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Shi C, O'Donoghue M, Yang L, Tsang H, Chen J, Zou J, Qin J, Mak YW, Pittet D, Xie YJ, Lai T, Li C, Cao J. Factors associated with hand washing effectiveness: an institution-based observational study. Antimicrob Resist Infect Control 2023; 12:85. [PMID: 37649107 PMCID: PMC10469426 DOI: 10.1186/s13756-023-01293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Few studies have investigated how the effectiveness of hand washing in removing hand contaminants is influenced by the performance and duration of each step involved. We conducted an observational study by recruiting participants from a university campus, with the aim to comprehensively evaluate how performance, duration and demographic factors influence hand washing effectiveness. METHODS A total of 744 videos were collected from 664 participants in July-October 2022 and independently evaluated by two infection control experts through labelling videos for correct and incorrect performance of each step. The individual hand washing effectiveness was determined by quantifying the percentage of residual fluorescent gel on the dorsum and palm areas of each participant's hands. A logistic regression analysis was conducted to identify factors that were significantly associated with better hand washing effectiveness. An exposure-response relationship was constructed to identify optimal durations for each step. Approximately 2300 hand images were processed using advanced normalization algorithms and overlaid to visualize the areas with more fluorescence residuals after hand washing. RESULTS Step 3 (rub between fingers) was the most frequently omitted step and step 4 (rub the dorsum of fingers) was the most frequently incorrectly performed step. After adjustment for covariates, sex, performance of step 4 and step 7 (rub wrists), rubbing hands during rinsing, and rinsing time were significantly associated with hand washing effectiveness. The optimal overall hand washing time was 31 s from step 1 to step 7, and 28 s from step 1 to step 6, with each step ideally lasting 4-5 s, except step 3. The palms of both hands had less fluorescence residuals than the dorsums. The areas where residuals most likely appeared were wrists, followed by finger tips, finger webs and thumbs. CONCLUSIONS Performance and duration of some hand washing steps, sex and rinsing time were associated with hand washing effectiveness. The optimal duration might be applied to all seven steps to achieve the best decontamination results. Further studies are needed to refine hand hygiene standards and enhance compliance.
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Affiliation(s)
- Chen Shi
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | | | - Lin Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Hilda Tsang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jing Chen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Jing Zou
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jing Qin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yim-Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Timothy Lai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Chen Li
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jiannong Cao
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
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Evans EW, Samuel EJ, Redmond EC. A case study of food handler hand hygiene compliance in high-care and high-risk food manufacturing environments using covert-observation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:638-651. [PMID: 32633547 DOI: 10.1080/09603123.2020.1791317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
Observation of behaviour is superior to cognitive data, which does not equate to behaviour. Covert-observation is seldom used in food manufacturing to assess behaviour. In this case study, closed-circuit-television footage (15 h) in a business were reviewed to assess hand hygiene compliance using an electronic-checklist. Hand hygiene attempts were observed prior to entering high-risk (cake/pie)(n= 47) and high-care (sandwich/salad)(n= 153) production areas. Business hand hygiene protocol required handwashing durations ≥ 20 s. Observed durations ranged 1-71 s, <96% of attempts were <20 s. Significantly longer durations were observed when food handlers were in the presence of others (12 s) than when alone (9 s). Although <99% utilised soap, only 56-69% wetted hands first. Failure to rub all parts of hands was commonplace (<87%) and 24-35% failed to apply sanitiser after drying. Consequently, >98% of observed attempts before entering production areas did not comply with the protocol. Observed non-compliant practices may have implications for food safety in manufacturing.
