carried out. Crude odds ratio and adjusted odds ratio with 95% confidence interval were calculated to determine the predictors. Results Out of 384 participants, three hundred and four participants were included in the final analyses after the exclusion of incomplete responses. Female participants represented 41.4% of the study participants. More than half (58.9%) of the pharmacy professionals had sufficient knowledge on ABHR utilization for COVID-19 prevention. Similarly, 56.6% of pharmacy professionals had positive attitude towards ABHR for COVID-19 prevention. But only 35.9% of the study participants had good ABHR utilization practice. Conclusion Despite the modest level of knowledge and attitude towards ABHR, pharmacy professionals’ utilization practice of ABHR for COVID-19 prevention was found to be suboptimal. Provision of ABHR solutions through hospitals and increasing the awareness of pharmacy professionals on ABHR needs to be encouraged.
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Affiliation(s)
- Assefa Mulu Baye
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - 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
| | - Minychel 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
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25
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Squire MM, Sessel GK, Lin G, Squire EN, Igusa T. Optimal Design of Paired Built Environment Interventions for Control of MDROs in Acute Care and Community Hospitals. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:109-129. [PMID: 33375862 DOI: 10.1177/1937586720976585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Our goal was to optimize infection control of paired environmental control interventions within hospitals to reduce methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococci (VRE). BACKGROUND The most widely used infection control interventions are deployment of handwashing (HW) stations, control of relative humidity (RH), and negative pressure (NP) treatment rooms. Direct costs of multidrug-resistant organism (MDRO) infections are typically not included in the design of such interventions. METHODS We examined the effectiveness of pairing HW with RH and HW with NP. We used the following three data sets: A meta-analysis of progression rates from uncolonized to colonized to infected, 6 years of MDRO treatment costs from 400 hospitals, and 8 years of MDRO incidence rates at nine army hospitals. We used these data as inputs into an Infection De-Escalation Model with varying budgets to obtain optimal intervention designs. We then computed the infection and prevention rates and cost savings resulting from these designs. RESULTS The average direct cost of an MDRO infection was $3,289, $1,535, and $1,067 for MRSA, CRE, and VRE. The mean annual incidence rates per facility were 0.39%, 0.034%, and 0.011% for MRSA, CRE, and VRE. After applying the cost-minimizing intervention pair to each scenario, the percentage reductions in infections (and annual direct cost savings) in large, community, and small acute care hospitals were 69% ($1.5 million), 73% ($631K), 60% ($118K) for MRSA, 52% ($460.5K), 58% ($203K), 50% ($37K) for CRE, and 0%, 0%, and 50% ($12.8K) for VRE. CONCLUSION The application of this Infection De-Escalation Model can guide cost-effective decision making in hospital built environment design to improve control of MDRO infections.
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Affiliation(s)
- Marietta M Squire
- Department of Civil and Systems Engineering, 1466Johns Hopkins University, Baltimore, MD, USA
| | - Gareth K Sessel
- Outreach Engineering NPC (Nonprofit Company), Johannesburg, South Africa
| | - Gary Lin
- Department of Emergency Medicine, 1466Johns Hopkins University, Baltimore, MD, USA
| | | | - Takeru Igusa
- Department of Civil and Systems Engineering, 1466Johns Hopkins University, Baltimore, MD, USA
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Cai H, Tyne IA, Spreckelmeyer K, Williams J. Impact of Visibility and Accessibility on Healthcare Workers' Hand-Hygiene Behavior: A Comparative Case Study of Two Nursing Units in an Academic Medical Center. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:271-288. [PMID: 33000659 DOI: 10.1177/1937586720962506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aims to explore the impacts of visibility and accessibility of alcohol gel-based hand sanitizer dispensers (HSDs) on healthcare workers' hand-hygiene (HH) behaviors. BACKGROUND Despite the importance of HH in reducing nosocomial infection, few empirical studies have quantitatively investigated the impacts of unit shape and size, and the resulted visibility and accessibility on HH, due to the lack of consistent methods to measure and evaluate visibility. METHODS The research was developed as a cross-sectional comparative study of two nursing units (Units A and B) with similar patient acuity and nursing care model but different shape and layout. The study applied quantitative research methods including visibility and accessibility analysis using space syntax, 1-week on-site observation, and secondary data analysis on HH compliance rates. RESULTS Results indicate that the unit with higher visibility and accessibility is associated with higher HH frequencies. Unit B has significantly higher visibility of HSDs, p < .001, t(60) = 4.615, and significantly higher frequency of HH activity occurrences, 5.17% versus 1.52%; p < .001, t(16.750) = 5.332, than Unit A, even though Unit B has lower HSD to bed ratio (0.708:1 vs. 1.375:1). The linear regression models also demonstrate that visibility and accessibility of HSDs are significant predictors of HH behavior. CONCLUSIONS Overall, this exploratory study identified the importance of visibility of HSDs to improve the chances of HH. It also points out the impacts of nursing unit typology on the visibility of HSDs and in turn affects HH behavior.
