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Xiao S, Li C, Zhao F, Lin R, Zhang N, Li Y. A coupled hand and surface hygiene criterion on heterogeneous surface touch networks. JOURNAL OF HAZARDOUS MATERIALS 2024; 479:135589. [PMID: 39191014 DOI: 10.1016/j.jhazmat.2024.135589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/27/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024]
Abstract
Contaminated hands of people and contaminated surfaces of inanimate objects (fomites) can spread microbes that cause enteric and respiratory infections. Thus, hand hygiene and surface hygiene are probably the most widely adopted public health interventions for controlling such infections. However, conclusions of studies on the effectiveness of these interventions are often inconsistent, likely because such studies have examined these interventions separately and thus not detected their interactions, leading to differing conclusions about their individual impact. In this study, it is proposed that hand and environmental surface hygiene (including disinfection) should be coupled to control contamination spread between surfaces, especially within heterogeneous surface touch networks. In these networks, surfaces and individuals have varying contact frequencies and patterns, reflecting the diverse and non-uniform interactions that typically occur in real-world environments. Accordingly, we propose a new theoretical framework to delineate the relationships between hand hygiene and surface hygiene. In addition, the performance of a model based on this framework that used real-world behavioural data from a graduate student office is reported. Moreover, a coupled hygiene criterion for heterogeneous networks is derived. This criterion stipulates that the product of the pathogen-removal rates for hands and surfaces must exceed a cleaning threshold to ensure the exponential decay of contamination. Failure to meet this threshold results in a non-zero steady prevalence of contamination. Furthermore, the cleaning threshold increases as the numbers of surfaces and hands increase, highlighting the significant impact of network structures on hygiene practices. Thus, extensive cleaning may be necessary in crowded indoor environments with many surfaces and occupants, such as cruise ships, to prevent super-large outbreaks of, for example, noroviral infections. Overall, the findings of this study reveal how improved and integrated hygiene control can prevent fomite transmission.
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Affiliation(s)
- Shenglan Xiao
- Shenzhen Key Laboratory of Pathogenic Microbes and Biosafety, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China; Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, PR China
| | - Congying Li
- Shenzhen Key Laboratory of Pathogenic Microbes and Biosafety, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Fangli Zhao
- Shenzhen Key Laboratory of Pathogenic Microbes and Biosafety, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Ruizhen Lin
- Shenzhen Key Laboratory of Pathogenic Microbes and Biosafety, School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, PR China
| | - Nan Zhang
- Beijing Key Laboratory of Green Built Environment and Energy Efficient Technology, Beijing University of Technology, Beijing 100124, PR China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, PR China.
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Mim MF, Sikder MH, Chowdhury MZH, Bhuiyan AUA, Zinan N, Islam SMN. The dynamic relationship between skin microbiomes and personal care products: A comprehensive review. Heliyon 2024; 10:e34549. [PMID: 39104505 PMCID: PMC11298934 DOI: 10.1016/j.heliyon.2024.e34549] [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] [Received: 02/09/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 08/07/2024] Open
Abstract
Healthy skin reflects a healthy microbiome and vice versa. The contemporary society, marked by a sharp increase in skin irritation cases, has compelled researchers, dermatologists, and the cosmetics industry to investigate the correlation between skin microbiomes and the use of skincare products. Different cosmetics can change skin's normal flora to a varying degree -some changes can be detrimental, there are also instances where these alterations aid in restoring the skin microbiome. Previous studies using artificial skin models, metagenomic analysis, and culture-based approaches have suggested that skincare products play an important role in skin microbial alteration. This article assessed current knowledge on microbial shifts from daily use of various personal and skincare products. We have also introduced a readily applicable framework, synthesized from various observations, which can be employed to identify the normal skin microbiome and evaluate the impact of personal care and skincare products on it. We also discussed how lifestyle choice remake skin microbial makeup. Future studies are warranted to examine the effect of personal and skincare product usage on skin microbiome across various age groups, genders, and body sites with a multi-study approach.
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Affiliation(s)
- Mahjabin Ferdaous Mim
- Institute of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, 1706, Bangladesh
| | - Mahmudul Hasan Sikder
- Department of Pharmacology, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Md. Zahid Hasan Chowdhury
- Institute of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, 1706, Bangladesh
| | - Ashkar-Ul-Alam Bhuiyan
- Institute of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, 1706, Bangladesh
| | - Nayeematul Zinan
- Institute of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, 1706, Bangladesh
| | - Shah Mohammad Naimul Islam
- Institute of Biotechnology and Genetic Engineering, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, 1706, Bangladesh
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Tuschhoff BM, Kennedy DA. Detecting and quantifying heterogeneity in susceptibility using contact tracing data. PLoS Comput Biol 2024; 20:e1012310. [PMID: 39074159 PMCID: PMC11309420 DOI: 10.1371/journal.pcbi.1012310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 08/08/2024] [Accepted: 07/10/2024] [Indexed: 07/31/2024] Open
Abstract
The presence of heterogeneity in susceptibility, differences between hosts in their likelihood of becoming infected, can fundamentally alter disease dynamics and public health responses, for example, by changing the final epidemic size, the duration of an epidemic, and even the vaccination threshold required to achieve herd immunity. Yet, heterogeneity in susceptibility is notoriously difficult to detect and measure, especially early in an epidemic. Here we develop a method that can be used to detect and estimate heterogeneity in susceptibility given contact by using contact tracing data, which are typically collected early in the course of an outbreak. This approach provides the capability, given sufficient data, to estimate and account for the effects of this heterogeneity before they become apparent during an epidemic. It additionally provides the capability to analyze the wealth of contact tracing data available for previous epidemics and estimate heterogeneity in susceptibility for disease systems in which it has never been estimated previously. The premise of our approach is that highly susceptible individuals become infected more often than less susceptible individuals, and so individuals not infected after appearing in contact networks should be less susceptible than average. This change in susceptibility can be detected and quantified when individuals show up in a second contact network after not being infected in the first. To develop our method, we simulated contact tracing data from artificial populations with known levels of heterogeneity in susceptibility according to underlying discrete or continuous distributions of susceptibilities. We analyzed these data to determine the parameter space under which we are able to detect heterogeneity and the accuracy with which we are able to estimate it. We found that our power to detect heterogeneity increases with larger sample sizes, greater heterogeneity, and intermediate fractions of contacts becoming infected in the discrete case or greater fractions of contacts becoming infected in the continuous case. We also found that we are able to reliably estimate heterogeneity and disease dynamics. Ultimately, this means that contact tracing data alone are sufficient to detect and quantify heterogeneity in susceptibility.
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Affiliation(s)
- Beth M. Tuschhoff
- Department of Biology, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - David A. Kennedy
- Department of Biology, The Pennsylvania State University, University Park, Pennsylvania, United States of America
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Yang X, Qiu M, Yang Y, Yan J, Tang K. Maternal postnatal confinement practices and postpartum depression in Chinese populations: A systematic review. PLoS One 2023; 18:e0293667. [PMID: 37903136 PMCID: PMC10615300 DOI: 10.1371/journal.pone.0293667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The postpartum period is critical for maternal health status after childbirth. The traditional Chinese postpartum confinement practice, "doing-the-month", is considered especially effective in helping mothers recover during the postpartum period. However, research has not provided evidence to confirm its benefits. Postpartum depression is a common postpartum disease that seriously threatens maternal health. The systematic review aims to explore the association between "doing-the-month" and postpartum depression in the Chinese female population and to provide a scientific foundation for evidence-based postpartum maternal care. METHODS Five databases (PubMed, Embase, Web of Science, Scopus, Cochrane, PsycINFO, and Web of Science) were searched according to the protocol (INPALSY202320102). The JBI assessment tool was used to assess the quality of the included studies. RESULTS Sixteen quantitative studies from China and Chinese female immigrants in other countries, including 15 cross-sectional studies and 1 randomized controlled study, were identified. Four studies indicated that "doing-the-month" rituals reduced postpartum depression risk while 2 studies showed opposite results; 10 studies did not show a significant association between "doing-the-month" practices and postpartum depression. CONCLUSION There is conflicting evidence regarding the association between "doing-the-month" and the likelihood of developing postpartum depression. Some studies have explored the impact of family ties, particular rituals, and specific stressors during the postpartum period on the occurrence of postpartum depression in Chinese women. According to current research, "doing-the-month" practice failed to show a significant protective effect on postpartum depression in the Chinese maternal population. Evidence-based medical health education for the Chinese postpartum female community is urgently needed.
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Affiliation(s)
- Xiao Yang
- Health Policy and Management Department, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mujie Qiu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yichun Yang
- Department of Obstetrics, Longgang District Central Hospital of Shenzhen, Shenzhen, China
| | - Junlin Yan
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Nishioka Y, Nagano K, Koga Y, Okada Y, Mori I, Hayase A, Mori T, Manabe K. Lactic acid as a major contributor to hand surface infection barrier and its association with morbidity to infectious disease. Sci Rep 2021; 11:18608. [PMID: 34545150 PMCID: PMC8452697 DOI: 10.1038/s41598-021-98042-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023] Open
Abstract
Although the surface of the human hands contains high antimicrobial activity, studies investigating the precise components involved and the relationship between natural antimicrobial activity and morbidity in infectious diseases are limited. In this study, we developed a method to quantitatively measure the antimicrobial activity of hand surface components. Using a clinical survey, we validated the feasibility of our method and identified antimicrobial factors on the surface of the human hand. In a retrospective observational study, we compared the medical histories of the participants to assess infectious diseases. We found that the antimicrobial activity on the surface of the hands was significantly lower in the high morbidity group (N = 55) than in the low morbidity group (N = 54), indicating a positive association with the history of infection in individuals. A comprehensive analysis of the hand surface components indicated that organic acids, especially lactic acid and antimicrobial peptides, are highly correlated with antimicrobial activity. Moreover, the application of lactic acid using the amount present on the surface of the hand significantly improved the antimicrobial activity. These findings suggest that hand hygiene must be improved to enhance natural antimicrobial activity on the surface of the hands.
