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Haseeb A, Saleem Z, Faidah HS, Saati AA, AlQarni A, Iqbal MS, Alghamdi S, Elrggal ME, AlGethamy M, Radwan RM, Mahrous AJ, Abuhussain SSA, Khayyat SM, Ibrahim K, Godman B, Sheikh A. Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic. Antibiotics (Basel) 2023; 12:1299. [PMID: 37627718 PMCID: PMC10451798 DOI: 10.3390/antibiotics12081299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023] Open
Abstract
Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Hani Saleh Faidah
- Department of Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdullah A. Saati
- Department of Community Medicine & Pilgrims Healthcare, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Abdullmoin AlQarni
- Department of Infectious Diseases, Alnoor Specialist Hospital Makkah, Makkah 24382, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Al Baha University, Al Baha 57911, Saudi Arabia
| | - Mahmoud E. Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Manal AlGethamy
- Department of Infection Prevention & Control Program, Alnoor Specialist Hospital Makkah, Makkah 24382, Saudi Arabia
| | - Rozan Mohammad Radwan
- Pharmaceutical Care Department, Alnoor Specialist Hospital, Makkah 24382, Saudi Arabia
| | - Ahmad Jamal Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | | | - Sarah M. Khayyat
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Kiran Ibrahim
- Department of Epidemiology and Public Health, University of Nottingham, Nottingham NG7 2QL, UK
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh EH16 4UX, UK
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Alosaimy S, Mohammad I, Chahine EB, Saad A, Jaber LA, El‐Ghali A. Culturally Sensitive Recommendations for the Clinical Pharmacist to Engage the Arab American Patient. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sara Alosaimy
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Insaf Mohammad
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Elias B. Chahine
- Department of Pharmacy Practice Gregory School of Pharmacy, Palm Beach Atlantic University West Palm Beach Florida
| | - Aline Saad
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Linda A. Jaber
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
| | - Amer El‐Ghali
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan
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Fenny AP, Otieku E, Labi KAK, Asante FA, Enemark U. Cost-effectiveness analysis of alcohol handrub for the prevention of neonatal bloodstream infections: Evidence from HAI-Ghana study. PLoS One 2022; 17:e0264905. [PMID: 35245332 PMCID: PMC8896731 DOI: 10.1371/journal.pone.0264905] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 02/21/2022] [Indexed: 11/19/2022] Open
Abstract
Published evidence of the cost-effectiveness of alcohol-based handrub (ABH) for the prevention of neonatal bloodstream infections (BSI) is limited in sub-Saharan Africa. Therefore, this study evaluates the cost-effectiveness of a multimodal hand hygiene involving alcohol-based hand rub (ABH) for the prevention of neonatal BSI in a neonatal intensive care unit (NICU) setting in Ghana using data from HAI-Ghana study. Design was a before and after intervention study using economic evaluation model to assess the cost-effectiveness of a multimodal hand hygiene strategy involving alcohol-based hand rub plus soap and water compared to existing practice of using only soap and water. We measured effect and cost by subtracting outcomes without the intervention from outcomes with the intervention. The primary outcome measure is the number of neonatal BSI episode averted with the intervention and the consequent cost savings from patient and provider perspectives. The before and after intervention studies lasted four months each, spanning October 2017 to January 2018 and December 2018 to March 2019, respectively. The analysis shows that the ABH program was effective in reducing patient cost of neonatal BSI by 41.7% and BSI-attributable hospital cost by 48.5%. Further, neonatal BSI-attributable deaths and extra length of hospital stay (LOS) decreased by 73% and 50% respectively. Also, the post-intervention assessment revealed the ABH program contributed to 16% decline in the incidence of neonatal BSI at the NICU. The intervention is a simple and adaptable strategy with cost-saving potential when carefully scaled up across the country. Though the cost of the intervention may be more relative to using just soap and water for hand hygiene, the outcome is a good reason for investment into the intervention to reduce the incidence of neonatal BSI and the associated costs from patient and providers' perspectives.
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Affiliation(s)
- Ama Pokuaa Fenny
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra, Ghana
| | - Evans Otieku
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra, Ghana
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Kwaku Appiah-Korang Labi
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Accra, Ghana
| | - Felix Ankomah Asante
- Economics Division, Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon, Accra, Ghana
| | - Ulrika Enemark
- Department of Public Health, Aarhus University, Aarhus, Denmark
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Al Sawafi KM. Examining the Importance of Hand Hygiene Policy and Patient Safety Culture on Improving Healthcare Workers' Adherence to Hand Hygiene Practice in Critical Care Settings in the Sultanate of Oman: A Scoping Review. Cureus 2021; 13:e19773. [PMID: 34950551 PMCID: PMC8687176 DOI: 10.7759/cureus.19773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/05/2022] Open
Abstract
Several studies suggest that adherence to hand hygiene (HH) policy would be enhanced by improving the culture of safety in an organization. This could be achieved through continuous awareness programs about the dramatic effect of HH practice according to the HH policy on improving patient safety and quality care. Understanding the importance and purposes of HH policy by healthcare workers would allow them to prioritize HH policy in their planning. Therefore, healthcare leaders should be responsible and accountable for strengthening their healthcare system by improving infrastructure, providing adequate support and resources, providing comprehensive monitoring and evaluation of patient safety initiatives, monitoring adherence to the regional Gulf Cooperation Council (GCC) and local Oman HH policy and using World Health Organization (WHO) guidelines for patient safety and HH as a basis for providing safer care. This should involve HH policy as a basic and mandatory program during an internship or in new staff orientation programs, spending enough resources on conducting more research studies and benchmarking findings with other international countries or any other organization such as WHO or Centres for Disease Control (CDC). The development of an HH policy at three different levels, macro, meso, and micro, is discussed in this article. In this sense, patient safety and quality care are the most important issues when adopting any policy.
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El Othman R, Touma E, El Othman R, Haddad C, Hallit R, Obeid S, Salameh P, Hallit S. COVID-19 pandemic and mental health in Lebanon: a cross-sectional study. Int J Psychiatry Clin Pract 2021; 25:152-163. [PMID: 33587678 DOI: 10.1080/13651501.2021.1879159] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To evaluate depression, stress, anxiety and obsessive-compulsive behaviours in the Lebanese population in response to COVID-19 pandemic. METHODS This cross-sectional study was conducted between March and April 2020 on 386 participants randomly recruited from Lebanese general population. RESULTS Following the evolution of the COVID-19 pandemic in Lebanon compared to was not significantly associated with higher stress, higher depression, lower obsessive-compulsive traits, higher anxiety. Moreover, higher compulsion (Beta = 0.092), having a university level of education (Beta = 0.573), intermediate income (Beta = 1.889), following the evolution of the COVID-19 pandemic in Lebanon all of the time (Beta = 7.064), most of the time (Beta = 5.592), sometimes (Beta = 4.235) and little of the time (Beta = 7.676) were significantly associated with a higher hygienic prevention practices score. Higher age (Beta = -0.051), being a male (Beta = -1.432), higher depression (Beta = -0.083) and practicing religion some of the time (Beta = -0.826) were significantly associated with a lower hygienic prevention practices score. CONCLUSION This study found a strong interrelationship between psychological stress, depression, anxiety and obsessive-compulsive traits during the COVID-19 pandemic and identified the most vulnerable sub-groups in the Lebanese population. Additional measures should be deployed by health authorities in Lebanon and worldwide to face the impact of COVID-19 pandemic on mental health.Key pointsFollowing the evolution of the COVID-19 pandemic in Lebanon compared to not was significantly associated with higher stress, higher depression, lower obsessive-compulsive disorder, higher anxiety.Higher compulsion, having a university level of education, following the evolution of the COVID-19 pandemic in Lebanon were significantly associated with a higher hygienic prevention practices score.Higher depression, male gender, and practicing religion some of the time were significantly associated with a lower hygienic prevention practices score.Additional measures should be deployed by health authorities in Lebanon and worldwide to face the impact of COVID-19 pandemic on mental health.