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Affiliation(s)
- Hui Cai
- Department of Architecture, 4202The University of Kansas, Lawrence, KS, USA
| | - Intisar Ameen Tyne
- Department of Architecture, 4202The University of Kansas, Lawrence, KS, USA
| | - Kent Spreckelmeyer
- Department of Architecture, 4202The University of Kansas, Lawrence, KS, USA
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Osborne ARH, Connell C, Morphet J. Investigating emergency nurses' beliefs and experiences with patient handling in the emergency department. Australas Emerg Care 2020; 24:49-54. [PMID: 32819885 DOI: 10.1016/j.auec.2020.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient handling policy intends to decrease the risk of musculoskeletal injury for nurses. Many factors influence nurses' adherence to patient handling policy, including the context in which the activities take place. The aim of this study was to investigate emergency nurses' beliefs and experiences with patient handling in the emergency department. METHODS A phenomenological approach was used to explore the participants' experience of patient handling in the ED. Focus group interviews were held in a Victorian emergency department. The interviews were audio-recorded, transcribed, and the data were analysed using thematic analysis. RESULTS Five interviews were held with 40 nurse participants. Four themes were identified that described participants beliefs and experiences of patient handling: 'Putting the patient first' describes participants prioritisation of patient safety over their own; 'Patient -related challenges' describes the patient factors (e.g. language, mobility, size) that make patient handling more difficult; 'Staff knowledge' of policy and procedure; and 'Inadequate resources' which describes the physical and human resource limitations that made patient handling more difficult. CONCLUSIONS Issues with equipment, education and patient handling culture are widespread, and this study reaffirms the importance of considering context in developing interventions to improve practice. Introduction of a Safe Patient Handling Program in the ED, that addresses multiple barriers simultaneously, may improve adherence to policy, and reduce the risk of musculoskeletal injury in emergency nurses.
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Affiliation(s)
- Abra R H Osborne
- Nursing & Midwifery, Monash University, Clayton, Victoria, 3800, Australia; Monash Health, Australia
| | - Clifford Connell
- Nursing & Midwifery, Monash University, Clayton, Victoria, 3800, Australia; Monash Emergency Research Collaborative, Monash Health, Australia
| | - Julia Morphet
- Nursing & Midwifery, Monash University, Clayton, Victoria, 3800, Australia; Monash Emergency Research Collaborative, Monash Health, Australia
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No increase in compliance before aseptic procedures in German hospitals. A longitudinal study with data from the national surveillance system over four years. J Hosp Infect 2020; 106:71-75. [PMID: 32673636 DOI: 10.1016/j.jhin.2020.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/02/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hand hygiene plays a crucial role in the prevention of healthcare-associated infections and transmission of pathogens. In 2008 the national campaign 'Aktion Saubere Hände' was launched in Germany. It is based on the World Health Organization (WHO) 'Clean Care is Safer Care' initiative. Direct observation and feedback of the results are key components in the improvement of hand hygiene compliance. In 2014 a voluntary national surveillance electronic tool for the documentation of directly observed compliance to hand hygiene was introduced. AIM Description and evaluation of compliance with the WHO model 'my 5 moments' in German hospitals after implementation. METHODS Direct observation was performed in the participating hospitals by trained local staff according to the WHO recommendations. We evaluated wards that reported annually at least 150 hand hygiene opportunities (HHOs) of hand hygiene per observation period from January 1st, 2015 until December 31st, 2018. FINDINGS In all, 1,485,622 HHOs observed on 3337 wards in 525 hospitals were included into analysis. Overall compliance increased from 72% (interquartile range: 61-82) to 76% (66-84). Compliance significantly increased for all individual moments of the WHO model except moment 2. In the multivariate logistic regression analysis the following parameters were independently associated with a high compliance in hand hygiene: intensive care unit, nurse, opportunity observed in 2017 or 2018, as well as all moments except moment 2. CONCLUSION Overall compliance in German hospitals increased over time. To improve HH compliance 'before aseptic procedures' appears to be difficult and should be addressed explicitly. Underlying reasons need to be the focus of future investigations.
