1
|
AlBahrani S, Saad M, Alqahtani JS, Almoosa Z, Alabdulla M, Algezery M, AlShehri S, Al-Tawfiq JA. Multicomponent Approaches to Reduce Multidrug-Resistant Organisms in Critical Care: Determining the Ideal Strategy. J Epidemiol Glob Health 2024:10.1007/s44197-024-00297-3. [PMID: 39347929 DOI: 10.1007/s44197-024-00297-3] [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: 09/18/2023] [Accepted: 09/02/2024] [Indexed: 10/01/2024] Open
Abstract
Although there is ample proof of the advantages of infection prevention and Control (IPC) in acute-care hospitals, there is still some questions about the efficacy of IPC interventions for multidrug-resistant organisms (MDROs), and there is a need for the development of evidence-based practices. No healthcare facility has found a single effective technique to reduce MDRO. However, a multicomponent intervention that included improved barrier protection, chlorhexidine bathing, microbiological monitoring, and staff involvement significantly decreased the likelihood of infection in the patient surroundings with multidrug-resistant organisms. A practical strategy suited to reducing the burden of MDROs and their transmission potential in the critical care unit must be established in light of the global development of AMR. In this review, we summarize key findings of a multicomponent approaches to reduce MDROs in critical care units.
Collapse
Affiliation(s)
- Salma AlBahrani
- Infectious Disease Unit, Specialty Internal Medicine, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
- College of medicine-Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mustafa Saad
- Department of Infection Control, Alhasa, Saudi Arabia
- Infectious Disease Department, Almoosa specialist Hospital, Alhasa, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Zainab Almoosa
- Infectious Disease Department, Almoosa specialist Hospital, Alhasa, Saudi Arabia
| | - Mohammed Alabdulla
- Infectious Disease Department, Almoosa specialist Hospital, Alhasa, Saudi Arabia
| | - Mohammed Algezery
- Infection control Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Sondos AlShehri
- Quality Department, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Accreditation and Infection Control Division, Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia.
| |
Collapse
|
2
|
Teo YX, Lee SX, White IR, McFadden JP. Irritant hand dermatitis to alcohol hand sanitisers in healthcare workers: Possible role of alcohol metabolism polymorphisms. Contact Dermatitis 2024; 90:317-320. [PMID: 38086342 DOI: 10.1111/cod.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 02/13/2024]
Affiliation(s)
- Ying X Teo
- Department of Cutaneous Allergy, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shan X Lee
- Department of Dermatology, Changi General Hospital, Singapore, Singapore
| | - Ian R White
- Department of Cutaneous Allergy, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John P McFadden
- Department of Cutaneous Allergy, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| |
Collapse
|
3
|
Velardo F, Péfau M, Nasso R, Parneix P, Venier AG. Using patients' observations to evaluate healthcare workers' alcohol-based hand rub with Pulpe'friction audits: a promising approach? GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc29. [PMID: 38111599 PMCID: PMC10726723 DOI: 10.3205/dgkh000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Background Hand hygiene plays an important role in the transmission of nosocomial infections from healthcare workers (HCW) to patients. Patients could play a key role in improving hand hygiene by sharing their experience of the HCW's practices. Already in 2019, the French national mission of transversal support for actions to prevent healthcare-associated infections proposed the national "Pulpe'friction" audit, to assess HCW's reported practices, social representations, and barriers to using alcohol-based hand rubs (ABHR). This audit consisted of a positive discussion between an auditor and the HCW as well as patients, which led the HCW to declare their real practices and the barriers they faced in the field and the patients to report about the HCW's ABHR practices and the information they received about when they should perform hand hygiene. Objective To assess whether an association existed between HCW's reported ABHR compliance and patients' declarations about HCW's compliance in the Pulpe'friction audit data. Methods Data from Pulpe'friction were collected from 1st January to 31st December 2019, before the COVID-19 pandemic. Mixed linear models were performed to analyze the association between self-reporting by HCW and patients, regarding hand rubs performed by HCW prior to patient care. Results There was a positive association between patients' observations and HCW's declared practices regarding the frequency of with which professionals performed hand rubs before patient contact. This indicates that professional and patient statements show the same tendency. The positive association was found in hospitals for patients under 45 and over 64 years old and for paramedics, but not for physicians and not in nursing homes or long-term care facilities. Patients felt more motivated to observe and evaluate HCWs' practices if they had received information about how to correctly wash their hands. Conclusion Patients agreed to be involved in the evaluation or professional practices. The patients' observations were positively associated with HCWs reports. New indicators taking patients' observations into account could be interesting.
Collapse
Affiliation(s)
- Fanny Velardo
- Center for Prevention of Healthcare Associated Infections of Nouvelle Aquitaine, CPias Nouvelle-Aquitaine, Bordeaux, France
| | - Muriel Péfau
- Center for Prevention of Healthcare Associated Infections of Nouvelle Aquitaine, CPias Nouvelle-Aquitaine, Bordeaux, France
| | - Raymond Nasso
- Center for Prevention of Healthcare Associated Infections of Guadeloupe, CPias Iles de Guadeloupe, Pointe-à-Pitre, France
| | - Pierre Parneix
- Center for Prevention of Healthcare Associated Infections of Nouvelle Aquitaine, CPias Nouvelle-Aquitaine, Bordeaux, France
| | - Anne-Gaëlle Venier
- Center for Prevention of Healthcare Associated Infections of Nouvelle Aquitaine, CPias Nouvelle-Aquitaine, Bordeaux, France
| |
Collapse
|
4
|
Boyce JM. Current issues in hand hygiene. Am J Infect Control 2023; 51:A35-A43. [PMID: 37890952 DOI: 10.1016/j.ajic.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Multiple aspects of hand hygiene have changed in recent years. METHODS A PubMed search was conducted to identify recent articles about hand hygiene. RESULTS The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. CONCLUSIONS Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
Collapse
Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
| |
Collapse
|
5
|
Selam MN, Habte BM, Marew T, Bitew M, Getachew T, Getachew S, Abate A, Mitiku M, Matsabisa M, Birhanu G. Evaluation of quality and antimicrobial efficacy of locally manufactured alcohol-based hand sanitizers marketed in Addis Ababa, Ethiopia in the era of COVID-19. Antimicrob Resist Infect Control 2022; 11:126. [PMID: 36209192 PMCID: PMC9547578 DOI: 10.1186/s13756-022-01163-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has been rapidly spreading across the globe since the World Health Organization (WHO) has declared the disease outbreak as a global pandemic on March 11, 2020. Hand hygiene, via either regular handwashing with soap and water or using hand sanitizers, is among the various measures that need to be followed to control the outbreak of the disease. Alcohol-based hand sanitizers (ABHS) are the "gold standard" for hand disinfection because of their broad antimicrobial spectrum of activity, easy availability, better safety profile, and general acceptability to users. This study aimed at evaluating the physicochemical quality and antimicrobial efficacy of the locally manufactured ABHS marketed in Addis Ababa, Ethiopia. METHODS A cross-sectional survey was used to collect ABHS from Addis Ababa marketplaces. A total of 25 sample products were randomly selected from different categories of hand sanitizer manufacturers. The physicochemical evaluation of the products was carried out as per the United States Pharmacopoeia and WHO standards. Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Staphylococcus aureus, Salmonella spp., and Shigella spp clinical isolates were used for the antimicrobial efficacy test. RESULTS The Fourier Transform Infrared result confirmed that all the test products met the identification test for ethanol. The majority (68%) of ABHS complied with the test for ethanol content (75-85% v/v). However, only 3 products fulfilled the hydrogen peroxide content (0.112-0.137% v/v). LPC307 showed the maximum zone of inhibition of 12 mm against Escherichia coli whereas MPC204 exhibited only 3 mm. LPC101 was found to be more sensitive to Shigella and Klebsiella Spp with minimum inhibitory concentration values of 20% and 10%, respectively. The sample product LPC101 showed a minimum bactericidal concentration of 20% against Escherichia coli, Pseudomonas aeruginosa, and Klebsiella spp. CONCLUSION One-third of the tested ABHS did not comply with the WHO ethanol content limit and the majority of the products failed to meet the label claim for hydrogen peroxide content. Besides, nearly all products proved that they have activity against all the tested pathogenic microorganisms at a minimum concentration from 10 to 80%; though, they did not show 99.9% bacteriostatic or bactericidal activities as claimed. The study findings suggested regular monitoring of the quality of marketed ABHS considering the current wide use of these products.