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Affiliation(s)
- Radwan El Othman
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Elsie Touma
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Rola El Othman
- Department of Pediatrics, Bahman Hospital, Beirut, Lebanon
| | - Chadia Haddad
- Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,INSERM, Univ. Limoges, CH Esquirol Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Rabih Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Sahar Obeid
- Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban, Beirut, Lebanon
| | - Pascale Salameh
- Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon.,Faculty of Medicine, University of Nicosia, Nicosia, Cyprus
| | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban, Beirut, Lebanon
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Abuosi AA, Akoriyea SK, Ntow-Kummi G, Akanuwe J, Abor PA, Daniels AA, Alhassan RK. Hand hygiene compliance among healthcare workers in Ghana’s health care institutions: An observational study. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2020. [DOI: 10.1177/2516043520958579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess hand hygiene compliance in selected primary hospitals in Ghana. Design A cross-sectional health facility-based observational study was conducted in primary health care facilities in five regions in Ghana. A total of 546 healthcare workers including doctors, nurses, midwives and laboratory personnel from 106 health facilities participated in the study. Main outcome measures The main outcome measures included availability of hand hygiene materials and alcohol job aids; compliance with moments of hand hygiene; and compliance with steps in hygienic hand washing. These were assessed using descriptive statistics. Results The mean availability of hand hygiene material and alcohol job aids was 75% and 71% respectively. This was described as moderately high, but less desirable. The mean hand hygiene compliance with moments of hand hygiene was 51%, which was also described asmoderately high, but less desirable. It was observed that, generally, hand hygiene was performed after procedures than before. However, the mean compliance with steps in hygienic hand washing was 86%, which was described as high and desirable. Conclusion Healthcare workers are generally competent in performance of hygienic hand washing. However, this does not seem to influence compliance with moments of hand hygiene. Efforts must therefore be made to translate the competence of healthcare workers in hygienic hand washing into willingness to comply with moments of hand hygiene, especially contact with patients.
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Affiliation(s)
- Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | | | | | - Joseph Akanuwe
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Patience Aseweh Abor
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Anita Anima Daniels
- Department of Public Administration and Health Services Management, University of Ghana, Accra, Ghana
| | - Robert Kaba Alhassan
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
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Goni MD, Hasan H, Wan-Arfah N, Naing NN, Deris ZZ, Arifin WN, Baaba AA, Aliyu A, Adam BM. Health Education Intervention as an Effective Means for Prevention of Respiratory Infections Among Hajj Pilgrims: A Review. Front Public Health 2020; 8:449. [PMID: 33014965 PMCID: PMC7494962 DOI: 10.3389/fpubh.2020.00449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
The prevalence of respiratory illness has continued to surge among Hajj pilgrims from different countries despite having some practices of preventive measures. Respiratory illnesses during Hajj could be due to many reasons and many factors that promote disease spread. These factors include overcrowding, cigarette smoking, and direct contact with infectious agents particularly viruses promote the spread of respiratory infections. However, due to the longer duration of the pilgrimage, there are high chances of pilgrims contracting various respiratory illnesses due to exposure to respiratory pathogens. Hajj pilgrims' knowledge, attitudes, and practices toward respiratory tract infections are used as the determinant of the effectiveness of the health education interventions. Knowledge and application of basic hygiene principles, use of face masks, following cough etiquettes, engaging in social distancing, and engaging in other measures are highly important. In this paper, we reviewed the various effective intervention strategies implemented to help prevent respiratory tract infections during Hajj.
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Affiliation(s)
- Mohammed Dauda Goni
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Habsah Hasan
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Nadiah Wan-Arfah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Nyi Nyi Naing
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Zakuan Zainy Deris
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Wan Nor Arifin
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Aisha Abubakar Baaba
- Centre for Language Studies and Generic Development, Universiti Malaysia Kelantan, Kota Bharu, Malaysia
| | - Abdulwahab Aliyu
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Gombe State University, Gombe, Nigeria
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Mohanty A, Gupta PK, Gupta P, Kaistha N, Gupta P, Shankar R, Kumar P. Baseline assessment of hand hygiene knowledge perception: An observational study at a newly set up teaching hospital. J Family Med Prim Care 2020; 9:2460-2464. [PMID: 32754520 PMCID: PMC7380811 DOI: 10.4103/jfmpc.jfmpc_20_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Hand hygiene plays a crucial role in preventing health-care-associated infections (HCAIs) by reducing the spread of antimicrobial resistance. But, its compliance with optimal practices usually remains low at most of our health-care settings. Aim: This study focused on one of the primordial, basic and low-cost practice of infection control. Materials and Methods: A cross-sectional observational study was conducted among medical faculty, senior residents, postgraduates, nursing faculty, ward sisters/matron, and staff nurses at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand. Data were collected on a pretested structured questionnaire distributed among the participants, which consisted of questions to assess the knowledge and perception toward hand hygiene. Results: A total of 171 health-care workers (HCWs) were assessed in this study. Overall response rate observed was 87.8% ± 11.6%. Majority of the participants were staff nurses. Approximately 55% of them had received formal hand hygiene training in the last 3 years. Overall correct knowledge seen among participants was 66.4% ± 27.5%. It was observed that in situations requiring hand hygiene, it was performed in approximately 70%–80% of the times. Alcohol-based hand rub was not available at every point of care, whereas single-use towel was not present at every sink. When monitored whether the HCW started hand hygiene activity or not, compliance was seen in only 32% of the total. Conclusion: It is now essential for developing countries to formulate the policies for implementation of basic infection control practices. As we are facing an era of multidrug-resistant pathogens that are rapidly increasing globally, and paucity of availability of new antimicrobials, it is been essential to look at the role of basic infection control practices at health-care settings and implement them at priority level.
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Affiliation(s)
- Aroop Mohanty
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Puneet K Gupta
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Priyanka Gupta
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Neelam Kaistha
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ravi Shankar
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Pradeep Kumar
- Department of Microbiology, Institute of Liver and Billiary Sciences, New Delhi, Delhi, India
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Yehouenou CL, Dohou AM, Fiogbe AD, Esse M, Degbey C, Simon A, Dalleur O. Hand hygiene in surgery in Benin: opportunities and challenges. Antimicrob Resist Infect Control 2020; 9:85. [PMID: 32539867 PMCID: PMC7296752 DOI: 10.1186/s13756-020-00748-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 06/04/2020] [Indexed: 02/03/2023] Open
Abstract
Background Hand Hygiene (HH) has been described as the cornerstone and starting point in all infection control. Compliance to HH is a fundamental quality indicator. The aim of this study was to investigate the HH compliance among Health-care Workers (HCWs) in Benin surgical care units. Methods A multicenter prospective observational study was conducted for two months. The World Health Organization (WHO) Hand Hygiene Observation Tool was used in obstetric and gastrointestinal surgery through six public hospitals in Benin. HH compliance was calculated by dividing the number of times HH was performed by the total number of opportunities. HH technique and duration were also observed. Results A total of 1315 HH opportunities were identified during observation period. Overall, the compliance rate was 33.3% (438/1315), without significant difference between professional categories (nurses =34.2%; auxiliaries =32.7%; and physicians =32.4%; p = 0.705). However, compliance rates differed (p < 0.001) between obstetric (49.4%) and gastrointestinal surgery (24.3%). Generally, HCWs were more compliant after body fluid exposure (54.5%) and after touching patient (37.5%), but less before patient contact (25.9%) and after touching patient surroundings (29.1%). HCWs were more likely to use soap and water (72.1%) compared to the alcohol based hand rub solution (27.9%). For all of the WHO five moments, hand washing was the most preferred action. For instance, hand rub only was observed 3.9% after body fluid exposure and 16.3% before aseptic action compared to hand washing at 50.6 and 16.7% respectively. Duration of HH performance was not correctly adhered to 94% of alcohol hand rub cases (mean duration 9 ± 6 s instead of 20 to 30 s) and 99.5% of hand washing cases (10 ± 7 s instead of the recommended 40 to 60 s). Of the 432 HCWs observed, 77.3% followed HH prerequisites (i.e. no artificial fingernails, no jewellery). We also noted a lack of permanent hand hygiene infrastructures such as sink, soap, towels and clean water. Conclusion Compliance in surgery was found to be low in Benin hospitals. They missed two opportunities out of three to apply HH and when HH was applied, technique and duration were not appropriate. HH practices should be a priority to improve patient safety in Benin.
