Hand hygiene: simple and complex

Hand contamination and hand hygiene knowledge and practices among commercial transport users after the SARS-CoV-2 virus (COVID-19) scare, Enugu State, Nigeria

Contaminated hands are one of the most common modes of microorganism transmission that are responsible for many associated infections in healthcare, food industries, and public places such as transportation parks. Public health approaches during COVID-19 pandemic have shown that hand hygiene practices and associated knowledge are critical measure to control the spread of infectious agent. Hence, assessment of commercial transport users' knowledge, belief and practices on hand hygiene, and potential contamination with infectious agents which is the aim of the study, aligns with general health concern of quantifying contamination risk levels to predict disease outbreaks. This study utilized a randomized sampling approach to select 10 frequently used commercial parks within two districts in the State: Enugu and Nsukka. The parameters analysed include a cross-sectional questionnaire survey, hand swab and hand washed samples collected from dominant hand of participants. A total of 600 participants responded to the questionnaire survey, while 100 participants' hand swabs were examined for microbial contamination. This study recorded a high prevalence of fungal (90.0%) and bacterial (87.0%) species; 20 species of fungus were identified with prevalence range of 1% to 14%; 21 bacterial species were isolated with prevalence range of 1% to 16%. These species were identified as either opportunistic, non-invasive, or pathogenic, which may constitute a health concern amongst immunocompromised individuals within the population. Aspergillus spp. (14%), was the most common fungal species that was exclusively found amongst Nsukka commercial users, while E. coli was the most prevalent isolated bacterial species amongst Nsukka (12%) and Enugu (20%) commercial park users. Prevalence of fungal contamination in Nsukka (94.0%; 47/50) and Enugu (86.0%; 43/50) were both high. Prevalence of bacterial contamination was higher in Enugu than Nsukka but not significantly (47[94.0%] vs. 40[80.0%], p = 0.583). A greater number of participants (99.3%) were aware of the importance of hand hygiene, however with low compliance rate aside "after using the toilet" (80%) and "before eating" (90%), other relevant hand washing and sanitizing practices were considered less important. With these observations, we can emphatically say that despite the COVID-19 scare, commercial park users within the sampled population do not efficiently practice quality hand wash and hygiene measures, hence, risking the widespread of infectious agents in situation of disease outbreak or among immunocompromised individuals.

Development and Implementation of an Ultraviolet-Dye-Based Qualification Procedure for Hand Washing and Disinfection to Improve Quality Assurance of Pharmacy Preparations and Compounding, Especially in Cleanrooms: A Pilot Study

Even though, nowadays, most medicines are manufactured industrially, patients may have medical needs that can only be met by a tailor-made approach. This requires the availability of pharmacy preparations made under Good Manufacturing Practice (GMP) conditions. An efficient hand hygiene practice is essential herewith, especially if sterile products that are prepared in a cleanroom are concerned. The effectiveness of hand washing and hand disinfection procedures greatly relies on adequate training. We carried out an observational cross-sectional pilot study aimed at optimizing hand hygiene training with objective and measurable quality assessments using an ultraviolet (UV) dye. Practical acceptance criteria for qualifying personnel through this method were set and evaluated. In total, 25 GMP-qualified cleanroom operators washed and disinfected their hands with UV dye hand wash lotion and UV dye hand alcohol, respectively. To obtain a proof-of-concept, the results were judged based on adherence to the WHO six-step protocol and associated acceptance criteria. Commonly missed areas were brought to light, and the influence of procedure duration was investigated. UV-dye-based assessments appeared to be more valuable in hand disinfection than in hand washing. In both procedures, the back of the hands and the thumbs were frequently missed. This underpins the need for enhanced and repeated education on hand washing and disinfection. Additionally, a dry skin gave rise to extra cleaning challenges. From this pharmacy practice pilot study with a focus on pharmaceutical product care, it may be concluded that the application of UV-dye-based assessments offers valuable insights for pharmacists to optimize hand hygiene, thereby increasing the safety of tailor-made medicines and on-site preparations.

Factors affecting hand hygiene practice during the COVID-19 pandemic in the Zimbabwean population: a qualitative study

BACKGROUND

Practicing hand hygiene is recommended as one of the key preventive measures for reducing the transmission of COVID-19 and other infectious agents. However, it is often not practiced frequently enough or correctly by the public. We aimed to identify barriers to and facilitators of hand hygiene in the Zimbabwean population during the COVID-19 pandemic.

METHODS

A qualitative study was conducted with a purposive sample of health workers, village health workers, church leaders, traditional healers, teachers, youth leaders and the general population selected from ten districts across the country from September to October 2022. Semistructured interviews were conducted with 3 key informant interviews per site. In addition, one homogenous focus group discussion was also conducted per site using a focus group discussion guide. The data were recorded on audiotapes, transcribed verbatim, and translated into English. All the analyses were performed manually using thematic analysis.

RESULTS

Two themes were identified as facilitators of hand hygiene. These include individual factors (knowledge of hand hygiene practices and how they are performed) and access-related factors (access to hand washing infrastructure, soap, and sanitizers). Among the barriers to hand hygiene, four themes were identified: individual factors (knowledge gaps in proper hand washing, lack of conviction about hand hygiene, and habitual behaviour), access-related factors (lack of access to hand washing infrastructure, soap, and sanitizers), safety concerns (concern about the side effects of sanitizers), and sociocultural and religious factors (social customs, cultural beliefs, values, and religious practices).

CONCLUSION

During public health emergencies, there is a need for people to access uninterrupted, on-premises water supplies to promote compliance with hand hygiene. The provision of clean water and hand washing facilities is critical for vulnerable communities to afford them the opportunity to improve quality of life and facilitate resilience in the event of future pandemics. Community engagement is important for identifying vulnerability factors to provide appropriate mitigatory measures.

Animal Handling Practice Among Rural Households in Northwest Ethiopia Increases the Risk of Childhood Diarrhea and Exposure to Pathogens From Animal Sources

Background

In Ethiopia, domestic animals and their feces are not properly contained. However, the risk of exposure to zoonotic pathogens is not well documented. This study was conducted to assess animal handling practices and the risk of childhood diarrhea among rural households in northwest Ethiopia.

Methods

This study was done among 403 randomly selected households. Information on animal handling was collected using a questionnaire and spot-check observation. The occurrence of childhood diarrhea in 14 days prior to the survey was assessed based on the reports of female head of households. Multivariable binary logistic regression analysis was performed to identify the association between animal handling practices and childhood diarrhea.

Results

All the female head of households had contact with animal feces when preparing fuel disks and plastering the house components with animal dung. Domestic animals shared a corral within the living space of the humans in 20% of the households. Animals entered the human living quarters and accessed foods in 32% of the households. Moreover, 24% of the children aged 24 to 59 months had diarrhea in a 2-week period prior to the survey. Childhood diarrhea was associated with domestic animals sharing the same house as humans (AOR: 3.3, 95% CI: 1.3, 8.6), presence of animal excreta in child playing areas (AOR: 2.4, 95% CI: 1.2, 4.6), contact of domestic animals with stored foods (AOR: 3.5, 95% CI: 2.0, 5.9), trapped dirt under fingernails of female heads (AOR: 3.7, 95% CI: 1.9, 7.5), open defecation (AOR: 3.24, 95% CI: 1.8, 5.9), and unprotected sources (AOR: 4.2, 95% CI: 1.1, 15.3).

Conclusion

Domestic animals and their excreta are not hygienically contained in the area. Animal handling practices including their excreta and the hygiene behavior of female head of households (eg, handwashing and food handling practices) should be improved to prevent childhood diarrhea.