Collapse
Affiliation(s)
- Muluken Nigatu Selam
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Bruck Messele Habte
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Tesfa Marew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia
| | - Molalegne Bitew
- Bio and Emerging Technology Institute, Addis Ababa, Ethiopia
| | - Tigist Getachew
- Bio and Emerging Technology Institute, Addis Ababa, Ethiopia
| | | | - Atlaw Abate
- Ethiopian Food and Drug Authority, Addis Ababa, Ethiopia
| | - Mequanint Mitiku
- Department of Medical Laboratory, Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Motlalepula Matsabisa
- Department of Pharmacology, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300, South Africa
| | - Gebremariam Birhanu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, P.O. Box 1176, Addis Ababa, Ethiopia.
- Department of Pharmacology, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300, South Africa.
| |
Collapse
|
6
|
Saveanu CI, Anistoroaei D, Todireasa S, Saveanu AE, Bobu LI, Bamboi I, Boronia O, Balcos C. Evaluation of the Efficiency of Hand Hygiene Technique with Hydroalcoholic Solution by Image Color Summarize. Medicina (B Aires) 2022; 58:medicina58081108. [PMID: 36013575 PMCID: PMC9413243 DOI: 10.3390/medicina58081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The HH (hand hygiene) technique is relatively simple. Even so, in practice there are still non-conformities regarding this aspect. Lack of knowledge or lack of compliance can be reasons for non-adherence with HH techniques. In this context, the purpose of this study was to follow the realization of the hand-washing technique with hydroalcoholic solution, applied before and after receiving the HH recommendations. Materials and Methods: A descriptive, cross-sectional study was conducted from May 2022 to June 2022. Students from a second year dental medicine class teaching in French 2021/22 “Grigore T. Popa” University of Medicine and Pharmacy in Iasi were included in the study. The approval of the ethics commission was received: No. 184/05.05.2022. The study was conducted in two stages. In the first stage, HH was performed without any recommendation. In the second stage, the antiseptic hand rubbing technique was presented following the WHO recommendations. The fluorescent Fluo-Add solution, Wood lamp for dermatology (4 × 5.5 W ultraviolet tubes with a wavelength of 360 nm), and photo camera were used. Subjects performed their HH movement before and after receiving instructions according to WHO. Images were initially taken from the backhand and palm and were finally analyzed with Image Color Summarizer. The data were analyzed by the Mann–Whitney U Test, t-test paired samples using IBM-SPSS version 26 (IBM, Armonk, NY, USA), and p ≤ 0.05 was considered statistically significant. Results: After analyzing the images, there were 70 subjects, 45.7% (32) female and 54.33% (38) male. Final average covered area of backhand was 60.89% (±17.17), 28.84:86.11, compared to 52.07% (±17.04), 9:85.23. Final average covered area for palm was 69.91% (±13.5), 31.61:93.41 compared to 59.74% (±16.64), 26.13:92.72. No statistical significance was obtained by gender. Conclusions: The study showed an improvement in hand hygiene technique without highlighting gender differences.
Collapse
Affiliation(s)
| | - Daniela Anistoroaei
- Correspondence: (D.A.); (A.E.S.); Tel.: +40-721-377-269 (D.A.); +40-0755569120 (A.E.S.)
| | | | | | | | | | | | | |
Collapse
|
7
|
Yim HK, Moon S, Min JH. Response to the coronavirus disease 2019 pandemic of dental hygienists in South Korea-Part Ⅰ: Knowledge and practice of infection control. Int J Dent Hyg 2022; 20:580-589. [PMID: 35007394 DOI: 10.1111/idh.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/11/2021] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate infection control knowledge and its practice of clinical dental hygienists in response to Coronavirus Disease 2019 (COVID-19) in South Korea. METHODS Nine questions (Q9-K) on the degree of knowledge acquisition of dental hygienists in response to COVID-19, and another 9 questions (Q9-P) on the practices for COVID-19 infection and spread prevention were prepared. From 500 clinical dental hygienists in South Korea, answers about their general characteristics, Q9-K, and Q9-P were collected. 1 point was given to each question based on the 'yes' answers from Q9-K and Q9-P, and Score-K and Score-P were calculated, respectively. To identify factors affecting Score-P, a multiple linear regression analysis was performed. In all analyses, p-values lower than 0.05 were considered statistically significant. RESULTS Average scores of Score-K and Score-P were 7.36 ± 1.35 and 6.26 ± 2.07, respectively. The regression model of Score-P was significant (F = 20.788, p < 0.001). Concerning Score-P, Score-K (β = 0.385), age (β = 0.275), dental hospital (β = 0.158), monthly income of $2,360~$2,730 (β = 0.104) had a significantly positive correlation, and the total years of career (β = -0.293) are found to have a significantly negative correlation. CONCLUSIONS Infection control knowledge and practice of clinical dental hygienists in South Korea was found to be vulnerable in the group of hygienists who are younger than 27 years old, working in dental clinics, and whose monthly income is less than under $2,000. Also, the factor that influences infection control practice the most was the degree of knowledge. Therefore, continuous infection control education and supplement targeting these vulnerable groups are necessary.
Collapse
Affiliation(s)
- Hyun-Kyung Yim
- Department of Dental Hygiene, College of Medical and Health Sciences, Cheongju University, Cheongju, Korea
| | - Sook Moon
- Department of Dental Hygiene, Daejeon Health Institute of Technology, Daejeon, Korea
| | - Ji-Hyun Min
- Department of Dental Hygiene, College of Medical and Health Sciences, Cheongju University, Cheongju, Korea
| |
Collapse
|
8
|
Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
9
|
Biswas SS, Karmakar R. Determinants of hand-hygiene practices in India: reflections from the 76th round National Sample Survey, 2018. JOURNAL OF WATER AND HEALTH 2022; 20:68-82. [PMID: 35100155 DOI: 10.2166/wh.2021.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper studies the differences and determinants of handwashing practices in India and identifies sections of the population with poor handwashing practices who are relatively more vulnerable during the COVID-19 pandemic. We have used the data from the recent National Sample Survey (NSS, 76th round) for India (2018). Bivariate and logistic regression analyses have been performed to predict the determinants of handwashing practices across states and socio-economic groups. Levels of education of the household head, Usual Monthly Per Capita Expenditure (UMPCE) of the household, access to water (other than drinking water) resources and sanitation facilities, and the availability of water with soap in and around latrines are major socio-economic and demographic factors that impact handwashing practices. Higher access to principal sources of water for drinking and other purposes, access to bathrooms and latrines with soap, and the availability of water in or around latrines increase the likelihood of handwashing among the people. Universal handwashing across different sections of the population will be effective to prevent further infection. The available data help us to identify the vulnerable sections of the population which are towards the lower end of the handwashing compliance spectrum. The policymakers can outline specific planning and strategy implementation for them.
