1
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Lobo RD, Oliveira MSD, Colella JJ, Silva NDD, Pastore Junior L, Souza RCDS. Assessment of the Hawthorne effect during central venous catheter manipulation. Rev Esc Enferm USP 2022; 56:e20220125. [PMID: 36082984 PMCID: PMC10116874 DOI: 10.1590/1980-220x-reeusp-2022-0125en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/08/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To describe the compliance to the practices of hand hygiene and hub disinfection before manipulation of the central venous catheter in two moments: before and after educational intervention. Adherence to hand hygiene was assessed with two methods: direct observation and video camera. METHODS Before and after study conducted with the nursing team in an adult intensive care unit, in São Paulo, Brazil, including 180 observations using video cameras and direct observation. Hand hygiene compliance before catheter manipulation and compliance with the correct technique and the hub disinfection for five seconds were observed. RESULTS When video cameras recording was observed, hand hygiene compliance increased from 46% to 66% and the use of the proper technique increased from 23% to 46% (p < 0.05). Regarding hub disinfection compliance, no difference was observed between the periods. Hand hygiene compliance in direct observation increased from 83% to 87% and in indirect observation, from 46% to 66% after the intervention. CONCLUSION After the educational intervention, hand hygiene compliance before CVC manipulation and the use of the correct technique improved. When observed indirectly, the adherence to these practices was lower, reinforcing the Hawthorne effect.
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Affiliation(s)
- Renata Desordi Lobo
- Hospital Sírio Libanês, Serviço de Controle de Infecção Hospitalar, São Paulo, SP, Brazil
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2
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Hagiya H, Takase R, Sazumi Y, Nishimura Y, Honda H, Otsuka F. Gap between self-evaluation and actual hand hygiene compliance among health-care workers. J Infect Prev 2022; 23:239-242. [PMID: 36003134 PMCID: PMC9393601 DOI: 10.1177/17571774221094160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/22/2022] [Accepted: 02/24/2022] [Indexed: 09/03/2023] Open
Abstract
Hand hygiene (HH) compliance among health-care workers has not satisfactorily improved despite multiple educative approaches. Between October 2019 and February 2020, we performed a self-evaluation test and a direct observation for the compliance of the 5 Moments for Hand Hygiene program advocated by the World Health Organization at two Japanese hospitals. Average percentages of self-evaluated HH compliance were as follows: (i) 76.9% for "Before touching a patient," (ii) 85.8% for "Before clean/aseptic procedures," (iii) 95.9% for "After body fluid exposure/risk," (iv) 84.0% for "After touching a patient," and (v) 69.2% for "After touching patient surroundings." On the other hand, actual HH compliance was 11.7% for "Before touching a patient" and 18.0% for "After touching a patient or patient surroundings." The present study demonstrated a big gap between self-evaluation and actual HH compliance among nurses working at hospitals, indicating the need of further providing the education in infection prevention.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ryosuke Takase
- Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Sazumi
- Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshito Nishimura
- Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Honda
- Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine,
Dentistry and Pharmaceutical Sciences, Okayama, Japan
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3
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Zhang Y, Chen X, Lao Y, Qiu X, Liu K, Zhuang Y, Gong X, Wang P. Effects of the Implementation of Intelligent Technology for Hand Hygiene in Hospitals: A Systematic Review and Meta-analysis (Preprint). J Med Internet Res 2022; 25:e37249. [DOI: 10.2196/37249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 12/12/2022] [Accepted: 03/19/2023] [Indexed: 03/20/2023] Open
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4
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Impact of the world hand hygiene and global handwashing days on public awareness between 2016 and 2020: Google trends analysis. Am J Infect Control 2022; 50:141-147. [PMID: 34718066 DOI: 10.1016/j.ajic.2021.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scientific evidence suggest that hand hygiene as one of the most effective measures to control infection. To promote good hand hygiene practices, the World Health Organization introduced May 5 as World Hand Hygiene Day (WHHD), and international stakeholders established Global Handwashing Day (GHD) on October 15. However, its contributions to raising public awareness of hand hygiene is unclear. METHODS This study evaluates the impact of the WHHD and GHD on the public awareness of hand hygiene in Japan, the United Kingdom, the United States, and worldwide from 2016 to 2020, using the relative search volume of "Hand hygiene" in Google Trends as a surrogate. To identify a statistically significant timepoint of a trend change, we performed Joinpoint regression analysis. RESULTS Upticks of the relative search volumes as well as joinpoints were noted worldwide around the WHHD and GHD from 2016 to 2019, but no joinpoints were identified around the WHHD and GHD in 2020. No such changes were observed in Japan, the United Kingdom, and the United States during these periods. CONCLUSIONS While the WHHD was originally established to raise awareness of hand hygiene in healthcare facilities, our result suggests that the WHHD and GHD may not have effectively disseminated the importance of hand hygiene to the general public at a country level. Additional policy measures to advocate hand hygiene to the public are necessary to communicate its benefits.