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Chaudhury A, Korompili G, Mitra M, Chronis N. A 3D-printed, touch-activated, sanitizer dispensing device for reducing healthcare-acquired infections. JOURNAL OF 3D PRINTING IN MEDICINE 2020; 4:91-104. [DOI: 10.2217/3dp-2020-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
Aim: We present a touch-activated, sanitizer dispensing (TSD) device, intended to be mounted on high-touch surfaces, that aims to reduce nosocomial infections. It disinfects the person’s hand touching its surface while being self-sterilizing. Materials & methods: The TSD device consists of an array of 3D-printed, passive, miniaturized, mechanical valves that dispense a small amount of liquid sanitizer when touched. Its mechanical performance and disinfecting efficiency were quantified using simulations and experimental tests. Results & conclusion: The TSD device has a disinfecting efficiency comparable to the standard hand sanitizing approach, reducing the microbiological load by approximately 30-times. It can be easily mounted on high-touch surfaces in a healthcare setting and it is expected to greatly reduce the spread of nosocomial infections.
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Affiliation(s)
- Amrita Ray Chaudhury
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Georgia Korompili
- Institute of Nanotechnology & Nanoscience, National Centre for Scientific Research Demokritos, Patriarchou Gregoriou & Neapoleos, Aghia Paraskevi, 15341 Athens, Greece
| | - Mainak Mitra
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nikolaos Chronis
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Institute of Nanotechnology & Nanoscience, National Centre for Scientific Research Demokritos, Patriarchou Gregoriou & Neapoleos, Aghia Paraskevi, 15341 Athens, Greece
- Department of Materials Science and Technology, University of Crete, Vassilika Voutes GR-70013 Heraklion, Greece
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Iversen AM, Kavalaris CP, Hansen R, Hansen MB, Alexander R, Kostadinov K, Holt J, Kristensen B, Knudsen JD, Møller JK, Ellermann-Eriksen S. Clinical experiences with a new system for automated hand hygiene monitoring: A prospective observational study. Am J Infect Control 2020; 48:527-533. [PMID: 31635879 DOI: 10.1016/j.ajic.2019.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hand hygiene compliance (HHC) among health care workers remains suboptimal, and good monitoring systems are lacking. We aimed to evaluate HHC using an automated monitoring system. METHODS A prospective, observational study was conducted at 2 Danish university hospitals employing a new monitoring system (Sani nudge). Sensors were located on alcohol-based sanitizers, health care worker name tags, and patient beds measuring hand hygiene opportunities and sanitations. RESULTS In total, 42 nurses were included with an average HHC of 52% and 36% in hospitals A and B, respectively. HHC was lowest in patient rooms (hospital A: 45%; hospital B: 29%) and highest in staff toilets (hospital A: 72%; hospital B: 91%). Nurses sanitized after patient contact more often than before, and sanitizers located closest to room exits and in hallways were used most frequently. There was no association found between HHC level and the number of beds in patient rooms. The HHC level of each nurse was consistent over time, and showed a positive correlation between the number of sanitations and HHC levels (hospital A: r = 0.69; hospital B: r = 0.58). CONCLUSIONS The Sani nudge system can be used to monitor HHC at individual and group levels, which increases the understanding of compliance behavior.