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Affiliation(s)
- Yuki Nishioka
- Personal Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Kenichi Nagano
- Analytical Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, Tochigi, 321-3497, Japan
| | - Yoshitaka Koga
- Biological Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, Tochigi, 321-3497, Japan
| | - Yasuhiro Okada
- Personal Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Ichiro Mori
- Personal Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan
| | - Atsuko Hayase
- Biological Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, Tochigi, 321-3497, Japan
| | - Takuya Mori
- Biological Science Laboratories, Kao Corporation, 2606 Akabane, Ichikai, Haga, Tochigi, 321-3497, Japan
| | - Kenji Manabe
- Personal Health Care Products Research, Kao Corporation, 2-1-3, Bunka, Sumida-ku, Tokyo, 131-8501, Japan.
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Hayashi K, Mori I, Takeda K, Okada Y, Hayase A, Mori T, Nishioka Y, Manabe K. Analysis of hand environment factors contributing to the hand surface infection barrier imparted by lactic acid. Skin Res Technol 2021; 27:1135-1144. [PMID: 34532902 PMCID: PMC9293006 DOI: 10.1111/srt.13078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Organic acids on the surface of human hands contribute to the barrier against transient pathogens. This is the first study to explore the synergistic contribution of lactic acid and other hand environment-related features on the antibacterial properties of the hand surface. MATERIALS AND METHODS We estimated the contribution of fingerprint depth, skin pH, stratum corneum water content, skin temperature, and sweat rate of the hands to the infection barrier using an observational survey of 105 subjects. The relationship between each factor and the antibacterial activity of the hands was analyzed using Pearson's correlation coefficient. We performed molecular dynamics simulations to study the interaction between lactic acid and bacterial membranes. RESULTS The amount of lactic acid on the hands and skin temperature contributed positively to the antimicrobial activity (r = 0.437 and P = 3.18 × 10-6 , r = 0.500 and P = 5.66 × 10-8 , respectively), while the skin pH contributed negatively (r = -0.471, P = 3.99 × 10-7 ). The predicted value of the combined antimicrobial effect of these parameters was [antimicrobial activity] = 0.21 × [lactic acid] - 0.25 × [skin pH] + 0.26 × [skin temperature] + 0.98. The coefficient of determination (R2 ) was 0.50. CONCLUSION The increase in the amount of non-ionic lactic acid due to lower pH and improvement in the fluidity of the cell membrane due to higher temperatures enable the efficient transport of lactic acid into cells and subsequent antimicrobial activity. The proposed mechanism could help to develop an effective hand infection barrier technology.
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Affiliation(s)
- Kaori Hayashi
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
| | - Ichiro Mori
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
| | - Kouske Takeda
- Analytical Science Laboratories, Kao Corporation, Wakayama, Japan
| | - Yasuhiro Okada
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
| | - Atsuko Hayase
- Biological Science Laboratories, Kao Corporation, Tochigi, Japan
| | - Takuya Mori
- Biological Science Laboratories, Kao Corporation, Tochigi, Japan
| | - Yuki Nishioka
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
| | - Kenji Manabe
- Personal Health Care Products Research Laboratories, Kao Corporation, Tokyo, Japan
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Laher AE, Van Rooyen LR, Jawa A, Enyuma COA, Swartzberg KM. Compliance with hygiene practices among healthcare workers at an academic hospital emergency department. Afr J Emerg Med 2021; 11:352-355. [PMID: 34367895 PMCID: PMC8327483 DOI: 10.1016/j.afjem.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/25/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Healthcare-associated infections (HCAIs) are an important contributor to patient morbidity and mortality. Healthcare workers (HCWs) hands are the chief mode of transmission of HCAIs. The emergency centre (EC) is frequently the first point of contact for patients within the health care system. The aim of this study is to determine compliance with hygiene practices among healthcare workers at a tertiary hospital EC. Methods Hygiene practices of staff were observed over a six-week period. Data pertaining to compliance rates with hand cleansing and other hygiene practices was collected. Consent was obtained retrospectively to avoid influencing participant behaviour. Results From a total of 477 potential hygiene opportunities, compliance with hand hygiene was only 34.4% (n = 164). Hand cleansing with an alcohol-based hand rub was observed in 87 (26.7%) of the 326 (68.3%) opportunities where it was indicated, while handwashing with soap and water was observed in 35 (23.2%) of the 151 opportunities where this was indicated. Compliance to each of the six steps of handwashing ranged between 62.2% and 83.5%, with there being a gradual deterioration in compliance from step one through to step six. Compliance with ‘bare below the elbows’ was observed in 242 (50.7%) opportunities while disposable surgical gloves were worn on 85 (44.7%) of the 190 opportunities where this was indicated. Conclusion Compliance with hygiene practices among EC HCWs is suboptimal. Various strategies including ongoing systematic training and regular audits may improve overall hygiene practices among EC staff.
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Affiliation(s)
- Abdullah E. Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Corresponding author at: Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 5 Jubilee Road, Parktown, Johannesburg 2193, South Africa.
| | - Ljuba-Ruth Van Rooyen
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ali Jawa
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Callistus OA Enyuma
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Paediatrics, Faculty of Medicine, University of Calabar, Nigeria
| | - Kylen M. Swartzberg
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Chen CC, Lin YC, Wang ST, Huang CC. Temporal Trends of Acute Kidney Injury and Associated Risk Exposures in Extremely Preterm Infants. Clin J Am Soc Nephrol 2021; 16:1169-1177. [PMID: 34348930 PMCID: PMC8455040 DOI: 10.2215/cjn.19301220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Neonatal AKI in the preterm population is an under-recognized morbidity. Detecting AKI in preterm infants is important for their long-term kidney health. We aimed to examine the yearly trends of incidence and the related morbidities and care practices affecting the occurrence of neonatal AKI in extremely preterm (gestational age <29 weeks) and very preterm (gestational age 29-32 weeks) infants. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The trends and the related risk factors and care practices of AKI were examined in the extremely preterm (n=434) and very preterm (n=257) infants who were admitted within 14 days after birth from 2005 to 2018 to the University Hospital and had at least two serum creatinine measurements during hospitalization. We defined AKI as a serum creatinine rise of 0.3 mg/dl or more within 48 hours or a 1.5-fold increase within 7 days. RESULTS The extremely preterm group had a three-fold higher incidence of AKI (30% versus 10%) than the very preterm group. Among preterm infants with AKI, 92% had one episode of AKI, and 45% experienced stage 2 or 3 AKI; the mean duration of AKI was 12±9 days. Across the 14-year period, the crude incidence of AKI declined markedly from 56% to 17% in the extremely preterm group and from 23% to 6% in the very preterm group. After adjustment, a significant decline of AKI incidence was still observed in the extremely preterm group. The declining AKI in the extremely preterm infants was related to the trends of decreasing incidences of neonatal transfer, prolonged aminoglycoside exposure, prophylactic use of nonsteroidal anti-inflammatory drugs, and sepsis. CONCLUSIONS We observed a declining trend in the incidence of neonatal AKI among extremely preterm infants from 2005 to 2018, which may be related to improvement of care practices.
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Affiliation(s)
- Chih-Chia Chen
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan,Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yung-Chieh Lin
- Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan,Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shan-Tair Wang
- Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Division of Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan,Correspondence: Prof. Chao-Ching Huang, Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, North District, Tainan 70403, Taiwan.
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George J, Kurian L, Das S, Narayan P, Dutta N, Debasis D. Fixed Time Alarm Bell Technique as a Method to Improve Hand Hygiene Compliance. Indian J Community Med 2021; 46:334-335. [PMID: 34321758 PMCID: PMC8281842 DOI: 10.4103/ijcm.ijcm_268_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jins George
- Department of Cardiac Nursing, Narayana Superpeciality Hospital, Howrah, West Bengal, India
| | - Lijo Kurian
- Department of Cardiac Nursing, Narayana Superpeciality Hospital, Howrah, West Bengal, India
| | - Shubhadeep Das
- Department of Pediatric Intensive Care, Narayana Superpeciality Hospital, Howrah, West Bengal, India
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Nilanjan Dutta
- Department of Cardiac Surgery, Narayana Superpeciality Hospital, Howrah, West Bengal, India
| | - Das Debasis
- Department of Cardiac Surgery, Narayana Superpeciality Hospital, Howrah, West Bengal, India
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Lakkis C, Lian K, Napper G, Kiely PM. Infection control guidelines for optometrists 2007. Clin Exp Optom 2021; 90:434-44. [DOI: 10.1111/j.1444-0938.2007.00192.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Carol Lakkis
- Clinical Vision Research Australia, Carlton, Victoria, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, Victoria, Australia
| | - Ka‐yee Lian
- Clinical Vision Research Australia, Carlton, Victoria, Australia
- Melbourne Optometry Clinic, Victorian College of Optometry, Carlton, Victoria, Australia
| | - Genevieve Napper
- Melbourne Optometry Clinic, Victorian College of Optometry, Carlton, Victoria, Australia
| | - Patricia M Kiely
- Optometrists Association Australia, Carlton, Victoria, Australia
E‐mail:
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Aggarwal P, Muddasani S, Fleischer AB. Sanitation, Obesity, and Low Body Mass Index as Risk Factors for Bacterial Skin Infections. J Cutan Med Surg 2021; 25:293-297. [PMID: 33504194 DOI: 10.1177/1203475420988857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Bacterial skin infections can cause significant disability and can lead to mortality with inadequate treatment. OBJECTIVE To determine whether sanitation and body mass index (BMI) are statistically significant risk factors for the incidence and prognosis of bacterial skin infections. METHODS Country-level data regarding the age-standardized rates of incidence, prevalence, and years lived with disability (YLD) from bacterial skin infection per 100 000 persons from the Global Burden of disease dataset, and country-level data on age-standardized prevalence of obesity (BMI ≥30) and low BMI (BMI <18.5) from World Health Organization Global Health Observatory data repository were analyzed. Regression models were created to examine the effects of sanitation, obesity, and low BMI on the burden of bacterial skin infections. RESULTS The percentage of population using basic sanitation services was positively associated with incidence, prevalence, and YLD from bacterial skin infections (P < .05). After controlling for sanitation, in countries with more than 50% of the population using basic sanitation services, obesity was positively associated with incidence, prevalence, and YLD from bacterial skin infections (P < .05). In countries with less than or equal to 50% of the population using basic sanitation services, low BMI was positively associated with incidence, prevalence, and YLD from bacterial skin infections (P < .05). CONCLUSIONS Improving sanitation access in all countries, reducing the percentage of obese population in countries with good sanitation/hygiene techniques, and addressing malnutrition in countries with poor sanitation/hygiene techniques may help to reduce the burden of bacterial skin infections.