Hand Hygiene Knowledge and Practices Among Visitors to the Holy Masjid (Masjid Al-Haram) During the Month of Ramadan in 2023

Introduction Visits to the Holy Masjid are considered mass gatherings (MGs), defined as concentrations of people at a specific location for a certain objective over a predetermined amount of time. Such gatherings might strain the host nation's preparation and reaction capabilities, increasing the chances of spreading infectious diseases. Aim To evaluate the comprehension of hand hygiene (HH) and proper HH habits among visitors to the Holy Masjid during the month of Ramadan in 2023. Methods A total of 690 visitors to the Holy Masjid were interviewed for this cross-sectional study. The questionnaire was developed using model questions from another published survey. Results Of the participants, 541 (78.4%), predominantly female, had generally good knowledge about HH. A total of 282 (40.9%) participants used nothing to clean their hands after shaking hands with someone. Four hundred and eighty (69.6%) participants were aware that poor HH does not spread HIV/AIDS, and 504 (73%) stated that consistent HH does not reduce the body's natural immunity. A total of 530 (76.8%) participants with good knowledge about HH cleaned their hands before meals, compared to 131 (19%) participants with poor knowledge of HH. Conclusion Based on the results of our study, the participants' awareness of HH was generally high, with most recognizing the role of good HH in preventing common infectious diseases, such as gastrointestinal and respiratory infections. However, certain aspects of HH, such as the necessity and proper use of alcohol-based hand sanitizers, were not well understood. Regular, focused awareness-raising initiatives are recommended to enhance HH knowledge and practices among visitors to the Holy Masjid.

To Analyze and Evaluate the Rate of Compliance of Hand Hygiene Practices in a Tertiary Care Hospital: Initiation of Quality Improvement Program and Clinical Audit

INTRODUCTION

Health care as a service organization is associated with hospital-acquired infection which is drawing attention. There are concerns raised by patients, attenders, stake holders, insurers, government agencies, and regulatory bodies. The study aims to evaluate the awareness and the rate of compliance with hand hygiene.

METHODS

The audit methodology implemented is a concurrent medical record audit. The period of the audit was conducted for 6 months. A random sampling method was incorporated. The sample size was determined as 20% of the staff had been involved.

RESULTS

The Total average level of awareness of hand hygiene and adherence to policy is 93.6%. The average of all the 3 categories of compliance at 5 levels of hand hygiene in percentage is 82.3%.

DISCUSSION

Hand hygiene practices if stringently implemented will minimize the cross-transmission of infection in health care facilities. By knowing the awareness level and compliance level are measured with standardized training modules.

APPLICATIONS

Create awareness on hand hygiene and provide training with respect to the effectiveness of implementation. Incorporate hand hygiene steps as well as in the audit process.

CONCLUSIONS

There is a requirement for training with respect to the effectiveness of the implementation of the techniques. The level of care and quality of services can be made better by incorporating quality improvement programs (QIPs). By regular audits, we can raise the service quality and benchmark it.

Prevalence and determinants of hand hygiene behavior among Indian population: a systematic review and meta-analysis

Despite a global call to action, many deaths occur yearly in developing nations from contagious diseases due to poor sanitation and hygiene. Although hand hygiene (HH) behavior was critical in preventing the COVID-19 pandemic, the sustainability of such practices is still questionable. Therefore, the current systematic review and meta-analysis investigated the prevalence and determinants of HH behavior among the Indian population (PROSPERO registration ID: CRD42022344961). Systematic searches on electronic databases, including ScienceDirect, Scopus, Web of Science, JSTOR, PubMed, and Google Scholar, targeted qualitative and quantitative studies that report HH behaviors in India. Pooled effect sizes were calculated with the inverse-variance method using random-effects models, acknowledging the study heterogeneity. Out of 1053 studies, 15 studies that met eligibility criteria were included in the qualitative synthesis. Among them, five studies were included in the meta-analyses. The overall prevalence of HH before food was 55% (95% CI = 31-78), and after the toilet was 84% (95% CI = 65-96). Subgroup analysis showed that before-food HH prevalence pre- and post-COVID-19 was 61% and 36%, respectively, whereas after-toilet HH prevalence was 91% and 74%, respectively. Meta-regression revealed statistically non-significant results for COVID-19 status. While it could not adequately explain the heterogeneity of the 'before-food prevalence' studies (Adj. R2 = - 34.80%), it did account for more than 19% in 'after-toilet prevalence' (Adj. R2 = 19.72%). This systematic review highlights various demographic, psychosocial, and environmental determinants of HH behavior. The results offer the potential for a deeper comprehension of the key factors influencing HH in India and could find implications for developing viable interventions. This aids in planning efficient promotional campaigns to enhance personal hygiene and control infectious diseases in the nation.

Development of transmission-reducing behaviour adherence measure (TRAM) for monitoring and predicting transmission-reducing behaviours during the pandemic

There is a need for a measure to monitor adherence to transmission-reducing behaviours (TRBs) during pandemics. An adherence measure can monitor current TRBs, assess change over time and, potentially, predict later behaviours. The TRB adherence measure (scale consisting of seven items) includes questions based on government behavioural directives in Scotland that were common internationally, i.e., physical distancing, face covering and hand hygiene. Data were collected weekly for 6 weeks at the beginning of the pandemic, including a later follow-up repeated measure of some participants, in 20-minute structured telephone surveys with a nationally representative random sample of adults in Scotland. A total of 2969 people completed the adherence items and were highly adherent. Confirmatory factor analysis supported a unidimensional scale (CFI = .95; TLI = .93; RMSEA = .08; SRMR = .08), although internal consistency was low (Cronbach's alpha = .49). The adherence score significantly predicted adherence to a validity test item (ΔR2 = .114, F(1,2964) = 379.76, p < .001). It also predicted adherence to TRBs later over and above personal habitual styles (Creature of Habit Scale: COHS). The adherence score has been developed for routine monitoring of adherence to TRBs during the COVID-19 pandemic. It can be used to predict future similar behaviours and adherence to other behaviours, although it may be necessary to explore adherence to the specific behaviours occasionally. Adherent behaviour for one TRB is likely to be associated with adherence to government directives to other TRBs. Importantly, these TRBs are likely to be crucial in reducing COVID-19 case numbers, as well as protecting against other infectious diseases including influenza and the common cold.

Development of a novel hand cleansing product for low-income contexts: The case of tab soap

Handwashing with soap is a widely advocated public health measure, but seldom practiced, partly because it is often difficult (especially outside of rich Western country contexts) to make both soap and water readily available in relevant situations. This study used both Behaviour Centred Design and Human Centred Design to guide development of a novel hand cleansing technology appropriate for the context of post-toilet hand cleansing in resource-poor societies. Extensive prototyping and field testing resulted in the pilot production of 'tab' soap, a small but durable single-use, decomposable substrate embedded with soap. It can be produced in dispenser roll or tear-off formats. With this affordable solution, one may use soap without worrying about contamination pretty much anytime and anywhere. A small-scale field test showed that all poor households in rural and peri-urban areas in Tanzania included in the proof-of-concept study (N = 12 households) would use the product reliably over the medium term. Tab soap awaits full-scale production and marketing but could make hand cleansing a more popular practice around the world.

Real-time hand rubbing quality estimation using deep learning enhanced by separation index and feature-based confidence metric

Hand hygiene plays a crucial role in healthcare environments which can cease infections and diseases from spreading. It is also regarded as the second most effective way to control the transmission of COVID-19. The World Health Organization (WHO) recommends a 12-step guideline for alcohol-based hand rubbing. Compliance with this guideline is vital in order to clean the hands thoroughly. Hence, an automated system can help to improve the quality of this procedure. In this study, a large-scale and diverse dataset for both real and fake hand rubbing motions is collected as the first stage of building a reliable hand hygiene system. In the next stage, various pre-trained networks were analyzed and compared using a swift version of the Separation Index (SI) method. The proposed Swift SI method facilitates choosing the best pre-trained network without fine-tuning them on the whole dataset. Accordingly, the Inception-ResNet architecture achieved the highest SI among Inception, ResNet, Xception, and MobileNet networks. Fine-tuning the Inception-ResNet model led to an accuracy of 98% on the test dataset, which is the highest score in the literature. Therefore, from the proposed approach, a lightweight version of this model with fewer layers but almost the same accuracy is produced and examined. In the final stage, a novel metric, called Feature-Based Confidence (FBC), is devised for estimating the confidence of models in prediction. The proposed confidence measure is able to profoundly differentiate models with similar accuracy and determine the superior one. Based on the metrics results, the Inception-ResNet model is about 2x slower but 5% more confident than its lightweight version. Putting all together, by addressing the real-time application concerns, a Deep Learning based method is offered to qualify the hand rubbing process. The model is also employed in a commercial machine, called DeepHARTS, to estimate the quality of the hand rubbing procedure in different organizations and healthcare environments.