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Akram H, Andrews-Paul A, Washburn R. Assessing Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed Methods Approach. JMIR Nurs 2020; 3:e18788. [PMID: 34345785 PMCID: PMC8279436 DOI: 10.2196/18788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hand hygiene and low-level disinfection of equipment behaviors among hospital staff are some of the leading cost-effective methods to reduce hospital-acquired infections (HAI) among patients. OBJECTIVE The aim of this study is to examine hand hygiene and low-level disinfection of equipment practices in a central Texas hospital and to explore pertaining gaps, perceptions, and challenges. METHODS Data were collected using a multipronged mixed methods approach that included the following: (1) observation of hand hygiene and low-level disinfection practices (12 and 8 units during morning and evening shifts, respectively); (2) observation of usability/placement of hand sanitizer dispensers; (3) semistructured interviews; and (4) a follow-up email survey. RESULTS In total, 222 (156 morning shift and 66 evening shift) staff members were observed. Of 526 hand hygiene and 33 low-level disinfection opportunities, compliance was observed 410 (78%) and 17 (51%) times, respectively. Overall, 6 units (50%) had ≥0.80 (favorable) hand hygiene compliance during the morning shift and 2 units (25%) had ≥0.80 hand hygiene compliance during the evening shift. Aggregated low-level disinfection compliance was 0.54 during the morning and 0.33 during the evening. Overall, the odds of noncompliant hand hygiene behavior were 1.4 times higher among staff who worked during night shifts compared to day shifts; however, this relationship was not statistically significant (95% CI 0.86-2.18; P=.18). Noncompliant behavior was most likely among unit B staff during the evening; however, this relationship was not statistically significant (OR 5.3, 95% CI 0.84-32.9; P=.07) All units, except one, had similar hand sanitizer dispenser usability characteristics. In the qualitative part of the study, the following challenges were identified: "shortage of time while seeing patients," "sometimes the staff forgets," "concern about drying hands," "behavior is difficult or requires reminders," and "there may be issues with resources or access to supplies to perform these behaviors." Staff also stated that "a process that is considered effective is the Stop the Line program," and that the "behavior is easy and automatic." CONCLUSIONS Hand hygiene and low-level disinfection compliance is dependent on several personal and nonpersonal factors. Issues such as time constraints, peer pressure, work culture, available resources, and understanding of guidelines could influence staff behavior. The information collected through this study can be used to re-examine similar or related issues at a larger scale.
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Affiliation(s)
- Hammad Akram
- Baylor Scott and White Medical Center-Hillcrest Waco, TX United States
| | | | - Rachel Washburn
- Baylor Scott and White Medical Center-Hillcrest Waco, TX United States
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Gartmeier M, Baumgartner M, Burgkart R, Heiniger S, Berberat PO. Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment. GMS JOURNAL FOR MEDICAL EDUCATION 2019; 36:Doc39. [PMID: 31544139 PMCID: PMC6737265 DOI: 10.3205/zma001247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 05/06/2019] [Accepted: 05/28/2019] [Indexed: 06/10/2023]
Abstract
Adhering to hygiene standards in daily clinical work is an important characteristic of qualitatively high-value medical care. In this regards, hand hygiene is often focused on in the literature. From the viewpoint of medical education research, we argue that this focus is too narrow to explain how staff who are working clinically with patients implement and adhere to standards of hygiene across a wide variety of tasks of their daily clinical routine. We present basic features of a differentiated concept of hygiene competence, which includes specialized knowledge, corresponding inner attitudes, and action routines that are customized to the needs of specific situations. Building on that, we present a current simulation-based course concept aimed at developing hygiene competence in medical education. Furthermore, we describe a test instrument that is designed according to the principle of a situational judgment test and that appears promising for the assessment of hygiene competence. The course and the measurement instrument are discussed in regards to their fit to the competence model and the related perspectives for research and teaching.
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Affiliation(s)
- Martin Gartmeier
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Maria Baumgartner
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Rainer Burgkart
- Technical University of Munich, Klinikum rechts der Isar, Department of Orthopedics and Sports Orthopedics, Munich, Germany
| | - Susanne Heiniger
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
| | - Pascal O. Berberat
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Medical Education Center, Munich, Germany
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Hammerschmidt J, Manser T. Nurses' knowledge, behaviour and compliance concerning hand hygiene in nursing homes: a cross-sectional mixed-methods study. BMC Health Serv Res 2019; 19:547. [PMID: 31382968 PMCID: PMC6683349 DOI: 10.1186/s12913-019-4347-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background Effective hand hygiene is one of the most important measures for protecting nursing home residents from nosocomial infections. Infections with multi-resistant bacteria’s, associated with healthcare, is a known problem. The nursing home setting differs from other healthcare environments in individual and organisational factors such as knowledge, behaviour, and attitude to improve hand hygiene and it is therefore difficult to research the influential factors to improve hand hygiene. Studies have shown that increasing knowledge, behaviour and attitudes could enhance hand hygiene compliance in nursing homes. Therefore, it may be important to examine individual and organisational factors that foster improvement of these factors in hand hygiene. We aim to explore these influences of individual and organisational factors of hand hygiene in nursing home staff, with a particular focus on the function of role modelling by nursing managers. Methods We conducted a mixed-methods study surveying 165 nurses and interviewing 27 nursing managers from nursing homes in Germany. Results Most nurses and nursing managers held the knowledge of effective hand hygiene procedures. Hygiene standards and equipment were all generally available but compliance to standards also depended upon availability in the immediate work area and role modelling. Despite a general awareness of the impact of leadership on staff behaviour, not all nursing managers fully appreciated the impact of their own consistent role modelling regarding hand hygiene behaviours. Conclusion These results suggest that improving hand hygiene should focus on strategies that facilitate the provision of hand disinfectant materials in the immediate work area of nurses. In addition, nursing managers should be made aware of the impact of their role model function and they should implement this in daily practice.