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Affiliation(s)
- Pushkar Aggarwal
- 12303 College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Suraj Muddasani
- 12303 College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Alan B Fleischer
- 12303 College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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12
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Singh G, Singh R. The practice of hand hygiene among undergraduate medical students. MGM JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.4103/mgmj.mgmj_93_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kashkoush A, Agarwal N, Ayres A, Novak V, Chang YF, Friedlander RM. Scrubbing technique and surgical site infections: an analysis of 14,200 neurosurgical cases. J Neurosurg 2020; 133:580-587. [PMID: 31200383 DOI: 10.3171/2019.3.jns1930] [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: 01/05/2019] [Accepted: 03/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The preoperative scrub has been shown to lower the incidence of surgical site infections (SSIs). Various scrubbing and gloving techniques exist; however, it is unknown how specific scrubbing technique influences SSI rates in neurosurgery. The authors aimed to assess whether the range of scrubbing practice in neurosurgery is associated with the incidence of SSIs. METHODS The authors conducted a retrospective review of a prospectively maintained database to identify all 90-day SSIs for neurosurgical procedures between 2012 and 2017 at one of their teaching hospitals. SSIs were classified by procedure type (craniotomy, shunt, fusion, or laminectomy). Surveys were administered to attending and resident physicians to understand the variation in scrubbing methods (wet vs dry, iodine vs chlorhexidine, single vs double glove). The chi-square followed by multivariate logistic regression analyses were utilized to identify independent predictors of SSI. RESULTS Forty-two operating physicians were included in the study (18 attending physicians, 24 resident physicians), who performed 14,200 total cases. Overall, SSI rates were 2.1% (296 SSIs of 14,200 total cases) and 2.0% (192 of 9,669 cases) for attending physicians and residents, respectively. Shunts were independently associated with an increased risk of SSI (OR 1.7 [95% CI 1.3-2.1]), whereas laminectomies were associated with a decreased SSI risk (OR 0.4 [95% CI 0.2-0.8]). Wet versus dry scrub (OR 0.9 [95% CI 0.6-1.4]), iodine versus chlorhexidine (OR 0.6 [95% CI 0.4-1.1]), and single- versus double-gloving (OR 1.1 [95% CI 0.8-1.4]) preferences were not associated with SSIs. CONCLUSIONS There is no evidence to suggest that perioperative infection is associated with personal scrubbing or gloving preference in neurosurgical procedures.
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Lin P, Zhu S, Huang Y, Li L, Tao J, Lei T, Song J, Liu D, Chen L, Shi Y, Jiang S, Liu Q, Xie J, Chen H, Duan Y, Xia Y, Zhou Y, Mei Y, Zhou X, Wu J, Fang M, Meng Z, Li H. Adverse skin reactions among healthcare workers during the coronavirus disease 2019 outbreak: a survey in Wuhan and its surrounding regions. Br J Dermatol 2020; 183:190-192. [PMID: 32255197 PMCID: PMC7262186 DOI: 10.1111/bjd.19089] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- P Lin
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
| | - S Zhu
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Y Huang
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - L Li
- Department of Infection Management, Peking University First Hospital, Beijing, China
| | - J Tao
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - T Lei
- Department of Dermatology and Venerology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - J Song
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - D Liu
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - L Chen
- Department of Dermatology, Wuhan First Hospital, Wuhan, Hubei, China
| | - Y Shi
- Department of Dermatology and Venerology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - S Jiang
- Department of Dermatology and Venerology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Q Liu
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - J Xie
- Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - H Chen
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Y Duan
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Y Xia
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Y Zhou
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Y Mei
- Department of Dermatology, Wuhan First Hospital, Wuhan, Hubei, China
| | - X Zhou
- Department of Dermatology, Wuhan First Hospital, Wuhan, Hubei, China
| | - J Wu
- Department of Dermatology, Wuhan First Hospital, Wuhan, Hubei, China
| | - M Fang
- Department of Dermatology, Xiaogan Central Hospital, Xiaogan, Hubei, China
| | - Z Meng
- Department of Dermatology, Renmin Hospital Hubei University of Medicine, Shiyan, Hubei, China
| | - H Li
- Department of Dermatology and Venerology, Peking University First Hospital, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China
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15
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Ahuja S, Pandey A. Assessing the effectiveness of structured teaching on knowledge of hand hygiene among healthcare workers. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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16
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Bingham J, Cartner TJ, Mays Suko PA, Leslie RA. Multifactor Assessment of Non-Antimicrobial Soap Performance. Open Forum Infect Dis 2019; 6:ofz151. [PMID: 31065561 PMCID: PMC6499895 DOI: 10.1093/ofid/ofz151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/19/2019] [Indexed: 11/17/2022] Open
Abstract
A non-antimicrobial soap was benchmarked against 2 reference soaps for microbial removal and skin compatibility, key factors in soap effectiveness and usage. The non-antimicrobial test soap removed more Staphylococcus aureus (P = .024) when applied to nonwetted hands and showed no difference in skin barrier function compared with the reference soaps (P = .736).
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Affiliation(s)
- James Bingham
- Research and Development, GOJO Industries, Inc., Akron, Ohio
| | - Todd J Cartner
- Research and Development, GOJO Industries, Inc., Akron, Ohio
| | | | - Rachel A Leslie
- Research and Development, GOJO Industries, Inc., Akron, Ohio
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17
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Burgess BA. Prevention and surveillance of surgical infections: A review. Vet Surg 2019; 48:284-290. [DOI: 10.1111/vsu.13176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 01/08/2019] [Accepted: 01/17/2019] [Indexed: 01/03/2023]
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18
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Gupta B, Kotia P, Gupta R, Sharma A, Raina K, Nissar I. Comparing the antimicrobial efficacy of different hand sanitizers: An In vitro Study. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2019. [DOI: 10.4103/jiaphd.jiaphd_97_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Mutters R, Warnes SL. The method used to dry washed hands affects the number and type of transient and residential bacteria remaining on the skin. J Hosp Infect 2018; 101:408-413. [PMID: 30537524 DOI: 10.1016/j.jhin.2018.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Widespread antibiotic resistance has led to fears that we are entering a post-antibiotic era and the relatively simple premise of hand washing to reduce transfer of bacteria and viruses has never been more important. Much of the emphasis has been on hand-washing technique, type of soap, and maintaining compliance but effective drying of the hands is just as important. AIM To compare the efficacy of drying washed hands with a jet air dryer or paper towels to remove transient bacterial contamination and to determine the effect on residential flora. METHODS Eighty volunteers were recruited. The entire surfaces of volunteers' hands were artificially contaminated with Escherichia coli before being washed and dried; then bacteria remaining on the skin were recovered and enumerated. In the second part of the study the number and types of bacteria comprising the natural flora remaining on washed and dried hands were determined. FINDINGS Significantly fewer transient and residential bacteria remained on the skin if hands were dried with a jet air dryer (P < 0.001). Drying hands with paper towels increased the number of resident bacteria, including potentially pathogenic species, released from the volunteers' skin, compared to a jet air dryer. CONCLUSION The number and types of bacteria remaining on washed hands were affected by the drying method. Hands dried with a jet air dryer harboured fewer viable bacteria, reducing the risk of infection transmission via touch. This could be especially important for healthcare workers who are constantly in contact with large numbers of vulnerable patients.
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Affiliation(s)
- R Mutters
- Institute for Medical Microbiology and Hygiene, Philipps University of Marburg, Marburg, Germany.
| | - S L Warnes
- Independent Scientific Writer, Southampton, UK
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20
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Alsagher MR, Soudah SA, Khsheba AE, Fadel SM, Dadiesh MA, Houme MA, Eshagroni AS, Alosta FF, Almsalaty SM. Hand Washing Before and After Applying Different Hand Hygiene Techniques in Places of Public Concern in Tripoli-Libya. Open Microbiol J 2018. [DOI: 10.2174/1874285801812010364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:Hand hygiene has being considered as one of the primary measures to improve standards and practice for hospital care and to minimize the transmission of nosocomial pathogens. There is substantial evidence that incidence of hospital acquired infections is reduced by applying hand antisepsis. Regarding hand hygiene and public concern, hand washing has revealed that 85% of the observed adults wash their hands after using public toilets.Objective:To compare the efficacy of hand rubbing with an alcohol based solution versus conventional hand washing with antiseptic and non-antiseptic soaps in reducing bacterial counts using different hand hygiene techniques.Methods:Ninety-three volunteers took part in this study; 57 from Tripoli Medical Center (TMC); 16 from school; 11 from bank; and 9 from office. All volunteers performed six hand hygiene techniques, immediately before and after a volunteer practice activity: hand washing with non-antiseptic soap for 10 and 30 second (s); hand washing with antiseptic soap for 10, 30 or 60 s; and alcohol-based hand rub. A total of 864 specimens were taken: 432 before and 432 after volunteer's hand hygiene. The fingertips of the dominant hand for each volunteer were pressed on to agar for culture before and after each hand hygiene technique. Plates were incubated at 37oC, and colony-forming units were counted after 48 hours and pathogenic bacteria were identified.Results:Results showed that 617 specimens (71.41%) were positive for bacterial growth. 301 (48.78%) were from TMC, 118 (19.12%) were from office; 107 (14.34%) were from school and 91 (14.75%) were from bank.Conclusion:Both antiseptic and non–antiseptic soaps did not work properly in reducing bacterial counts of worker’s hands at all places of study, but significantly improved by an application of alcohol based gel.
