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Di Bella S, Sanson G, Monticelli J, Zerbato V, Principe L, Giuffrè M, Pipitone G, Luzzati R. Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options. Clin Microbiol Rev 2024; 37:e0013523. [PMID: 38421181 PMCID: PMC11324037 DOI: 10.1128/cmr.00135-23] [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] [Indexed: 03/02/2024] Open
Abstract
SUMMARYClostridioides difficile infection (CDI) is one of the major issues in nosocomial infections. This bacterium is constantly evolving and poses complex challenges for clinicians, often encountered in real-life scenarios. In the face of CDI, we are increasingly equipped with new therapeutic strategies, such as monoclonal antibodies and live biotherapeutic products, which need to be thoroughly understood to fully harness their benefits. Moreover, interesting options are currently under study for the future, including bacteriophages, vaccines, and antibiotic inhibitors. Surveillance and prevention strategies continue to play a pivotal role in limiting the spread of the infection. In this review, we aim to provide the reader with a comprehensive overview of epidemiological aspects, predisposing factors, clinical manifestations, diagnostic tools, and current and future prophylactic and therapeutic options for C. difficile infection.
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of
Medical, Surgical and Health Sciences, Trieste
University, Trieste,
Italy
| | - Gianfranco Sanson
- Clinical Department of
Medical, Surgical and Health Sciences, Trieste
University, Trieste,
Italy
| | - Jacopo Monticelli
- Infectious Diseases
Unit, Trieste University Hospital
(ASUGI), Trieste,
Italy
| | - Verena Zerbato
- Infectious Diseases
Unit, Trieste University Hospital
(ASUGI), Trieste,
Italy
| | - Luigi Principe
- Microbiology and
Virology Unit, Great Metropolitan Hospital
“Bianchi-Melacrino-Morelli”,
Reggio Calabria, Italy
| | - Mauro Giuffrè
- Clinical Department of
Medical, Surgical and Health Sciences, Trieste
University, Trieste,
Italy
- Department of Internal
Medicine (Digestive Diseases), Yale School of Medicine, Yale
University, New Haven,
Connecticut, USA
| | - Giuseppe Pipitone
- Infectious Diseases
Unit, ARNAS Civico-Di Cristina
Hospital, Palermo,
Italy
| | - Roberto Luzzati
- Clinical Department of
Medical, Surgical and Health Sciences, Trieste
University, Trieste,
Italy
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Boyce JM, Pittet D. Rinse, gel, and foam - is there any evidence for a difference in their effectiveness in preventing infections? Antimicrob Resist Infect Control 2024; 13:49. [PMID: 38730473 PMCID: PMC11084031 DOI: 10.1186/s13756-024-01405-5] [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: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). METHODS Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. RESULTS The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. CONCLUSIONS Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.
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Affiliation(s)
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Gould D, Hawker C, Drey N, Purssell E. Should automated electronic hand-hygiene monitoring systems be implemented in routine patient care? Systematic review and appraisal with Medical Research Council Framework for Complex Interventions. J Hosp Infect 2024; 147:180-187. [PMID: 38554805 DOI: 10.1016/j.jhin.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024]
Abstract
Manual hand-hygiene audit is time-consuming, labour-intensive and inaccurate. Automated hand-hygiene monitoring systems (AHHMSs) offer advantages (generation of standardized data, avoidance of the Hawthorne effect). World Health Organization Guidelines for Hand Hygiene published in 2009 suggest that AHHMSs are a possible alternative. The objective of this review was to assess the current state of the literature for AHHMSs and offer recommendations for use in real-world settings. This was a systematic literature review, and publications included were from the time that PubMed commenced until 19th November 2023. Forty-three publications met the criteria. Using the Medical Research Council's Framework for Developing and Evaluating Complex Interventions, two were categorized as intervention development studies. Thirty-nine were evaluations. Two described implementation in real-world settings. Most were small scale and short duration. AHHMSs in conjunction with additional intervention (visual or auditory cue, performance feedback) could increase hand hygiene compliance in the short term. Impact on infection rates was difficult to determine. In the few publications where costs and resources were considered, time devoted to improving hand hygiene compliance increased when an AHHMS was in use. Health workers' opinions about AHHMSs were mixed. In conclusion, at present too little is known about the longer-term advantages of AHHMSs to recommend uptake in routine patient care. Until more longer-term accounts of implementation (over 12 months) become available, efforts should be made to improve direct observation of hand hygiene compliance to improve its accuracy and credibility. The Medical Research Council Framework could be used to categorize other complex interventions involving use of technology to prevent infection to help establish readiness for implementation.