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5
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Bhikharee D, Elzagheid M, Rhyman L, Ramasami P. Effect of water or ethanol on the tautomeric stability and proton transfer reaction of all possible tautomers of hydantoin: Implicit v/s explicit solvation. J Mol Liq 2022. [DOI: 10.1016/j.molliq.2021.117942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Gopalakrishnan S, Chaurasia S, Sankar MJ, Paul VK, Deorari AK, Joshi M, Agarwal R. Stepwise interventions for improving hand hygiene compliance in a level 3 academic neonatal intensive care unit in north India. J Perinatol 2021; 41:2834-2839. [PMID: 34321595 DOI: 10.1038/s41372-021-01141-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/20/2021] [Accepted: 06/30/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We evaluated effect of sequentially introducing four WHO-recommended interventions to promote hand-hygiene compliance in tertiary-care NICU. STUDY DESIGN Four dedicated research nurses directly observed doctors and nurses to record success in hand-hygiene opportunities at randomly selected NICU beds and randomly sampled time-slots in four phases (of 4-weeks each): I-Baseline, II-Self-directed learning; III-Participatory learning; IV-Closed-Circuit Television (CCTV); and V-CCTV-plus (with feedback). FINDINGS Hand-hygiene compliance changed from 61.8% (baseline) to 77% (end) with overall relative change: 24.6% (95% CI 18, 32; p value= 0.003); compared with preceding phase, relative changes of 21% (15, 28; <0.001), 4% (0, 8; 0.008), -10% (-13, -6; <0.001), and 10% (5, 15; <0.001) during phases II, III, IV, and V, respectively were observed. Rise in hand-hygiene compliance was higher for after-WHO-moments (12.7%; upto 2.5-folds for moment 5, <0.001) compared to before-WHO-moments (5.2%). Educational interventions, feedback and monitoring WHO moments can improve hand-hygiene compliance significantly among health-care providers in NICU.
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Affiliation(s)
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Dehradun, 249203, Uttarakhand, India.
| | - M J Sankar
- Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - V K Paul
- Department of Pediatrics, AIIMS, New Delhi, India
| | - A K Deorari
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - M Joshi
- WHO Collaborating Centre for Training & Research in Newborn Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - R Agarwal
- Newborn Health Knowledge Centre (NHKC) and WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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7
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Maru V. The 'new normal' in post-COVID-19 pediatric dental practice. Int J Paediatr Dent 2021; 31:528-538. [PMID: 34148269 PMCID: PMC8447441 DOI: 10.1111/ipd.12764] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/15/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Abstract
The COVID-19 pandemic has posed an extraordinary challenge to the world. Dental healthcare personnel are considered to be at high risk as they work in close proximity to the oral cavity of patients. New procedures of approach and management should be incorporated in different aspects of routine dental practice. In addition, pediatric dentists are posed with unique and extraordinary challenges of parental anxiety and behavioral guidance of pediatric patients and parents/guardians. The aim of this study was to highlight the changing perceptions of pediatric dental practice as the 'new normal' in the post-COVID era.
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Affiliation(s)
- Viral Maru
- Department of Pediatric DentistryGovernment Dental College and HospitalMumbaiIndia
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8
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Vascular Access Device Care and Management: A Comprehensive Organizational Approach. JOURNAL OF INFUSION NURSING 2021; 43:246-254. [PMID: 32881811 DOI: 10.1097/nan.0000000000000385] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Infusion Nurses Society asserts that a comprehensive organizational approach to vascular access device (VAD) care and management is imperative to ensure safe and efficacious patient care. It is essential that each organization (1) develops policies and procedures to align VAD care and management with recognized standards of practice; (2) integrates unique aspects of organization-selected VAD care products into policies and procedures and establishes expectations for adherence to these organizational directives; (3) develops a framework for gathering and analyzing clinical data related to patient outcomes for VAD care and management; (4) utilizes quality outcome data to facilitate evidence-based best practices within the organization; and (5) evaluates and facilitates educational programming to validate clinician competency.