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Affiliation(s)
- Judith Hammerschmidt
- Institute for Patient Safety, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Tanja Manser
- University of Applied Sciences and Arts Northwestern Switzerland, FHNW School of Applied Psychology, Olten, Switzerland
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Drews FA, Visnovsky LC, Mayer J. Human Factors Engineering Contributions to Infection Prevention and Control. HUMAN FACTORS 2019; 61:693-701. [PMID: 30884250 PMCID: PMC7207010 DOI: 10.1177/0018720819833214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/30/2019] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This article provides a review of areas that present significant challenges in infection prevention and control and describes human factors engineering (HFE) approaches that have been applied successfully to these areas. In addition, implications and recommendations for HFE use in future research are discussed. BACKGROUND Infection prevention and control aims to prevent patients and health care personnel from acquiring preventable infections in healthcare. Effective infection control practices of healthcare-associated infections have recently become even more critical with the emergence of life-threatening infections. HFE could benefit infection prevention and control in addressing older and more recent challenges, but uptake has been limited. METHOD/RESULTS This literature review is an integration and synthesis of recently published research that describes HFE-based approaches in infection prevention and control to address the challenges for three specific topics. The results of the review suggests that HFE is in a position to support work in infection prevention and control and improve overall healthcare safety. CONCLUSION HFE provides conceptual frameworks and methods that have significant potential to improve infection prevention and control. APPLICATION The work reviewed can provide potential solutions for current infection prevention and control challenges by applying HFE based recommendations.
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Plemmons MM, Marcenaro J, Oermann MH, Thompson J, Vacchiano CA. Improving infection control practices of nurse anesthetists in the anesthesia workspace. Am J Infect Control 2019; 47:551-557. [PMID: 30665777 DOI: 10.1016/j.ajic.2018.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anesthesia providers commonly cross-contaminate their workspace and subsequently put patients at risk for a health care-acquired infection. The primary objective of this project was to determine if education and implementation of standardized infection control guidelines that address evidence-based best practices would improve compliance with infection control procedures in the anesthesia workspace. METHODS Patient care-related hand hygiene of nurse anesthetists was observed in 3 areas of anesthesia practice before and 3 weeks and 3 months after staff education, placement of visual reminders, and the implementation of infection control guidelines. After the observation periods, the percent compliance on the part of the providers was calculated for each of the 3 areas of anesthesia practice, and the results were compared using the Fisher exact test. RESULTS There were a total of 95 observations performed during the 3 observation periods. When compared with preimplementation baseline data, there was a 26.2% increase in the number of providers compliant with hand hygiene practices after airway instrumentation (P = .029) and a 71.9% increase in the number of providers who separated clean from contaminated items in the workspace (P = .0001). CONCLUSIONS Education, visual reminders, and standardized infection control guidelines were shown to improve compliance with infection control best practices in a group of nurse anesthetists.
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Affiliation(s)
| | | | | | | | - Charles A Vacchiano
- Duke University School of Nursing, Durham, NC; Duke University Hospital, Durham, NC
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Kim D, Lee O. Effects of Audio-Visual Stimulation on Hand Hygiene Compliance among Family and Non-Family Visitors of Pediatric Wards: A Quasi-Experimental Pre-post Intervention Study. J Pediatr Nurs 2019; 46:e92-e97. [PMID: 30935725 PMCID: PMC7126652 DOI: 10.1016/j.pedn.2019.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/02/2019] [Accepted: 03/25/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE This study aimed to identify the differences in interventional effects on hand hygiene compliance (HHC) among families and visitors in pediatric wards. DESIGN & METHODS A total of 2787 family and non-family visitors entering through the glass sliding door of 6 pediatric wards at a university children's hospital were observed for 4 h, respectively, before and after interventions between April 27 and May 20, 2018. In the first intervention, a visual stimulus emphasized the location of the hand sanitizer. In the second intervention, an additional auditory stimulus transmitted a cue through a motion sensor speaker. RESULTS During the preliminary observation, the HHC rates of family and non-family visitors were 0.0% and 1.5%, respectively; after the visual stimulus, they were 0.6% and 5.4%, and after the audio-visual stimulus, 1.8% and 8.2%. There was a significant increase in the overall HHC with the visual (OR, 5.22; 95% CI, 1.76-20.90) and audio-visual (OR, 8.67; 95% CI, 3.08-33.70) stimuli (Fisher's exact test, p < .05). CONCLUSIONS The HHC of family and non-family visitors entering pediatric wards was very low and the audio-visual stimulus was found to be more effective than was the visual stimulus alone. PRACTICE IMPLICATIONS To reduce healthcare-associated infection, pediatric wards must actively implement effective interventions. Using audio-visual stimulation to increase HHC among visitors will provide advantages. Follow-up research should examine the current state of HHC among visitors in various locations and conditions.