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21
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Tyagi M, Hanson C, Schellenberg J, Chamarty S, Singh S. Hand hygiene in hospitals: an observational study in hospitals from two southern states of India. BMC Public Health 2018; 18:1299. [PMID: 30482180 PMCID: PMC6257976 DOI: 10.1186/s12889-018-6219-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hand hygiene is a simple and low-cost measure to reduce healthcare associated infection yet it has always been a concern in low as well as high resource settings across the globe. Poor hand hygiene during intra-partum and newborn care may result in sepsis, which is a major cause of death among newborns and puts a financial burden on already strained health systems. METHODS We conducted non-participatory observations in newborn care units and labour rooms from secondary and tertiary level, public and private hospitals, as part of a baseline evaluation of a quality improvement collaborative across two southern states of India. We assessed hand hygiene compliance during examinations and common procedures, using tools adapted from internationally recommended checklists and World Health Organization's concept of five moments of hand hygiene. We assessed differences in compliance by type (public/private), level (secondary/tertiary) and case load (low/intermediate/high). Analysis was adjusted for clustering and weighted as appropriate. RESULTS We included 49 newborn care units (19 private, 30 public) and 35 labour rooms (5 private, 30 public) that granted permission. We observed 3661 contacts with newborns and their environment, 242 per-vaginal examinations and 235 deliveries. For the newborns, a greater proportion of contacts in private newborn units than public complied with all steps of hand hygiene (44% vs 12%, p < 0.001), and similarly in tertiary than secondary units (33% vs 12%, p < 0.001) but there was no evidence of a difference by case load of the facility (low load-28%; intermediate load-14%; high load- 24%, p = 0.246). The component with lowest compliance was glove usage where indicated (20%). For deliveries, hand hygiene compliance before delivery was universal in private facilities but seen in only about one-quarter of observations in public facilities (100% vs 27%, p = 0.012). Average overall compliance for hand-hygiene during per-vaginal examinations was 35% and we found no evidence of differences by type of facility. CONCLUSION Observed compliance with hand hygiene was low overall, although better in private than public facilities in both newborn units and labour rooms. Glove usage was a particular problem in newborn care units. TRIAL REGISTRATION Retrospectively registered with Clinical Trials Registry- India ( CTRI/2018/04/013014 ).
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Affiliation(s)
- Mukta Tyagi
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Swecha Chamarty
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
| | - Samiksha Singh
- Public Health Foundation, Kavuri Hills, Madhapur, Hyderabad 500081 India
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22
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Moureau NL, Marsh N, Zhang L, Bauer MJ, Larsen E, Mihala G, Corley A, Lye I, Cooke M, Rickard CM. Evaluation of Skin Colonisation And Placement of vascular access device Exit sites (ESCAPE Study). J Infect Prev 2018; 20:51-59. [PMID: 30719089 DOI: 10.1177/1757177418805836] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/14/2018] [Indexed: 01/08/2023] Open
Abstract
Background Skin microorganisms may contribute to the development of vascular access device (VAD) infections. Baseline skin microorganism type and quantity vary between body sites, yet there is little evidence to inform choice of VAD site selection. Objective To compare microorganisms present at different body sites used for VAD insertions and understand the effect of transparent dressings on skin microflora. Methods The ESCAPE observational study consisted of three phases: (1) skin swabs of four sites (mid-neck, base neck, chest, upper arm) from 48 hospital patients; (2) skin swabs of five body sites (mid-neck, base neck, chest, upper arm, lower arm) from 10 healthy volunteers; and (3) paired skin swabs (n = 72) under and outside of transparent dressings from 36 hospital patients (16 mid/base neck, 10 chest, upper arm). Specimens were cultured for 72 h, species identified and colony-forming units (CFU) counted. Ordinal logistic regression compared CFU categories between variables of interest. Results The chest and upper arm were significantly associated with fewer microorganisms compared to neck or forearm (odds ratio [OR] = 0.40, 95% confidence interval [CI] = 0.25-0.65, P < 0.05). CFU levels under transparent dressings were not significantly different from outside (OR = 0.57, 95% CI = 0.22-1.45). Staphylococci were predominant at all sites. Other significant (P < 0.05) predictors of higher CFU count included prolonged hospitalisation and medical/surgical patient status. Discussion Skin microorganism load was significantly lower at the upper arm or chest, compared to the mid- or base neck. This may impact VAD site selection and subsequent infection risk.
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Affiliation(s)
- Nancy L Moureau
- PICC Excellence, Inc., Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland (MHIQ), Griffith University, Brisbane, Australia
| | - Nicole Marsh
- Royal Brisbane and Women's Hospital, AVATAR, MHIQ, Griffith University, Brisbane, Australia
| | - Li Zhang
- AVATAR, MHIQ, Griffith University, Brisbane, Australia
| | | | - Emily Larsen
- AVATAR, MHIQ, Griffith University, Brisbane, Australia
| | - Gabor Mihala
- Centre for Applied Health Economics, MHIQ, Griffith University, Brisbane, Australia
| | - Amanda Corley
- AVATAR, MHIQ, Griffith University, Brisbane, Australia.,Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia
| | - India Lye
- AVATAR, MHIQ, Griffith University, Brisbane, Australia.,Critical Care Research Group, Prince Charles Hospital, Brisbane, Australia
| | - Marie Cooke
- AVATAR, MHIQ, Griffith University, Brisbane, Australia
| | - Claire M Rickard
- AVATAR, MHIQ, Griffith University, Brisbane, Australia.,Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Brisbane, Australia
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23
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Uzuner H, Karadenizli A, Er D, Osmani A. Investigation of the efficacy of alcohol-based solutions on adenovirus serotypes 8, 19 and 37, common causes of epidemic keratoconjunctivitis, after an adenovirus outbreak in hospital. J Hosp Infect 2018; 100:e30-e36. [DOI: 10.1016/j.jhin.2018.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022]
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24
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Identifying heterogeneity in the Hawthorne effect on hand hygiene observation: a cohort study of overtly and covertly observed results. BMC Infect Dis 2018; 18:369. [PMID: 30081843 PMCID: PMC6090841 DOI: 10.1186/s12879-018-3292-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 08/01/2018] [Indexed: 12/19/2022] Open
Abstract
Background Observation and feedback are core strategies of hand hygiene (HH) improvement. Direct overt observation is currently the gold standard method. Observation bias, also known as the Hawthorne effect, is a major disadvantage of this method. Our aim was to examine the variation of the Hawthorne effect on HH observation in different healthcare groups and settings. Methods A prospective cohort study was performed in a tertiary teaching hospital during a 15-month period. Up to 38 overt observers (82% nurses) and 93 covert observers (81% medical students) participated in HH observation. The HH events observed overtly were matched for occupation, department, observation time, and location with those observed covertly. The data of matched pairs were then analysed to detect possible Hawthorne effects on different variables. Results A total of 31,522 HH opportunities were observed (4581 overtly, 26,941 covertly). There were 3047 matched pairs after 1:1 matching of overt and covert observations. The overall HH compliance was higher with overt observation than with covert observation (78% vs. 55%, p < 0.001). The Hawthorne effect was nearly three times larger in nurses (30 percentage points) than in physicians (11 percentage points) and was significantly greater in outpatient clinics (41 percentage points) than in intensive care units (11 percentage points). The magnitude of the Hawthorne effect varied among healthcare worker occupations and observation locations (p values both < 0.001) but not among departments, observation times, or HH indications. Conclusions Heterogeneity in the Hawthorne effect may influence the interpretation of overt observations and prevent the correct identification of target populations with poor HH compliance. Therefore, directly observed HH compliance may not be an adequate performance indicator for infection control.
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25
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Greene C, Ceron NH, Eisenberg MC, Koopman J, Miller JD, Xi C, Eisenberg JN. Asymmetric transfer efficiencies between fomites and fingers: Impact on model parameterization. Am J Infect Control 2018; 46:620-626. [PMID: 29397229 DOI: 10.1016/j.ajic.2017.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) affect millions of patients every year. Pathogen transmission via fomites and healthcare workers (HCWs) contribute to the persistence of HAIs in hospitals. A critical parameter needed to assess risk of environmental transmission is the pathogen transfer efficiency between fomites and fingers. Recent studies have shown that pathogen transfer is not symmetric. In this study,we evaluated how the commonly used assumption of symmetry in transfer efficiency changes the dynamics of pathogen movement between patients and rooms and the exposures to uncolonized patients. METHODS We developed and analyzed a deterministic compartmental model of Acinetobacter baumannii describing the contact-mediated process among HCWs, patients, and the environment. We compared a system using measured asymmetrical transfer efficiency to 2 symmetrical transfer efficiency systems. RESULTS Symmetric models consistently overestimated contamination levels on fomites and underestimated contamination on patients and HCWs compared to the asymmetrical model. The magnitudes of these miscalculations can exceed 100%. Regardless of the model, relative percent reductions in contamination declined after hand hygiene compliance reached approximately 60% in the large fomite scenario and 70% in the small fomite scenario. CONCLUSIONS This study demonstrates how healthcare facility-specific data can be used for decision-making processes. We show that the incorrect use of transfer efficiency data leads to biased effectiveness estimates for intervention strategies. More accurate exposure models are needed for more informed infection prevention strategies.
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Antiseptic Agents Elicit Short-Term, Personalized, and Body Site-Specific Shifts in Resident Skin Bacterial Communities. J Invest Dermatol 2018; 138:2234-2243. [PMID: 29753031 DOI: 10.1016/j.jid.2018.04.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/09/2018] [Accepted: 04/23/2018] [Indexed: 01/19/2023]
Abstract
Despite critical functions in cutaneous health and disease, it is unclear how resident skin microbial communities are altered by topical antimicrobial interventions commonly used in personal and clinical settings. Here we show that acute exposure to antiseptic treatments elicits rapid but short-term depletion of microbial community diversity and membership. Thirteen subjects were enrolled in a longitudinal treatment study to analyze the effects of topical treatments (i.e., ethanol, povidone-iodine, chlorhexidine, and water) on the skin microbiome at two skin sites of disparate microenvironment: forearm and back. Treatment effects were highly dependent on personalized and body site-specific colonization signatures, which concealed community dynamics at the population level when not accounted for in this analysis. The magnitude of disruption was influenced by the identity and abundance of particular bacterial inhabitants. Lowly abundant members of the skin microbiota were more likely to be displaced, and subsequently replaced, by the most abundant taxa prior to treatment. Members of the skin commensal family Propionibactericeae were particularly resilient to treatment, suggesting a distinct competitive advantage in the face of disturbance. These results provide insight into the stability and resilience of the skin microbiome, while establishing the impact of topical antiseptic treatment on skin bacterial dynamics and community ecology.