Collapse
Affiliation(s)
- Sonali Smriti Biswas
- Jawaharlal Nehru University, PhD Research Scholar, Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi 110067, India
| | - Ranjan Karmakar
- Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi 110067, India E-mail:
| |
Collapse
|
10
|
Sensitivity of SARS-CoV-2 towards Alcohols: Potential for Alcohol-Related Toxicity in Humans. Life (Basel) 2021; 11:life11121334. [PMID: 34947865 PMCID: PMC8708630 DOI: 10.3390/life11121334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 12/13/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative organism that is highly contagious and has been responsible for more than 240 million cases and 5 million deaths worldwide. Using masks, soap-based hand washing, and maintaining social distancing are some of the common methods to prevent the spread of the virus. In the absence of any preventive medications, from the outset of pandemic, alcohol-based hand sanitizers (ABHS) have been one of the first-line measures to control transmission of Coronavirus Disease 2019 (COVID-19). The purpose of this narrative review is to evaluate the sensitivity of SARS-CoV-2 towards ABHS and understand their potential adverse effects on humans. Ethanol and isopropanol have been the most commonly used alcohols in ABHS (e.g., gel, solution, spray, wipes, or foam) with alcohol in the range of 70–85% v/v in World Health Organization or Food and Drug Administration-approved ABHS. The denaturation of proteins around the envelope of SARS-CoV-2 positive sense single-stranded RNA virus is the major mechanism of action of ABHS. Due to frequent use of high-percentage alcohol-containing ABHS over an extended period of time, the oral, dermal, or pulmonary absorption is a possibility. In addition to the systemic toxicity, topical adverse effects such as contact dermatitis and atopic dermatitis are plausible and have been reported during COVID-19. ABHS appear to be effective in controlling the transmission of SARS-CoV-2 with the concern of oral, dermal, or pulmonary absorption.
Collapse
|
11
|
Curran NursD ET. What can the early infection preventing pioneers teach infection prevention and control teams today? Infect Dis Health 2021; 27:105-110. [PMID: 34862150 DOI: 10.1016/j.idh.2021.10.003] [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: 08/23/2021] [Revised: 10/02/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Puerperal fever and erysipelas were common Streptococcal infections of the 18th and 19th centuries which caused extensive nosocomial outbreaks. With dramatic clinical presentations and high-mortality, physicians struggled to understand and prevent them. Three infection prevention and control (IPC) pioneers (Gordon, Holmes and Semmelweis) in the pre-antibiotic and pre-epidemiology era made significant discoveries. Although much has been written of their breakthroughs, this has been selective and at times misinterpreted. METHODS The primary sources of the three IPC pioneers (1 translation) were reviewed to present 3 narratives of their discoveries. An interpretation of the pioneers' discoveries in the current context is provided. RESULTS The IPC pioneers' achievements are much wider than acknowledged in extant hand hygiene guidance - in relation to the role of indirect contact transmission (environment and equipment), e.g. Semmelweis considered the primary measure to prevent infection to be the avoidance of contamination - not hand hygiene. CONCLUSIONS The pioneers provided strong evidence of both direct and indirect transmission to significant 18th -19th century infections. They make a strong case for environment and equipment decontamination and cleanliness alongside decontaminating hands.
Collapse
Affiliation(s)
- Evonne T Curran NursD
- Honorary Senior Research Fellow - School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, G4 0BA, UK.
| |
Collapse
|
12
|
Calcagni N, Venier AG, Nasso R, Broc G, Ardichen E, Jarrige B, Parneix P, Quintard B. Barriers and facilitators on hand hygiene and hydro-alcoholic solutions' use: representations of health professionals and prevention perspectives. Infect Prev Pract 2021; 3:100169. [PMID: 34522880 PMCID: PMC8426555 DOI: 10.1016/j.infpip.2021.100169] [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: 03/31/2021] [Accepted: 08/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background Healthcare-associated infections pose a serious problem in terms of health and mortality. Their prevention is a necessity, and healthcare professionals are one of their main vectors. Thus, they must be at the centre of preventative strategies. As hydro-alcoholic solutions (alcohol-based hand rub) represent the most effective means of preventing these infections, it is necessary to identify the representations, barriers, and facilitators of their use. Method Forty-six healthcare professionals from two areas in France, New Aquitaine and Guadeloupe, were questioned about their practices through semi-structured registered interviews and four focus groups. Each interview and focus group were transcribed then analysed through lexicometric and thematic content analyses. Results The interviewed identified several barriers and facilitators related to the composition and characteristics of hydro-alcoholic solutions (unpleasantness, harmfulness, personal preferences for other hand hygiene products), personal factors (work habits, cognitive bias, lack of knowledge and communication) and organizational (professional constraints, product accessibility, financial resources). Conclusion Strategies to prevent healthcare-associated infections should be constructed with consideration of psychosocial facilitators and barriers for healthcare professionals in using hydro-alcoholic solutions. These strategies should also ensure that they are well informed about the effectiveness of alcohol-based solutions, through prevention campaigns and scientific articles. This awareness should equally be conveyed with educational tools that involve healthcare professionals and use the social dynamics of their work environment.
Collapse
Affiliation(s)
- Nicolas Calcagni
- INSERM U1219 équipe Handicap, Activité, Cognition, Santé, Université de Bordeaux, Bordeaux, F-33000, France
| | - Anne-Gaëlle Venier
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Raymond Nasso
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Iles de Guadeloupe, Pointe à Pitre, F-97100, France
| | - Guillaume Broc
- Unité Dynamique des capacités humaines et des conduites de santé, Université Paul-Valéry Montpellier 3, Montpellier, F-34000, France
| | - Eva Ardichen
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Bruno Jarrige
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Iles de Guadeloupe, Pointe à Pitre, F-97100, France
| | - Pierre Parneix
- Centre d'appui pour la prévention des Infections Associées aux Soins, CPias Nouvelle-Aquitaine, CHU de Bordeaux, Bordeaux, F-33000, France
| | - Bruno Quintard
- INSERM U1219 équipe Handicap, Activité, Cognition, Santé, Université de Bordeaux, Bordeaux, F-33000, France
| |
Collapse
|
13
|
Ramirez-Quizon M, Murrell DF. Managing epidermolysis bullosa during the coronavirus pandemic: Experience and ideals. Clin Dermatol 2021; 39:369-373. [PMID: 34517994 PMCID: PMC7849544 DOI: 10.1016/j.clindermatol.2021.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The 2019 novel coronavirus pandemic has tremendously affected health-seeking behaviors. Fear of contracting the disease has been a major factor keeping patients from presenting to hospitals, even when urgent or emergent medical attention is needed. Hospitals limiting staff exposure and capacity to accommodate patients also limits opportunities to seek care. Although physical distancing is encouraged to curb infections, this call needs to be tempered with public health education for what constitutes emergencies and urgent medical conditions needing face-to-face attention. Measures to assuage fears among patients and their caregivers to ensure their safety in the hospital or health care setting need to be communicated and executed effectively. Epidermolysis bullosa is an inherited mechanobullous disorder that is usually stable, but in some patients with underlying comorbidities, close monitoring or face-to-face management is required . We present our experience and provide recommendations pertinent to epidermolysis bullosa patients of all subtypes during the coronavirus crisis.