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Affiliation(s)
- Duri Kim
- Seoul National University Children's Hospital, Jongno-Gu, Seoul, Republic of Korea
| | - Ogcheol Lee
- Red Cross College of Nursing, Chung-Ang University, Dongjak-Gu, Seoul, Republic of Korea.
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Squire MM, Igusa T, Siddiqui S, Sessel GK, Squire EN. Cost-Effectiveness of Multifaceted Built Environment Interventions for Reducing Transmission of Pathogenic Bacteria in Healthcare Facilities. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2019; 12:147-161. [PMID: 30991849 DOI: 10.1177/1937586719833360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study is to determine the optimal allocation of budgets for pairs of alterations that reduce pathogenic bacterial transmission. Three alterations of the built environment are examined: handwashing stations (HW), relative humidity control (RH), and negatively pressured treatment rooms (NP). These interventions were evaluated to minimize total cost of healthcare-associated infections (HAIs), including medical and litigation costs. BACKGROUND HAIs are largely preventable but are difficult to control because of their multiple mechanisms of transmission. Moreover, the costs of HAIs and resulting mortality are increasing with the latest estimates at US$9.8 billion annually. METHOD Using 6 years of longitudinal multidrug-resistant infection data, we simulated the transmission of pathogenic bacteria and the infection control efforts of the three alterations using Chamchod and Ruan's model. We determined the optimal budget allocations among the alterations by representing them under Karush-Kuhn-Tucker conditions for this nonlinear optimization problem. RESULTS We examined 24 scenarios using three virulence levels across three facility sizes with varying budget levels. We found that in general, most of the budget is allocated to the NP or RH alterations in each intervention. At lower budgets, however, it was necessary to use the lower cost alterations, HW or RH. CONCLUSIONS Mathematical optimization offers healthcare enterprise executives and engineers a tool to assist with the design of safer healthcare facilities within a fiscally constrained environment. Herein, models were developed for the optimal allocation of funds between HW, RH, and negatively pressured treatment rooms (NP) to best reduce HAIs. Specific strategies vary by facility size and virulence.
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Affiliation(s)
- Marietta M Squire
- 1 Department of Civil Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Takeru Igusa
- 1 Department of Civil Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Sauleh Siddiqui
- 1 Department of Civil Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Gareth K Sessel
- 2 Outreach Engineering NPC (non-profit company), Johannesburg, South Africa
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Keller J, Wolfensberger A, Clack L, Kuster SP, Dunic M, Eis D, Flammer Y, Keller DI, Sax H. Do wearable alcohol-based handrub dispensers increase hand hygiene compliance? - a mixed-methods study. Antimicrob Resist Infect Control 2018; 7:143. [PMID: 30534364 PMCID: PMC6260844 DOI: 10.1186/s13756-018-0439-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Hand Hygiene (HH) compliance was shown to be poor in several studies. Improving the availability of alcohol-based hand rub (ABHR) is a cornerstone for increasing HH compliance. Methods In this study, we introduced wearable dispensers for ABHR in an Emergency Department (ED) well equipped with mounted ABHR dispensers and accompanied this single-modal intervention by a quasi-experimental mixed-method study. The study was performed in the ED of the University Hospital Zurich, Switzerland, a 950-bed tertiary teaching hospital. During a five-week baseline period and a seven-week intervention period, we observed HH compliance according to the WHO 'Five Moments' concept, measured ABHR consumption, and investigated perceived ABHR availability, self-reported HH compliance and knowledge of HH indications by questionnaire. Multivariable logistic regression was used to identify independent determinants for HH compliance. In addition, semi-structured interviews were conducted and thematically analyzed to assess barriers and facilitators for the use of the newly introduced dispensers. Results Across 811 observed HH opportunities, the HH compliance for all moments was 56% (95% confidence interval (CI), 51-62%) during baseline and 64% (CI, 59-68%) during intervention period, respectively. In the multivariable analysis adjusted for sex, profession, and WHO HH moment, there was no difference in HH compliance between baseline and intervention (adjusted Odds ratio: 1.22 (0.89-1.66), p = 0.22), No significant changes were observed in consumption and perceived availability of ABHR. During intervention, 7.5% ABHR was consumed using wearable dispensers. HCP perceived wearable dispensers as unnecessary since mounted dispensers were readily accessible. Poor ergonomic design of the wearable dispenser emerged as a main barrier, especially its lid and fastening mechanism. Interviewees identified two ideal situations for wearable dispensers, HCP who accompany patients from ED to other wards, and HCP approaching a patient from a non-patient areas in the ED such as the central working station or the meeting room. Conclusion The introduction of wearable dispensers did not increase observed hand hygiene compliance or ABHR consumption in an ED already well equipped with mounted dispensers. For broader acceptance and use, wearable dispensers might benefit from an optimized ergonomic design.