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9
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Lin TY, Lin CT, Chen KM, Hsu HF. Information technology on hand hygiene compliance among health care professionals: A systematic review and meta-analysis. J Nurs Manag 2021; 29:1857-1868. [PMID: 33772923 DOI: 10.1111/jonm.13316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 12/25/2022]
Abstract
AIM To determine the effectiveness of information technology interventions on hand hygiene compliance among health care professionals. BACKGROUND Performing hand hygiene is the optimal approach to prevent the transmission of health care-associated infections. However, results regarding the effectiveness of information technology interventions on hand hygiene compliance were inconsistent to date. EVALUATION A search for studies published up to May 2020 was undertaken. A meta-analysis was conducted using RevMan 5.3 software. KEY ISSUES The most commonly used information technology systems were as follows: automated training, electronic counting devices and remote monitoring, real-time hand hygiene reminders and feedback, and automated monitoring. These four types of technology systems can significantly improve hand hygiene compliance among health care professionals (odds ratio = 3.06, p < .001). CONCLUSION The four types of information technology can be effectively used to change the hand hygiene behaviour. Because the information systems can monitor personnel and conduct statistical analyses automatically, they save labour costs of human monitors, are more time efficient and eliminate accompanying human error. IMPLICATIONS FOR NURSING MANAGEMENT The use of the four types of information technology is convenient and could reduce health care-associated infections; thus, they could be widely used in the future as the key to increase hand hygiene compliance rate.
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Affiliation(s)
- Tang-Yu Lin
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Ting Lin
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Center for Long-term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Fen Hsu
- Center for Long-term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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10
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Zhang L, Qin X, Zeng J, Feng Y, Zhang N, Tan Y, Chen J, Chen S. A kindergarten-based, family-involved intervention to improve children's hand hygiene behavior: A cluster-randomized controlled trial. Public Health Nurs 2021; 38:738-750. [PMID: 33682194 DOI: 10.1111/phn.12882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The present study determined the feasibility and initial efficacy of a kindergarten-based, family-involved intervention in improving children's hand hygiene (HH) behaviors. DESIGN A cluster-randomized controlled trial was performed, with a cluster defined as a kindergarten class. SAMPLE Participants were recruited from 20 classes in six kindergartens. A total of 289 children and their families were enrolled in the intervention group, and 293 children and their families were enrolled in the control group. MEASUREMENTS HH behavior and a related knowledge survey, as well as data on absences due to infection, were collected. INTERVENTION An 8-week training session on HH for children and an education program combining a seminar and WeChat groups for parents were provided to participants in the intervention group. RESULTS Two HH behaviors of children, namely, HH after playing outside and 7-stage HH compliance, were significantly different between the two groups after the intervention. The two HH behaviors and knowledge of infections of parents/legal guardians in the intervention group were better than those in the control group after the intervention. The number of absences due to infections in children was lower in the intervention group than in the control group. CONCLUSIONS Kindergarten-based, family-involved interventions effectively improved the HH behavior of kindergarten children and decreased absences due to infections.
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Affiliation(s)
- Lifeng Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Xiuqun Qin
- Pediatric Department, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jixiao Zeng
- Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yongshen Feng
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Ningning Zhang
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Yuqin Tan
- Abdominal and Pelvic Oncology Department, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jielin Chen
- School of Nursing, Sun Yat-sen University, Guangzhou, China
| | - Shiyin Chen
- Research Management Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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11
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Kirkby M, Sabri AB, Scurr DJ, Moss GP. Dendrimer-mediated permeation enhancement of chlorhexidine digluconate: Determination of in vitro skin permeability and visualisation of dermal distribution. Eur J Pharm Biopharm 2021; 159:77-87. [PMID: 33359754 DOI: 10.1016/j.ejpb.2020.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/06/2020] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
Chlorhexidine digluconate (CHG) is a cationic bisbiguanide used in the UK as the first-line skin antiseptic prior to surgery in the UK due to its favourable efficacy and safety profile, high affinity for skin binding and minimal reports of resistance. Despite this, bacteria remain within deeper skin layers, furrows and appendages that are considered inaccessible to CHG, due to its poor dermal penetration. In this study a third generation, polyamidoamine dendrimer (G3 PAMAM-NH2) was utilised to improve dermal penetration of CHG. A topical gel formulation was optimised to maximise CHG delivery (containing 0.5% gelling agent and 4% drug), followed by drug and dendrimer co-formulation into a commercially viable gel. The gel containing 4% CHG and 1 mM PAMAM dendrimer significantly increased the depth permeation of CHG compared to the commercial benchmark (Hibiscrub®, containing 4% w/v CHG) (p < 0.05). The optimised formulation was further characterised using Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS), which indicated that the depth of dermal penetration achieved was sufficient to reach the skin strata that typically harbours pathogenic bacteria, which is currently inaccessible by commercial CHG formulations. This study therefore indicates that a G3 PAMAM-NH2 dendrimer gel may be viable as a permeation enhancer of CHG, for improved skin antisepsis in those at risk of a skin or soft tissue infection as a result of surgical intervention.