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Affiliation(s)
- D Gould
- Independent Consultant, London, UK
| | - C Hawker
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - N Drey
- School of Health & Psychological Sciences, Department of Nursing, City University, London, UK
| | - E Purssell
- Faculty of Health, Medicine and Social Care, School of Nursing and Midwifery, Anglia Ruskin University, Chelmsford, UK.
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Guerrero-Soler M, Gras-Valentí P, Gómez-Sotero IL, Platas-Abenza G, Silva-Afonso RDF, Benito-Miralles CM, Fuster-Pérez M, Cartagena-Llopis L, Sánchez-Valero M, Sánchez-Payá J, Chico-Sánchez P. Impact of COVID-19 on the degree of compliance with hand hygiene: a repeated cross-sectional study. Epidemiol Infect 2024; 152:e69. [PMID: 38557427 PMCID: PMC11077604 DOI: 10.1017/s0950268824000505] [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: 10/19/2023] [Revised: 02/22/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024] Open
Abstract
Hand hygiene (HH) is the paramount measure used to prevent healthcare-associated infections. A repeated cross-sectional study was undertaken with direct observation of the degree of compliance on HH of healthcare personnel during the SARS-CoV-2 pandemic. Between, 2018-2019, 9,083 HH opportunities were considered, and 5,821 in 2020-2022. Chi squared tests were used to identify associations. The crude and adjusted odds ratios were used along with a logistic regression model for statistical analyses. Compliance on HH increased significantly (p < 0.001) from 54.5% (95% CI: 53.5, 55.5) to 70.1% (95% CI: 68.9, 71.2) during the COVID-19 pandemic. This increase was observed in four of the five key moments of HH established by the World Health Organization (WHO) (p < 0.05), except at moment 4. The factors that were significantly and independently associated with compliance were the time period considered, type of healthcare-personnel, attendance at training sessions, knowledge of HH and WHO guidelines, and availability of hand disinfectant alcoholic solution in pocket format. Highest HH compliance occurred during the COVID-19 pandemic, reflecting a positive change in healthcare-personnel's behaviour regarding HH recommendations.
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Affiliation(s)
- Maria Guerrero-Soler
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Paula Gras-Valentí
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Isel Lilibeth Gómez-Sotero
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Guillermo Platas-Abenza
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Raissa de Fátima Silva-Afonso
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Carmen-María Benito-Miralles
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Marina Fuster-Pérez
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Lidia Cartagena-Llopis
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María Sánchez-Valero
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - José Sánchez-Payá
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pablo Chico-Sánchez
- Epidemiology Unit, Preventive Medicine Service, Alicante Dr. Balmis University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
- Department of Community Nursing, Preventive Medicine and Public Health and History of Science, University of Alicante, Alicante, Spain
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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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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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Bloch N, Männer J, Gardiol C, Kohler P, Kuhn J, Münzer T, Schlegel M, Kuster SP, Flury D. Effective infection prevention and control measures in long-term care facilities in non-outbreak and outbreak settings: a systematic literature review. Antimicrob Resist Infect Control 2023; 12:113. [PMID: 37853477 PMCID: PMC10585745 DOI: 10.1186/s13756-023-01318-9] [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: 04/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Healthcare-associated infections in long-term care are associated with substantial morbidity and mortality. While infection prevention and control (IPC) guidelines are well-defined in the acute care setting, evidence of effectiveness for long-term care facilities (LTCF) is missing. We therefore performed a systematic literature review to examine the effect of IPC measures in the long-term care setting. METHODS We systematically searched PubMed and Cochrane libraries for articles evaluating the effect of IPC measures in the LTCF setting since 2017, as earlier reviews on this topic covered the timeframe up to this date. Cross-referenced studies from identified articles and from mentioned earlier reviews were also evaluated. We included randomized-controlled trials, quasi-experimental, observational studies, and outbreak reports. The included studies were analyzed regarding study design, type of intervention, description of intervention, outcomes and quality. We distinguished between non-outbreak and outbreak settings. RESULTS We included 74 studies, 34 (46%) in the non-outbreak setting and 40 (54%) in the outbreak setting. The most commonly studied interventions in the non-outbreak setting included the effect of hand hygiene (N = 10), oral hygiene (N = 6), antimicrobial stewardship (N = 4), vaccination of residents (N = 3), education (N = 2) as well as IPC bundles (N = 7). All but one study assessing hand hygiene interventions reported a reduction of infection rates. Further successful interventions were oral hygiene (N = 6) and vaccination of residents (N = 3). In outbreak settings, studies mostly focused on the effects of IPC bundles (N = 24) or mass testing (N = 11). In most of the studies evaluating an IPC bundle, containment of the outbreak was reported. Overall, only four articles (5.4%) were rated as high quality. CONCLUSION In the non-outbreak setting in LTCF, especially hand hygiene and oral hygiene have a beneficial effect on infection rates. In contrast, IPC bundles, as well as mass testing seem to be promising in an outbreak setting.