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Affiliation(s)
- Jonas Keller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Aline Wolfensberger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Lauren Clack
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Mesida Dunic
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Doris Eis
- Emergency Department, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yvonne Flammer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.,Baraka Health Centre, German Doctors Nairobi, Nairobi, Kenya
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
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Barr N, Holmes M, Roiko A, Dunn P, Lord B. Self-reported behaviors and perceptions of Australian paramedics in relation to hand hygiene and gloving practices in paramedic-led health care. Am J Infect Control 2017; 45:771-778. [PMID: 28385466 DOI: 10.1016/j.ajic.2017.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/15/2017] [Accepted: 02/15/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Noncompliance with recommended hand hygiene and gloving practices by workers in the emergency medical services may contribute to the transmission of health care-associated infections and lead to poor patient outcomes. The aim of this study was to explore the self-reported behaviors and perceptions of Australian paramedics in relation to their hand hygiene and gloving practices in paramedic-led health care. METHODS A national online survey (n = 417; 17% response rate) and 2 semistructured focus groups (6 per group) were conducted with members of Paramedics Australasia. RESULTS Although most of the study participants perceived hand hygiene and gloving to be important, the findings suggest poor compliance with both practices, particularly during emergency cases. All participants reported wearing gloves throughout a clinical case, changing them either at the completion of patient care or when visibly soiled or broken. Hand hygiene was missed at defined moments during patient care, possibly from the misuse of gloves. CONCLUSIONS Paramedic hand hygiene and gloving practices require substantial improvement to lower potential transmission of pathogens and improve patient safety and clinical care. Further research is recommended to explore how to alleviate the barriers to performing in-field hand hygiene and the misuse of gloves during paramedic-led health care.
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Affiliation(s)
- Nigel Barr
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia.
| | - Mark Holmes
- School of Health and Sport Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Anne Roiko
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Peter Dunn
- School of Health and Sport Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Bill Lord
- School of Nursing, Midwifery and Paramedicine, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, QLD, Australia
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Ataee RA, Ataee MH, Mehrabi Tavana A, Salesi M. Bacteriological Aspects of Hand Washing: A Key for Health Promotion and Infections Control. Int J Prev Med 2017; 8:16. [PMID: 28382192 PMCID: PMC5364736 DOI: 10.4103/2008-7802.201923] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 01/02/2017] [Indexed: 12/15/2022] Open
Abstract
The aim of this review is to show the historical aspects of hands washing for healthy life and explains how can reduce the transmission of community-acquired infectious agents by healthcare workers and patients. This review article is prepared based on available database. The key words used were hands washing, risk assessment, hands hygiene, bacterial flora, contamination, infection, nosocomial, tap water, sanitizer, bacterial resistance, hands bacterial flora, washing methods, antiseptics, healthcare workers, healthcare personnel, from PubMed, ScienceDirect, Embase, Scopus, Web of Sciences, and Google Scholar. Data were descriptively analyzed. The insistence on hand washing has a history of 1400 years. The research results indicate that the bacteria released from the female washed hands in wet and dry condition was lower than from the male's hands with a significance level (3 CFU vs. 8 CFU; confidence interval 95%, P ≤ 0.001). The valuable results of the study indicated that released amount of bacterial flora from wet hands is more than 10 times in compared to dry hands. In addition, established monitoring systems for washing hands before and after patient's manipulation as well as after toilet were dominant indices to prevent the transfer of infectious agents to the patients. Increasing awareness and belief of the healthcare workers have shown an important role by about 30% reduction in the transfection. Hand washing could reduce the episodes of transmission of infectious agents in both community and healthcare settings. However, hand washing is an important key factor to prevent transmission of infectious agents to patients. There is no standard method for measuring compliance. Thus, permanent monitoring of hand washing to reduce the transmission of infections is crucial. Finally, the personnel must believe that hand washing is an inevitable approach to infection control.