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Affiliation(s)
- Melissa Kirkby
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, United Kingdom.
| | - Akmal B Sabri
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - David J Scurr
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, United Kingdom
| | - Gary P Moss
- School of Pharmacy and Bioengineering, Keele University, Staffordshire ST5 5BG, United Kingdom
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12
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Reynolds K, Sexton J, Norman A, McClelland D. Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature. J Appl Microbiol 2021; 130:25-39. [PMID: 32794646 PMCID: PMC7818469 DOI: 10.1111/jam.14796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Abstract
Numerous studies are published on the benefits of electric hand dryers vs paper towels (PT) for drying hands after washing. Data are conflicting and lacking key variables needed to assess infection risks. We provide a rapid scoping review on hand-drying methods relative to hygiene and health risks. Controlled vocabulary terms and keywords were used to search PubMed (1946-2018) and Embase (1947-2018). Multiple researchers independently screened abstracts for relevance using predetermined criteria and created a quality assessment scoring system for relative study comparisons. Of 293 papers, 23 were included in the final analysis. Five studies did not compare multiple methods; however, 2 generally favoured electric dryers (ED); 7 preferred PT; and 9 had mixed or statistically insignificant results (among these, 3 contained scenarios favourable to ED, 4 had results supporting PT, and the remaining studies had broadly conflicting results). Results were mixed among and within studies and many lacked consistent design or statistical analysis. The breadth of data does not favour one method as being more hygienic. However, some authors extended generalizable recommendations without sufficient scientific evidence. The use of tools in quantitative microbial risk assessment is suggested to evaluate health exposure potentials and risks relative to hand-drying methods. We found no data to support any human health claims associated with hand-drying methods. Inconclusive and conflicting results represent data gaps preventing the advancement of hand-drying policy or practice recommendations.
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Affiliation(s)
- K.A. Reynolds
- Zuckerman College of Public HealthThe University of ArizonaTucsonAZUSA
| | - J.D. Sexton
- Zuckerman College of Public HealthThe University of ArizonaTucsonAZUSA
| | - A. Norman
- Zuckerman College of Public HealthThe University of ArizonaTucsonAZUSA
| | - D.J. McClelland
- Zuckerman College of Public HealthThe University of ArizonaTucsonAZUSA
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13
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Jairoun AA, Al-Hemyari SS, Shahwan M. The pandemic of COVID-19 and its implications for the purity and authenticity of alcohol-based hand sanitizers: The health risks associated with falsified sanitizers and recommendations for regulatory and public health bodies. Res Social Adm Pharm 2021; 17:2050-2051. [PMID: 32334979 PMCID: PMC7195349 DOI: 10.1016/j.sapharm.2020.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/21/2022]
Abstract
With the beginning of the pandemic of COVID-19 throughout the world, the demand and consumption of hand sanitizers has increased, which had led to a sharp crunch in these products at all levels. This shortage has led to an increase in the prevalence of falsified alcohol-based hand sanitizers, including the illegal addition of methanol to hand sanitizers and the production of hand sanitizers with an alcohol concentration of less than 60%. These findings indicate that regulatory and public health bodies should take an active role in ensuring the safety and quality of antimicrobial products such as alcohol-based hand sanitizers at every stage of the products' lifecycle, including distribution, manufacture and import.
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Affiliation(s)
| | | | - Moyad Shahwan
- College of Pharmacy and Health Sciences, Ajman University, United Arab Emirates.
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14
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Xu N, Liu C, Feng Y, Li F, Meng X, Lv Q, Lan C. Influence of the Internet of Things management system on hand hygiene compliance in an emergency intensive care unit. J Hosp Infect 2020; 109:101-106. [PMID: 33346043 DOI: 10.1016/j.jhin.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hand hygiene is a critical strategy for infection prevention in all healthcare settings. Automated electronic monitoring systems are expected to improve hand hygiene performance. AIM To investigate the impact of the Internet of Things (IoT) management system on hand hygiene compliance among medical staff in an emergency intensive care unit (EICU). METHODS This retrospective observational study was conducted between July 1st, 2017 and February 28th, 2018 in a 19-bed EICU. The changes in hand hygiene compliance among 54 members of medical staff and the incidence of hospital infections were compared, counted, and analysed before and after implementing the IoT management system in the EICU that was initiated on November 1st, 2017. FINDINGS After the application of the IoT management system, the hand hygiene compliance rates among the members of the medical staff before (29.5% (3347/11,338) vs 57.9% (4690/8094), P < 0.001) and after (59.9% (9915/16,556) vs 73.8% (17,194/23 286), P < 0.001) the contact with patients and surrounding environment significantly improved. However, hand hygiene compliance among three cleaning staff did not significantly improve after the application. Moreover, there was no significant difference in healthcare-acquired infection rates (2.535% (9/355) vs 2.047% (7/342), P = 0.667) nor in the detection rates of the four major multidrug-resistant bacteria in the EICU before and after the application of the IoT management system (P > 0.05). CONCLUSION The IoT management system significantly improved hand hygiene compliance among medical staff, except cleaners, in the EICU of one provincial hospital; however, the rates of nosocomial infection did not significantly decrease. The quality of hand hygiene implementation needs to be improved.