Hand hygiene practice and associated factors among rural communities in northwest Ethiopia

This community-based cross-sectional study was conducted among 1190 randomly selected rural households in northwest Ethiopia to assess hand hygiene practice and associated factors. Frequent handwashing with rubbing agents, drying mechanisms; and condition of fingernails were used to assess hand hygiene practice. Multivariable binary logistic regression analysis was used to identify factors associated with hand hygiene and statistically significant association was declared on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-values < 0.05. Results showed that 28.8% (95% CI 26.2, 31.4%) of the households had good hand hygiene practice. Good hand hygiene practice was significantly associated with formal education attended household heads (AOR 1.79, 95% CI 1.33, 2.40), family discussion on sanitation (AOR 1.56, 95% CI 1.08, 2.26), provision of health education (AOR 2.23, 95% CI 1.62, 3.06), and availability of water (AOR 3.51, 95% CI 1.02, 12.05). In conclusion, about one-third of the rural households had good hand hygiene practice and more than two-third had poor hand hygiene practice in the study area, and this may imply that hands in the area may play roles in spreading infections in the community. Therefore, people need to be informed to always keep their hand hygiene good.

Not in their hands only: hospital hygiene, evidence and collective moral responsibility

Hospital acquired infections (HAIs) are a major threat to patient safety. This paper addresses the following question: given what is known about the causes of and possible interventions on HAIs, to whom or what should the moral responsibility for preventing these infections be attributed? First, we show how generating robust evidence on the effectiveness of preventive hygiene measures is a complex endeavour and review the existing evidence on the causes of HAIs. Second, we demonstrate that the existing literature on the ethical aspects of infection control has focused on responsibility at the individual-level. Thirdly, we argue that these accounts do not accommodate systemic factors relevant for HAI prevention. We show that the notion of collective responsibility is useful for making understandable how systemic factors, such as employment conditions in hospitals, are both causally and ethically relevant in infection control.

Carriage of Antibiotic Resistant Bacteria and Associated Factors Among Food Handlers in Tamale Metropolis, Ghana: Implications for Food Safety

Background

Bacteria pathogens constitute a significant proportion of diarrhoea-causing food contaminants. Transmission of antibiotic resistant foodborne pathogens to humans is a major threat to food safety, especially in developing countries where quality hygiene and sanitation facilities are lacking. Factors related to antibiotic use, sanitation and hand hygiene have been associated with the spread of infectious diseases as well as antibiotic resistant bacteria. Proper food handling ensures that food is not contaminated with potential pathogenic bacteria. This study assessed the carriage of antibiotic resistant bacteria and associated factors.

Methods

A cross-sectional study was conducted among food handlers who sell ready to eat food in the Tamale metropolis of the Northern Region of Ghana. Food vending stations with huge customer base were randomly selected and the food handlers recruited using written informed consent. Structured questionnaires were used to collect participants sociodemographic details and information on sanitation, hand hygiene practice and antibiotic use. Sterile cotton swabs soaked in phosphate buffered saline was used to swab the palms of participating food handlers for bacteria isolation. All identified bacteria were tested for susceptibility to 12 antibiotics.

Results

In all, 406 food handlers participated in this study, the mean (SD) age was 26.5 (2.64) years. Bacteria isolated were predominantly Staphylococci 60 (14.8%) and Escherichia coli 54 (13.3%). All the isolates were resistant to at least one antibiotic tested. The isolates showed high resistance to broad-spectrum antibiotics such as ampicillin (40.0%-75.0%), tetracycline (40.0%-80.0%), amoxiclav (20.0%-80.0%) and chloramphenicol (7.7%-50.0%). Logistic regression model revealed that the carriage of antibiotic resistant bacteria by food handlers was significantly associated with age, educational level, years on the job, training in food preparation, hygiene practice, water source, type of toilet facility used and antibiotic use.

Conclusion

Street food handlers could be potential sources of food-borne transmission of antibiotic resistant bacteria.

Reducing Carbapenem-Resistant Enterobacteriaceae Using the Targeted Solution Tool: A Quality Improvement Project

BACKGROUND

Carbapenem-resistant Enterobacteriaceae (CRE) is a worldwide urgent health problem. Hand hygiene (HH) is an effective intervention to reduce the spread of CRE.

LOCAL PROBLEM

In 2017, an increase in the rate of health care-associated (HA) CRE colonization was observed in a large multiorgan transplant center in Italy. This study aimed to reduce the HA-CRE colonization rates by improving HH compliance.

METHODS

A pre-/post-intervention project was conducted from November 2017 through December 2020.

INTERVENTIONS

The DMAIC (Define, Measure, Analyze, Improve, and Control) framework was used to implement the HH Targeted Solution Tool (TST).

RESULTS

Hand hygiene compliance increased from 49% to 76.9% after the Improve phase ( P = .0001), and to 81.9% after the second Control phase ( P = .0001). The rate of HA-CRE decreased from 24.9% to 5.6% ( P = .0001).

CONCLUSIONS

Using the DMAIC framework to implement the TST can result in significant improvements in HH compliance and HA-CRE colonization rates.

Hand disinfectants and their activity against clinical isolates of Bordetella pertussis

OBJECTIVES

The aim of the study was to investigate possible emergence of resistance to disinfectants in Bordetella pertussis strains isolated from patients with whooping cough in the Czech Republic in 2014 and 2015.

METHODS

In an EN1500-based study, clean and dry fingertips of volunteers were always contaminated with one of the two clinical isolates of B. pertussis. Clinical isolates of B. pertussis were obtained from the National Reference Laboratory for Pertussis and Diphtheria, National Institute of Public Health (NIPH), Prague, Czech Republic. Dry and contaminated fingertips were immersed in 10 ml medium and then rubbed with the fingers for 1 minute. After that, the hands were treated with isopropanol 60% v/v or tested products, and then the fingertips were rubbed again into 10 ml of pure medium for 1 minute. The suspensions obtained were immediately diluted and plated on charcoal medium.

RESULTS

Ethanol-based product A and propanol-based product B showed bactericidal activity after 30 s of contact. The confidence interval limit for product A and B was 0.12 and 0.19, respectively. Quaternary ammonium compound-based product C was found to be ineffective after 30 s of contact. The confidence interval limit for product C was 0.62.

CONCLUSION

Products A and B were assessed as effective against clinical isolates of B. pertussis in accordance with EN 1500. Quaternary ammonium compound-based product C did not comply with the requirements of EN 1500.

Occupational health hazards among healthcare providers and ancillary staff in Ghana: a scoping review

OBJECTIVE

The strict implementation of occupational health and safety policy curbs exposure to occupational hazards. However, empirical evidence is lacking in the Ghanaian context. This review primarily aimed to explore exposure to occupational hazards among healthcare providers and ancillary staff in Ghana.

DESIGN

A scoping review was conducted based on Arksey and O'Malley's methodological framework and Levac et al's methodological enhancement.

DATA SOURCES

Searches were conducted of the PubMed, MEDLINE, CINAHL, Embase, PsycINFO and Scopus databases, as well as Google Scholar and websites of tertiary institutions in Ghana, for publications from 1 January 2010 to 30 November 2021.

ELIGIBILITY CRITERIA

Quantitative studies that were published in the English language and focused on occupational exposure to biological and/or non-biological hazards among healthcare professionals in Ghana were included.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers extracted the data based on the type of occupational exposure and descriptive characteristics of the studies. The data are presented in tables and graphs. A narrative summary of review findings was prepared based on the review research questions.

RESULTS

Our systematic search strategy retrieved 507 publications; however, only 43 met the inclusion criteria. A little over one-quarter were unpublished theses/dissertations. The included studies were related to biological, psychosocial, ergonomic and other non-biological hazards. 55.8% of the studies were related to exposure to biological hazards and related preventive measures. In general, health workers were reported to use and comply with control and preventive measures; however, knowledge of control and preventive measures was suboptimal.

CONCLUSION

Work is needed to address the issue of occupational health hazard exposure in Ghana's health system. More research is needed to understand the extent of these exposures and their effects on the health system.