Collapse
Affiliation(s)
- Mae Ramirez-Quizon
- Department of Dermatology, University of the Philippines Manila-Philippine General Hospital, Manila, Philippines; Department of Dermatology, Rizal Medical Center, Pasig, Philippines; Department of Dermatology, St. Luke's Medical Center Global City, Taguig, Philippines
| | - Dédée F Murrell
- The George Institute for Global Health, Sydney, Australia; University of New South Wales, Sydney, Australia.
| |
Collapse
|
14
|
Abstract
Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.
Collapse
Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, 62 Sonoma Lane, Middletown, CT 06457, USA.
| |
Collapse
|
15
|
Mustafa R, Purdy SK, Nelson FB, Tse TJ, Wiens DJ, Shen J, Reaney MJT. Canadian policy changes for alcohol-based hand rubs during the COVID-19 pandemic and unintended risks. WORLD MEDICAL & HEALTH POLICY 2021; 15:WMH3463. [PMID: 34540336 PMCID: PMC8441665 DOI: 10.1002/wmh3.463] [Citation(s) in RCA: 3] [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: 12/07/2020] [Revised: 05/06/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022]
Abstract
The COVID-19 pandemic led to major changes in public policies to address supply chain disruption and escalated the price of consumer disinfectant products. To address market demands on alcohol-based hand rubs and disinfectants, Health Canada implemented major changes to the regulations regarding composition, handling, transportation, and packaging to insure product availability. Furthermore, accelerated licensing of ingredients and packaging did not meet standard medical quality guidelines yet were authorized for manufacturing and packaging of alcohol-based hand rubs and disinfectants. The accountability associated with these policy changes were reactive, including industry self-reporting, consumer reporting, and Health Canada advisories and recalls that were responsive to products after they were available in the market. Nonetheless, Canadian public health policy increased hand sanitizers availability. However, some of the interim policies have raised major public health concerns associated with ethanol quality, packaging, and labeling, and enforcement of regulations. In this paper, we review the changes in the Canadian regulations amid the current pandemic and we evaluate the unintended health risks that might arise from these changes.
Collapse
Affiliation(s)
- Rana Mustafa
- Department of Plant SciencesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Sarah K. Purdy
- Department of Plant SciencesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Fina B. Nelson
- Department of Plant SciencesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Timothy J. Tse
- Department of Plant SciencesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Daniel J. Wiens
- Department of Plant SciencesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Jianheng Shen
- Department of Plant SciencesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Martin J. T. Reaney
- Strategic Research Program, Department of Plant SciencesMinistry of AgricultureUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| |
Collapse
|
16
|
Sayeed A, Rahman MH, Bundschuh J, Herath I, Ahmed F, Bhattacharya P, Tariq MR, Rahman F, Joy MTI, Abid MT, Saha N, Hasan MT. Handwashing with soap: A concern for overuse of water amidst the COVID-19 pandemic in Bangladesh. GROUNDWATER FOR SUSTAINABLE DEVELOPMENT 2021; 13:100561. [PMID: 33585670 PMCID: PMC7871103 DOI: 10.1016/j.gsd.2021.100561] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 05/24/2023]
Abstract
Handwashing is one of the vital public health measures. It helps to prevent the spread of the COVID-19 pandemic. However, water overuse during hand scrubbing with soap keeping the tap on may put enormous pressure on the already overstretched groundwater resources and households' economic well-being. Therefore, this study aimed to determine the overuse of water while scrubbing hands with soap for handwashing when the tap is on amid the COVID-19 pandemic in Bangladesh. Sociodemographic data were collected using a web-based survey tool among 1980 participants and an experiment was conducted among 126 participants to estimate the overuse of water during hand scrubbing while the tap is on. A total of 80% of the participants washed their hands regularly after returning home from outside. About 57.3% of participants did not turn off their tap throughout the handwashing process. A single participant, who kept his tap on throughout the handwashing process, overused approximately 1.7 L of water per handwash and 14.9 L of water per day. Hand scrubbing with soap keeping the tap on, raised the overuse of water 13-fold during this pandemic compared to the non-pandemic situation which cost an extra 225.0 BDT (2.7$) per day for 1980 participants. Minimize the speed of tap, using automatic taps, and using taps operated by legs might be an effective solution to reduce the water overuse. Furthermore, behavioral change interventions are needed to aware people turn off the tap during hand scrubbing with soap.
Collapse
Affiliation(s)
- Abu Sayeed
- Department of Post-Harvest Technology and Marketing, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Md Hafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Mohakhali, Dhaka, 1212, Bangladesh
- Department of Environmental Sanitation, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Jochen Bundschuh
- UNESCO Chair on Groundwater Arsenic within the 2030 Agenda for Sustainable Development, University of Southern Queensland, West Street, Toowoomba, 4350, Queensland, Australia
| | - Indika Herath
- School of Civil Engineering and Surveying, Faculty of Health, Engineering and Sciences, University of Southern Queensland, West Street, Toowoomba, Queensland, 4350, Australia
| | - Fahad Ahmed
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Prosun Bhattacharya
- COVID-19 Research@KTH, Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institution of Technology, Teknikringen 10B, SE-100 44, Stockholm, Sweden
| | - Mohammad Raihan Tariq
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Faujhia Rahman
- Faculty of Environmental Science and Disaster Management, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Md Tarikul Islam Joy
- Faculty of Land Management and Administration, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Mohammad Tazrian Abid
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - Nondo Saha
- Department of Environmental Sanitation, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
| | - M Tasdik Hasan
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| |
Collapse
|
17
|
Das A, Barua A, Mohimin MA, Abedin J, Khandaker MU, Al-mugren KS. Development of a Novel Design and Subsequent Fabrication of an Automated Touchless Hand Sanitizer Dispenser to Reduce the Spread of Contagious Diseases. Healthcare (Basel) 2021; 9:445. [PMID: 33920290 PMCID: PMC8070052 DOI: 10.3390/healthcare9040445] [Citation(s) in RCA: 3] [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: 02/08/2021] [Revised: 03/18/2021] [Accepted: 04/07/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The use of a touchless automated hand sanitizer dispenser may play a key role to reduce contagious diseases. The key problem of the conventional ultrasonic and infra-red-based dispensers is their malfunctioning due to the interference of sunlight, vehicle sound, etc. when deployed in busy public places. To overcome such limitations, this study introduced a laser-based sensing device to dispense sanitizer in an automated touchless process. METHOD The dispensing system is based on an Arduino circuit breadboard where an ATmega328p microcontroller was pre-installed. To sense the proximity, a light-dependent resistor (LDR) is used where the laser light is to be blocked after the placement of human hands, hence produced a sharp decrease in the LDR sensor value. Once the LDR sensor value exceeds the lower threshold, the pump is actuated by the microcontroller, and the sanitizer dispenses through the nozzle. RESULTS AND DISCUSSION A novel design and subsequent fabrication of a low-cost, touchless, automated sanitizer dispenser to be used in public places, was demonstrated. The overall performance of the manufactured device was analyzed based on the cost and power consumption, and environmental factors by deploying it in busy public places as well as in indoor environment in major cities in Bangladesh, and found to be more efficient and cost-effective compared to other dispensers available in the market. A comprehensive discussion on this unique design compared to the conventional ultrasonic and infra-red based dispensers, is presented to show its suitability over the commercial ones. The guidelines of the World Health Organization are followed for the preparation of sanitizer liquid. A clear demonstration of the circuitry connections is presented herein, which facilitates the interested individual to manufacture a cost-effective dispenser device in a relatively short time and use it accordingly. Conclusion: This study reveals that the LDR-based automated hand sanitizer dispenser system is a novel concept, and it is cost-effective compared to the conventional ones. The presented device is expected to play a key role in contactless hand disinfection in public places, and reduce the spread of infectious diseases in society.