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A Novel In Situ Simulation Intervention Used to Mitigate an Outbreak of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit. J Pediatr 2018; 194:22-27.e5. [PMID: 29217101 DOI: 10.1016/j.jpeds.2017.10.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe the successful implementation of an in situ simulation program to diagnose and correct latent safety threats in a level 4 neonatal intensive care unit (NICU) to mitigate a methicillin-resistant Staphylococcus aureus (MRSA) outbreak. STUDY DESIGN An investigational report describes a simulation intervention that occurred during a 4-month MRSA outbreak in a single-center, 46-bed, newly renovated level 4 NICU. The simulation program was developed for all NICU providers in which they were exposed to a 30-minute in situ human simulation intervention that included education, evaluation, and debriefing to resolve perceived or observed latent safety threats. The primary study outcome was improved hand hygiene compliance and an enhanced estimate of the culture of safety during a 6-month period. RESULTS A total of 99 healthcare providers including physicians, nurses, respiratory therapists, and environmental service workers completed the course. Before the simulation intervention, there were 18 patients colonized or infected with a single MRSA clone; after the intervention, there were no new episodes of colonization or infection. CONCLUSIONS An in situ, simulation-based intervention can counter threats to patient safety related to workflow and lapses in infection control practices and improve patient outcomes.
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28
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DalBen MF. Transmission-Based Precautions for Multidrug-Resistant Organisms: What to Prioritize When Resources Are Limited. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0143-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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How Does a Photocatalytic Antimicrobial Coating Affect Environmental Bioburden in Hospitals? Infect Control Hosp Epidemiol 2018; 39:398-404. [DOI: 10.1017/ice.2017.297] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUNDThe healthcare environment is recognized as a source for healthcare-acquired infection. Because cleaning practices are often erratic and always intermittent, we hypothesize that continuously antimicrobial surfaces offer superior control of surface bioburden.OBJECTIVETo evaluate the impact of a photocatalytic antimicrobial coating at near-patient, high-touch sites in a hospital ward.SETTINGThe study took place in 2 acute-care wards in a large acute-care hospital.METHODSA titanium dioxide-based photocatalytic coating was sprayed onto 6 surfaces in a 4-bed bay in a ward and compared under normal illumination against the same surfaces in an untreated ward: right and left bed rails, bed control, bedside locker, overbed table, and bed footboard. Using standardized methods, the overall microbial burden and presence of an indicator pathogen (Staphylococcus aureus) were assessed biweekly for 12 weeks.RESULTSTreated surfaces demonstrated significantly lower microbial burden than control sites, and the difference increased between treated and untreated surfaces during the study. Hygiene failures (>2.5 colony-forming units [CFU]/cm2) increased 2.6% per day for control surfaces (odds ratio [OR], 1.026; 95% confidence interval [CI], 1.009–1.043; P=.003) but declined 2.5% per day for treated surfaces (OR, 0.95; 95% CI, 0.925–0.977; P<.001). We detected no significant difference between coated and control surfaces regarding S. aureus contamination.CONCLUSIONPhotocatalytic coatings reduced the bioburden of high-risk surfaces in the healthcare environment. Treated surfaces became steadily cleaner, while untreated surfaces accumulated bioburden. This evaluation encourages a larger-scale investigation to ascertain whether the observed environmental amelioration has an effect on healthcare-acquired infection.Infect Control Hosp Epidemiol 2018;39:398–404
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30
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A framework for designing hand hygiene educational interventions in schools. Int J Public Health 2017; 63:251-259. [PMID: 29275443 DOI: 10.1007/s00038-017-1066-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 12/06/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Hygiene education appears to be the commonest school-based intervention for preventing infectious diseases, especially in the developing world. Nevertheless, there remains a gap in literature regarding a school-specific theory-based framework for designing a hand hygiene educational intervention in schools. We sought to suggest a framework underpinned by psychosocial theories towards bridging this knowledge gap. Furthermore, we sought to propound a more comprehensive definition of hand hygiene which could guide the conceptualisation of hand hygiene interventions in varied settings. METHODS Literature search was guided by a standardized tool and literature was retrieved on the basis of a predetermined inclusion criteria. Databases consulted include PubMed, ERIC, and EBSCO host (Medline, CINAHL, PsycINFO, etc.). Evidence bordering on a theoretical framework to aid the design of school-based hand hygiene educational interventions is summarized narratively. RESULTS School-based hand hygiene educational interventions seeking to positively influence behavioural outcomes could consider enhancing psychosocial variables including behavioural capacity, attitudes and subjective norms (normative beliefs and motivation to comply). CONCLUSIONS A framework underpinned by formalized psychosocial theories has relevance and could enhance the design of hand hygiene educational interventions, especially in schools.
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Dai D, Prussin AJ, Marr LC, Vikesland PJ, Edwards MA, Pruden A. Factors Shaping the Human Exposome in the Built Environment: Opportunities for Engineering Control. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:7759-7774. [PMID: 28677960 DOI: 10.1021/acs.est.7b01097] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The "exposome" is a term describing the summation of one's lifetime exposure to microbes and chemicals. Such exposures are now recognized as major drivers of human health and disease. Because humans spend ∼90% of their time indoors, the built environment exposome merits particular attention. Herein we utilize an engineering perspective to advance understanding of the factors that shape the built environment exposome and its influence on human wellness and disease, while simultaneously informing development of a framework for intentionally controlling the exposome to protect public health. Historically, engineers have been focused on controlling chemical and physical contaminants and on eradicating microbes; however, there is a growing awareness of the role of "beneficial" microbes. Here we consider the potential to selectively control the materials and chemistry of the built environment to positively influence the microbial and chemical components of the indoor exposome. Finally, we discuss research gaps that must be addressed to enable intentional engineering design, including the need to define a "healthy" built environment exposome and how to control it.
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Affiliation(s)
- Dongjuan Dai
- Via Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , Blacksburg Virginia 24061, United States
| | - Aaron J Prussin
- Via Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , Blacksburg Virginia 24061, United States
| | - Linsey C Marr
- Via Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , Blacksburg Virginia 24061, United States
| | - Peter J Vikesland
- Via Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , Blacksburg Virginia 24061, United States
| | - Marc A Edwards
- Via Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , Blacksburg Virginia 24061, United States
| | - Amy Pruden
- Via Department of Civil and Environmental Engineering, Virginia Polytechnic Institute and State University , Blacksburg Virginia 24061, United States
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Vandegrift R, Bateman AC, Siemens KN, Nguyen M, Wilson HE, Green JL, Van Den Wymelenberg KG, Hickey RJ. Cleanliness in context: reconciling hygiene with a modern microbial perspective. MICROBIOME 2017; 5:76. [PMID: 28705228 PMCID: PMC5513348 DOI: 10.1186/s40168-017-0294-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 06/28/2017] [Indexed: 05/04/2023]
Abstract
The concept of hygiene is rooted in the relationship between cleanliness and the maintenance of good health. Since the widespread acceptance of the germ theory of disease, hygiene has become increasingly conflated with sterilization. In reviewing studies across the hygiene literature (most often hand hygiene), we found that nearly all studies of hand hygiene utilize bulk reduction in bacterial load as a proxy for reduced transmission of pathogenic organisms. This treatment of hygiene may be insufficient in light of recent microbial ecology research, which has demonstrated that humans have intimate and evolutionarily significant relationships with a diverse assemblage of microorganisms (our microbiota). The human skin is home to a diverse and specific community of microorganisms, which include members that exist across the ecological spectrum from pathogen through commensal to mutualist. Most evidence suggests that the skin microbiota is likely of direct benefit to the host and only rarely exhibits pathogenicity. This complex ecological context suggests that the conception of hygiene as a unilateral reduction or removal of microbes has outlived its usefulness. As such, we suggest the explicit definition of hygiene as "those actions and practices that reduce the spread or transmission of pathogenic microorganisms, and thus reduce the incidence of disease."
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Affiliation(s)
- Roo Vandegrift
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - Ashley C. Bateman
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - Kyla N. Siemens
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - May Nguyen
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Energy Studies in Buildings Laboratory, Department of Architecture, University of Oregon, Eugene, OR USA
| | - Hannah E. Wilson
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - Jessica L. Green
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
| | - Kevin G. Van Den Wymelenberg
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Energy Studies in Buildings Laboratory, Department of Architecture, University of Oregon, Eugene, OR USA
| | - Roxana J. Hickey
- Biology and the Built Environment Center, University of Oregon, Eugene, OR USA
- Institute of Ecology and Evolution, Department of Biological Sciences, University of Oregon, Eugene, OR USA
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Ibeneme S, Maduako V, Ibeneme GC, Ezuma A, Ettu TU, Onyemelukwe NF, Limaye D, Fortwengel G. Hand Hygiene Practices and Microbial Investigation of Hand Contact Swab among Physiotherapists in an Ebola Endemic Region: Implications for Public Health. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5841805. [PMID: 28691027 PMCID: PMC5485314 DOI: 10.1155/2017/5841805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/13/2017] [Accepted: 04/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hand hygiene practices (HHP), as a critical component of infection prevention/control, were investigated among physiotherapists in an Ebola endemic region. METHOD A standardized instrument was administered to 44 randomly selected physiotherapists (23 males and 21 females), from three tertiary hospitals in Enugu, Nigeria. Fifteen participants (aged 22-59 years) participated in focus group discussions (FGDs) and comprised 19 participants in a subsequent laboratory study. After treatment, the palms/fingers of physiotherapists were swabbed and cultured, then incubated aerobically overnight at 37°C, and examined for microbial growths. An antibiogram of the bacterial isolates was obtained. RESULTS The majority (34/77.3%) of physiotherapists were aware of the HHP protocol, yet only 15/44.1% rated self-compliance at 71-100%. FGDs identified forgetfulness/inadequate HHP materials/infrastructure as the major barriers to HHP. Staphylococcus aureus were the most prevalent organisms, prior to (8/53.33%) and after (4/26.67%) HPP, while Pseudomonas spp. were acquired thereafter. E. coli were the most antibiotic resistant microbes but were completely removed after HHP. Ciprofloxacin and streptomycin were the most effective antibiotics. CONCLUSION Poor implementation of HPP was observed due to inadequate materials/infrastructure/poor behavioral orientation. Possibly, some HPP materials were contaminated; hence, new microbes were acquired. Since HPP removed the most antibiotic resistant microbes, it might be more effective in infection control than antibiotic medication.