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Affiliation(s)
- Carine Laurence Yehouenou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium. .,Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin. .,Faculte des Sciences de la Sante (FSS), Université d'Abomey Calavi (UAC), Cotonou, Benin, O3BP1326.
| | - Angèle Modupe Dohou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium.,Faculte des Sciences de la Sante (FSS), Université d'Abomey Calavi (UAC), Cotonou, Benin, O3BP1326
| | - Ariane Dessièdé Fiogbe
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium.,Faculte des Sciences de la Sante (FSS), Université d'Abomey Calavi (UAC), Cotonou, Benin, O3BP1326
| | - Marius Esse
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin
| | - Cyriaque Degbey
- Institut Régional de Santé Publique Comlan Alfred Quenum (IRSP), Ouidah, Benin.,Clinique Universitaire d'Hygiène Hospitalière, Centre National Hospitalo-universitaire Hubert Koutoukou Maga, Cotonou, Benin
| | - Anne Simon
- Pole de microbiologie, Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain UCLouvain, Brussels, Belgium.,Microbiologie, Cliniques universitaires Saint-Luc, Université catholique de Louvain, UCLouvain, Brussels, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université catholique de Louvain UCLouvain, Brussels, Belgium.,Pharmacy, Cliniques universitaires Saint-Luc, Université catholique de Louvain, UCLouvain, Brussels, Belgium
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Xiao J, Shiu EYC, Gao H, Wong JY, Fong MW, Ryu S, Cowling BJ. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Personal Protective and Environmental Measures. Emerg Infect Dis 2020; 26:967-975. [PMID: 32027586 PMCID: PMC7181938 DOI: 10.3201/eid2605.190994] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
There were 3 influenza pandemics in the 20th century, and there has been 1 so far in the 21st century. Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence base on the effectiveness of nonpharmaceutical personal protective measures and environmental hygiene measures in nonhealthcare settings and discuss their potential inclusion in pandemic plans. Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.
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Ahmed QA, Memish ZA. The cancellation of mass gatherings (MGs)? Decision making in the time of COVID-19. Travel Med Infect Dis 2020; 34:101631. [PMID: 32184129 PMCID: PMC7102544 DOI: 10.1016/j.tmaid.2020.101631] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 02/01/2023]
Abstract
Our recommendation, as experts who have monitored health hazards at the Hajj for over 15 years, especially if the situation with COVID-19 continues to escalate globally is that Hajj 2020 will be at risk of being suspended and a means for Muslims to fulfill their rights in the future either personally or even by proxy need to be announced. The same holds true for the Summer 2020 Olympics in Japan and for many other MGs and large gatherings. Decisions in the time of COVID-19 will be closely followed and will be a blueprint for other mass gatherings.
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Affiliation(s)
- Qanta A Ahmed
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, NYU- Winthrop Hospital, NYU-Langone Health, Mineola, NY, USA.
| | - Ziad A Memish
- Research & Innovation Center, King Saud Medical City, Ministry of Health and College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Blenkharn JI. Rigid infection prevention and control rules and religious discrimination: An uncomfortable juxtaposition? J Infect Prev 2020; 21:35-39. [PMID: 32030102 DOI: 10.1177/1757177419884690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 10/04/2019] [Indexed: 11/15/2022] Open
Abstract
Confusion and conflict arise when infection prevention and control (IPC) policies lead to allegations of religious discrimination. Many IPC standards are generic in construct, often failing to address wider issues and general policy applicable to all may have unequal impact on minority groups. Achieving uniformity by treating everyone the same is not necessarily the same as treating them equally. Some variation in approach might be acceptable, often desirable and sometimes inevitable but must not compromise staff safety or patient welfare. Concerns regarding clinical safety may overlook or override cultural and religious; without care, the outcome might change from cooperative to confrontational. Where, and how, to draw the line?
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Ng WK, Shaban RZ, van de Mortel T. Hand hygiene beliefs and behaviours about alcohol-based hand rub use: Questionnaire development, piloting and validation. Infect Dis Health 2019; 25:43-49. [PMID: 31727595 DOI: 10.1016/j.idh.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Behavioural theories are crucial to the development and success of effective hand hygiene interventions. Research demonstrates that hand hygiene behaviours can also be influenced by religious and cultural beliefs. In this paper we detail the processes undertaken to develop a valid and reliable questionnaire to examine healthcare workers' beliefs and behaviours related to the use of alcoholbased hand rub (ABHR), with particular emphasis on associated religious and cultural factors. METHODS Using the Theory of Planned Behaviour, an existing questionnaire was modified and pilot-tested on 35 staff in the Quality Department. Cronbach's alpha values and mean inter-item correlations of the scale items were the main outcome measures. A Pearson correlation was conducted to assess for social desirability response bias. RESULTS The questionnaire demonstrated high content and face validity and satisfactory internal consistency in most scales, except for the religious beliefs, cultural beliefs and perceived behavioural control scales, where the inter-item correlations were 0.10, 0.13, and 0.14, respectively. There was a significant correlation between scores on the social desirability scale and the attitude scale. Partial correlation should be used to control the effect of social desirability responding when analysing data from the attitudes scale. CONCLUSIONS A validation process allowed the introduction and subsequent modification of religious and cultural belief scales to an existing questionnaire examining behavioural and attitudinal influences on hand hygiene using ABHR. Such processes should be considered for questionnaire development and modification when considering religious and cultural factors as drivers of behaviour.
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Affiliation(s)
- Wai Khuan Ng
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia.
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Thea van de Mortel
- School of Nursing and Midwifery, Griffith University, Clinical Sciences 2 Building (G16), Parklands Drive, Southport, Qld, 4215, Australia.
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Loftus MJ, Guitart C, Tartari E, Stewardson AJ, Amer F, Bellissimo-Rodrigues F, Lee YF, Mehtar S, Sithole BL, Pittet D. Hand hygiene in low- and middle-income countries. Int J Infect Dis 2019; 86:25-30. [PMID: 31189085 DOI: 10.1016/j.ijid.2019.06.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 06/04/2019] [Indexed: 02/05/2023] Open
Abstract
A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview evidence based strategies to reduce the transmission of pathogens via the hands of healthcare workers and the subsequent incidence of hospital acquired infections with a focus on implementing these strategies in low- and middle-income countries. Existing data suggests that hospital patients in low- and middle-income countries are exposed to rates of healthcare associated infections at least 2-fold higher than in high income countries. In addition to the universal challenges to the implementation of effective hand hygiene strategies, hospitals in low- and middle-income countries face a range of unique barriers, including overcrowding and securing a reliable and sustainable supply of alcohol-based handrub. The WHO Multimodal Hand Hygiene Improvement Strategy and its associated resources represent an evidence-based framework for developing a locally-adapted implementation plan for hand hygiene promotion.
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Affiliation(s)
- Michael J Loftus
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Chloe Guitart
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ermira Tartari
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Andrew J Stewardson
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Fatma Amer
- Department of Microbiology, Zagazig University, Zagazig, Egypt
| | | | - Yew Fong Lee
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Shaheen Mehtar
- Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa
| | - Buyiswa L Sithole
- Infection Control Africa Network, Unit of IPC, Tygerberg Hospital, Cape Town, South Africa
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Ng WK, Shaban RZ, van de Mortel T. The effect of a hand hygiene program featuring tailored religion-relevant interventions on healthcare workers' hand rubbing compliance and beliefs in the United Arab Emirates: A cohort study. Infect Dis Health 2019; 24:115-123. [PMID: 30795983 DOI: 10.1016/j.idh.2019.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hand hygiene with ABHR is more effective, time-saving and skin-friendly than traditional handwashing. However, alcohol-based hand rub (ABHR) use can be an obstacle for specific religions. The study aimed to test the effect of a modified hand hygiene program featuring religion-relevant, culturally-specific interventions on compliance and beliefs about ABHR use. METHODS A cohort study design was employed between August and November 2017 at a large tertiary hospital in the United Arab Emirates. Hand hygiene audit data and a cross-sectional survey were used to measure the impact of the modified hand hygiene program on compliance with, and beliefs about, ABHR use. RESULTS The intervention group had higher mean compliance with overt (p = 0.002) and covert (p = 0.04) ABHR use post-intervention, and higher mean compliance with overt ABHR use (p = 0.002) than the control group. The intervention group had more positive religious beliefs (p = 0.01) about ABHR use than the control group. CONCLUSION Implementing a hand hygiene program featuring tailored religion-relevant interventions in a culturally appropriate way had a positive effect on compliance with, and beliefs about, ABHR use.