The Association between Hand Disinfection Techniques and Their Barriers, as Well as the "Bare below the Elbows" Concept, among Healthcare Professionals-A Study Based on a Polish Population

Hand hygiene is the most effective way to prevent nosocomial infections. Nevertheless, the hands of healthcare professionals are still the primary route of transmission of pathogens responsible for such infections. The aim of this study was to evaluate hand disinfection techniques and investigate the risk factors that may explain the improper hand disinfection techniques among healthcare workers. We selected 7544 hospital workers directly involved in patient care. We recorded data based on the questionnaires, demographic data, and the preparation of hands for disinfection, including risk factors. Correct hand disinfection was verified by COUCOU BOX, with a UV camera. Proper hand disinfection was demonstrated among 4879 (64.7%) subjects, while 2665 (35.3%) subjects disinfected their hands incorrectly. In most places of work, nurses properly disinfected their hands more often than the physicians, particularly in general departments (62.1% vs. 69.2%; p = 0.0019). We observed that long nails and artificial/polished nails were more often observed in the group of nurses than in the group of physicians (7.3% vs. 4.7%, respectively; p = 0.0006 and 19.3% vs. 10.1%; p = 0.0000), while an inverse relationship was found in relation to watches (24.0% vs. 12.0%; p = 0.0000) and long sleeves (24.4% vs. 8.1%; p = 0.0000). Incorrect and less effective hand hygiene among some groups of hospital workers is still present. Therefore, the continuation of education actions concerned with hand hygiene among healthcare workers is needed.

Rapid-killing efficacy substantiates the antiseptic property of the synergistic combination of carvacrol and nerol against nosocomial pathogens

Globally, new classes of synthetic and natural antibiotics and antivirulents have continuously been validated for their potential broad-spectrum antagonistic activity with the aim of identifying an effective active molecule to prevent the spread of infectious agents in both food industry and medical field. In view of this, present study is aimed at evaluating the rapid killing efficacy of bioactive molecules Carvacrol (C) and Nerol (N) through British Standard European Norm 1276: phase2/step1 (EN1276) protocol. Active molecules C and N showed broad-spectrum antimicrobial activity against the test strains Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli and Enterococcus hirae at concentration range of 78.125, 625, 156.25 and 312.5 μg/mL, respectively, for C, and 625 μg/mL for N. Whereas, combinatorial approach showed efficient activity with four times reduced concentration of C and N at 78.125 and 156.25 µg/mL, respectively, against test strains. Further, EN1276 results proved the rapid killing efficacy of test strains in 1 min of contact time with significant (> 5 log) growth reduction at 100X concentration of actives. SEM analysis and reduced concentration of protease, lipids and carbohydrate contents of treated group biofilm components ascertained preformed biofilm disruption potential of C + N on polystyrene and nail surfaces. C + N at synergistic concentration exhibited no adverse effect on HaCaT cells at 78.125 µg/mL (C) + 156.25 µg/mL (N). Taken together, based on the observed experimental results, present study evidence the antiseptic/disinfectant ability of C + N and suggest that the combination can preferentially be used in foam-based hand wash formulations.

Capability, Opportunity, Motivation, and Hand Hygiene Behavior in Healthcare Workers: A Structural Equation Modeling

Background

Hand hygiene among healthcare workers is the leading measure to reduce healthcare-associated infections. However, hand hygiene behavior is complex and not readily understood. This study aimed to identify the determinants and the underlying mechanism of hand hygiene behavior based on the capability, opportunity, motivation-behavior model.

Methods

A self-constructed questionnaire survey was conducted among healthcare workers in Chongqing, China. Capability, opportunity, and motivation were designed as independent variables, and hand hygiene behavior was measured as a dependent variable. Internal consistency reliability analysis and confirmatory factor analysis were applied to examine the reliability and validity of the questionnaire. Structural equation modeling was performed to explore the relationships among capability, opportunity, motivation, and hand hygiene behavior.

Results

Four hundred and ninety-nine physicians and nurses were investigated. The Cronbach’s α coefficients were above 0.764. Confirmatory factor analysis was confirmed with good data fitness. The structural equation modeling had a good fit (root mean square error of approximation=0.070, comparative fit index=0.960, Tucker–Lewis index=0.956). Both opportunity (β=0.265, p<0.05) and motivation (β=0.333, p<0.05) directly affected hand hygiene behavior. Both capability (β=0.194, p<0.001) and opportunity (β=0.719, p<0.001) were indirectly linked to hand hygiene behavior through motivation.

Conclusion

To improve hand hygiene behavior, more efforts need to be focused on resource provision and motivation enhancement in the future compared to training.

Level of Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Eka Kotebe General Hospital, Addis Ababa, Ethiopia

BACKGROUND

Poor hand hygiene is an important source of infection, but maintaining hand hygiene is the most important measure to prevent infections. Hand hygiene compliance and its associated factors are not well recognized in Ethiopia. Therefore, this study was intended to determine hand hygiene compliance and its associated factors among health care workers in Eka Kotebe General Hospital.

METHODS

A cross-sectional study was conducted among health care workers at Eka Kotebe General Hospital. A self-administered questionnaire supplemented by a World Health Organization Hand Hygiene Technical Reference Manual was used to collect data. Data was entered using Epi Info 7.2.0.1 and exported to SPSS 23 for analysis. The data were analyzed using descriptive and inferential statistics. Statistical significance was determined using a P-value of ⩽.05 with a 95% confidence interval.

RESULTS

Hand hygiene compliance among healthcare workers was 22.2%. Hand hygiene training (AOR = 2.9, 95% CI: 1.13-7.52), presence of hand hygiene indication poster (AOR = 3.38, 95% CI: 1.18-9.66), hand hygiene promotion by IPC team (AOR = 4.2, 95% CI: 2.53-8.58)), working experience ⩾5 years of a health care providers (AOR = 3.96, 95% CI: 1.12-13.9), being midwife (AOR = 17.1, 95% CI: 2.8-10), being nurse (AOR = 5.3, 95% CI: 2.09-7.8) by profession, and presence of water (AOR = 2.50, 95% CI: 2.20-11.78) were significantly associated factors to hand hygiene compliance.

CONCLUSION

The level of hand hygiene compliance among health care providers was found to be low. Training about hand hygiene, the presence of hand hygiene indication posters, hand hygiene promotion by the IPC team, working experience of health care providers, being a nurse and midwife, and the presence of water were independent predictors of hand hygiene compliance. Health care workers need to be given training on hand hygiene as well as hand hygiene facilities shall be installed and supplied by the hospital in a sustained manner.

Identifying gaps in hand hygiene practice to support tailored target audience messaging in Soweto: A cross-sectional community survey

Effective risk communication is essential for outbreak mitigation, as recently highlighted during the coronavirus disease 2019 (COVID-19) pandemic. Hand hygiene is one of the proposed public health interventions to protect against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) acquisition and transmission along with social distancing, improved ventilation, environmental cleaning, and wearing of masks. Improving hand hygiene practices in the community requires an understanding of the socio-behavioural context. This cross-sectional community survey in Soweto identified gaps in hand hygiene, which can inform appropriate messaging at the community level. Only 42% of survey respondents practiced adequate hand hygiene. Tailored educational messaging should be targeted at young adults in particular, and the importance of soap for hand hygiene must be emphasised for all age groups. Risk communication should expand to focus on preventing multiple infectious diseases during and beyond the COVID-19 pandemic.

Determinants of hand-hygiene practices in India: reflections from the 76th round National Sample Survey, 2018

This paper studies the differences and determinants of handwashing practices in India and identifies sections of the population with poor handwashing practices who are relatively more vulnerable during the COVID-19 pandemic. We have used the data from the recent National Sample Survey (NSS, 76th round) for India (2018). Bivariate and logistic regression analyses have been performed to predict the determinants of handwashing practices across states and socio-economic groups. Levels of education of the household head, Usual Monthly Per Capita Expenditure (UMPCE) of the household, access to water (other than drinking water) resources and sanitation facilities, and the availability of water with soap in and around latrines are major socio-economic and demographic factors that impact handwashing practices. Higher access to principal sources of water for drinking and other purposes, access to bathrooms and latrines with soap, and the availability of water in or around latrines increase the likelihood of handwashing among the people. Universal handwashing across different sections of the population will be effective to prevent further infection. The available data help us to identify the vulnerable sections of the population which are towards the lower end of the handwashing compliance spectrum. The policymakers can outline specific planning and strategy implementation for them.