Collapse
Affiliation(s)
- Arnab Das
- Department of Mechanical Engineering, Chittagong University of Engineering and Technology, Chittagong 4349, Bangladesh; (A.D.); (A.B.); (M.A.M.)
| | - Adittya Barua
- Department of Mechanical Engineering, Chittagong University of Engineering and Technology, Chittagong 4349, Bangladesh; (A.D.); (A.B.); (M.A.M.)
| | - Md. Ajwad Mohimin
- Department of Mechanical Engineering, Chittagong University of Engineering and Technology, Chittagong 4349, Bangladesh; (A.D.); (A.B.); (M.A.M.)
| | - Jainal Abedin
- Faculty of Public Health, Thammasat University, Bangkok 10200, Thailand;
| | - Mayeen Uddin Khandaker
- Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, Bandar Sunway 47500, Selangor, Malaysia
| | - Kholoud S. Al-mugren
- Department of Physics, Princess Nourah Bint Abdulrahman University, Riyadh 11144, Saudi Arabia;
| |
Collapse
|
18
|
Kumar S, Das A. Hand sanitizers: Science and rationale. Indian J Dermatol Venereol Leprol 2021; 87:309-314. [PMID: 33769729 DOI: 10.25259/ijdvl_598_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/01/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Satarupa Kumar
- Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
| | - Anupam Das
- Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India
| |
Collapse
|
19
|
Abuga K, Nyamweya N. Alcohol-Based Hand Sanitizers in COVID-19 Prevention: A Multidimensional Perspective. PHARMACY 2021; 9:64. [PMID: 33808754 PMCID: PMC8006002 DOI: 10.3390/pharmacy9010064] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
The global use of alcohol-based hand sanitizers (ABHS) as an important means of controlling the transmission of infectious disease has increased significantly as governments and public health agencies across the world advocated hand hygiene as a preventative measure during the COVID-19 pandemic. Although the performance of these products is most commonly defined as a function of their alcohol concentration, they are multifaceted products in which an interplay of several factors is important in determining efficacy. This paper discusses the interplay between ABHS input (formulation) factors and output (product performance) factors in the context of a multidimensional perspective using a novel representative paradigm. In the model, represented in the form of a three-dimensional tetrahedron, each of the faces represents inputs in the manufacturing of the ABHS product, which are the type and amount of alcohol, the inactive ingredients, the formulation and the manufacturing practices. The four corners of the tetrahedron represent the product performance factors which include product efficacy, sensory characteristics, usage and compliance and product safety. The multidimensional approach to the formulation and evaluation of ABHS shows that several factors contribute to the effectiveness and utility of these products. The paradigm provides a useful framework for manufacturers of ABHS and related healthcare products.
Collapse
Affiliation(s)
- Kennedy Abuga
- Department of Pharmaceutical Chemistry, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya
| | - Nasser Nyamweya
- Pharma Manufacturing Solutions, Nairobi P.O. Box 21297-00505, Kenya;
| |
Collapse
|
20
|
Yeasmin D, Dutta NC, Nizame FA, Rahman MJ, Ashraf S, Ram PK, Leontsini E, Rahman M, Winch PJ, Luby SP, Unicomb L. Could Alcohol-Based Hand Sanitizer Be an Option for Hand Hygiene for Households in Rural Bangladesh? Am J Trop Med Hyg 2021; 104:874-883. [PMID: 33534756 PMCID: PMC7941831 DOI: 10.4269/ajtmh.20-0755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 11/10/2020] [Indexed: 11/20/2022] Open
Abstract
In low- and middle-income countries (LMICs), hand sanitizer may be a convenient alternative to soap and water to increase hand hygiene practices. We explored perceptions, acceptability, and use of hand sanitizer in rural Bangladesh. We enrolled 120 households from three rural villages. Promoters distributed free alcohol-based hand sanitizer, installed handwashing stations (bucket with tap, stand, basin, and bottle for soapy water), and conducted household visits and community meetings. During Phase 1, promoters recommended handwashing with soap or soapy water, or hand sanitizer after defecation, after cleaning a child's anus/feces, and before food preparation. In Phase 2, they recommended separate key times for hand sanitizer: before touching a child ≤ 6 months and after returning home. Three to 4 months after each intervention phase, we conducted a survey, in-depth interviews, and group discussions with child caregivers and male household members. After Phase 1, 82/89 (92%) households reported handwashing with soap after defecation versus 38 (43%) reported hand sanitizer use. Participants thought soap and water removed dirt from their hands, whereas hand sanitizer killed germs. In Phase 2, 76/87 (87%) reported using hand sanitizer after returning home and 71/87 (82%) before touching a child ≤ 6 months. Qualitative study participants reported that Phase 2-recommended times for hand sanitizer use were acceptable, but handwashing with soap was preferred over hand sanitizer when there was uncertainty over choosing between the two. Hand sanitizer use was liked by household members and has potential for use in LMICs, including during the coronavirus pandemic.
Collapse
Affiliation(s)
- Dalia Yeasmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Notan C. Dutta
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Fosiul A. Nizame
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Musarrat J. Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Sania Ashraf
- The Center for Social Norms and Behavioral Dynamics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pavani K. Ram
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Elli Leontsini
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Mahbubur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Peter J. Winch
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Leanne Unicomb
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| |
Collapse
|
21
|
Ifversen M, Meisel R, Sedlacek P, Kalwak K, Sisinni L, Hutt D, Lehrnbecher T, Balduzzi A, Diesch T, Jarisch A, Güngör T, Stein J, Yaniv I, Bonig H, Kuhlen M, Ansari M, Nava T, Dalle JH, Diaz-de-Heredia C, Trigoso E, Falkenberg U, Hartmann M, Deiana M, Canesi M, Broggi C, Bertaina A, Gibson B, Krivan G, Vettenranta K, Matic T, Buechner J, Lawitschka A, Peters C, Yesilipek A, Yalçin K, Lucchini G, Bakhtiar S, Turkiewicz D, Niinimäki R, Wachowiak J, Cesaro S, Dalissier A, Corbacioglu S, Willasch AM, Bader P. Supportive Care During Pediatric Hematopoietic Stem Cell Transplantation: Prevention of Infections. A Report From Workshops on Supportive Care of the Paediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT). Front Pediatr 2021; 9:705179. [PMID: 34395344 PMCID: PMC8358428 DOI: 10.3389/fped.2021.705179] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/25/2021] [Indexed: 02/02/2023] Open
Abstract
Specific protocols define eligibility, conditioning, donor selection, graft composition and prophylaxis of graft vs. host disease for children and young adults undergoing hematopoietic stem cell transplant (HSCT). However, international protocols rarely, if ever, detail supportive care, including pharmaceutical infection prophylaxis, physical protection with face masks and cohort isolation or food restrictions. Supportive care suffers from a lack of scientific evidence and implementation of practices in the transplant centers brings extensive restrictions to the child's and family's daily life after HSCT. Therefore, the Board of the Pediatric Diseases Working Party (PDWP) of the European Society for Blood and Marrow Transplantation (EBMT) held a series of dedicated workshops since 2017 with the aim of initiating the production of a set of minimal recommendations. The present paper describes the consensus reached within the field of infection prophylaxis.