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Affiliation(s)
- Wai Khuan Ng
- Nursing Division, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, United Arab Emirates; Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia.
| | - Ramon Z Shaban
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, Australia; Nursing, Midwifery and Clinical Governance Directorate, Western Sydney Local Health District, Westmead, NSW, Australia.
| | - Thea van de Mortel
- School of Nursing and Midwifery, Griffith University, Clinical Sciences 2 Building (G16), Parklands Drive, Southport, Qld, 4215, Australia; Menzies Health Institute Queensland, Griffith University, Health Sciences Building (N48), 170 Kessels Road, Nathan, Qld, 4111, Australia.
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Zhu Y, Liu S, Chen W, Liu B, Zhang F, Lv H, Ji C, Zhang X, Zhang Y. Epidemiology of low-energy lower extremity fracture in Chinese populations aged 50 years and above. PLoS One 2019; 14:e0209203. [PMID: 30640907 PMCID: PMC6331176 DOI: 10.1371/journal.pone.0209203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/01/2018] [Indexed: 12/21/2022] Open
Abstract
This study aimed to investigate the epidemiology of low-energy lower-extremity fracture in Chinese men and women aged 50 years and above. This study was a part of Chinese National Fracture Survey (CNFS), which used the stratified multistage cluster random sampling method to recruit subjects between January and May 2015. A total of 512187 individuals participated in the CNFS and of them there were 154099 men and women aged 50 years and above included in this study for data analysis. Low-energy fracture was defined as a fracture caused by slip, trip or fall from standing height. Univariate analyses and gender-based multivariate logistic regression models were constructed to identify the independent risk factors. A total of 215 patients had sustained low-energy lower extremity fractures in 2014, indicating the overall incidence was 139.5 (120.9 to 158.2) per 100000 persons, with 127.8 (102.5 to 153.1) and 151.1 (123.8 to 178.5) per 100000 person-year in men and women. Over 80% of fractures occurred at home and on the common road. In men, alcohol consumption (OR, 2.00; 95%CI, 1.29 to 3.08), sleep duration<7h/d (OR, 2.60; 95%CI, 1.68 to 4.03) and history of past fracture (OR, 2.57; 95%CI, 1.33 to 4.95) were identified as significant risk factors associated with low-energy fractures. In women, advanced age (80+ years) (OR, 3.22; 95%CI, 1.80 to 5.75), alcohol consumption(OR, 1.72; 95%CI, 1.00 to 2.98), sleep duration <7h/d (OR, 2.11; 95%CI, 1.40 to 3.18), and history of past fracture (OR, 3.46; 95%CI, 1.97 to 6.09) were identified as significant risk factors and living in western region (OR, 0.60; 95%CI, 0.38 to 0.94) and current weight of 50 to 59.9 kg (OR, 0.17; 95%CI, 0.04 to 0.73) were identified as protective factors for fractures. Accordingly, awareness on the importance of sleep and alcohol consumption on fragility fracture should be improved, and health policies that focus on decreasing alcohol consumption and encouraging individuals to improve their sleep quality and duration should be considered. Maintaining a healthy bodyweight for women should be specifically emphasized to prevent low-energy fractures.
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Affiliation(s)
- Yanbin Zhu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Song Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Wei Chen
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Bo Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Fei Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Hongzhi Lv
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Chenni Ji
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Xiaolin Zhang
- Department of Statistics and Epidemiology, Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
- Chinese Academy of Engineering, Beijing, P.R. China
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Harrison BL, Ogara C, Gladstone M, Carrol ED, Dusabe-Richards J, Medina-Lara A, Ditai J, Weeks AD. "We have to clean ourselves to ensure that our children are healthy and beautiful": findings from a qualitative assessment of a hand hygiene poster in rural Uganda. BMC Public Health 2019; 19:1. [PMID: 30606151 PMCID: PMC6318918 DOI: 10.1186/s12889-018-6343-3] [Citation(s) in RCA: 323] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 12/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Neonatal sepsis is a major cause of mortality worldwide, with most deaths occurring in low-income countries. The World Health Organisation (WHO) ‘5 Moments for Hand Hygiene’ poster has been used to reduce hospital-acquired infections, but there is no similar tool to prevent community-acquired newborn infections in low-resource settings. This assessment, part of the BabyGel Pilot study, evaluated the acceptability of the ‘Newborn Moments for Hand Hygiene in the Home’ poster. This was an educational tool which aimed to remind mothers in rural Uganda to clean their hands to prevent neonatal infection. Methods The BabyGel pilot was a cluster randomised trial that assessed the post-partum use of alcohol-based hand rub (ABHR) to prevent neonatal infections in Mbale, Uganda. Fifty-five women in 5 village clusters received the ABHR and used it from birth to 3 months postnatally, with use guided by the new poster. Following the study, 5 focus group discussions (FGDs) were conducted consisting of 6–8 purposively sampled participants from intervention villages. FGDs were audio-recorded, transcribed then translated into English. Transcripts were inductively coded using ATLAS.ti® and qualitatively analysed using thematic content analysis. Results Most mothers reported that they understood the message in the poster (“The picture shows me you must use these drugs to keep your baby healthy”) and that they could adhere to the moments from the poster. Some participants used the information from the poster to encourage other caregivers to use the ABHR (“after explaining to them, they liked it”). Other potential moments for hand hygiene were introduced by participants, such as after tending to domestic animals and gardening. Conclusion The poster was well-received, and participants reported compliance with the moments for hand hygiene (although the full body wipe of the baby has since been removed). The poster will be adapted into a sticker format on the ABHR bottle. More focus could be put into an education tool for other caregivers who wish to hold the baby. Overall, the study demonstrated the acceptability of an adapted version of the WHO Moments for Hand Hygiene poster in the introduction of an intervention in the community. Trial registration ISRCTN67852437, registered 02/03/2015. Trial funding Medical Research Council/ Wellcome Trust/ DfID (Global Health Trials Scheme).
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Affiliation(s)
- B L Harrison
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.
| | - C Ogara
- Sanyu Africa Research Institute (SAfRI), Mbale, Uganda
| | - M Gladstone
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - E D Carrol
- Institute of Infection and Global Health, University of Liverpool, Mbale, Uganda
| | | | | | - J Ditai
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK.,Sanyu Africa Research Institute (SAfRI), Mbale, Uganda.,Busitema University Faculty of Health Sciences, Tororo, Uganda
| | - A D Weeks
- Sanyu Research Unit, Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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Wai Khuan N, Shaban RZ, van de Mortel T. The influence of religious and cultural beliefs on hand hygiene behaviour in the United Arab Emirates. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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19
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Ditai J, Mudoola M, Gladstone M, Abeso J, Dusabe-Richards J, Adengo M, Olupot-Olupot P, Carrol ED, Storr J, Medina-Lara A, Faragher B, Weeks AD. Preventing neonatal sepsis in rural Uganda: a cross-over study comparing the tolerance and acceptability of three alcohol-based hand rub formulations. BMC Public Health 2018; 18:1279. [PMID: 30458740 PMCID: PMC6245533 DOI: 10.1186/s12889-018-6201-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neonatal sepsis causes 0.5 million deaths annually, mostly in low resource settings. Babies born in African rural homes without running water or toilet facilities are especially vulnerable. Alcohol-based hand rub (ABHR) may be used by mothers and carers as an alternative to hand washing with soap to prevent neonatal infection. However, no definite study has established the preferred formulation of hand rub for the mothers. This study aimed to assess the effects of addition of bitterants and perfume towards the acceptability of the alcohol-based hand rubs by the mothers in their homes after childbirth. METHODS This was a 3-way blinded cross-over study design. Mothers with children aged ≤3 months were recruited from immunisation clinics at 3 local health facilities in rural eastern Uganda and received 3-different ABHR formulations (in the order plain, bitterant and perfumed) packed in 100 ml bottles. Each ABHR was used for 5 consecutive days followed by a 2-day 'washout' period (evaluation period). Overall satisfaction with each hand rub was evaluated at the end of each week using a 7-point Likert scale. RESULTS A total of 43 women were recruited, whose ages ranged from 16 to 45 years (mean 26.2 years old). None of the participants normally used a hand protective lotion/cream. The three formulations were used for a mean of 5 (range 3-7) days. A significantly greater volume of the "bitterant" and "perfumed" formulations (mean 91 and 83 ml respectively) were used in comparison to the "plain" formulation (mean 64 ml). Overall satisfaction was high with all the hand rubs, but the perfumed formulation had a significantly higher overall satisfaction score [mean 6.7, range 4-7] compared with the plain [6.4, 3-7] and bitterant [6.2, 2-7] formulations. CONCLUSIONS All the 3 ABHR formulations were well accepted with little to choose between them. The ABHR with added perfume scored highest on overall satisfaction and was used significantly more often than plain ABHR. ABHR with bitterant additive did, however, score highly and may be a preferable choice to those with concern over alcohol misuse. TRIAL REGISTRATION ISRCTN67852437 , prospectively registered on 18/03/2018.