Hand Hygiene Compliance and Associated Factors among Healthcare Workers in Ethiopia: A Systematic Review and Meta-Analysis

Background

Promoting hand hygiene compliance should be a priority for health authorities and all healthcare facilities at all levels. Therefore, this systematic review and meta-analysis aimed to provide a pooled estimate of hand hygiene compliance and associated factors among healthcare professionals in Ethiopia.

Methods

PubMed, Science Direct, EMBASE, the Google search engine, and Google Scholar were used to retrieve studies that were eligible for the study. The searches included all studies published in English prior to July 2021. Using a structured data extraction format, two authors independently extracted the required data. STATA Version 16 software has been used for statistical analysis. To measure the heterogeneity of the studies, the Cochrane Q-test statistics and I2 test were used. Because of the significant heterogeneity, a random-effects model was used.

Results

The pooled hand hygiene compliance among healthcare workers in Ethiopia was 38% (95% CI: 0.16-0.59). According to the study's subgroup analysis, Addis Ababa City administration health workers had the highest hand hygiene compliance, at 73% (95% CI: 0.50-0.96), while SNNP regional state had the lowest, at 9% (95% CI: 0.05-0.13). Presence of hand hygiene promotion (OR: 2.14, 95% CI: 1.04-3.24), towel/tissue paper availability (OR: 3.97, 95% CI: 2.09-5.86), having a positive attitude toward hand hygiene (OR: 1.79, 95% CI: 1.28-2.30), having good knowledge about hand hygiene (OR: 3.45, 95% CI: 1.26-5.64), and being trained for hand hygiene (OR:4.97, 95% CI:1.81-8.14) were significantly associated with hand hygiene compliance.

Conclusion

In this analysis, hand hygiene compliance among healthcare workers in Ethiopia was less than half. Providing hand hygiene promotion, towel/tissue paper presence, having a positive attitude toward hand hygiene, having good knowledge about hand hygiene, and being trained for hand hygiene were important variables for the increment of hand hygiene compliance.

Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water

Waterborne diseases account for 1.5 million deaths a year globally, particularly affecting children in low-income households in subtropical areas. It is one of the most enduring and economically devastating biological hazards in our society today. The World Health Organization Health Emergency and Disaster Risk Management (health-EDRM) Framework highlights the importance of primary prevention against biological hazards across all levels of society. The framework encourages multi-sectoral coordination and lessons sharing for community risk resilience. A narrative review, conducted in March 2021, identified 88 English-language articles published between January 2000 and March 2021 examining water, sanitation, and hygiene primary prevention interventions against waterborne diseases in resource-poor settings. The literature identified eight main interventions implemented at personal, household and community levels. The strength of evidence, the enabling factors, barriers, co-benefits, and alternative measures were reviewed for each intervention. There is an array of evidence available across each intervention, with strong evidence supporting the effectiveness of water treatment and safe household water storage. Studies show that at personal and household levels, interventions are effective when applied together. Furthermore, water and waste management will have a compounding impact on vector-borne diseases. Mitigation against waterborne diseases require coordinated, multi-sectoral governance, such as building sanitation infrastructure and streamlined waste management. The review showed research gaps relating to evidence-based alternative interventions for resource-poor settings and showed discrepancies in definitions of various interventions amongst research institutions, creating challenges in the direct comparison of results across studies.

Lactic acid as a major contributor to hand surface infection barrier and its association with morbidity to infectious disease

Although the surface of the human hands contains high antimicrobial activity, studies investigating the precise components involved and the relationship between natural antimicrobial activity and morbidity in infectious diseases are limited. In this study, we developed a method to quantitatively measure the antimicrobial activity of hand surface components. Using a clinical survey, we validated the feasibility of our method and identified antimicrobial factors on the surface of the human hand. In a retrospective observational study, we compared the medical histories of the participants to assess infectious diseases. We found that the antimicrobial activity on the surface of the hands was significantly lower in the high morbidity group (N = 55) than in the low morbidity group (N = 54), indicating a positive association with the history of infection in individuals. A comprehensive analysis of the hand surface components indicated that organic acids, especially lactic acid and antimicrobial peptides, are highly correlated with antimicrobial activity. Moreover, the application of lactic acid using the amount present on the surface of the hand significantly improved the antimicrobial activity. These findings suggest that hand hygiene must be improved to enhance natural antimicrobial activity on the surface of the hands.

Soap, water, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): an ancient handwashing strategy for preventing dissemination of a novel virus

Public Health Agencies worldwide (World Health Organization, United States Centers for Disease Prevention & Control, Chinese Center for Disease Control and Prevention, European Centre for Disease Prevention and Control, etc.) are recommending hand washing with soap and water for preventing the dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. In this review, we have discussed the mechanisms of decontamination by soap and water (involving both removal and inactivation), described the contribution of the various components of formulated soaps to performance as cleansers and to pathogen inactivation, explained why adherence to recommended contact times is critical, evaluated the possible contribution of water temperature to inactivation, discussed the advantages of antimicrobial soaps vs. basic soaps, discussed the differences between use of soap and water vs. alcohol-based hand sanitizers for hand decontamination, and evaluated the limitations and advantages of different methods of drying hands following washing. While the paper emphasizes data applicable to SARS-CoV-2, the topics discussed are germane to most emerging and re-emerging enveloped and non-enveloped viruses and many other pathogen types.

Assessing Student Perceptions of a Norwegian University's COVID-19 Response Strategy: A Cross-Sectional Study

Aim: This study aims to investigate Norwegian students' perceptions toward a higher education institution (HEI)'s COVID-19 response strategy, differentiating between three behavioral techniques: informing (i. e., email updates about COVID-19), nudging (i.e., visual cues as reminders), and creating novel opportunities (i.e., provision of antibacterial dispensers). In addition, the study assesses to what extent these perceptions are influenced by COVID-19 related psychological factors: risk perception; attitudes toward infection prevention and control (IPC) behaviors; perceived behavior control; institutional trust.

Methods: A cross-sectional online survey was conducted among a student population. The survey was developed to evaluate the HEI's response strategy, and distinct perceptions of COVID-19 and related practices. Structural equation modeling (SEM) was applied to estimate the effect of the psychological factors on the attitude toward different behavioral techniques.

Results: Creating novel opportunities was perceived most positively from the students, secondly, informing the students through email updates about COVID-19, finally, reminders through visual cues. Institutional trust presented the largest positive effect on informing the students through email updates, while no effect was measured for reminders. Attitudes toward IPC behaviors showed the strongest effect on students' perceptions of new opportunities and reminders, whereas providing email updates about COVID-19 is less affected by pre-existing perceptions.

Conclusions: A host of factors such as institutional trust, and perceptions concerning IPC measures and risk severity, influence students' perceptions of different behavior change techniques. This type of knowledge can contribute to understanding how perceptions can impact acceptance and adoption of specific preventive measures within a pandemic response. An assessment as such may result in more ethical and relevant future efforts.

Targeted antiviral treatment using non-ionizing radiation therapy for SARS-CoV-2 and viral pandemics preparedness: Technique, methods and practical notes for clinical application

OBJECTIVE

Pandemic outbreaks necessitate effective responses to rapidly mitigate and control the spread of disease and eliminate the causative organism(s). While conventional chemical and biological solutions to these challenges are characteristically slow to develop and reach public availability; recent advances in device components operating at Super High Frequency (SHF) bands (3-30 GHz) of the electromagnetic spectrum enable novel approaches to such problems.

METHODS

Based on experimentally documented evidence, a clinically relevant in situ radiation procedure to reduce viral loads in patients is devised and presented. Adapted to the currently available medical device technology to cause viral membrane fracture, this procedure selectively inactivates virus particles by forced oscillations arising from Structure Resonant Energy Transfer (SRET) thereby reducing infectivity and disease progression.