Collapse
Affiliation(s)
- Marianne Ifversen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Roland Meisel
- Division of Pediatric Stem Cell Therapy, Department of Pediatric Oncology, Hematology and Clinical Immunology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Petr Sedlacek
- Department of Pediatric Hematology and Oncology, Hospital Motol, Charles University, Prague, Czechia
| | - Krzysztof Kalwak
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - Luisa Sisinni
- Pediatric Hematology, Oncology and Hematopoietic Stem Cell Transplantation Unit, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Daphna Hutt
- Division of Pediatric Hematology, Oncology and Bone Marrow Transplantation, The Edmond and Lily Safra Children's Hospital, Tel Aviv, Israel
| | - Thomas Lehrnbecher
- Division for Pediatric Hematology and Oncology, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Adriana Balduzzi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Tamara Diesch
- Division of Pediatric Hematology-Oncology, University Children's Hospital of Basel, Basel, Switzerland
| | - Andrea Jarisch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Tayfun Güngör
- Department of Hematology, Immunology, Oncology and Stem Cell Transplantation, University Children's Hospital Zürich, Zurich, Switzerland
| | - Jerry Stein
- Division of Pediatric Hematoloy-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Isaac Yaniv
- Division of Pediatric Hematoloy-Oncology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Halvard Bonig
- Institute for Transfusion Medicine and Immunohematology of Goethe University, German Red Cross Blood Service Baden-Württemberg-Hessen, Frankfurt am Main, Germany
| | - Michaela Kuhlen
- Paediatrics and Adolescent Medicine, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Marc Ansari
- Division of Pediatric Hematology-Oncology, University Hospital of Geneva, Geneva, Switzerland.,Cansearch Research Platform in Paediatric Oncology and Haematology, Department of Paediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Tiago Nava
- Division of Pediatric Hematology-Oncology, University Hospital of Geneva, Geneva, Switzerland.,Cansearch Research Platform in Paediatric Oncology and Haematology, Department of Paediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean-Hugues Dalle
- Hematology and Immunology Department, Robert-Debre Hospital, Assistance Publique-Hopitaux de Paris and University of Paris, Paris, France
| | - Cristina Diaz-de-Heredia
- Department of Pediatric Oncology and Hematology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Eugenia Trigoso
- Paediatric Transplant Unit, Hospital University and Polytechnic, Hospital LA FE, Valencia, Spain
| | - Ulrike Falkenberg
- Stem Cell Transplantation-Unit, Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Mihaela Hartmann
- Stem Cell Transplantation-Unit, Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Marco Deiana
- Paediatric Haematology-Oncology Department, Istituto di Ricovero e Cura a Carattere Scientifico G Gaslini, Genova, Italy
| | - Marta Canesi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Chiara Broggi
- Clinica Pediatrica Università degli Studi di Milano Bicocca, Fondazione Monza e Brianza per il Bambino e la sua Mamma, Ospedale San Gerardo, Monza, Italy
| | - Alice Bertaina
- Department of Pediatric Hematology-Oncology and Cell and Gene Therapy, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale Bambino Gesù, Rome, Italy.,Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
| | - Brenda Gibson
- Department of Paediatric Haematology-Oncology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Gergely Krivan
- Central Hospital of Southern Pest, National Institute of Hematology and Infectious Disease, Budapest, Hungary
| | - Kim Vettenranta
- Children's Hospital and Pediatric Research Center, University of Helsinki, Helsinki, Finland
| | - Toni Matic
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia
| | - Jochen Buechner
- Department of Pediatric Hematology and Oncology, Oslo University Hospital, Oslo, Norway
| | - Anita Lawitschka
- Stem Cell Transplantation-Unit, Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Christina Peters
- Stem Cell Transplantation-Unit, Department of Pediatrics, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Akif Yesilipek
- Department of Pediatric Hematology and Pediatric Stem Cell Transplantation Unit, Antalya and Göztepe Medicalpark Hospitals, Antalya, Turkey
| | - Koray Yalçin
- Department of Pediatric Bone Marrow Transplantation Unit, Medicalpark Göztepe Hospital, Istanbul, Turkey
| | - Giovanna Lucchini
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Children, National Health Service Foundation Trust, London, United Kingdom
| | - Shahrzad Bakhtiar
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | | | - Riitta Niinimäki
- Department of Pediatrics, Oulu University Hospital, Oulu, Finland
| | - Jacek Wachowiak
- Department of Pediatric Oncology, Hematology and Hematopoietic Stem Cell Transplantation, Poznan University of Medical Sciences, Poznan, Poland
| | - Simone Cesaro
- Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Arnaud Dalissier
- European Society for Blood and Marrow Transplantation Paris Office, Hôpital Saint Antoine, Paris, France
| | - Selim Corbacioglu
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital of Regensburg, Regensburg, Germany
| | - Andre Manfred Willasch
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Peter Bader
- Division for Stem Cell Transplantation, Immunology and Intensive Care Medicine, Hospital for Children and Adolescents, University Hospital, Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
22
|
Alasmari AK, Edwards PJ, Assiri AM, Behrens RH, Bustinduy AL. Use of face masks and other personal preventive measures by Hajj pilgrims and their impact on health problems during the Hajj. J Travel Med 2020; 27:5903249. [PMID: 32901805 DOI: 10.1093/jtm/taaa155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/25/2020] [Accepted: 08/24/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Hajj is one of the world's largest pilgrimage and gathers millions of Muslims from different nationalities every year. Communicable diseases have been reported frequently, during and following the Hajj, and these have been linked to individual behavioural measures. This study aimed to measure the effect of personal preventive measures, such as face mask use, hand hygiene and others, adopted by pilgrims in reducing the acquisition of infectious diseases. METHODS We conducted a cross-sectional study at the Hajj terminal in King Abdulaziz International Airport in Jeddah, Saudi Arabia. Pilgrims were approached in the airport lounges after the 2017 Hajj season and prior to the departure of their flights from Jeddah to their home countries. An electronic data collection tool ('Open Data Kit') was used to gather survey data in regards to health problems and preventive measures during the Hajj. RESULTS A total of 2973 Hajj pilgrims were surveyed. In all, 38.7% reported symptoms of upper respiratory tract infections (URTIs) and 5.4% reported symptoms of travel diarrhoea. Compliance with face mask use was 50.2%. Changing a face mask every 4 h was found to be significantly associated with lower prevalence of URTIs [adjusted odds ratio 0.56 (95% confidence interval 0.34-0.92), P = 0.02]. There was no statistical difference between overall face mask use and URTI acquisition. The main sources of food, eating raw vegetables/food, frequency of hand washing or use of hand sanitizers were not found to be significantly associated with reported travellers' diarrhoea. Unlicensed barbers were used by 12% of pilgrims and 9.2% of pilgrims reported using blades that were reused by other pilgrims. CONCLUSION Preventive measures are the most effective way to prevent infections. Pilgrims can benefit from face masks by changing them frequently. There is still limited information on the effect of the use of face mask in decreasing the risk of URTI in mass gatherings.