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Affiliation(s)
- S. Ibeneme
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Clinical Trial Consortium University of Nigeria, Nsukka, Nigeria
- UNIRED Research Group, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
| | - V. Maduako
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - G. C. Ibeneme
- Department of Nursing Sciences, Faculty of Health Sciences & Technology, College of Medicine, University of Nigeria, Enugu Campus, Abakaliki, Ebonyi State, Nigeria
| | - A. Ezuma
- Department of Medical Rehabilitation, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Physiotherapy, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - T. U. Ettu
- National Open University of Nigeria, Owerri Study Centre, Owerri, Imo State, Nigeria
| | - N. F. Onyemelukwe
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - D. Limaye
- UNIRED Research Group, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
- German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
| | - G. Fortwengel
- UNIRED Research Group, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
- German UNESCO Unit on Bioethics, Fakultät III-Medien, Information und Design, Hochschule Hannover-University of Applied Sciences and Arts, Hannover, Germany
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White CG, Shinder FS, Shinder AL, Dyer DL. Reduction of Illness Absenteeism in Elementary Schools Using an Alcohol-free Instant Hand Sanitizer. J Sch Nurs 2016. [DOI: 10.1177/10598405010170050401] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hand washing is the most effective way to prevent the spread of communicable disease. The purpose of this double-blind, placebo-controlled study was to assess whether an alcohol-free, instant hand sanitizer containing surfactants, allantoin, and benzalkonium chloride could reduce illness absenteeism in a population of 769 elementary school children and serve as an effective alternative when regular soap and water hand washing was not readily available. Prior to the study, students were educated about proper hand washing technique, the importance of hand washing to prevent transmission of germs, and the relationship between germs and illnesses. Children in kindergarten through the 6th grade (ages 5–12) were assigned to the active or placebo hand-sanitizer product and instructed to use the product at scheduled times during the day and as needed after coughing or sneezing. Data on illness absenteeism were tracked. After 5 weeks, students using the active product were 33% less likely to have been absent because of illness when compared with the placebo group.
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Affiliation(s)
- Catherine G. White
- Catherine G. White, RN, BSN, is a district nurse at Los Alamitos
Unified School District in Los Alamitos, CA
| | - Fay S. Shinder
- Fay S. Shinder, RN, BSN, is with Woodward Laboratories, Inc., in
Los Alamitos, CA
| | | | - David L. Dyer
- David L. Dyer, PhD, is with Woodward Laboratories, Inc., in Los
Alamitos, CA
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O’Donoghue M, Ng SH, Suen LKP, Boost M. A quasi-experimental study to determine the effects of a multifaceted educational intervention on hand hygiene compliance in a radiography unit. Antimicrob Resist Infect Control 2016; 5:36. [PMID: 27777757 PMCID: PMC5070356 DOI: 10.1186/s13756-016-0133-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Whilst numerous studies have investigated nurses' compliance with hand hygiene and use of alcohol-based hand rub (ABHR), limited attention has been paid to these issues in allied health staff. Reports have linked infections to breaches in infection control in the radiography unit (RU). With advances in medical imaging, a higher proportion of patients come into contact with RU staff increasing the need for good hand hygiene compliance. This study aimed to evaluate effectiveness on compliance of an intervention to improve awareness of hand hygiene in the RU of a district hospital. METHODS A quasi-experimental study design including questionnaires assessing knowledge and attitudes of hand hygiene and direct observation of participants was used to evaluate an educational programme on hand hygiene of the RU of a large district hospital. All healthcare workers (HCW), comprising 76 radiographers, 17 nurses, and nine healthcare assistants (HCA), agreed to participate in the study. Of these, 85 completed the initial and 76 the post-test anonymous questionnaire. The hand hygiene compliance of all 102 HCW was observed over a 3-week period prior to and after the intervention. The 2-month intervention consisted of talks on hand hygiene and benefits of ABHR, provision of visual aids, wall-mounted ABHR dispensers, and personal bottles of ABHR. RESULTS Before the intervention, overall hand hygiene compliance was low (28.9 %). Post-intervention, compliance with hand hygiene increased to 51.4 %. This improvement was significant for radiographers and HCA. Additionally, knowledge and attitudes improved in particular, understanding that ABHR can largely replace handwashing and there is a need to perform hand hygiene after environmental contact. The increased use of ABHR allowed HCW to feel they had enough time to perform hand hygiene. CONCLUSIONS The educational intervention led to increased awareness of hand hygiene opportunities and better acceptance of ABHR use. The reduced time needed to perform hand rubbing and improved access to dispensers resulted in fewer missed opportunities. Although radiographers and other allied HCW make frequent contact with patients, these may be mistakenly construed as irrelevant with respect to healthcare associated infections. Stronger emphasis on hand hygiene compliance of these staff may help reduce infection risk.
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Affiliation(s)
- Margaret O’Donoghue
- The Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Suk-Hing Ng
- The Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Lorna KP Suen
- The Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Maureen Boost
- The Squina International Centre for Infection Control, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Zamani S, Sadeghi G, Yazdinia F, Moosa H, Pazooki A, Ghafarinia Z, Abbasi M, Shams-Ghahfarokhi M, Razzaghi-Abyaneh M. Epidemiological trends of dermatophytosis in Tehran, Iran: A five-year retrospective study. J Mycol Med 2016; 26:351-358. [PMID: 27520535 DOI: 10.1016/j.mycmed.2016.06.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Dermatophytosis is the most frequent fungal infection all over the world and its frequency is constantly increasing. The aim of this study was to evaluate clinical features and epidemiological trends of dermatophytosis over the years 2010 to 2014 in Tehran, Iran. PATIENTS AND METHODS A total of 13,312 patients clinically suspected of cutaneous fungal infections were examined. Skin scales, plucked hairs, nail clippings and sub-ungual debris were examined by direct microscopy and culture. Dermatophyte species were identified at the species level by a combination of morphological and physiological criteria. RESULTS Direct microscopy confirmed a contamination rate of 19.7% (2622/13,312 cases) of which 1535 cases (58.5%) were culture positive distributed in male (1022 cases) and female (513 cases). The most commonly infected age group was the 30-39 years old. Tinea pedis (30.4%) was the most prevalent type of dermatophytosis followed by tinea cruris (29.8%) and tinea corporis (15.8%). Epidermophyton floccosum (31%) was the most prevalent causative agent, followed by Trichophyton rubrum (26.2%) and Trichophyton mentagrophytes (20.3%). CONCLUSION Our results showed considerable distribution of dermatophytosis from zoophilic, anthropophilic and geophilic species among population with diverse age groups. Although anthropophilic fungi such as T. mentagrophytes, E. floccosum, and T. rubrum were the main etiologic agents of dermatophytosis, the prevalence of T. verrucosum showed a meaningful increase over the years, which highlights the importance of rural dermatophytosis mainly transmitted from large animals. This noticeable information improves our current knowledge about dermatophytosis and assists to establish effective prevention and therapeutic strategies to overcome the disease.
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Affiliation(s)
- S Zamani
- Department of Medical Mycology, Pasteur Institute of Iran, Tehran 13164, Iran
| | - G Sadeghi
- Department of Medical Mycology, Pasteur Institute of Iran, Tehran 13164, Iran
| | - F Yazdinia
- Department of Medical Mycology, Pasteur Institute of Iran, Tehran 13164, Iran
| | - H Moosa
- Department of Medical Mycology, Pasteur Institute of Iran, Tehran 13164, Iran
| | - A Pazooki
- Department of Medical Mycology, Pasteur Institute of Iran, Tehran 13164, Iran
| | - Z Ghafarinia
- Department of Medical Mycology, Pasteur Institute of Iran, Tehran 13164, Iran
| | - M Abbasi
- Department of Medical Mycology, Pasteur Institute of Iran, Tehran 13164, Iran
| | - M Shams-Ghahfarokhi
- Department of Medical Mycology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14115-331, Iran
| | - M Razzaghi-Abyaneh
- Department of Medical Mycology, Pasteur Institute of Iran, Tehran 13164, Iran.
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Lai KK, Fontecchio S, Melvin Z, Baker SP. Impact of Alcohol-Based, Waterless Hand Antiseptic on the Incidence of Infection and Colonization With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci. Infect Control Hosp Epidemiol 2016; 27:1018-24. [PMID: 17006807 DOI: 10.1086/507916] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2006] [Indexed: 11/03/2022]
Abstract
Objective:Colonized and infected inpatients are major reservoirs for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), and transient carriage of these pathogens on the hands of healthcare workers remains the most common mechanism of patient-to-patient transmission. We hypothesized that use of alcohol-based, waterless hand antiseptic would lower the incidence of colonization and/or infection with MRSA and VRE.Methods.On June 19, 2001, alcohol hand antiseptic was introduced at the University campus and not the nearby Memorial campus of the University of Massachusetts Medical School (Worcester, MA), allowing us to evaluate the impact of this antiseptic on the incidence of MRSA and VRE colonization and infection. From January 1 through December 31, 2001, the incidence of MRSA colonization or infection was compared between the 2 campuses before and after the hand antiseptic was introduced. Its effect on VRE colonization and infection was only studied in the medical intensive care unit at the University campus.Results.At the University campus, the incidence of MRSA colonization or infection decreased from 1.26 cases/1,000 patient-days before the intervention to 0.75 cases/1,000 patient-days after the intervention, for a 1.46-fold decrease (95% confidence interval, 1.04-2.58; P = .037). At the Memorial campus, the incidence of MRSA colonization or infection remained virtually unchanged, from 0.34 cases/1,000 patient-days to 0.49 cases/1,000 patient-days during the same period. However, a separate analysis of the University campus data that controlled for proximity to prevalent cases did not show a significant improvement in the rates of infection or colonization. The incidence of nosocomial VRE colonization or infection before and after the hand antiseptic decreased from 12.0 cases/1,000 patient-days to 3.0 cases/1,000 patient-days, a 2.25-fold decrease (P = .018). Compliance with rectal surveillance for detection of VRE was 86% before and 84% after implementation of the hand antiseptic intervention. The prevalences of VRE cases during these 2 periods were 25% and 29%, respectively (P = .017).Conclusions.Alcohol hand antiseptic appears to be effective in controlling the transmission of VRE. However, after controlling for proximity to prevalent cases (ie, for clustering), it does not appear to be more effective than standard methods for controlling MRSA. Further controlled studies are needed to evaluate its effectiveness.