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Affiliation(s)
- J. Ditai
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
- Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool c/o Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS UK
| | - M. Mudoola
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
| | - M. Gladstone
- Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool c/o Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS UK
| | - J. Abeso
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
- Department of Paediatrics, Mbale Regional Referral Hospital, Mbale, Uganda
| | - J. Dusabe-Richards
- Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Clinical Trials Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - M. Adengo
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
| | - P. Olupot-Olupot
- Mbale Regional Referral Hospital Clinical Research Unit, Mbale, Uganda
- Busitema University, Faculty of Health Sciences, P.o Box 1460, Mbale, Uganda
| | - E. D. Carrol
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, 8 West Derby Street, Liverpool, L69 7BE UK
| | - J. Storr
- WHO Consultant, Geneva, Switzerland
- S3 Global, London, UK
| | - A. Medina-Lara
- Health Economics Group, University of Exeter, Exeter, UK
| | - B. Faragher
- Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Clinical Trials Unit, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - A. D. Weeks
- Sanyu Africa Research Institute (SAfRI), Mbale Regional Referral Hospital, Pallisa-Kumi Road Junction, P.o Box 2190, Mbale, Uganda
- Sanyu Research Unit, Department of Women’s and Children’s Health, University of Liverpool c/o Liverpool Women’s Hospital, Crown Street, Liverpool, L8 7SS UK
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Matar MJ, Moghnieh RA, Awad LS, Kanj SS. Effective Strategies for Improving Hand Hygiene in Developing Countries. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0152-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
The mass gathering of people is a potential source for developing, propagating, and disseminating infectious diseases on a global scale. Of the illnesses associated with mass gatherings, respiratory tract infections are the most common, the most easily transmitted, and the most likely to be spread widely beyond the site of the meeting by attendees returning home. Many factors contribute to the spread of these infections during mass gatherings, including crowding, the health of the attendees, and the type and location of meetings. The annual Hajj in the Kingdom of Saudi Arabia is the largest recurring single mass gathering in the world. Every year more than 10 million pilgrims attend the annual Hajj and Umrah. Attendees assemble in confined areas for several days. People with a wide range of age, health, susceptibility to illness, and hygiene sophistication come in close contact, creating an enormous public health challenge. Controlling respiratory infections at the Hajj requires surveillance, rapid diagnostic testing, and containment strategies. Although the Hajj is without equal, other mass gatherings can generate similar hazards. The geographic colocalization of the Zika virus epidemic and the 2016 Summer Olympic Games in Brazil is a current example of great concern. The potential of international mass gatherings for local and global calamity calls for greater global attention and research.
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Seyed Nematian SS, Palenik CJ, Mirmasoudi SK, Hatam N, Askarian M. Comparing knowledge and self-reported hand hygiene practices with direct observation among Iranian hospital nurses. Am J Infect Control 2017; 45:e65-e67. [PMID: 28427787 DOI: 10.1016/j.ajic.2017.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 10/19/2022]
Abstract
We compared knowledge and self-reported hand hygiene practices with direct observations among Shiraz Nemazee Hospital nurses. Overall hand hygiene compliance was low (39.6%). Use and appreciation for alcohol-based handrubs were suboptimal. Some reluctance was due to religious concerns. Most nurses self-reported performing proper hand hygiene more than 75% of the time, whereas direct observation indicated much lower levels of compliance. It appears that additional training and improved monitoring are needed.
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Determination of five alcohol compounds in fermented Korean foods via simple liquid extraction with dimethyl-sulfoxide followed by gas chromatography-mass spectrometry for Halal food certification. Lebensm Wiss Technol 2016. [DOI: 10.1016/j.lwt.2016.08.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Kurtz SL. Are we sending the wrong message when we ask health care workers to wash their hands? Am J Infect Control 2016; 44:1184-1186. [PMID: 27067519 DOI: 10.1016/j.ajic.2016.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/12/2016] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
Abstract
When asking healthcare workers to wash their hands, perhaps a better message would be to ask them not to transmit diseases. This changes the emphasis from a single act of adherence to a concept of behavior change. Proper hand hygiene, proper use of personal protective equipment, and cough etiquette are the means to an end, to stop the transfer to organisms and disease, but not the ultimate goal itself. The ultimate goal is to stop the transmission of diseases and ultimately to decrease the occurrence of healthcare associated infections.
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Gautret P, Benkouiten S, Sridhar S, Al-Tawfiq JA, Memish ZA. Diarrhea at the Hajj and Umrah. Travel Med Infect Dis 2015; 13:159-66. [PMID: 25765485 DOI: 10.1016/j.tmaid.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/20/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
This systematic review aims to summarize the incidence and etiology of diarrheal illness among pilgrims attending the Hajj and Umrah. Gastroenteritis and diarrhea have been potential threats during previous Hajj pilgrimages. The last cases of Hajj related cholera were reported in 1989. Currently, respiratory tract infections account for the majority of health problems during the Hajj. This shift in epidemiology reflects the improvement of sanitary conditions in Saudi Arabia in general, and at religious sites in particular. Nevertheless, gastrointestinal diseases, food-poisoning outbreaks, and diarrhea continue to occur among pilgrims. Available studies about diarrhea among Hajj pilgrims indicate a mean prevalence of 2% with the highest prevalence of 23% among a group of French pilgrims in 2013. There is an obvious lack of information about the etiology of diarrheal disease at the Hajj. Further studies addressing this issue in hospitalized patients as well as prospective cohort studies would be of interest. During the Hajj, hand washing is regularly carried out by pilgrims under a ritual purification, often called ablution. We recommend implementation of effective hand hygiene practices focusing on the regular use of alcohol-based hand rubs, as they require less time than traditional hand washing, act more rapidly, and contribute to sustained improvement in compliance associated with decreased infection rates.
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Affiliation(s)
- Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France.
| | - Samir Benkouiten
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Shruti Sridhar
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ziad A Memish
- Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Allegranzi B, Pittet D. Healthcare-Associated Infection in Developing Countries: Simple Solutions to Meet Complex Challenges. Infect Control Hosp Epidemiol 2015; 28:1323-7. [DOI: 10.1086/521656] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 07/11/2007] [Indexed: 01/08/2023]
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Benkouiten S, Brouqui P, Gautret P. Non-pharmaceutical interventions for the prevention of respiratory tract infections during Hajj pilgrimage. Travel Med Infect Dis 2014; 12:429-42. [PMID: 24999278 PMCID: PMC7110686 DOI: 10.1016/j.tmaid.2014.06.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/10/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022]
Abstract
Overcrowding during the yearly Hajj mass gatherings is associated with increased risk of spreading infectious diseases, particularly respiratory diseases. Non-pharmaceutical interventions (e.g., hand hygiene, wearing face masks, social distancing) are known to reduce the spread of respiratory viruses from person to person and are therefore recommended to pilgrims by public health agencies. The implementation of effective public health policies and recommendations involves evaluating the adherence to and effectiveness of these measures in the specific context of the Hajj. This review summarizes the evidence related to the effectiveness of non-pharmaceutical interventions in preventing the spread of respiratory infectious diseases during the Hajj. Overall, although hand hygiene compliance is high among pilgrims, face mask use and social distancing remain difficult challenges. Data about the effectiveness of these measures at the Hajj are limited, and results are contradictory, highlighting the need for future large-scale studies.