Collapse
Affiliation(s)
- Abrar K Alasmari
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Phil J Edwards
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Abdullah M Assiri
- Preventive Health, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Ronald H Behrens
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Amaya L Bustinduy
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
23
|
Akpokonyan TE, Esan O, Ikem IC, Ako-Nai KA, Omo-Omorodion BI. Hand Bacterial Repopulation Dynamics Following Two Methods of Surgical Hand Preparation during Elective Orthopedic Surgeries. Niger Med J 2020; 61:241-244. [PMID: 33487846 PMCID: PMC7808281 DOI: 10.4103/nmj.nmj_185_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 07/04/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022] Open
Abstract
Context: Antiseptic hand preparations are routine prior to surgical procedures to reduce microbial load on the operating gloved hands. Two methods of surgical hand preparations available are the antibacterial detergent hand wash and an alcohol-based hand rub. Aim: The aim of the study was to compare quantitatively, the efficacy of the two methods in hand bacterial reductions during elective orthopedic surgeries. Setting and Design: This comparative study was conducted at the orthopedic surgery department of a tertiary health facility. Subjects and Methods: One-hundred and sixty dominant hands of operating surgeons and nurses involved in forty elective orthopedic surgeries were studied. The subjects were randomly assigned to either the antibacterial detergent hand-washing (HW) or the alcohol-based hand-rubbing (HR) groups. Swab samples were obtained from the hands before and after hand preparations and at the end of surgeries following removal of the operating gloves. These samples were then subjected to culture. The bacterial counts on these were then obtained through an automated colony counter, and the results were expressed in logarithmic values (log10). Statistical Analysis Used: The analysis was done using IBM SPSS software version 20. The mean results obtained were subjected to an independent t-test analysis with the statistical significance level set at P < 0.05. Results: Both methods of hand antisepsis showed comparable efficacies in attaining surgical hand hygiene at 1-min postapplication (P = 0.73). HR group, however, showed greater sustained effects during the period of surgeries, though not statistically significant (P = 0.18). Conclusion: Scrubbing using the HR method is a viable alternative to the HW method during elective orthopedic surgery.
Collapse
Affiliation(s)
- Thompson Ehis Akpokonyan
- Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Oluwadare Esan
- Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Innocent Chiedu Ikem
- Department of Orthopaedic Surgery and Traumatology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | |
Collapse
|
24
|
Tan SW, Oh CC. Contact Dermatitis from Hand Hygiene Practices in the COVID-19 Pandemic. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2020136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) pandemic continues to spread globally at a staggering speed. At present, there is no effective treatment or vaccine for COVID-19. Hand disinfection is a cost-effective way to prevent its transmission. According to the Centres for Disease Control and Prevention (CDC) guidelines, we should wash our hands with soap and water for at least 20 seconds. If soap and water are not readily available, alcohol-based hand rubs (ABHRs) with at least 60% alcohol are the alternative. With diligent hand disinfection reinforced during COVID-19, there is an increased prevalence of contact dermatitis. This commentary highlights the fact that contact dermatitis is a readily treatable condi tion and should not cause any deviation of proper hand hygiene. In irritant contact dermatitis (ICD), the management strategies are selection of less irritating hand hygiene products, frequent use of moisturisers to rebuild the skin barrier, and education on proper hand hygiene practices. In allergic contact dermatitis (ACD), the identification and avoidance of the contact allergen is the key to treatment. However, ACD is less common and only accounts for 20% of the cases. The identified allergens in hand cleansers are predominantly preservative excipients a nd ACD attributable to ABHR are very uncommon. Alcohol-free hand rubs are widely available on the market but it is not a recommended alternative to ABHRs by the CDC.
Collapse
|
25
|
Amiraslani S, Darbemamieh G, Karimian F, Tabatabai Ghomsheh F. Design, Fabrication, and Testing of a Novel Surgical Handwashing Machine. Surg Innov 2020; 28:323-328. [PMID: 32921227 DOI: 10.1177/1553350620958241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Surgical hand scrub is strongly recommended as an essential measure to reduce surgical site infections (SSIs). SSI results in morbidity and additional cost. Micropunctures may occur on surgical gloves during operation, thus hand scrub cannot be omitted in any condition. Generally speaking, the adequacy of hand scrub is decided by the surgeon. Only occasionally, surveillance of hygienic status of hands is performed after scrub. Therefore, the potential exists that suboptimal handwash leads to SSIs. There are standards for preoperative handwash, but all of them are operator dependent, and continuous surveillance is actually impossible. One solution is to omit the role of surgeon in handwashing. This can be achieved by designing a standard procedure, performed mechanically by a machine, considering the detailed requirements of hygienic surgical hand scrub. The goal of this study was to develop a procedure that works on the design, fabrication, and trial of a new handwashing machine, for surgical hand scrub. Methods. A machine with a reciprocal spraying mechanism was designed that covers from the fingertips up to the elbow. Various combinations of staged irrigations with antiseptic solutions and water were to be programmed and implemented. Clinical experiments were performed several times with different handwashing programs, and swabs were taken from the skin surface and creases. Results. There was no microbial growth after 72 hours with any handwashing program. Conclusion. The preliminary experiments with this new handwashing machine show promising results for its application in surgical hand scrub.
Collapse
Affiliation(s)
- Shahryar Amiraslani
- Department of Biomedical Engineering, Central Tehran Branch, 201585Islamic Azad University, Tehran, Iran
| | - Goldis Darbemamieh
- Department of Biomedical Engineering, Central Tehran Branch, 201585Islamic Azad University, Tehran, Iran
- Hard Tissue Engineering Research Center, Tissue Engineering and Regenerative Medicine Institute, Central Tehran Branch, 201585Islamic Azad University, Tehran, Iran
| | - Faramarz Karimian
- Department of Surgery, IK Teaching Hospital, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Tabatabai Ghomsheh
- Pediatric Neurorehabilitation Research Center, 48533University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
26
|
Emami A, Javanmardi F, Keshavarzi A, Pirbonyeh N. Hidden threat lurking behind the alcohol sanitizers in COVID-19 outbreak. Dermatol Ther 2020; 33:e13627. [PMID: 32436262 PMCID: PMC7280687 DOI: 10.1111/dth.13627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 12/01/2022]
Abstract
The ongoing COVID‐19 pandemic has made various challenges for communications all over the world. Nowadays hand hygiene practices with alcohol sanitizers are an unavoidable reality for many people, which cause skin dryness and flaking. The current short communication has been explained about monitoring the quality control of alcohol concentrations and hand rub formulation, which needs more attention and should consider meticulous in this crisis.
Collapse
Affiliation(s)
- Amir Emami
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Infection Control Committee, Vice Chancellor of Treatment, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Javanmardi
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolkhalegh Keshavarzi
- Surgery Department, General Surgery, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Pirbonyeh
- Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
27
|
Wilson AM, Reynolds KA, Jaykus LA, Escudero-Abarca B, Gerba CP. Comparison of estimated norovirus infection risk reductions for a single fomite contact scenario with residual and nonresidual hand sanitizers. Am J Infect Control 2020; 48:538-544. [PMID: 31676157 DOI: 10.1016/j.ajic.2019.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The purpose of this study was to relate experimentally measured log10 human norovirus reductions for a nonresidual (60% ethanol) and a residual (quaternary ammonium-based) hand sanitizer to infection risk reductions. METHODS Human norovirus log10 reductions on hands for both sanitizers were experimentally measured using the ASTM International Standard E1838-10 method, with modification. Scenarios included product application to: (1) inoculated fingerpads with 30- and 60-second contact times, and (2) hands followed by inoculation with human norovirus immediately and 4 hours later. Hand sanitizer efficacies were used in a mathematical model estimating norovirus infection risk from a single hand-to-fomite contact under low and high environmental contamination conditions. RESULTS The largest log10 reductions for the residual and nonresidual hand sanitizers were for a 60-second contact time, reducing infection risk by approximately 99% and 85%, respectively. Four hours after application, the residual hand sanitizer reduced infection risks by 78.5% under high contamination conditions, whereas the nonresidual hand sanitizer offered no reduction. DISCUSSION Log10 virus and infection risk reductions were consistently greater for the residual hand sanitizer under all scenarios. Further data describing residual hand sanitizer efficacy with additional contamination or tactile events are needed. CONCLUSIONS Residual antinoroviral hand sanitizers may reduce infection risks for up to 4 hours.