RESULTS

Effective resonant frequencies for pleiomorphic Coronavirus SARS-CoV-2 is calculated to be in the 10-17 GHz range. Using the relation y = -3.308x + 42.9 with x and y representing log10 number of virus particles and the clinical throat swab Ct value respectively; in situ patient-specific exposure duration of ~15x minutes can be utilized to inactivate up to 100% of virus particles in the throat-lung lining, using an irradiation dose of 14.5 ± 1 W/m2; which is within the 200 W/m2 safety standard stipulated by the International Commission on Non-Ionizing Radiation Protection (ICNIRP).

CONCLUSIONS

The treatment is designed to make patients less contagious enhancing faster recoveries and enabling timely control of a spreading pandemic.

ADVANCES IN KNOWLEDGE

The article provides practically applicable parameters for effective clinical adaptation of this technique to the current pandemic at different levels of healthcare infrastructure and disease prevention besides enabling rapid future viral pandemics response.

Risk communication during COVID-19: A descriptive study on familiarity with, adherence to and trust in the WHO preventive measures

BACKGROUND

Risk communication is a key component of public health interventions during an outbreak. As the coronavirus pandemic unfolded in late 2019, the World Health Organization (WHO) was at the forefront in the development of risk communication strategies. The WHO introduced a range of activities with the purpose of enabling the public to avail verified and timely information on COVID-19 prevention behaviors. Given the various WHO activities to protect the public health during COVID-19, it is important to investigate the extent of familiarity and uptake of the WHO recommendations among the public during the first wave of the pandemic.

METHODS

To do this, we conducted a large-scale Pan-European survey covering around 7500 individuals that are representative of populations from seven European countries, collected online during April 2-April 15, 2020. We use descriptive statistics including proportions and correlations and graphical representations such as bar charts to analyze and display the data.

RESULTS

Our findings suggest that information from the WHO in the context of COVID-19 is well trusted and acted upon by the public. Overall familiarity and adherence were quite high in most countries. Adherence was higher for social distancing recommendations compared to hygiene measures. Familiarity and adherence were higher among older, female, and highly educated respondents. However, country level heterogeneities were observed in the level of trust in information from the WHO, with countries severely affected by the pandemic reporting lower levels of trust.

CONCLUSION

Our findings call for efforts from health authorities to get regular feedback from the public on their familiarity and compliance with recommendations for preventive measures at all stages of the pandemic, to further develop and adapt risk communication as the pandemic evolves.

Embedded System Prototype to Fight Covid-19 Pandemic Contamination with Less Cost

In the shadow of the coronavirus (Covid-19) pandemic, the sterilization has become a major necessity for humans to avoid exponential Infection. In order to avoid touching contaminated surfaces, we develop an embedded system prototype, which allows the bottle or any other medium to pour the sterilization product without touching it. The human hands are detected using two sensors HC-SR04 and LM35. To overcome the stability problem due to the problem of sensor noise and enhance the system performance a Kalman filter algorithm is implemented to ensure stable hands detection. The efficiency of the prototype mounted on an Arduino board is checked. After the completion of the prototype, a comprehensive cost analysis is conducted.

Occurrence and Antibiogram of Escherichia coli O157 : H7 in Raw Beef and Hygienic Practices in Abattoir and Retailer Shops in Ambo Town, Ethiopia

Foodborne infections are widespread and growing public health problems in the world. Shiga toxin-producing Escherichia coli O157 : H7 is one of the most significant foodborne pathogens. This study was conducted to assess the occurrence and antibiogram of E. coli O157 : H7 from raw beef as well as hygienic and sanitary practices of meat handling in abattoir and retailer shops. Systematic random sampling technique and census methods were used to collect samples from abattoir and retailer shops, respectively. All tryptone soya broth preenriched carcass samples were subcultured onto MacConkey agar. Then, the bacterium confirmed as Escherichia coli using biochemical tests was streaked onto Sorbitol-MacConkey agar and incubated at 37°C for 24 hrs. Escherichia coli O157 : H7 was confirmed by latex agglutination kit. In vitro antimicrobial susceptibility test of Escherichia coli O157 : H7 isolates was done against 13 antimicrobials. Hygiene and sanitation data were collected using a pretested structured questionnaire and observational checklist. Pearson Chi-square and Fisher's exact two-tailed tests were performed and differences were considered significant at P ≤ 0.05. Out of 197 meat samples, 23.4% (95% confidence interval (CI): 17.6-29.9%) and 9.1% (95% CI: 5.5-14.1%) were contaminated with Escherichia coli and Escherichia coli O157 : H7, respectively. There was a significant variation in the occurrence of Escherichia coli O157 : H7 between retailer shops (19.1%) and abattoir (7.2%) (P = 0.03). The study revealed that the municipal abattoir and retailer shops in Ambo town did not adhere to the required sanitation and hygienic standards. All Escherichia coli O157 : H7 isolates were susceptible to norfloxacin, sulfamethoxazole-trimethoprim, chloramphenicol, and ceftazidime. However, all isolates were resistant to amoxicillin. Multidrug resistance was widespread and was found in 66.3% of Escherichia coli O157 : H7 isolates. The occurrence of Escherichia coli O157 : H7 was high. Therefore, fulfilling national and international meat safety requirements, training and monitoring of meat handlers, and rational use of antimicrobials are recommended.

Protocol of the COVID-19 Health and Adherence Research in Scotland (CHARIS) study: understanding changes in adherence to transmission-reducing behaviours, mental and general health, in repeated cross-sectional representative survey of the Scottish population

INTRODUCTION

COVID-19 has unprecedented consequences on population health, with governments worldwide issuing stringent public health directives. In the absence of a vaccine, a key way to control the pandemic is through behavioural change: people adhering to transmission-reducing behaviours (TRBs), such as physical distancing, hand washing and wearing face covering. Non-adherence may be explained by theories of how people think about the illness (the common-sense model of self-regulation) and/or how they think about the TRBs (social cognition theory and protection motivation theory). In addition, outbreaks of infectious diseases and the measures employed to curb them are likely to have detrimental effects on people's mental and general health. Therefore, in representative repeated surveys, we will apply behavioural theories to model adherence to TRBs and the effects on mental and general health in the Scottish population from June to November 2020, following the initial outbreak of COVID-19.

METHODS AND ANALYSIS

Repeated 20 min structured telephone surveys will be conducted with nationally representative random samples of 500 adults in Scotland. The first 6 weeks the survey will be conducted weekly, thereafter fortnightly, for a total of 14 waves (total n=7000). Ipsos MORI will recruit participants through random digit dialling. The core survey will measure the primary outcomes of adherence to TRBs, mental and general health, and explanatory variables from the theories. Further questions will be added, enabling more detailed measurement of constructs in the core survey, additional themes and questions that align with the evolving pandemic.

ETHICS AND DISSEMINATION

Ethical approval for this study was granted by the Life Sciences and Medicine College Ethics Review Board (CERB) at the University of Aberdeen (CERB/2020/5/1942). Results will be made available to policy makers, funders, interested lay people and other researchers through weekly reports and three bimonthly bulletins placed on the CHARIS website and advertised through social media.

A Label-Free Optical Detection of Pathogens in Isopropanol as a First Step towards Real-Time Infection Prevention

The detection of pathogens is a major public health issue. Every year, thousands of people die because of nosocomial infections. It is therefore important to be able to detect possible outbreaks as early as possible, especially in the hospital environment. Various pathogen detection techniques have already been demonstrated. However, most of them require expensive and specific equipment, and/or complex protocols, which, most of the time, involve biochemical reaction and labelling steps. In this paper, a new method that combines microscopic imaging and machine learning is described. The main benefits of this approach are to be low-cost, label-free and easy to integrate in any suitable medical device, such as hand hygiene dispensers. The suitability of this pathogen detection method is validated using four bacteria, both in PBS (Phosphate Buffered Saline) and in isopropanol. In particular, we demonstrated an efficient pathogenic detection that is sensible to changes in the composition of a mixture of pathogens, even in alcohol-based solutions.

Prevalence, Characteristics, and Epidemiology of Microbial Hand Contamination Among Minnesota State Fair Attendees (2014)

Background: Many antimicrobial-resistant infections are community-acquired, yet community carriage of microorganisms by healthy individuals is poorly characterized. We assessed microorganism carriage on the hands of Minnesota State Fair attendees and explored associated factors.