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Affiliation(s)
- Kwan Kew Lai
- University of Massachusetts Medical School, Worcester, MA, USA.
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Gordin FM, Schultz ME, Huber RA, Gill JA. Reduction in Nosocomial Transmission of Drug-Resistant Bacteria After Introduction of an Alcohol-Based Handrub. Infect Control Hosp Epidemiol 2016; 26:650-3. [PMID: 16092747 DOI: 10.1086/502596] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To assess quantitatively the clinical impact of using an alcohol-based handrub (ABHR) in the hospital environment, measuring impact as the incidence of new, nosocomial isolates of drug-resistant organisms.Design:An observational survey from 1998 to 2003 comparing the first 3 years of no ABHR use with the 3 years following, when an ABHR was provided for hand hygiene.Setting:An inner-city, tertiary-care medical center.Intervention:At baseline, an antimicrobial soap with 0.3% triclosan was provided for staff hand hygiene. The intervention was placement in all inpatient and all outpatient clinic rooms of wall-mounted dispensers of an ABHR with 62.5% ethyl alcohol. Data were collected on change in the incidence of three drug-resistant bacteria.Results:During the 6 years of the survey, all new, nosocomially acquired isolates of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile-associated diarrhea were recorded. On comparison of the first 3 years with the final 3 years, there was a 21% decrease in new, nosocomially acquired MRSA (90 to 71 isolates per year; P = .01) and a 41% decrease in VRE (41 to 24 isolates per year; P < .001). The incidence of new isolates of C. difficile was essentially unchanged.Conclusion:In the 3 years following implementation of an ABHR, this hospital experienced the value of reductions in the incidence of nosocomially acquired drug-resistant bacteria. These reductions provide clinical validation of the recent CDC recommendation that ABHRs be the primary choice for hand decontamination. (Infect Control Hosp Epidemiol 2005;26:650-653)
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Affiliation(s)
- Fred M Gordin
- Veterans Affairs Medical Center, Washington, DC 20422, USA.
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Petlin A, Schallom M, Prentice D, Sona C, Mantia P, McMullen K, Landholt C. Chlorhexidine gluconate bathing to reduce methicillin-resistant Staphylococcus aureus acquisition. Crit Care Nurse 2016; 34:17-25; quiz 26. [PMID: 25274761 DOI: 10.4037/ccn2014943] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent organism causing substantial morbidity and mortality in intensive care units. Chlorhexidine gluconate, a topical antiseptic solution, is effective against a wide spectrum of gram-positive and gram-negative bacteria, including MRSA. Objectives To examine the impact of a bathing protocol using chlorhexidine gluconate and bath basin management on MRSA acquisition in 5 adult intensive care units and to examine the cost differences between chlorhexidine bathing by using the bath-basin method versus using prepackaged chlorhexidine-impregnated washcloths. METHODS The protocol used a 4-oz bottle of 4% chlorhexidine gluconate soap in a bath basin of warm water. Patients in 3 intensive care units underwent active surveillance for MRSA acquisition; patients in 2 other units were monitored for a new positive culture for MRSA at any site 48 hours after admission. RESULTS Before the protocol, 132 patients acquired MRSA in 34333 patient days (rate ratio, 3.84). Afterwards, 109 patients acquired MRSA in 41376 patient days (rate ratio, 2.63). The rate ratio difference is 1.46 (95% CI, 1.12-1.90; P = .003). The chlorhexidine soap and bath basin method cost $3.18 as compared with $5.52 for chlorhexidine-impregnated wipes (74% higher). CONCLUSIONS The chlorhexidine bathing protocol is easy to implement, cost-effective, and led to decreased unit-acquired MRSA rates in a variety of adult intensive care units.
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Affiliation(s)
- Ann Petlin
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.
| | - Marilyn Schallom
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Donna Prentice
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Carrie Sona
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Paula Mantia
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Kathleen McMullen
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
| | - Cassandra Landholt
- Ann Petlin is a clinical nurse specialist in the cardiothoracic intensive care unit at Barnes-Jewish Hospital, St Louis, Missouri.Marilyn (Lynn) Schallom is a clinical nurse specialist and research scientist in the Department of Research for Patient Care Services at Barnes-Jewish Hospital.Donna Prentice is a clinical nurse specialist in a medical intensive care unit at Barnes-Jewish Hospital.Carrie Sona is a clinical nurse specialist in the surgery/burns/trauma intensive care unit at Barnes-Jewish Hospital.Paula Mantia is the advanced practice nurse in a medical intensive care unit at Barnes-Jewish Hospital.Kathleen McMullen is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital.Cassandra (Casey) Landholt is an infection prevention specialist for the Department Hospital Epidemiology and Infection Prevention at Barnes-Jewish Hospital
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Infektionsschutz und spezielle Hygienemaßnahmen in klinischen Disziplinen. KRANKENHAUS- UND PRAXISHYGIENE 2016. [PMCID: PMC7152143 DOI: 10.1016/b978-3-437-22312-9.00005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spierings EJW, Spierings PTJ, Nabuurs-Franssen M, Hopman J, Perencevich E, Voss A. A cross-sectional observational study about media and infection control practices: are photographic portrayals of healthcare workers setting a bad example? Antimicrob Resist Infect Control 2015; 4:53. [PMID: 26613018 PMCID: PMC4660788 DOI: 10.1186/s13756-015-0094-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
Background Attempts to increase compliance with infection control practices are complex and are - in part - based on attempts to change behaviour. In particular, the behaviour of significant peers (role models) has been shown to be a strong motivator. While role models within the working environment are obviously the most important, some experts suggest that media and public display cannot be ignored. The aim of this present study was to examine the display of technique recommended by current infection control guidelines including the “bare below the elbow” principle, which is considered a basic requirement for good infection control in many countries, in sets of professional stock photos. Findings From 20 random photo-stock websites we selected pictures with search terms “doctor and patient” and “nurse and patient”. In all selected photos a doctor or nurse and a patient were presented, healthcare workers (HCWs) were wearing white coats or uniforms, and their arms were visible. Each photo was evaluated with regard to: closure of white coat, sleeve length, personal clothing covered, hairstyle and presence of a wristwatch, bracelet and/or ring. Overall, 1600 photos were evaluated. The most common mistakes were with regard to HCWs’ white coats/uniforms. Eighty-nine percent of the photos containing doctor’s images were considered incorrect while 28 % of nurse-containing photos were incorrect. Conclusions The results seem to reflect the real world with only 40 % displaying correct behaviour with doctors being worse than nurses. It seems that the stereotypical image of a doctor does not agree with the current infection control guidelines. If we aim for higher compliance rates of HCWs, we need to change the social image of doctors and improve production, selection and display of stock photo images.
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Affiliation(s)
- E J W Spierings
- Radboud University of Nijmegen, Medical School, Platolaan 340, 6525 KD Nijmegen, The Netherlands
| | | | - M Nabuurs-Franssen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - J Hopman
- Department of Medical Microbiology, Radboud University of Nijmegen, Nijmegen, The Netherlands
| | - E Perencevich
- Division of Infectious Diseases and Epidemiology, University of Iowa Hospital and Clinics, Iowa City, IA USA
| | - A Voss
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands ; Department of Medical Microbiology, Radboud University of Nijmegen, Nijmegen, The Netherlands
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Edmonds-Wilson SL, Nurinova NI, Zapka CA, Fierer N, Wilson M. Review of human hand microbiome research. J Dermatol Sci 2015; 80:3-12. [DOI: 10.1016/j.jdermsci.2015.07.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 01/14/2023]
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Cummings KL, Anderson DJ, Kaye KS. Hand Hygiene Noncompliance and the Cost of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection. Infect Control Hosp Epidemiol 2015; 31:357-64. [DOI: 10.1086/651096] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.Hand hygiene noncompliance is a major cause of nosocomial infection. Nosocomial infection cost data exist, but the effect of hand hygiene noncompliance is unknown.Objective.To estimate methicillin-resistant Staphylococcus aureus (MRSA)-related cost of an incident of hand hygiene noncompliance by a healthcare worker during patient care.Design.Two models were created to simulate sequential patient contacts by a hand hygiene-noncompliant healthcare worker. Model 1 involved encounters with patients of unknown MRSA status. Model 2 involved an encounter with an MRSA-colonized patient followed by an encounter with a patient of unknown MRSA status. The probability of new MRSA infection for the second patient was calculated using published data. A simulation of 1 million noncompliant events was performed. Total costs of resulting infections were aggregated and amortized over all events.Setting.Duke University Medical Center, a 750-bed tertiary medical center in Durham, North Carolina.Results.Model 1 was associated with 42 MRSA infections (infection rate, 0.0042%). Mean infection cost was $47,092 (95% confidence interval [CI], $26,040–$68,146); mean cost per noncompliant event was $1.98 (95% CI, $0.91–$3.04). Model 2 was associated with 980 MRSA infections (0.098%). Mean infection cost was $53,598 (95% CI, $50,098–$57,097); mean cost per noncompliant event was $52.53 (95% CI, $47.73–$57.32). A 200-bed hospital incurs $1,779,283 in annual MRSA infection-related expenses attributable to hand hygiene noncompliance. A 1.0% increase in hand hygiene compliance resulted in annual savings of $39,650 to a 200-bed hospital.Conclusions.Hand hygiene noncompliance is associated with significant attributable hospital costs. Minimal improvements in compliance lead to substantial savings.
