Hand hygiene: a COVID beneficiary?

Coronavirus Disease 2019 Pandemic and Reduced Surgical Site Infection After Cardiac Surgery: A Potential Blessing in Disguise

Background: The coronavirus disease 2019 (COVID-19) pandemic has brought about drastic hygienic measures, one upside of which might be the mitigated occurrence of surgical site infection (SSI). This study investigated the association of the pandemic with SSI occurrence after cardiac surgeries. Patients and Methods: From 2014 to 2022, patients undergoing cardiac surgery were included and categorized into pre-pandemic and during-pandemic groups. Surgical site infections were classified into harvest-site, superficial sternal, and complex sternal infection. Multiple logistic regression and inverse probability weighting assessed the association of the pandemic with SSI. Results: Among a total of 26,143 patients, 793 SSIs occurred. The during-pandemic patients were younger (61.87 ± 10.58 vs. 65.64 ± 11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of all studied comorbidities/risk factors (expect cigarette smoking). Total SSI rate decreased substantially from 3.3% before COVID-19 to 1.8% afterward (p < 0.001). Inverse probability weights analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted odds ratio [OR]; 0.59; 95% confidence interval [CI], 0.45-0.78), harvest-site (adjusted OR, 0.36; 95% CI, 0.19-0.70), and superficial sternal infection (adjusted OR, 0.60; 95% CI, 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted OR, 1.05; 95% CI, 0.55-2.01). Multivariable regression recapitulated these findings. Conclusions: The COVID-19 pandemic independently pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. However, there remains the possibility of the implications of other known and unknown confounders on the observed association. To some extent, the decrease in SSIs after the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending the adherence to these measurements into the post-COVID-19 era to maintain the status quo.

The flip side of frequent sanitising and hand washing

The stratum corneum is the outermost layer of the epidermis. It acts as an interface with the external environment and functions as a barrier that prevents microorganisms and allergens from penetrating the skin, while preventing bodily fluids, electrolytes and proteins from being lost in a process aimed at maintaining homeostasis. With the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an increase in hygiene practice, particularly hand washing and the use of hand sanitisers. These practices have undoubtedly assisted a great deal in combatting the rate of transmission and contributed immensely to saving lives. However, repeated hand washing and the use of sanitisers have both been linked with marked skin dryness and contact dermatitis. This especially holds true when the above-mentioned practices are carried out in the absence of intermittent hand moisturiser usage.

Exposure risk management: Personal protective equipment and the risk of accidents occurring during aerosol generating procedures applied to COVID-19 patients

BACKGROUND

COVID-19 is considered to be very contagious as it can be spread through multiple ways. Therefore, exposure risk of healthcare workers (HCWs) treating COVID-19 patients is a highly salient topic in exposure risk management. From a managerial perspective, wearing personal protective equipment and the risk of accidents occurring during aerosol generating procedures applied to COVID-19 patients are two interconnected issues encountered in all COVID-19 hospitals.

OBJECTIVE

The study was conducted to understand the realistic impact of exposure risk management on HCWs exposed to risks of SARS-CoV-2 virus infection in a healthcare unit. In particular, this study discusses the role of personal protective equipment (PPEs) used in aerosol generating procedures (AGPs) to protect HCWs, and the related risk of accidents occurring when performing AGPs.

METHODOLOGY

This is a cross-sectional single-hospital study conducted at the "Sf. Ioan cel Nou" Hospital in Suceava, Romania, that had to ensure safety of healthcare workers (HCWs) getting in contact with COVID-19 cases. Data used in the study were collected between 10.12.2020-19.03.2021 by means of a questionnaire that collected information on risk assessment and healthcare workers' exposure management, and which was translated and adapted from the World Health Organization (WHO) and applied to respondents online. For this purpose, ethical approval was obtained, doctors and nurses from all hospital departments being invited to complete the questionnaire. Data processing, as well as descriptive, correlation and regression analyses have been done by using the 21.0 version of the Statistical Package for Social Sciences software.

RESULTS

Most of the 312 HCWs reported having always used disposable gloves (98.13%), medical masks N95 (or equivalent) (92.86%), visors or googles (91.19%), disposable coverall (91.25%) and footwear protection (95.00%) during AGPs. The waterproof apron had always been worn only by 40% of the respondents, and almost 30% of staff had not used it at all during AGPs. Over the last three months, the period when the questionnaire was completed, 28 accidents were reported while performing AGPs: 11 accidents with splashing of biological fluids/ respiratory secretions in the eyes, 11 with splashing of biological fluids/ respiratory secretions on the non-idemn skin, 3 with splashing of biological fluids/ respiratory secretions in the oral/ nasal mucosa and 3 with puncture/ sting with any material contaminated with biological fluids/ respiratory secretions. Also, 84.29% of respondents declared having changed their routine, at least, moderately due to COVID-19.

CONCLUSION

An effective risk exposure management is based on wearing protective equipment. The only protection offered by the disposable coverall, as it results from our analysis, is related to splashing of biological fluids/ respiratory secretions on the non-idemn skin. In addition, the results show that the number of accidents should decrease due to the fact that disposable gloves and footwear protection are used while performing AGPs on patients with COVID-19 and hand hygiene is practised before and after touching a patient with COVID-19 (regardless of glove wearing).

Acceptability of an alcohol-based handrub gel with superfatting agents among healthcare workers: a randomized crossover controlled study

Introduction

Healthcare workers often experience skin dryness and irritation from performing hand hygiene frequently. Low acceptability and tolerability of a formulation are barriers to hand hygiene compliance, though little research has been conducted on what specific types of formulation have higher acceptability than others.

Objective

To compare the acceptability and tolerability of an ethanol-based handrub gel with superfatting agents to the isopropanol-based formulations (a rub and a gel formulation) currently used by healthcare workers at the University of Geneva Hospitals, Geneva, Switzerland.

Methods

Forty-two participants were randomized to two sequences, testing the isopropanol-based formulation that they are using currently (Hopirub® or Hopigel®), and the ethanol-based formulation containing superfatting agents (Saniswiss Sanitizer Hands H1). Participants tested each of the formulations over 7–10 day work shifts, after which skin condition was assessed and feedback was collected.

Results

H1 scored significantly better than the control formulations for skin dryness (P = 0.0209), and participants felt less discomfort in their hands when using that formulation (P = 0.0448). H1 caused less skin dryness than Hopirub®/Hopigel® (P = 0.0210). Though overall preference was quite polarized, 21 participants preferred H1 intervention formulation and 17 preferred the Hopirub®/Hopigel® formulation that they normally used in their care activities.

Conclusion

We observed a difference in acceptability and strongly polarized preferences among the participants' reactions to the formulations tested. These results indicate that giving healthcare workers a choice between different high-quality products is important to ensure maximum acceptability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-022-01129-4.

Impact of the world hand hygiene and global handwashing days on public awareness between 2016 and 2020: Google trends analysis

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.