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Affiliation(s)
- Nando Bloch
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland.
| | - Jasmin Männer
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | | | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Jacqueline Kuhn
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St.Gallen, St.Gallen, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
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Seferi A, Parginos K, Jean W, Calero C, Fogel J, Modeste S, Scott BA, Daly-Walsh M, Yap W, Kaur M, Brady T, Madaline T. Hand hygiene behavior change: a review and pilot study of an automated hand hygiene reminder system implementation in a public hospital. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e122. [PMID: 37502248 PMCID: PMC10369449 DOI: 10.1017/ash.2023.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 07/29/2023]
Abstract
Objective To review and study implementation of an automated hand hygiene reminder system (AHHRS). Design Prospective, nonrandomized, before-after quality improvement pilot study conducted over 6 months. Setting Medical-surgical unit (MSU) and medical intensive care unit (MICU) at a public hospital in New York City. Participants There were 2,642 healthcare worker observations in the direct observation (DO) period versus 265,505 in the AHHRS period, excluding AHHRS observations collected during the 1-month crossover period when simultaneous DO occurred. Intervention We compared hand hygiene adherence (HHA) measured by DO prior to the pilot and after AHHRS implementation. We compared changes in HHA and potential cross-contamination events (CCEs) (room exit and subsequent entry without HHA) from baseline for each biweekly period during the pilot. Results Engagement, education/training, data transparency, and optimization period resulted in successful implementation and adoption of the AHHRS. Observations were greater utilizing AHHRS than DO (265,505 vs 2,642, P < .01). Due to the expected Hawthorne effect, HHA was significantly less for AHHRS than DO in MSU (90.99% vs 97.21%, P < .01) and MICU (91.21% vs 98.65%, P < .01). HHA significantly improved from 86.47% to 89.68% in MSU (P < .001) and 85.93% to 91.24% in the MICU (P < .001) from the first biweekly period of AHHRS utilization to the last. CCE decreased from 73.42% to 65.11% in the MSU and significantly decreased from 81.22% to 53.19% in the MICU (P < .05). Conclusions We describe how an AHHRS approach was successfully implemented at our facility. With ongoing feedback and system optimization, AHHRS improved HHA and reduced CCE over time.
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Affiliation(s)
- Arta Seferi
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Kalliopi Parginos
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Wiline Jean
- Department of Infection Prevention, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
- HealthCare Transformation, Chicago, IL, USA
| | - Christopher Calero
- Department of Infection Prevention, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Joshua Fogel
- Department of Obstetrics and Gynecology, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
- Department of Business Management, Brooklyn College, Brooklyn, NY, USA
| | - Shantel Modeste
- Department of Quality Management, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Beverley-Ann Scott
- Department of Quality Management, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Marjorie Daly-Walsh
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Wilfredo Yap
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Manjinder Kaur
- Department of Nursing, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
| | - Terence Brady
- Department of Medicine, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
- Department of Medicine, St. George’s University School of Medicine, Grenada, West Indies
| | - Theresa Madaline
- Department of Medicine, New York City Health + Hospitals/South Brooklyn Health, Brooklyn, NY, USA
- Department of Medicine, St. George’s University School of Medicine, Grenada, West Indies
- Department of Medicine, Touro College of Osteopathic Medicine, New York, NY, USA
- Department of Medicine, New York Institute of Technology College of Osteopathic Medicine, New York, NY, USA
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Cawthorne KR, Cooke R. A survey of commercially available electronic hand hygiene monitoring systems and their impact on reducing healthcare-associated infections. J Hosp Infect 2021; 111:40-46. [DOI: 10.1016/j.jhin.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 01/18/2023]
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