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Affiliation(s)
- Samir Benkouiten
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Philippe Brouqui
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France
| | - Philippe Gautret
- Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005 Marseille, France; Institut Hospitalo-Universitaire Méditerranée Infection, 13005 Marseille, France.
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β-Lactamase production in key gram-negative pathogen isolates from the Arabian Peninsula. Clin Microbiol Rev 2014; 26:361-80. [PMID: 23824364 DOI: 10.1128/cmr.00096-12] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SUMMARY Infections due to Gram-negative bacilli (GNB) are a leading cause of morbidity and mortality worldwide. The extent of antibiotic resistance in GNB in countries of the Gulf Cooperation Council (GCC), namely, Saudi Arabia, United Arab Emirates, Kuwait, Qatar, Oman, and Bahrain, has not been previously reviewed. These countries share a high prevalence of extended-spectrum-β-lactamase (ESBL)- and carbapenemase-producing GNB, most of which are associated with nosocomial infections. Well-known and widespread β-lactamases genes (such as those for CTX-M-15, OXA-48, and NDM-1) have found their way into isolates from the GCC states. However, less common and unique enzymes have also been identified. These include PER-7, GES-11, and PME-1. Several potential risk factors unique to the GCC states may have contributed to the emergence and spread of β-lactamases, including the unnecessary use of antibiotics and the large population of migrant workers, particularly from the Indian subcontinent. It is clear that active surveillance of antimicrobial resistance in the GCC states is urgently needed to address regional interventions that can contain the antimicrobial resistance issue.
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Rashid H, Azeem MI, Heron L, Haworth E, Booy R, Memish ZA. Has Hajj-associated Middle East Respiratory Syndrome Coronavirus transmission occurred? The case for effective post-Hajj surveillance for infection. Clin Microbiol Infect 2014; 20:273-6. [PMID: 24313466 PMCID: PMC7128364 DOI: 10.1111/1469-0691.12492] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- H Rashid
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children's Hospital at Westmead and The University of Sydney, Sydney, NSW, Australia.
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Mahfouz AA, El Gamal MN, Al-Azraqi TA. Hand hygiene non-compliance among intensive care unit health care workers in Aseer Central Hospital, south-western Saudi Arabia. Int J Infect Dis 2013; 17:e729-32. [DOI: 10.1016/j.ijid.2013.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 10/27/2022] Open
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Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, Memish Z, Urroz O, Richet H, Storr J, Donaldson L, Pittet D. Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study. THE LANCET. INFECTIOUS DISEASES 2013; 13:843-51. [PMID: 23972825 DOI: 10.1016/s1473-3099(13)70163-4] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO's strategy for improvement of hand hygiene in five countries. METHODS We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3-6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygiene principles. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010. FINDINGS We noted 21,884 hand-hygiene opportunities during 1423 sessions before the intervention and 23,746 opportunities during 1784 sessions after. Overall compliance increased from 51.0% before the intervention (95% CI 45.1-56.9) to 67.2% after (61.8-72.2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio [OR] 4.67, 95% CI 3.16-6.89; p<0.0001) than in high-income countries (2.19, 2.03-2.37; p<0.0001). Implementation had a major effect on compliance of health-care workers across all sites after adjustment for main confounders (OR 2.15, 1.99-2.32). Health-care-workers' knowledge improved at all sites with an increase in the average score from 18.7 (95% CI 17.8-19.7) to 24.7 (23.7-25.6) after educational sessions. 2 years after the intervention, all sites reported ongoing hand-hygiene activities with sustained or further improvement, including national scale-up. INTERPRETATION Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide. FUNDING WHO, University of Geneva Hospitals, the Swiss National Science Foundation, Swiss Society of Public Health Administration and Hospital Pharmacists.
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Affiliation(s)
- Benedetta Allegranzi
- First Global Patient Safety Challenge, WHO Patient Safety Programme, WHO, Geneva, Switzerland
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Affiliation(s)
- Qanta A Ahmed
- Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, Winthrop University Hospital, State University of New York at Stony Brook, New York, USA
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Hand hygiene and healthcare system change within multi-modal promotion: a narrative review. J Hosp Infect 2013; 83 Suppl 1:S3-10. [DOI: 10.1016/s0195-6701(13)60003-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ahmed-Lecheheb D, Cunat L, Hartemann P, Hautemanière A. Dermal and pulmonary absorption of ethanol from alcohol-based hand rub. J Hosp Infect 2012; 81:31-5. [PMID: 22445089 DOI: 10.1016/j.jhin.2012.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Ethanol intoxication of healthcare workers (HCWs) using alcohol-based hand rubs (ABHRs) in the workplace is a potentially serious issue. This study quantified the level of ethanol absorption among HCWs after hygienic hand disinfection. METHODS Eighty-six HCWs from Nancy University Hospital were tested before and after a 4-h shift. Participants used ABHR containing 70% ethanol. Levels of ethanol, acetaldehyde and acetate in blood and urine were determined using gas chromatography. A breathalyzer was used to measure the level of ethanol in expired air. RESULTS Ethanol [mean concentration 0.076 (standard deviation 0.05) mg/L] was detected in the expired air of 28 HCWs 1-2 min post exposure. Ethanol, acetaldehyde and acetate were undetectable in blood after a 4-h shift, and urine tests were negative in all participants. CONCLUSION Ethanol exposure from ABHR, particularly inhalation of vapours, resulted in positive breathalyzer readings 1-2 min after exposure. Dermal absorption of ethanol was not detected. Pulmonary absorption was detected but was below toxic levels.
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Affiliation(s)
- D Ahmed-Lecheheb
- Department of Environment and Public Health, Faculty of Medicine, Nancy University, Nancy, France.
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Pittet D, Panesar SS, Wilson K, Longtin Y, Morris T, Allan V, Storr J, Cleary K, Donaldson L. Involving the patient to ask about hospital hand hygiene: a National Patient Safety Agency feasibility study. J Hosp Infect 2011; 77:299-303. [PMID: 21236515 DOI: 10.1016/j.jhin.2010.10.013] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 10/03/2010] [Indexed: 11/29/2022]
Abstract
Healthcare-associated infections (HAIs) affect at least 300,000 patients annually in the UK and represent a significant, yet largely preventable, burden to healthcare systems. Hand hygiene by healthcare workers (HCWs) is the leading prevention measure, but compliance with good practice is generally low. The UK National Patient Safety Agency surveyed the public, inpatients, and HCWs, particularly frontline clinical staff and infection control nurses, in five acute care hospitals to determine whether they agreed that a greater level of involvement and engagement with patients would contribute to increased compliance with hand hygiene and reduce HAIs. Fifty-seven percent (302/530) of the public were unlikely to question doctors on the cleanliness of their hands as they assumed that they had already cleaned them. Forty-three percent (90/210) of inpatients considered that HCWs should know to clean their hands and trusted them to do so, and 20% (42/210) would not want HCWs to think that they were questioning their professional ability to do their job correctly. Most HCWs surveyed (178/254, 71%) said that HAI could be reduced to a greater or lesser degree if patients asked HCWs if they had cleaned their hands before touching them. Inviting patients to remind HCWs about hand hygiene through the provision of individual alcohol-based hand-rub containers and actively supporting an 'It's OK to ask' attitude were perceived as the most useful interventions by both patients and HCWs. However, further work is required to refute the myth among HCWs that patient involvement undermines the doctor- or HCW-patient relationship.