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Affiliation(s)
- Ellen W Evans
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University, Cardiff, Wales
| | - Emma J Samuel
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University, Cardiff, Wales
| | - Elizabeth C Redmond
- ZERO2FIVE Food Industry Centre, Cardiff Metropolitan University, Cardiff, Wales
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Efficacy of Removing Bacteria and Organic Dirt from Hands-A Study Based on Bioluminescence Measurements for Evaluation of Hand Hygiene When Cooking. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168828. [PMID: 34444577 PMCID: PMC8394668 DOI: 10.3390/ijerph18168828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 12/04/2022]
Abstract
The objective of this study was to evaluate the efficacy of dirt removal (bacteria and organic matter) of several hand-cleaning procedures. The results from the hand hygiene experiment indicated that washing hands with warm water and soap for 20 s is the most effective method investigated when hands are either dirty or greasy. Even if not proper washing, rinsing under running water for 5 s is a cleaning procedure that may significantly reduce the probability of cross-contamination, as it removes 90% of the hands’ dirt. Although less effective than water and soap, the usage of antibacterial wipes was significantly more effective than wet wipes, indicating that they are a better choice when water and soap are not available. The results of this study enable us to inform consumers about the effectiveness of hand-cleaning procedures applied in their homes when cooking. Moreover, it can make consumers understand why, during the COVID-19 pandemic, authorities recommended washing hands as a preventive measure of infection and using an anti-bacterial hand gel or wiping hands with an antimicrobial wipe if water and soap are not available.
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Khan MH, Yadav H. Sanitization During and After COVID-19 Pandemic: A Short Review. TRANSACTIONS OF THE INDIAN NATIONAL ACADEMY OF ENGINEERING 2020; 5. [PMCID: PMC7603432 DOI: 10.1007/s41403-020-00177-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Sanitization is a preventive and strategic method to contain the spread of SARS-CoV2. Since there is no foolproof method to tackle the present COVID-19 pandemic, sanitization has a central role to play. The present article briefly reviews various methods of sanitization for individuals, surfaces and ambience. The article reviews different approaches toward sanitization and examines the historicity of the methods employed.
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Affiliation(s)
- Majid Hassan Khan
- Department of Mechanical Engineering, Indian Institute of Technology Bombay, Mumbai, 400076 India
| | - Harekrishna Yadav
- Discipline of Mechanical Engineering, Indian Institute of Technology Indore, Simrol, 453552 India
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Jena AK. Effects of Community Sanitation Program on the Awareness of Environmental Sustainability in Assam, India. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2018; 39:51-61. [PMID: 29979094 DOI: 10.1177/0272684x18787150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Community sanitation is now an essential issue of environmental sustainability. In recently, community-led total sanitation program is going in Bangladesh, India, Indonesia, Pakistan, Ethiopia, and Kenya with the help of government and nongovernmental organizations. In this context, a community sanitation program was organized in Silchar, India, in which the students, local community members, and university professors directly and indirectly participated and gave their valuable feedback. The study aimed to evaluate the effects of community sanitation program on the awareness of environmental sustainability. In this empirical research design, 20 university students, 6 university professors, and 14 local people participated in the community sanitation and hands-on activity program organized on the roadside of Silchar Medical College & Hospital and Irongmara Market nearer to the Assam University, Silchar. The participants' responses towards the feedback cum questionnaire was analyzed by Kruskal -Wallis H test resulted significant effects of community sanitation program on the awareness of environmental sustainability.