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Affiliation(s)
- N Xu
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - C Liu
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Y Feng
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - F Li
- Department of Infection Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - X Meng
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - Q Lv
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China
| | - C Lan
- Emergency Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, PR China.
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15
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María LT, Alejandro GS, María Jesús PG. Central venous catheter insertion: Review of recent evidence. Best Pract Res Clin Anaesthesiol 2020; 35:135-140. [PMID: 33742573 DOI: 10.1016/j.bpa.2020.12.009] [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] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022]
Abstract
Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs). Since their implementation, quality programs such as "Zero bacteremia" have achieved a reduction in CR-BSI rates, but there is still room for further improvement. New evidence is emerging regarding, e.g., antiseptic-antimicrobial impregnated catheters or the use of passive disinfection of closed connectors. These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.
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Affiliation(s)
- Lema Tomé María
- Anesthesiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain; Member of the ESAIC Patient Safety and Quality Committee, Spain; Patient Safety Expert and Coordinator in Madrid for SENSAR (Spanish Anesthesia Incident Reporting System), Spain.
| | - Garrido Sánchez Alejandro
- Anesthesiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain; Medical Simulation Instructor at Hospital Virtual de Valdecilla (Santander) and Institute for Medical Simulation (Boston), Spain; Patient Safety Expert and Vice-president of SENSAR (Spanish Anesthesia Incident Reporting System), Spain
| | - Pérez-Granda María Jesús
- Anesthesiology Department, Hospital General Universitario Gregorio Marañón Madrid, Spain; Ciber de Enfermedades Respiratorias (CIBERES) CIBER (CB06/06/0058) Madrid, Spain; Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón Madrid, Spain
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16
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Wu YH, Chen CJ, Wu HY, Chen I, Chang YH, Yang PH, Wang TY, Chen LC, Liu KT, Yeh IJ, Wu DC, Hou MF, Liu HL, Su WH. Plastic wrap combined with alcohol wiping is an effective method of preventing bacterial colonization on mobile phones. Medicine (Baltimore) 2020; 99:e22910. [PMID: 33126347 PMCID: PMC7598847 DOI: 10.1097/md.0000000000022910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/14/2020] [Accepted: 09/25/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Using mobile phones for communication in emergency departments is a common practice; however, several studies have demonstrated that they may act as vectors for bacteria and viruses. This study evaluated the effectiveness of plastic wrapping in decreasing bacterial contamination on mobile phone surfaces. METHOD We used culture dishes and a luminometer to detect bacterial colonies and contamination on the phone surfaces. RESULT Our experiment showed that bacterial colonies exist on mobile phones before and after work. We found that wiping with 75% alcohol sanitizers effectively reduces the number of colonies on either a mobile phone or a temporary plastic covering. In addition, we found that bacterial colonies do not contaminate or adhere to plastic wrap any easier than to mobile phones. CONCLUSION These results demonstrated the effectiveness of plastic wrap for protecting mobile phone surfaces against bacterial colonization. In addition, applying a layer of plastic wrap protects the phone from potential damage due to the alcohol.
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Affiliation(s)
- Yen-Hung Wu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine
| | | | | | - I Chen
- Division of Financial Management
| | | | - Pei-Hsuan Yang
- Department of Nursing, Department of Renal Care, School of Nursing, Fooyin University
| | - Tzu-Yi Wang
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Li-Chin Chen
- Department of Nursing, Kaohsiung Medical University
| | - Kuan-Ting Liu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - I-Jeng Yeh
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
- Graduate Institute of Clinical Medicine, College of Medicine
| | - Deng-Chyang Wu
- Division of Gastroenterology, Department of Internal Medicine
- Cell Therapy and Research Center, Kaohsiung Medical University Hospital
- Regenerative Medicine and Cell Therapy Research Center
| | - Ming-Feng Hou
- Department of Superintendent office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Liang Liu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Wen-Hui Su
- Department of Superintendent office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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17
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Ma JJ. Blowing in the wind: Bacteria and fungi are spreading from public restroom hand dryers. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:52-60. [PMID: 32720586 DOI: 10.1080/19338244.2020.1799183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This study aimed to identify and quantify fungi and bacteria in the airflow of restroom hand dryers in public areas. Airflow from restroom hand dryers in 8 retail locations was tested using three types of culture media, followed by PCR and sequence analysis to identify microbial species. Both bacterial and fungal colonies were detected in all locations. The number of colonies did not vary significantly across different locations, suggesting a similar level of microbial spread by hand dryers between different types of commercial stores. Molecular analysis revealed 24 bacterial species and 40 fungal species. Of these species, 48% (31/64) have been reported to be implicated in various infections in humans, primarily those with underlying medical conditions. This study is the first to demonstrate the spread of fungi by the airflow of restroom hand dryers, and the first to show the prevalence of different fungal and bacterial species spread by restroom hand dryers in common public areas.