Methods: Minnesota State Fair attendees (in 2014) from households with ≥2 members (≥1 member being <19 years old [a child]) were eligible to participate. Participants provided biological samples via a hand plating technique and completed a questionnaire on factors potentially related to microorganism carriage. Using presumptive taxonomic identifications and disk-diffusion-determined resistance phenotypes, hand-culture isolates were classified by microbial type; types were grouped into four broad categories based on inferred pathogenicity and consistency with the skin microbiota. Descriptive statistics, X² tests, and generalized linear mixed-effects models were used to explore associations between survey and culture data.

Results: We enrolled 206 participants from 82 households during 2 days; 50% of subjects were children. Overall, 99.5% (205/206) of hand samples yielded microorganisms. Most were non-pathogenic, whether skin microbiota (98.5% of participants) or non-skin microbiota (93.2% of participants). Only 2.4% (5/206) of samples yielded antibiotic-resistant bacteria. Children were more likely than adults to carry potentially pathogenic (OR = 3.63, 95% CI: 1.66–7.93) and presumably non-pathogenic (OR = 6.61, 95% CI: 1.67–26.15) non-skin microorganisms.

Conclusions: Large community gatherings can serve as efficient sites for estimating the prevalence of microorganism carriage. A small proportion of participants carried antimicrobial-resistant pathogens on their hands; most carried non-pathogenic microorganisms, and no exposures specific to the state fair were associated with microorganism carriage.

Association between socioeconomic status and influenza-like illness: A study from Western part of India

Objectives:

Health status is associated with socioeconomic status (SES) of the individuals. The aim of this study was to identify any link between the SES and influenza-like illness (ILI).

Materials and Methods:

This observational case-control study was done on 18–70 years old patients presented with ILI (cases) at tertiary care hospital of western India. Controls were selected from demographically matched elective surgery patients except the SES. SES was evaluated as per the Modified B G Prasad 2017 scale and participants were further classified in lower SES (per capita income <2000 INR) and non-lower SES groups.

Results:

810 cases and 830 controls were compared. Many cases were from lower SES, had poor hand hygiene, and were using soil, mud, ash (SMA) for hand cleaning as compared to the control. Among the cases significant numbers were from lower SES (543/810[67%], P < 0.02), many were alcoholics, smokers, had poor hand hygiene, were using SMA for hand cleaning, and had preexisting chronic obstructive pulmonary disease (COPD), while few were having diabetes in the lower SES group as compared to the non-lower SES group. ILI was more common among lower SES class in unadjusted analysis (odds ratio [OR] 1.58, 95% CI 0.89–2.76) and the results were significant even after the adjustment of covariates (OR 1.62, 95% CI, 0.94–2.85).

Conclusion:

Lower SES people were 2.8 times more prone to ILI as compared to the age- and sex-matched control in western part of India.

Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview

Healthcare-associated infections (HCAIs) are a major source of morbidity and mortality and are the second most prevalent cause of death. Furthermore, it has been reported that for every one-hundred patients admitted to hospital, seven patients in high-income economies and ten in emerging and low-income economies acquire at least one type of HCAI. Currently, almost all pathogenic microorganisms have developed antimicrobial resistance, and few new antimicrobials are being developed and brought to market. The literature search for this narrative review was performed by searching bibliographic databases (including Google Scholar and PubMed) using the search terms: "Strategies," "Prevention," and "Healthcare-Associated Infections," followed by snowballing references cited by critical articles. We found that although hand hygiene is a centuries-old concept, it is still the primary strategy used around the world to prevent HCAIs. It forms one of a bundle of approaches used to clean and maintain a safe hospital environment and to stop the transmission of contagious and infectious microorganisms, including multidrug-resistant microbes. Finally, antibiotic stewardship also has a crucial role in reducing the impact of HCAIs through conserving currently available antimicrobials.

Improving the impact of non-pharmaceutical interventions during COVID-19: examining the factors that influence engagement and the impact on individuals

BACKGROUND

During an evolving outbreak or pandemic, non-pharmaceutical interventions (NPIs) including physical distancing, isolation, and mask use may flatten the peak in communities. However, these strategies rely on community understanding and motivation to engage to ensure appropriate compliance and impact. To support current activities for COVID-19, the objectives of this narrative review was to identify the key determinants impacting on engagement.

METHODS

An integrative narrative literature review focused on NPIs. We aimed to identify published peer-reviewed articles that focused on the general community (excluding healthcare workers), NPIs (including school closure, quarantine, isolation, physical distancing and hygiene behaviours), and factors/characteristics (including social, physical, psychological, capacity, motivation, economic and demographic) that impact on engagement.

RESULTS

The results revealed that there are a range of demographic, social and psychological factors underpinning engagement with quarantine, school closures, and personal protective behaviours. Aside from the factors impacting on acceptance and compliance, there are several key community concerns about their use that need to be addressed including the potential for economic consequences.

CONCLUSION

It is important that we acknowledge that these strategies will have an impact on an individual and the community. By understanding the barriers, we can identify what strategies need to be adopted to motivate individuals and improve community compliance. Using a behavioural framework to plan interventions based on these key barriers, will also ensure countries implement appropriate and targeted responses.

Analysis of Gender-Dependent Personal Protective Behaviors in a National Sample: Polish Adolescents' COVID-19 Experience (PLACE-19) Study

During the coronavirus-19 disease (COVID-19) pandemic, the basic strategy that is recommended to reduce the spread of the disease is to practice proper hand hygiene and personal protective behaviors, but among adolescents, low adherence is common. The present study aimed to assess the gender-dependent hand hygiene and personal protective behaviors in a national sample of Polish adolescents. The Polish Adolescents’ COVID-19 Experience (PLACE-19) Study was conducted in a group of 2323 secondary school students (814 males, 1509 females). Schools were chosen based on the random quota sampling procedure. The participants were surveyed to assess their knowledge and beliefs associated with hand hygiene and personal protection, as well as their actual behaviors during the COVID-19 pandemic. The majority of respondents gave proper answers when asked about their knowledge. However, females displayed a higher level of knowledge (p < 0.05). Most of the respondents declared not leaving home, handwashing, using alcohol-based hand rub, avoiding contact with those who may be sick, and avoiding public places as their personal protective behaviors. They declared using face masks and gloves after the legal regulation requiring people to cover their nose and mouth in public places was enacted in Poland. Regarding the use of face masks and not touching the face, no gender-dependent differences were observed, while for all the other behaviors, females declared more adherence than males (p < 0.05). Females also declared a higher daily frequency of handwashing (p < 0.0001) and washing their hands always when necessary more often than males (68.2% vs. 54.1%; p < 0.0001). Males more often indicated various reasons for not handwashing, including that there is no need to do it, they do not feel like doing it, they have no time to do it, or they forget about it (p < 0.0001), while females pointed out side effects (e.g., skin problems) as the reason (p = 0.0278). Females more often declared handwashing in circumstances associated with socializing, being exposed to contact with other people and health (p < 0.05), and declared always including the recommended steps in their handwashing procedure (p < 0.05). The results showed that female secondary school students exhibited a higher level of knowledge on hand hygiene and personal protection, as well as better behaviors, compared to males. However, irrespective of gender, some false beliefs and improper behaviors were observed, which suggests that education is necessary, especially in the period of the COVID-19 pandemic.

Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews

BACKGROUND

Nudge interventions are those that seek to modify the social and physical environment to enhance capacity for subconscious behaviours that align with the intrinsic values of an individual, without actively restricting options. This study sought to describe the application and effects of nudge strategies on clinician implementation of health-related guidelines, policies and practices within studies included in relevant Cochrane systematic reviews.

METHODS

As there is varied terminology used to describe nudge, this study examined studies within relevant systematic reviews. A two-stage screening process was undertaken where, firstly, all systematic reviews published in the Cochrane Library between 2016 and 2018 were screened to identify reviews that included quantitative studies to improve implementation of guidelines among healthcare providers. Secondly, individual studies within relevant systematic reviews were included if they were (i) randomised controlled trials (RCTs), (ii) included a nudge strategy in at least one intervention arm, and (iii) explicitly aimed to improve clinician implementation behaviour. We categorised nudge strategies into priming, salience and affect, default, incentives, commitment and ego, and norms and messenger based on the Mindspace framework.