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Affiliation(s)
- Ramezan Ali Ataee
- Department of Medical Microbiology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Hosein Ataee
- Applied Microbial Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ali Mehrabi Tavana
- Department of Medical Microbiology and Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mahmud Salesi
- Department of Medical Microbiology and Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Islamic Republic of Iran
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Stiller A, Salm F, Bischoff P, Gastmeier P. Relationship between hospital ward design and healthcare-associated infection rates: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2016; 5:51. [PMID: 27957323 PMCID: PMC5129243 DOI: 10.1186/s13756-016-0152-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/22/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The influence of the hospital's infrastructure on healthcare-associated colonization and infection rates has thus far infrequently been examined. In this review we examine whether healthcare facility design is a contributing factor to multifaceted infection control strategies. METHODS We searched PubMed/MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from 1990 to December 31st, 2015, with language restriction to English, Spanish, German and French. RESULTS We identified three studies investigating accessibility of the location of the antiseptic hand rub dispenser. Each of them showed a significant improvement of hand hygiene compliance or agent consumption with the implementation of accessible dispensers near the patient bed. Nine eligible studies evaluated the impact of single-patient rooms on the acquisition of healthcare-associated colonization and infections in comparison to multi-bedrooms or an open ward design. Six of these studies showed a significant benefit of single-patient bedrooms in reducing the healthcare-associated colonization and infection rate, whereas three studies found that single-patient rooms are neither a protective nor risk factor. In meta-analyses, the overall risk ratio for acquisition of healthcare-associated colonization and infection was 0.55 (95% CI: 0.41 to 0.74), for healthcare-associated colonization 0.52 (95% CI: 0.32 to 0.85) and for bacteremia 0.64 (95% CI: 0.53 to 0.76), all in favor of patient care in single-patient bedrooms. CONCLUSION Implementation of single-patient rooms and easily accessible hand rub dispensers located near the patient's bed are beneficial for infection control and are useful parts of a multifaceted strategy for reducing healthcare-associated colonization and infections.
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Affiliation(s)
- Andrea Stiller
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Florian Salm
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Peter Bischoff
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité University Medical Center Berlin, Hindenburgdamm 27, D-12203 Berlin, Germany
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Verwilghen D. The World Health Organization's Clean Hands Save Lives: A concept applicable to equine medicine as Clean Hands Save Horses. EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- D. Verwilghen
- Section of Medicine and Surgery; Department of Large Animals Sciences; University of Copenhagen; Denmark
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Kirk J, Kendall A, Marx JF, Pincock T, Young E, Hughes JM, Landers T. Point of care hand hygiene-where's the rub? A survey of US and Canadian health care workers' knowledge, attitudes, and practices. Am J Infect Control 2016; 44:1095-1101. [PMID: 27178035 DOI: 10.1016/j.ajic.2016.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/04/2016] [Accepted: 03/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hand hygiene at the point of care is recognized as a best practice for promoting compliance at the moments when hand hygiene is most critical. The objective of this study was to compare knowledge, attitudes, and practices of US and Canadian frontline health care personnel regarding hand hygiene at the point of care. METHODS Physicians and nurses in US and Canadian hospitals were invited to complete a 32-question online survey based on evidence supporting point of care hand hygiene. Eligible health care personnel were in direct clinical practice at least 50% of the time. RESULTS Three hundred fifty frontline caregivers completed the survey. Among respondents, 57.1% were from the United States and 42.9% were from Canada. Respondents were evenly distributed between physician and nurses. The US and Canadian respondents gave identical ranking to their perceived barriers to hand hygiene compliance. More than half of the respondents from both the United States and Canada agreed or strongly agreed that they would be more likely to clean their hands when recommended if alcohol-based handrub was closer to the patient. CONCLUSION This survey demonstrates that similarities between Canada and the United States were more common than not, and the survey raises, or suggests, potential knowledge gaps that require further illumination.
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