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Impact of soap type—foaming vs. gel-based—on handwashing time. Food Control 2017. [DOI: 10.1016/j.foodcont.2016.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wolfe MK, Gallandat K, Daniels K, Desmarais AM, Scheinman P, Lantagne D. Handwashing and Ebola virus disease outbreaks: A randomized comparison of soap, hand sanitizer, and 0.05% chlorine solutions on the inactivation and removal of model organisms Phi6 and E. coli from hands and persistence in rinse water. PLoS One 2017; 12:e0172734. [PMID: 28231311 PMCID: PMC5322913 DOI: 10.1371/journal.pone.0172734] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/07/2017] [Indexed: 11/19/2022] Open
Abstract
To prevent Ebola transmission, frequent handwashing is recommended in Ebola Treatment Units and communities. However, little is known about which handwashing protocol is most efficacious. We evaluated six handwashing protocols (soap and water, alcohol-based hand sanitizer (ABHS), and 0.05% sodium dichloroisocyanurate, high-test hypochlorite, and stabilized and non-stabilized sodium hypochlorite solutions) for 1) efficacy of handwashing on the removal and inactivation of non-pathogenic model organisms and, 2) persistence of organisms in rinse water. Model organisms E. coli and bacteriophage Phi6 were used to evaluate handwashing with and without organic load added to simulate bodily fluids. Hands were inoculated with test organisms, washed, and rinsed using a glove juice method to retrieve remaining organisms. Impact was estimated by comparing the log reduction in organisms after handwashing to the log reduction without handwashing. Rinse water was collected to test for persistence of organisms. Handwashing resulted in a 1.94-3.01 log reduction in E. coli concentration without, and 2.18-3.34 with, soil load; and a 2.44-3.06 log reduction in Phi6 without, and 2.71-3.69 with, soil load. HTH performed most consistently well, with significantly greater log reductions than other handwashing protocols in three models. However, the magnitude of handwashing efficacy differences was small, suggesting protocols are similarly efficacious. Rinse water demonstrated a 0.28-4.77 log reduction in remaining E. coli without, and 0.21-4.49 with, soil load and a 1.26-2.02 log reduction in Phi6 without, and 1.30-2.20 with, soil load. Chlorine resulted in significantly less persistence of E. coli in both conditions and Phi6 without soil load in rinse water (p<0.001). Thus, chlorine-based methods may offer a benefit of reducing persistence in rinse water. We recommend responders use the most practical handwashing method to ensure hand hygiene in Ebola contexts, considering the potential benefit of chlorine-based methods in rinse water persistence.
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Affiliation(s)
- Marlene K. Wolfe
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Karin Gallandat
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Kyle Daniels
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Anne Marie Desmarais
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Pamela Scheinman
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
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Conover DM, Gibson KE. Comparison of two plain soap types for removal of bacteria and viruses from hands with specific focus on food service environments. Food Control 2016. [DOI: 10.1016/j.foodcont.2016.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Smith SMS, Sonego S, Wallen GR, Waterer G, Cheng AC, Thompson P. Use of non-pharmaceutical interventions to reduce the transmission of influenza in adults: A systematic review. Respirology 2015; 20:896-903. [PMID: 25873071 DOI: 10.1111/resp.12541] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/05/2015] [Accepted: 03/06/2015] [Indexed: 12/23/2022]
Abstract
During seasonal influenza epidemics and pandemics, virus transmission causes significant public health concern. Reduction of viral transmission by non-pharmaceutical interventions (NPI) has a significant appeal and is often recommended. However, the efficacy of such interventions is unclear. A systematic literature review was undertaken to identify and evaluate the published literature on NPI efficacy to prevent human transmission of influenza virus in adults. Reviewers assessed the quality of eligible studies utilizing the Critical Appraisal Skills Programme for bias and the Scottish Intercollegiate Guidelines Network for methodological quality. Studies were assessed for risk of bias domains of random sequence generation, allocation concealment, attribution bias, selective reporting and blinding. Relevant citations of 2247 were reduced to 100 for full-text evaluation. Only seven met all selection criteria and pooled analysis was not feasible. Of the seven studies, two were randomized controlled trials (RCT) and five were cluster RCT. The main NPI studied were disinfection and hygiene; barriers; and combined NPI. However, these seven RCT had significant design flaws. Only two studies used laboratory confirmed influenza and poor statistical power was a major problem. Positive significant interventions included professional oral hygiene intervention in the elderly and hand washing. Despite the potential for NPI in preventing influenza transmission, there is very limited data available. Hand washing and dental hygiene may be useful, but other interventions have not been fully assessed. Properly designed studies evaluating large populations including 'at risk' patients and in a variety of communities are needed.
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Affiliation(s)
- Sheree M S Smith
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia.,Centre for Pharmacology and Therapeutics, Imperial College, Chelsea and Westminster Campus, London, UK
| | - Sandra Sonego
- School of Nursing and Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Bethesda, Maryland, USA
| | - Grant Waterer
- School of Medicine and Pharmacology, Royal Perth Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Allen C Cheng
- Infectious Diseases Unit, Department of Epidemiology and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Philip Thompson
- School of Medicine and Pharmacology, Queen Elizabeth II Unit, University of Western Australia, Perth, Western Australia, Australia.,The Lung Health Clinic, Hollywood Hospital, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
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