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Affiliation(s)
- Jessie J Ma
- College of Arts and Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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18
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Bizzoca ME, Campisi G, Lo Muzio L. Covid-19 Pandemic: What Changes for Dentists and Oral Medicine Experts? A Narrative Review and Novel Approaches to Infection Containment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3793. [PMID: 32471083 PMCID: PMC7312076 DOI: 10.3390/ijerph17113793] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 12/22/2022]
Abstract
The authors performed a narrative review on Severe Acute Respiratory Syndrome- CoronaVirus-2 ( SARS-CoV-2) and all infectious agents with the primary endpoints to illustrate the most accepted models of safety protocols in dentistry and oral medicine, and to propose an easy view of the problem and a comparison (pre- vs post-COVID19) for the most common dental procedures. The outcome is forecast to help dentists to individuate for a given procedure the differences in terms of safety protocols to avoid infectious contagion (by SARS-CoV-2 and others dangerous agents). An investigation was performed on the online databases Pubmed and Scopus using a combination of free words and Medical Subject Headings (MESH) terms: "dentist" OR "oral health" AND "COVID-19" OR "SARS-CoV-2" OR "coronavirus-19". After a brief excursus on all infectious agents transmittable at the dental chair, the authors described all the personal protective equipment (PPE) actually on the market and their indications, and on the basis of the literature, they compared (before and after COVID-19 onset) the correct safety procedures for each dental practice studied, underlining the danger of underestimating, in general, dental cross-infections. The authors have highlighted the importance of knowing exactly the risk of infections in the dental practice, and to modulate correctly the use of PPE, in order to invest adequate financial resources and to avoid exposing both the dental team and patients to preventable risks.
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Affiliation(s)
- Maria Eleonora Bizzoca
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy;
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90121 Palermo, Italy;
| | - Lorenzo Lo Muzio
- Department of Clinical and Experimental Medicine, University of Foggia, 71121 Foggia, Italy;
- C.I.N.B.O. (Consorzio Interuniversitario Nazionale per la Bio-Oncologia), 66100 Chieti, Italy
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19
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Saitoh A, Sato K, Magara Y, Osaki K, Narita K, Shioiri K, Fowler KE, Ratz D, Saint S. Improving Hand Hygiene Adherence in Healthcare Workers Before Patient Contact: A Multimodal Intervention in Four Tertiary Care Hospitals in Japan. J Hosp Med 2020; 15:262-267. [PMID: 32379022 DOI: 10.12788/jhm.3446] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/12/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hand hygiene is key to preventing healthcare-associated infection and the spread of respiratory viruses like the novel coronavirus that causes COVID-19. Unfortunately, hand hygiene adherence of healthcare workers (HCWs) in Japan is suboptimal according to previous studies. OBJECTIVES Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. DESIGN, SETTING, AND PARTICIPANTS We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). INTERVENTION The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. MAIN OUTCOMES AND MEASURES We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. RESULTS There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). CONCLUSIONS A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.