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Affiliation(s)
- D Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Allegranzi B, Sax H, Bengaly L, Richet H, Minta DK, Chraiti MN, Sokona FM, Gayet-Ageron A, Bonnabry P, Pittet D. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol 2010; 31:133-41. [PMID: 20017633 DOI: 10.1086/649796] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country. DESIGN A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention. SETTING University Hospital, Bamako, Mali. Participants. Two hundred twenty-four healthcare workers. METHODS The intervention consisted of introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up. RESULTS Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up (P < .001). Improvement was observed across all professional categories and medical specialities and was independently associated with the intervention (odds ratio, 2.50; 95% confidence interval, 1.8-3.5). Knowledge enhanced significantly (P < .05), and perception surveys showed a high appreciation of each strategy component by staff. CONCLUSIONS Multimodal hand hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries.
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Pickering AJ, Boehm AB, Mwanjali M, Davis J. Efficacy of waterless hand hygiene compared with handwashing with soap: a field study in Dar es Salaam, Tanzania. Am J Trop Med Hyg 2010; 82:270-8. [PMID: 20134005 DOI: 10.4269/ajtmh.2010.09-0220] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci (P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed.
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Affiliation(s)
- Amy J Pickering
- Emmett Interdisciplinary Program in Environment and Resources, School of Earth Sciences and Civil and Environmental Engineering, and Woods Institute for the Environment, Stanford University, Stanford, CA 94305, USA.
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Gautret P, Soula G, Parola P, Brouqui P. Hajj pilgrims' knowledge about acute respiratory infections. Emerg Infect Dis 2010; 15:1861-2. [PMID: 19891890 PMCID: PMC2857473 DOI: 10.3201/eid1511.090201] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Pittet D. Statewide hand hygiene improvement: embarking on a crusade. Med J Aust 2009; 191:S5-7. [DOI: 10.5694/j.1326-5377.2009.tb02898.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 08/23/2009] [Indexed: 11/17/2022]
Affiliation(s)
- Didier Pittet
- Infection Control Programme, University of Geneva hospitals, Geneva, Switzerland
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Pittet D, Allegranzi B, Boyce J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009; 30:611-22. [PMID: 19508124 DOI: 10.1086/600379] [Citation(s) in RCA: 434] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus-based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools.
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Affiliation(s)
- Didier Pittet
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009; 73:305-15. [PMID: 19720430 DOI: 10.1016/j.jhin.2009.04.019] [Citation(s) in RCA: 523] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 04/03/2009] [Indexed: 12/26/2022]
Abstract
Healthcare workers' hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment. Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections (HCAIs), but healthcare worker compliance with optimal practices remains low in most settings. This paper reviews factors influencing hand hygiene compliance, the impact of hand hygiene promotion on healthcare-associated pathogen cross-transmission and infection rates, and challenging issues related to the universal adoption of alcohol-based hand rub as a critical system change for successful promotion. Available evidence highlights the fact that multimodal intervention strategies lead to improved hand hygiene and a reduction in HCAI. However, further research is needed to evaluate the relative efficacy of each strategy component and to identify the most successful interventions, particularly in settings with limited resources. The main objective of the First Global Patient Safety Challenge, launched by the World Health Organization (WHO), is to achieve an improvement in hand hygiene practices worldwide with the ultimate goal of promoting a strong patient safety culture. We also report considerations and solutions resulting from the implementation of the multimodal strategy proposed in the WHO Guidelines on Hand Hygiene in Health Care.
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Affiliation(s)
- B Allegranzi
- First Global Patient Safety Challenge, World Alliance for Patient Safety, IER/PSP, Room L319, L Building, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland.
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Comparison of national and subnational guidelines for hand hygiene. J Hosp Infect 2009; 72:202-10. [PMID: 19481295 PMCID: PMC7132489 DOI: 10.1016/j.jhin.2009.03.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 03/23/2009] [Indexed: 11/30/2022]
Abstract
Hand hygiene promotion is considered as the cornerstone for healthcare-associated infection prevention. Over the past years, hand hygiene guidelines have been developed by different agencies at international, national and subnational levels. A comparison of these documents could help in understanding recommendations in different parts of the world and the methods used for their development. Guidelines were identified through search engines, electronic libraries, and personal contacts, and their content was analysed using an adapted version of a tool from the European DG XII-funded HARMONY project. Twenty-two guidelines were retrieved and 21 were evaluated. Documents varied in scope, approach, content and terminology. Some were primarily advisory directives, whereas others focused on the technical issues of why, when, and how to perform hand hygiene. The extent to which evidence was collected and assessed varied considerably and details were provided only in very few. Grading systems and definitions to indicate the strength of evidence and recommendations also differed. The intended outcome was to improve hand hygiene practices in healthcare, thus leading to a reduction of healthcare-associated infections and/or antimicrobial resistance. Although overall agreement on indications and procedures was noted, the range and depth of recommendations on best practices and implementation varied. Essential aspects such as compliance measurement and audits to assess guideline effectiveness were neglected in most documents. In conclusion, there is a need for a more consistent approach leading to recommendations based on a thorough evaluation of evidence and applicable worldwide. Aspects related to implementation and impact monitoring deserve greater attention.
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Religion and culture: potential undercurrents influencing hand hygiene promotion in health care. Am J Infect Control 2009; 37:28-34. [PMID: 18834738 PMCID: PMC7115273 DOI: 10.1016/j.ajic.2008.01.014] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 01/10/2008] [Accepted: 01/11/2008] [Indexed: 11/08/2022]
Abstract
Background Health care–associated infections affect hundreds of millions of patients worldwide each year. The World Health Organization's (WHO) First Global Patient Safety Challenge, “Clean Care is Safer Care,” is tackling this major patient safety problem, with the promotion of hand hygiene in health care as the project's cornerstone. WHO Guidelines on Hand Hygiene in Healthcare have been prepared by a large group of international experts and are currently in a pilot-test phase to assess feasibility and acceptability in different health care settings worldwide. Methods An extensive literature search was conducted and experts and religious authorities were consulted to investigate religiocultural factors that may potentially influence hand hygiene promotion, offer possible solutions, and suggest areas for future research. Results Religious faith and culture can strongly influence hand hygiene behavior in health care workers and potentially affect compliance with best practices. Interesting data were retrieved on specific indications for hand cleansing according to the 7 main religions worldwide, interpretation of hand gestures, the concept of “visibly dirty” hands, and the use of alcohol-based hand rubs and prohibition of alcohol use by some religions. Conclusions The impact of religious faith and cultural specificities must be taken into consideration when implementing a multimodal strategy to promote hand hygiene on a global scale.
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Re: help or hindrance? Is current infection control advice applicable in low- and middle-income countries? A review of the literature. Am J Infect Control 2008; 36:499-501; author reply 501. [PMID: 18786456 DOI: 10.1016/j.ajic.2008.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 05/13/2008] [Indexed: 11/24/2022]
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Rashid H, Shafi S, Haworth E, El Bashir H, Memish ZA, Sudhanva M, Smith M, Auburn H, Booy R. Viral respiratory infections at the Hajj: comparison between UK and Saudi pilgrims. Clin Microbiol Infect 2008; 14:569-74. [PMID: 18373688 PMCID: PMC7129001 DOI: 10.1111/j.1469-0691.2008.01987.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A high incidence of respiratory infection, including influenza, has been reported at the Hajj in Mecca, Saudi Arabia. Reported rates of influenza have been higher among UK than among domestic pilgrims, but this could be explained by methodological differences among studies. Accordingly, the present study compared the frequencies of respiratory viruses among UK and Saudi pilgrims using the same study design. Pilgrims with upper respiratory tract symptoms were recruited from Mecca and the neighbouring valley Mina during the Hajj 2006. Nasal swabs were used for point-of-care influenza testing and real-time RT-PCR (rtRT-PCR) tests for influenza virus, rhinovirus, parainfluenza virus, adenovirus, human metapneumovirus and respiratory syncytial virus. Of 260 pilgrims investigated, 150 were from the UK and 110 were Saudi; of these, 38 (25%) UK pilgrims and 14 (13%) Saudi pilgrims had respiratory infections detectable by rtRT-PCR (p 0.01). In the UK group, there were 19 (13%) cases of rhinovirus infection, 15 (10%) cases of influenza virus infection, two (1%) cases of dual infections with influenza virus and rhinovirus, one (3%) case of parainfluenza virus infection, and one (1%) case of respiratory syncytial virus infection. Fifty-six (37%) UK pilgrims had been vaccinated against influenza virus, with the rates of influenza in the vaccinated and unvaccinated group being 7% and 14%, respectively (p 0.19). In the Saudi group, there were three (3%) cases of rhinovirus infection and 11 (10%) cases of influenza. Only four (4%) Saudi pilgrims had been vaccinated against influenza virus, and none of these was infected with influenza virus. Overall, a significantly higher proportion of the UK pilgrims had detectable respiratory infections (25% vs. 13%, p 0.01). Influenza rates were similar in both groups, but the reported rates of influenza vaccination differed.