SYNTHESIS

The number and percentage of trials using each nudge strategy was calculated. Due to substantial heterogeneity, we did not undertake a meta-analysis. Instead, we calculated within-study point estimates and 95% confidence intervals, and used a vote-counting approach to explore effects.

RESULTS

Seven reviews including 42 trials reporting on 57 outcomes were included. The most common nudge strategy was priming (69%), then norms and messenger (40%). Of the 57 outcomes, 86% had an effect on clinician behaviour in the hypothesised direction, and 53% of those were statistically significant. For continuous outcomes, the median effect size was 0.39 (0.22, 0.45), while for dichotomous outcomes the median Odds Ratio was 1.62 (1.13, 2.76).

CONCLUSIONS

This review of 42 RCTs included in Cochrane systematic reviews found that the impact of nudge strategies on clinician behaviour was at least comparable to other interventions targeting implementation of evidence-based guidelines. While uncertainty remains, the review provides justification for ongoing investigation of the evaluation and application of nudge interventions to support provider behaviour change.

TRIAL REGISTRATION

This review was not prospectively registered.

Tailoring of the ongoing water, sanitation and hygiene interventions for prevention and control of COVID-19

Water, sanitation, and hygiene (WASH) interventions remain to be important in the prevention of further spread of coronavirus disease-2019 (COVID-19). Basic hygiene interventions such as handwashing with water and soap (HWWS) when applied consistently will deactivate and remove the virus particles from the hands. Realizing the efforts that have been made by countries world over in controlling the COVID-19, this letter seeks to discuss how the available WASH services can be used in the fight against further spread of COVID-19. The letter highlights the challenges being faced by the current WASH services in middle- and low-income countries and suggests measures that can be employed to strengthen the WASH services in this period of the COVID-19 pandemic.

Improvement of hand hygiene compliance in a private hospital using the Plan-Do-Check-Act (PDCA) method

Objective:

Improving the compliance to hand hygiene in healthcare providers is important to reduce healthcare-associated infections. This study aimed to compare the compliance rate before and after the improvement of compliance to hand hygiene.

Methods:

In this study 270 of the 348 medical staff working in a 61-bed private hospital was observed. The informed observation was performed by the infection control committee in the entire hospital using “Five Moments for Hand Hygiene” for a period of one year. After the first six months, an improvement study was conducted together with the hospital’s quality department using the plan-do-check-act cycle. The study was conducted in a private hospital in Istanbul/Turkey; Kadıkoy Florence Nightingale Hospital in 2014.

Results:

In the first six months of the year, 153 actions were observed at 316 proper situations. The compliance rate was 35%, 54% and 64% for the physicians, nurses and, other healthcare staff, respectively. The overall compliance rate was 48%. One hundred eighty-three actions were observed for 306 situations after the improvement and education studies. The compliance rate was 29%, 72% and 86%. The overall mean compliance rate was 60%.

Conclusion:

The promotion of hand hygiene requires the cooperation of the hospital administrators, infection control committee, and quality departments for better hand hygiene practices among the healthcare providers.

Hand hygiene expectations in radiography: A critical evaluation of the opportunities for and barriers to compliance

Introduction:

Good hand hygiene practices reduce the risk of transmission of infection in healthcare. In common with other areas of healthcare, infection control knowledge and practice in radiography has potential for improvement. Regular hand hygiene compliance (HHC) monitoring indicated poor compliance in radiology which did not accurately reflect practice in one organisation. Using a quality improvement cycle, the process and context of work undertaken in radiology were examined in order to improve the validity and utility of HHC monitoring data collection process in the department.

Methods:

Following examination of the evidence base and with agreement from the radiology team, the chest X-ray process was observed and actions notated. This was then scored using the organisation and the World Health Organization five moments of hand hygiene tool. An alternative risk-based scoring system was developed.

Results:

The HHC score of 22% was obtained using standard measurements. Achievement of 100% compliance would require the radiographer to clean their hands nine times for each X-ray. The sequence of taking a chest X-ray was examined and two points in the process were identified as key points at which hand cleaning should take place to reduce the risk of transmission of infection.

Conclusions:

Cleaning hands frequently to achieve compliance expectations in this short low-risk process is neither feasible nor beneficial. A pragmatic risk-based approach to hand hygiene expectations in predictable procedures such as taking a chest X-ray reduces ambiguity and potentially increases compliance.

Biology of Hand-to-Hand Bacterial Transmission

Numerous studies have demonstrated that adequate hand hygiene among hospital staff is the best measure to prevent hand-to-hand bacterial transmission. The skin microbiome is conditioned by the individual physiological characteristics and anatomical microenvironments. Furthermore, it is important to separate the autochthonous resident microbiota from the transitory microbiota that we can acquire after interactions with contaminated surfaces. Two players participate in the hand-to-hand bacterial transmission process: the bacteria and the person. The particularities of the bacteria have been extensively studied, identifying some genera or species with higher transmission efficiency, particularly those linked to nosocomial infections and outbreaks. However, the human factor remains unstudied, and intrapersonal particularities in bacterial transmission have not been yet explored. Herein we summarize the current knowledge on hand-to-hand bacterial transmission, as well as unpublished results regarding interindividual and interindividual transmission efficiency differences. We designed a simple in vivo test based on four sequential steps of finger-to-finger contact in the same person artificially inoculated with a precise bacterial inoculum. Individuals can be grouped into one of three observed transmission categories: high, medium, and poor finger-to-finger transmitters. Categorization is relevant to predicting the ultimate success of a human transmission chain, particularly for the poor transmitters, who have the ability to cut the transmission chain. Our model allowed us to analyze transmission rate differences among five bacterial species and clones that cause nosocomial infections, from which we detected that Gram-positive microorganisms were more successfully transmitted than Gram-negative.

The effect of fake tan on hand hygiene practice

Hand hygiene is the single most important measure in reducing the spread of infection. The aim of this study was to assess the uptake of fake tan in nursing students and evaluate the impact of wearing fake tan on hand hygiene training lotion removal during handwashing with soap and water. Of the 217 participants recruited, 21% wore fake tan. Statistical analysis revealed no significant difference between fake tan and non-fake tan wearers. Consequentially, no guidelines regarding the wearing of fake tan in clinical practice are currently required.

Occupational Exposure to Alcohol-Based Hand Sanitizers: The Diagnostic Role of Alcohol Biomarkers in Hair

Ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEEs) in hair are effective direct biomarkers of ethanol ingestion, whose analytical determination can be used to discriminate between chronic and occasional ethanol intake. Ethanol is a compound widely used in some workplaces (e.g., clinics, hospitals) and is present in considerable amounts in mouthwash for oral cleaning, medications, cosmetic products, hydro-alcoholic disinfectants and antiseptics for hands. This study examined the ethyl alcohol exposure derived from hand disinfectants (in gel form) by simulating the typical occupational situation of medical-health workers (healthcare workers, nurses, surgeons, etc.) who frequently wash their hands with antiseptic sanitizer. Two types of hand disinfectants with 62% w/w of ethanol content were daily applied to the hands of a teetotaler for 20 times a day, for 4 consecutive weeks, thus simulating a typical workplace situation and a cumulative dermal exposure to ethanol of ~1,100 g. Different matrices (head, chest and beard hair, urine) were regularly sampled and analyzed using a ultra high-performance liquid chromatography tandem massspectrometry validated method for EtG and a (HS)SPME-GC-MS validated technique for FAEEs. The data obtained showed that a significant dermal absorption and/or inhalation of ethanol occurred, and that the use of detergents produce urinary EtG concentrations both higher than the cut-offs normally used for clinical and forensic analyses (either 100 and 500 ng/mL, depending on the context). The concentrations of the ethanol metabolites in the keratin matrices were, respectively, below the cut-off of 7 pg/mg for EtG and below 0.5 ng/mg for FAAEs (0.35 ng/mg for ethyl palmitate). In conclusion, the regular use of alcohol-based hand sanitizers can affect the concentration of urinary EtG and lead to positive analytical results, particularly when specimens are obtained shortly after sustained use of ethanol-containing hand sanitizer. On the other hand, direct biomarkers of alcohol abuse in the keratin matrix are capable of distinguishing between ethanol consumption and incidental exposures.

Update on infection control practices in cancer hospitals

Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.