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Affiliation(s)
- Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata Japan
| | - Kiyomi Sato
- Department of Nursing, Niigata Saiseikai Daini Hospital, Niigata, Japan
| | - Yoko Magara
- Department of Nursing, Niigata Saiseikai Daini Hospital, Niigata, Japan
| | - Kakuei Osaki
- Department of Nursing, Niigata City General Hospital, Niigata, Japan
| | - Kiyoko Narita
- Department of Nursing, Naga-oka Red Cross Medical Center, Niigata, Japan
| | - Kumiko Shioiri
- Department of Nursing, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Karen E Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - David Ratz
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sanjay Saint
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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20
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STANDARD OF INFECTION PREVENTION IN THE GASTROENTEROLOGY SETTING. Gastroenterol Nurs 2020; 43:E84-E97. [PMID: 32251230 DOI: 10.1097/sga.0000000000000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Adams M, Bassler D. Practice variations and rates of late onset sepsis and necrotizing enterocolitis in very preterm born infants, a review. Transl Pediatr 2019; 8:212-226. [PMID: 31413955 PMCID: PMC6675686 DOI: 10.21037/tp.2019.07.02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/08/2019] [Indexed: 01/01/2023] Open
Abstract
The burden of late onset sepsis (LOS) and necrotizing enterocolitis (NEC) remains high for newborns in low- and high-income countries. Very preterm born infants born below 32 weeks gestation are at highest risk because their immune system is not yet adapted to ex-utero life, providing intensive care frequently compromises their skin or mucosa and they require a long duration of hospital stay. An epidemiological overview is difficult to provide because there is no mutually accepted definition available for either LOS or NEC. LOS incidence proportions are generally reported based on identified blood culture pathogens. However, discordance in minimum day of onset and whether coagulase negative staphylococci or fungi should be included into the reported proportions lead to variation in reported incidences. Complicating the comparison are the absence of biomarkers, ancillary lab tests or prediction models with sufficiently high positive and/or negative predictive values. The only high negative predictive values result from negative blood culture results with negative lab results allowing to discontinue antibiotic treatment. Similar difficulties exist in reporting and diagnosing NEC. Although most publications base their proportions on a modified version of Bell's stage 2 or 3, comparisons are made difficult by the multifactorial nature of the disease reflecting several pathways to intestinal necrosis, the absence of a reliable biomarker and the unclear differentiation from spontaneous intestinal perforations. Comparable reports in very low birthweight infants range between 5% and 30% for LOS and 1.6% to 7.1% for NEC. Evidence based guidelines to support treatment are missing. Treatment for LOS remains largely empirical and focused mainly on antibiotics. In the absence of a clear diagnosis, even unspecific early warning signals need to be met with antibiotic treatment. Cessation after negative blood culture is difficult unless the child was asymptomatic from the beginning. As a result, antibiotics are the most commonly prescribed medications, but unnecessary exposure may result in increased risk for mortality, NEC, further infections and childhood obesity or asthma. Finding ways to limit antibiotic use are thus important and have shown a large potential for improvement of care and limitation of cost. Over recent decades, none of the attempts to establish novel therapies have succeeded. LOS and NEC proportions remained mostly stable. During the past 10 years however, publications emerged reporting a reduction, sometimes by almost 50%. Most concern units participating in a surveillance system using quality improvement strategies to prevent LOS or NEC (e.g., hand hygiene, evidence based "bundles", feeding onset, providing own mother's milk). We conclude that these approaches display a potential for wider spread reduction of LOS and NEC and for a subsequently more successful development of novel therapies as these often address the same pathways as the prevention strategies.
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Affiliation(s)
- Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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22
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Meng M, Sorber M, Herzog A, Igel C, Kugler C. Technological innovations in infection control: A rapid review of the acceptance of behavior monitoring systems and their contribution to the improvement of hand hygiene. Am J Infect Control 2019; 47:439-447. [PMID: 30527285 DOI: 10.1016/j.ajic.2018.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hand hygiene is crucial for preventing nosocomial infections; however, adherence rates need further attention. Prevention of nosocomial infections through regular hand hygiene monitoring and feedback is recommended by the World Health Organization. Technology holds the potential for achieving this goal. The aim of this study was to assess the influence of technological behavior monitoring innovations on hand hygiene adherence and their acceptance by healthcare professionals. METHODS A rapid review of the literature was conducted. A literature search was performed in electronic databases (Cochrane Library, Scopus, PubMed, CINAHL, PsycINFO, PsycARTICLES, PSYNDEX) and via citation tracking in November 2017. Records were screened for eligibility. Included studies were analyzed and synthesized in a narrative, tabular way. RESULTS Overall, 2,426 studies were identified, and 12 were included. Findings indicated that behavior monitoring technology improves hand hygiene adherence, resulting in adherence increases between 6.40%-54.97%. The majority of systems provided real-time feedback. Factors influencing acceptance of technology by healthcare professionals include transparency and confidentiality, user attitude and environment, device function, and device usability. CONCLUSIONS Recognizing the importance of hand hygiene adherence, active communication between behavior monitoring technology and healthcare workers seems to mediate improvement in sustainable hand hygiene adherence behavior.