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Affiliation(s)
- H. Rashid
- Academic Unit of Child Health, Barts and the London Queen Mary’s School of Medicine and Dentistry
| | - S. Shafi
- Clinical Microbiology & HPA Collaborating Laboratory, North West London Hospitals NHS Trust
| | - E. Haworth
- Health Protection Agency South East, London, UK
| | - H. El Bashir
- Academic Unit of Child Health, Barts and the London Queen Mary’s School of Medicine and Dentistry
| | - Z. A. Memish
- Departments of Medicine, Infection Prevention and Control, King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - M. Sudhanva
- South London Specialist Virology Centre, Health Protection Agency London Regional Laboratory, Kings College NHS Foundation Trust, London, UK
| | - M. Smith
- South London Specialist Virology Centre, Health Protection Agency London Regional Laboratory, Kings College NHS Foundation Trust, London, UK
| | - H. Auburn
- South London Specialist Virology Centre, Health Protection Agency London Regional Laboratory, Kings College NHS Foundation Trust, London, UK
| | - R. Booy
- Academic Unit of Child Health, Barts and the London Queen Mary’s School of Medicine and Dentistry
- National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, The Children’s Hospital at Westmead and The University of Sydney, New South Wales, Australia
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Bush K, Mah MW, Meyers G, Armstrong P, Stoesz J, Strople S. Going Dotty: a practical guide for installing new hand hygiene products. Am J Infect Control 2007; 35:690-3. [PMID: 18063135 DOI: 10.1016/j.ajic.2007.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 01/02/2007] [Accepted: 01/03/2007] [Indexed: 11/19/2022]
Abstract
This report distills our experiences coordinating the installation of a new commercial line of hand hygiene products in a large, integrated health care region in Western Canada into a practical guide that can benefit infection control professionals. Some key considerations while managing such a large hand hygiene products installation are stakeholder collaboration, management of occupational hand dermatitis, housekeeping support, and communication.
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Affiliation(s)
- Kathryn Bush
- Infection Prevention and Control Program, Calgary Health Region, Calgary, AB, Canada.
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Kramer A, Below H, Bieber N, Kampf G, Toma CD, Huebner NO, Assadian O. Quantity of ethanol absorption after excessive hand disinfection using three commercially available hand rubs is minimal and below toxic levels for humans. BMC Infect Dis 2007; 7:117. [PMID: 17927841 PMCID: PMC2089071 DOI: 10.1186/1471-2334-7-117] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 10/11/2007] [Indexed: 11/30/2022] Open
Abstract
Background Despite the increasing promotion of alcohol-based hand rubs and the worldwide use of ethanol-based hand rubs in hospitals only few studies have specifically addressed the issue of ethanol absorption when repeatedly applied to human skin. The aim of this study was to assess if ethanol absorption occurs during hygienic and surgical hand disinfection using three different alcohol-based hand-rubs, and to quantify absorption levels in humans. Methods Twelve volunteers applied three hand-rubs containing 95% (hand-rub A), 85% (hand-rub B) and 55% ethanol (hand-rub C; all w/w). For hygienic hand disinfection, 4 mL were applied 20 times for 30 s, with 1 minute break between applications. For surgical hand disinfection, 20 mL of each hand rub was applied to hands and arms up to the level of the elbow 10 times for 3 minutes, with a break of 5 minutes between applications. Blood concentrations of ethanol and acetaldehyde were determined immediately prior and up to 90 minutes after application using head space gas chromatography. Results The median of absorbed ethanol after hygienic hand disinfection was 1365 mg (A), 630 mg (B), and 358 mg (C). The proportion of absorbed ethanol was 2.3% (A), 1.1% (B), and 0.9% (C). After surgical hand disinfection, the median of absorbed ethanol was 1067 mg (A), 1542 mg (B), and 477 mg (C). The proportion of absorbed ethanol was 0.7% (A), 1.1% (B), and 0.5% (C). The highest median acetaldehyde concentration after 20 hygienic hand disinfections was 0.57 mg/L (hand-rub C, after 30 min), after 10 surgical hand disinfections 3.99 mg/L (hand-rub A, after 20 minutes). Conclusion The overall dermal and pulmonary absorption of ethanol was below toxic levels in humans and allows the conclusion that the use of the evaluated ethanol-based hand-rubs is safe.
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Affiliation(s)
- Axel Kramer
- Institute of Hygiene and Environmental Medicine, Ernst Moritz Arndt University, Walther-Rathenau-Str. 49a, 17489 Greifswald, Germany.
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Allegranzi B, Storr J, Dziekan G, Leotsakos A, Donaldson L, Pittet D. The First Global Patient Safety Challenge "Clean Care is Safer Care": from launch to current progress and achievements. J Hosp Infect 2007; 65 Suppl 2:115-23. [PMID: 17540254 DOI: 10.1016/s0195-6701(07)60027-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Healthcare-associated infection is a major safety issue affecting the quality of care of hundreds of millions of patients every year in both developed and developing countries. To meet the goal of ensuring patient safety across healthcare settings around the globe, the World Health Organization launched the World Alliance for Patient Safety in October 2004. Healthcare-associated infections were identified as a fundamental work priority and selected as the topic of the First Global Patient Safety Challenge launched by the Alliance. Under the banner "Clean Care is Safer Care", the Challenge aims at implementing several actions to reduce healthcare-associated infections worldwide, regardless of the level of development of healthcare systems and the availability of resources. Implementation strategies include the integration of multiple interventions in the areas of blood safety, injection safety, clinical procedure safety, and water, sanitation and waste management, with the promotion of hand hygiene in healthcare as the cornerstone. Several initiatives have been undertaken to raise global awareness and to obtain country commitment to support action on this issue. The new Guidelines on Hand Hygiene in Health Care, including the most consistent scientific evidence available, have been issued in an advanced draft form. An implementation strategy is proposed therein to provide solutions to overcome obstacles to improvement in compliance with hand hygiene practices, together with a range of practical tools for use in healthcare settings. The latter are currently undergoing testing in several pilot sites to evaluate feasibility, acceptability and sustainability.
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Affiliation(s)
- Benedetta Allegranzi
- First Global Patient Safety Challenge, WHO World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland
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Sax H, Allegranzi B, Uçkay I, Larson E, Boyce J, Pittet D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007; 67:9-21. [PMID: 17719685 DOI: 10.1016/j.jhin.2007.06.004] [Citation(s) in RCA: 456] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Accepted: 06/01/2007] [Indexed: 11/17/2022]
Abstract
Hand hygiene is a core element of patient safety for the prevention of healthcare-associated infections and the spread of antimicrobial resistance. Its promotion represents a challenge that requires a multi-modal strategy using a clear, robust and simple conceptual framework. The World Health Organization First Global Patient Safety Challenge 'Clean Care is Safer Care' has expanded educational and promotional tools developed initially for the Swiss national hand hygiene campaign for worldwide use. Development methodology involved a user-centred design approach incorporating strategies of human factors engineering, cognitive behaviour science and elements of social marketing, followed by an iterative prototype test phase within the target population. This research resulted in a concept called 'My five moments for hand hygiene'. It describes the fundamental reference points for healthcare workers (HCWs) in a time-space framework and designates the moments when hand hygiene is required to effectively interrupt microbial transmission during the care sequence. The concept applies to a wide range of patient care activities and healthcare settings. It proposes a unified vision for trainers, observers and HCWs that should facilitate education, minimize inter-individual variation and resource use, and increase adherence. 'My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices.
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Affiliation(s)
- H Sax
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland; Global Patient Safety Challenge, World Alliance for Patient Safety, World Health Organization, Geneva, Switzerland
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