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Dedrick RE, Sinkowitz-Cochran RL, Cunningham C, Muder RR, Perreiah P, Cardo DM, Jernigan JA. Hand Hygiene Practices After Brief Encounters With Patients: An Important Opportunity for Prevention. Infect Control Hosp Epidemiol 2015; 28:341-5. [PMID: 17326027 DOI: 10.1086/510789] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 04/26/2006] [Indexed: 11/03/2022]
Abstract
Objective.To identify characteristics of encounters between healthcare workers (HCWs) and patients that correlated with hand hygiene adherence among HCWs.Design.Observational study.Setting.Intensive care unit in a Veterans Affairs hospital.Participants.HCWs.Results.There were 767 patient encounters observed (48.6% involved nurses, 20.6% involved physicians, and 30.8% involved other HCWs); 39.8% of encounters involved patients placed under contact precautions. HCW contact with either the patient or surfaces in the patient's environment occurred during all encounters; direct patient contact occurred during 439 encounters (57.4%), and contact with environmental surfaces occurred during 710 encounters (92.6%). The median duration of encounters was 2 minutes (range, <1 to 51 minutes); 33.6% of encounters lasted 1 minute or less, with no significant occupation-associated differences in the median duration of encounters. Adherence with hand hygiene practices was correlated with the duration of the encounter, with overall adherences of 30.0% after encounters of ≤1 minute, 43.4% after encounters of >1 to ≤2 minutes, 51.1% after encounters of >3 to ≤5 minutes, and 64.9% after encounters of >5 minutes (P < .001 by the x2 for trend). In multivariate analyses, longer encounter duration, contact precautions status, patient contact, and nursing occupation were independently associated with adherence to hand hygiene recommendations.Conclusions.In this study, adherence to hand hygiene practices was lowest after brief patient encounters (ie, <2 minutes). Brief encounters accounted for a substantial proportion of all observed encounters, and opportunities for hand contamination occurred during all brief encounters. Therefore, improving adherence after brief encounters may have an important overall impact on the transmission of healthcare-associated pathogens and may deserve special emphasis in the design of programs to promote adherence to hand hygiene practices.
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Affiliation(s)
- Rebecca E Dedrick
- Prevention and Evaluation Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Conway LJ, Riley L, Saiman L, Cohen B, Alper P, Larson EL. Implementation and Impact of an Automated Group Monitoring and Feedback System to Promote Hand Hygiene Among Health Care Personnel. Jt Comm J Qual Patient Saf 2014; 40:408-17. [DOI: 10.1016/s1553-7250(14)40053-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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AlGhamdi KM, AlHomoudi FA, Khurram H. Skin care: Historical and contemporary views. Saudi Pharm J 2014; 22:171-8. [PMID: 25061400 PMCID: PMC4099567 DOI: 10.1016/j.jsps.2013.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022] Open
Abstract
Primary prevention, specifically skin care, is an important principle in Islamic theology just as it is emphasized in contemporary medicine. Many skin diseases can be prevented by a proactive approach to skin care, such as proper hygiene and routine inspections, principles that are constantly highlighted in the Islamic literature. Islam promotes primary prevention of disease, including recommendations for skin care practices. The recommendations for skin care practices in Islamic teachings are analogous to current medical guidelines. Sun avoidance, which is recommended by Islam, is mandatory for diseases such as systemic lupus erythematosus, melasma and skin cancers. Skin care and hygiene practices are recommended in Islam and it is considered an important mechanism for reducing the transmission of infections in modern medicine. The body creases and hair are ideal sites for malicious infestations to grow. The practice of "Wudu" includes washing the hands, feet, and hair with clean water. It is an indispensible part of daily prayers which is mandatory for every Muslim. Oral hygiene is also an integral part of both preventive medicine and Islamic teachings. Genital hygiene, particularly after urination and defecation, is recommended in Islamic teachings and is known to prevent urinary and vaginal infections in contemporary medicine. Male circumcision is an Islamic practice. Recently, it was proven that circumcised men are less likely to have sexually transmitted diseases, including HIV. This paper reviews skin care from an Islamic perspective and its relevance to contemporary medicine by translating the simple self care principles into practical guidelines in everyday use.
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Affiliation(s)
- Khalid M. AlGhamdi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad A. AlHomoudi
- Deanship of Academic Research, Imam University, Riyadh, Saudi Arabia
- Princess Noura bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Huma Khurram
- Vitiligo Research Chair, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Salmon S, Truong AT, Nguyen VH, Pittet D, McLaws ML. Health care workers' hand contamination levels and antibacterial efficacy of different hand hygiene methods used in a Vietnamese hospital. Am J Infect Control 2014; 42:178-81. [PMID: 24360520 DOI: 10.1016/j.ajic.2013.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/17/2013] [Accepted: 07/17/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Handwashing with soap or another antisepsis disinfectant solution is a common practice in Vietnam, but the availability and quality of tap water is unpredictable. We assessed the risk for hand contamination and compared the efficacy of 5 hand hygiene methods in a tertiary Vietnamese hospital. METHODS Five fingertip imprints of the dominant hand of 134 health care workers (HCWs) were sampled to establish the average bacterial count before and after hand hygiene action using (1) alcohol-based handrub (ABHR), (2) plain soap and water handwashing with filtered and unfiltered water, or (3) 4% chlorhexidine gluconate hand antisepsis with filtered and unfiltered water. RESULTS Average bacterial contamination of hands before hand hygiene was 1.65 log(10). Acinetobacter baumannii, Klebsiella pneumoniae, and Staphylococcus aureus were the most commonly isolated bacterial pathogens. The highest average count before hand hygiene was recovered from HCWs without direct patient contact (2.10 ± 0.11 log(10)). Bacterial counts were markedly reduced after hand hygiene with ABHR (1.4 log(10); P < .0001) and 4% chlorhexidine gluconate with filtered water (0.8 log(10); P < .0001). Use of unfiltered water was associated with minimal nonsignificant bacterial reduction. CONCLUSIONS HCWs carry high levels of bacteria on their dominant hand, even without direct patient contact. ABHR as an additional step may overcome the effect of high bacterial counts in unfiltered water when soap and water handwashing is indicated.
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Affiliation(s)
- Sharon Salmon
- UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Anh Thu Truong
- Department of Infection Control, Bach Mai Hospital, Hanoi, Vietnam
| | - Viet Hung Nguyen
- Department of Infection Control, Bach Mai Hospital, Hanoi, Vietnam
| | - Didier Pittet
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Vincent JL, Chierego M, Struelens M, Byl B. Infection control in the intensive care unit. Expert Rev Anti Infect Ther 2014; 2:795-805. [PMID: 15482241 DOI: 10.1586/14789072.2.5.795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Nosocomial infections are common in many hospital departments, but particularly so on the intensive care unit, where they affect some 20 to 30% of patients. While early diagnosis and appropriate treatment are, of course, important, perhaps the greatest challenge is in the application of techniques to limit the development of such infections. This review will briefly discuss some of the background pathophysiology and epidemiology of nosocomial infection, and then focus on general and infection-specific preventative strategies individually and as part of broader infection-control programs with infection surveillance.
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Affiliation(s)
- Jean-Louis Vincent
- Free University of Brussels, Department of Intensive Care, Erasme Hospital, Brussels, Belgium.
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Figueiredo AE, de Siqueira SL, Poli-de-Figueiredo CE, d'Avila DO. Hand hygiene in peritoneal dialysis patients: a comparison of two techniques. Perit Dial Int 2013; 33:655-61. [PMID: 24179108 PMCID: PMC3862095 DOI: 10.3747/pdi.2012.00298] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/30/2013] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Hand hygiene is essential for preventing peritoneal dialysis (PD)-related infections. The present study compared the effectiveness of two hygiene techniques in reducing the number of colony-forming units (CFUs) on the hands of patients undergoing PD. METHODS In this controlled clinical trial, 22 participants enrolled in the same PD program underwent a two-hand evaluation for microbiologic flora. Participants participated in two treatments: a) simple hand hygiene plus antiseptic hand hygiene, in which the patients washed their hands with water and glycerin soap for 1 minute and then rubbed and dried their hands with 70% ethyl alcohol gel; and b) antiseptic hand hygiene, in which the patients rubbed their hands with 70% ethyl alcohol gel until fully dry. To sample distal finger surfaces, we asked the participants to touch sheep blood agar plates directly. RESULTS The CFU count for both hands was significantly higher in the regular hygiene group than in the gel-only group [69.0 (16.0 - 101.0) CFU vs 9.0 (2.2 - 55.5) CFU, p < 0.010]. Growth of coagulase-negative Staphylococcus colonies was significantly higher in right-hand cultures from the regular hygiene group than in those from the gel-only group [69.5 (26.25 - 101.0) CFU vs 9.5 (1.0 - 41.7) CFU; p < 0.050]. CONCLUSIONS Among patients undergoing PD, using 70% ethyl alcohol gel to cleanse the hands may be more effective than following the regular hygiene recommendations in reducing bacterial populations.
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Affiliation(s)
- Ana Elizabeth Figueiredo
- School of Nursing, Physiotherapy and Nutrition,1 and Postgraduate Program in Medicine and Health Sciences, School of Medicine,2 Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
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Boog MC, Erasmus V, de Graaf JM, van Beeck E(AHE, Melles M, van Beeck EF. Assessing the optimal location for alcohol-based hand rub dispensers in a patient room in an intensive care unit. BMC Infect Dis 2013; 13:510. [PMID: 24171702 PMCID: PMC3826999 DOI: 10.1186/1471-2334-13-510] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 10/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of alcohol-based hand rub dispensers has had a positive influence on compliance of healthcare workers with the recommended guidelines for hand hygiene. However, establishing the best location for alcohol-based hand rub dispensers remains a problem, and no method is currently available to optimize the location of these devices. In this paper we describe a method to determine the optimal location for alcohol-based hand rub dispensers in patient rooms. METHODS We composed a method that consists of a combination of qualitative and quantitative research methods. Firstly, different arrangements of dispensers were determined based on the results of two types of assessment: workflow observations and interviews with nurses and physicians. Each arrangement was then evaluated using two types of assessment: interviews with nurses and physicians and electronic measurements of the user frequency of the dispensers. This procedure was applied in a single-bed patient room on a thoracic surgery intensive care unit. RESULTS The workflow observations revealed that the activities of patient care were most often at the entrance and near the computer at the right side of the test room. Healthcare workers stated that the location of the dispenser should meet several requirements. Measurements of the frequency of use showed that the dispenser located near the computer, at the back of the room, was used less frequently than the dispenser located near the sink and the dispenser located at the entrance to the room. CONCLUSION The applied method has potential for determining the optimal location for alcohol-based hand rub dispensers in a patient room. Workflow observations and the expressed preferences of healthcare workers guide the choice for the location of alcohol-based hand rub dispensers. These choices may be optimized based on measurement of the frequency of use of the dispensers.
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Affiliation(s)
- Matthijs C Boog
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Vicki Erasmus
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Jitske M de Graaf
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Elise (A) HE van Beeck
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, 2628CE Delft, The Netherlands
| | - Ed F van Beeck
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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