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Affiliation(s)
- Michael Meng
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Michaela Sorber
- Department of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Christoph Igel
- Educational Technology Lab, German Research Center for Artificial Intelligence, Berlin, Germany
| | - Christiane Kugler
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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23
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Chan APL, Chan TYK. Methanol as an Unlisted Ingredient in Supposedly Alcohol-Based Hand Rub Can Pose Serious Health Risk. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1440. [PMID: 29987197 PMCID: PMC6069146 DOI: 10.3390/ijerph15071440] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 12/03/2022]
Abstract
Alcohol-based hand rub (hand sanitizer) is heavily used in the community and the healthcare setting to maintain hand hygiene. Methanol must never be used in such a product because oral, pulmonary and/or skin exposures can result in severe systemic toxicity and even deaths. However, sporadic cases of acute poisoning indicate that alcohol-based hand rub with undeclared methanol may be found in the market from time to time. The unexpected presence of methanol poses a serious threat to public health. Unintentional ingestion by young children and inadvertent consumption by older subjects as alcohol (ethanol) substitute can occur. Methanol is more lethal and poisoning often requires antidotal therapy, in addition to supporting therapy and critical care. However, specific therapy may be delayed because the exposure to methanol is initially not suspected. When repeatedly used as a hand rub, skin absorption resulting in chronic toxicity (e.g., visual disturbances) occurs, particularly if methanol induced desquamation and dermatitis are present. Nationwide surveillance systems, regional/international toxicovigilance networks and situational awareness among the healthcare professionals should facilitate the early detection, management and prevention of such poisoning incidents of public health significance.
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Affiliation(s)
- Alan P L Chan
- Division of Clinical Pharmacology and Drug and Poisons Information Bureau, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Thomas Y K Chan
- Division of Clinical Pharmacology and Drug and Poisons Information Bureau, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
- Prince of Wales Hospital Poison Treatment Centre, Shatin, New Territories, Hong Kong, China.
- Asia Pacific Network of Clinical Toxicology Centres, Drug and Poisons Information Bureau, Hong Kong, China.
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24
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Dixon N, Morgan M, Equils O. Foam soap is not as effective as liquid soap in eliminating hand microbial flora. Am J Infect Control 2017; 45:813-814. [PMID: 28258814 DOI: 10.1016/j.ajic.2017.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
Foam soaps are aerosolized liquid soaps dispensed through a special pump mechanism. Currently there are no studies comparing liquid soap with foam soap in regard to efficacy of reducing hand microbial burden. In 3 separate experiments and with 2 different brands of foam soap, it was observed that nonantimicrobial foam soap was not as effective in reducing hand bacterial load as the liquid soap.
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Affiliation(s)
| | - Margie Morgan
- Department of Microbiology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Ozlem Equils
- Department of Pediatrics, Cedars-Sinai Medical Center/UCLA School of Medicine, Los Angeles, CA; Medical Division, Pfizer Inc, New York, NY; Miora Educational Foundation, Encino, CA.
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25
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Ramasethu J. Prevention and treatment of neonatal nosocomial infections. Matern Health Neonatol Perinatol 2017; 3:5. [PMID: 28228969 PMCID: PMC5307735 DOI: 10.1186/s40748-017-0043-3] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 01/27/2017] [Indexed: 12/02/2022] Open
Abstract
Nosocomial or hospital acquired infections threaten the survival and neurodevelopmental outcomes of infants admitted to the neonatal intensive care unit, and increase cost of care. Premature infants are particularly vulnerable since they often undergo invasive procedures and are dependent on central catheters to deliver nutrition and on ventilators for respiratory support. Prevention of nosocomial infection is a critical patient safety imperative, and invariably requires a multidisciplinary approach. There are no short cuts. Hand hygiene before and after patient contact is the most important measure, and yet, compliance with this simple measure can be unsatisfactory. Alcohol based hand sanitizer is effective against many microorganisms and is efficient, compared to plain or antiseptic containing soaps. The use of maternal breast milk is another inexpensive and simple measure to reduce infection rates. Efforts to replicate the anti-infectious properties of maternal breast milk by the use of probiotics, prebiotics, and synbiotics have met with variable success, and there are ongoing trials of lactoferrin, an iron binding whey protein present in large quantities in colostrum. Attempts to boost the immunoglobulin levels of preterm infants with exogenous immunoglobulins have not been shown to reduce nosocomial infections significantly. Over the last decade, improvements in the incidence of catheter-related infections have been achieved, with meticulous attention to every detail from insertion to maintenance, with some centers reporting zero rates for such infections. Other nosocomial infections like ventilator acquired pneumonia and staphylococcus aureus infection remain problematic, and outbreaks with multidrug resistant organisms continue to have disastrous consequences. Management of infections is based on the profile of microorganisms in the neonatal unit and community and targeted therapy is required to control the disease without leading to the development of more resistant strains.
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Affiliation(s)
- Jayashree Ramasethu
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, MedStar Georgetown University Hospital, Washington DC, 20007 USA
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