Collapse
|
28
|
Beiu C, Mihai M, Popa L, Cima L, Popescu MN. Frequent Hand Washing for COVID-19 Prevention Can Cause Hand Dermatitis: Management Tips. Cureus 2020; 12:e7506. [PMID: 32373409 PMCID: PMC7195203 DOI: 10.7759/cureus.7506] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) continues to spread globally, outpacing the capacity and resources of health systems worldwide. A therapeutic vaccine is not yet on the rise, and preventive measures are the current approach to restraint the transmission of cases. As the virus is highly contagious via respiratory route (droplets from infected persons, widely spread by coughing or sneezing) and via contact with contaminated surfaces, community transmission and spread can be decreased through the practice of regular and diligent hand hygiene. Frequent hand washing implies a prolonged exposure to water and other chemical or physical agents and may induce several pathophysiologic changes, such as epidermal barrier disruption, impairment of keratinocytes, the subsequent release of proinflammatory cytokines, activation of the skin immune system, and delayed-type hypersensitivity reactions. Adverse dermatologic effects, such as excessive skin dryness or even contact dermatitis (particularly the irritant subtype and, to a lesser extent, the allergic subtype), can occur, especially in individuals with a history of atopic dermatitis. These skin conditions are perfectly manageable, and applying a moisturizer immediately after washing hands or after using a portable hand sanitizer is the cornerstone in preventing the development of eczematous changes in the hands. In the current global context, the potential occurrence of these dermatological adverse events should in no way cause people to deviate from strict hand hygiene rules.
Collapse
Affiliation(s)
- Cristina Beiu
- Oncologic Dermatology, Elias Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Mara Mihai
- Oncologic Dermatology, Elias Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Liliana Popa
- Oncologic Dermatology, Elias Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Luiza Cima
- Pharmacy, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| | - Marius N Popescu
- Physical Medicine and Rehabilitation, "Carol Davila" University of Medicine and Pharmacy, Bucharest, ROU
| |
Collapse
|
29
|
Engdaw GT, Gebrehiwot M, Andualem Z. Hand hygiene compliance and associated factors among health care providers in Central Gondar zone public primary hospitals, Northwest Ethiopia. Antimicrob Resist Infect Control 2019; 8:190. [PMID: 31788237 PMCID: PMC6880540 DOI: 10.1186/s13756-019-0634-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/24/2019] [Indexed: 01/17/2023] Open
Abstract
Background Poor hand hygiene compliance is one in all the leading contributory factors to healthcare-associated infections. This is an important source of complications across the continuum of care and poses a serious threat to people admitted to hospitals. However, the magnitude and associated factors of hand hygiene compliance in public primary hospitals were not well investigated in Ethiopia. Therefore, this study was conducted to assess hand hygiene compliance and associated factors among health care providers in Central Gondar Zone public primary hospitals, Northwest Ethiopia. Methods An Institutional based cross-sectional study was conducted from March to April 2019 among health care providers. The data were collected using self-administered questionnaires and observational checklists. Using Epi Info 3.1, data was entered and analyzed using SPSS version 23. The data were analyzed using descriptive statistics and logistic regression models. A p-value less than 0.05 with 95% confidence interval was used to declare statistical significance. Results Of 335 study participants, 50 (14.9%), had good hand hygiene compliance. Training on hand hygiene (AOR = 8.07, 95%CI: 2.91, 22.39), availability of adequate soap and water for hand hygiene (AOR = 5.10, 95%CI: 1.93, 13.52), availability of alcohol-based hand rub (AOR = 3.23, 95%CI: 1.32, 7.92), knowledge about hand hygiene (AOR = 6.74, 95%CI: 2.96, 15.34) and attitude towards hand hygiene (AOR = 2.15, 95%CI: 1.04, 4.46) were factors associated with hand hygiene compliance. Conclusion The overall level of hand hygiene compliance among health care providers was poor. Training, availability of adequate soap and water, availability of alcohol-based hand rub, knowledge on hand hygiene, and attitude of health care providers were significantly associated with hand hygiene compliance.
Collapse
Affiliation(s)
- Garedew Tadege Engdaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Gebrehiwot
- Department of Environmental and Occupational Health and Safety, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zewudu Andualem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
30
|
Biswas A, Bhattacharya SD, Singh AK, Saha M. Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project. J Pediatric Infect Dis Soc 2019; 8:408-413. [PMID: 30189013 DOI: 10.1093/jpids/piy076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/01/2018] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit. MATERIALS AND METHODS We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively. RESULTS A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9-5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36-16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities. CONCLUSIONS Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.
Collapse
Affiliation(s)
- Arunava Biswas
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
| | | | | | - Mallika Saha
- Department of Neonatology, IPGMER & SSKM Hospital, Kolkata, India
| |
Collapse
|
31
|
Donkor ES, Kotey FCN, Dayie NTKD, Duodu S, Tetteh-Quarcoo PB, Osei MM, Tette EMA. Colonization of HIV-Infected Children with Methicillin-Resistant Staphylococcus aureus. Pathogens 2019; 8:E35. [PMID: 30884909 PMCID: PMC6470964 DOI: 10.3390/pathogens8010035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) poses a public health threat owing to its extensive resistance to antibiotics, association with persistent outbreaks, and markedly increased healthcare costs. Moreover, HIV-infected individuals are at a greater risk for colonization with MRSA, and may act as reservoirs for subsequent transmission to other individuals. In Ghana, little is known about MRSA in relation to at-risk populations, such as HIV-infected children. The aim of this study was to investigate nasal carriage of S. aureus and MRSA among HIV-infected children in Accra, including the prevalence, risk factors and antibiotic resistance. METHODOLOGY The study was cross-sectional, and involved 107 children with HIV infection and an equal number of sex- and age group- matched apparently healthy controls recruited from the Princess Marie Louis Children's Hospital in Accra. Nasal swab specimens were collected from the study participants and cultured for bacteria. S. aureus isolates were confirmed by the coagulase test while MRSA was confirmed by PCR of the mecA gene. Antimicrobial susceptibility testing of S. aureus isolates was done by the Kirby Bauer method. A structured questionnaire was used to collect data on demographic, household and clinical features of the study participants. A logistic regression analysis was performed to identify determinants of S. aureus and MRSA carriage among participants of both study groups. RESULTS The carriage prevalence of S. aureus and MRSA were 44.9% (48) and 5.6% (6), respectively, among the HIV-infected individuals, and the corresponding values within the control group were 23.4% (25) and 0.9% (1). There was a significant association between HIV infection and S. aureus colonization (p < 0.001), but not MRSA colonization (p = 0.055). The main predictor of S. aureus colonization in both study groups was absence of colonization with coagulase negative staphylococcus (p < 0.001). Furthermore, the main predictor of MRSA colonization was regular hand washing with soap (p = 0.043); this was observed among HIV-infected individuals but not the control group. The proportion of S. aureus isolates that were multidrug resistant was 62.3% (33/53) in the HIV-infected group and 80% (20/25) in the control group (p = 0.192). CONCLUSIONS HIV infection is a risk factor for nasal colonization of S. aureus among children in Accra but may not be for MRSA. Both the HIV-infected and uninfected children are reservoirs of multidrug resistant S. aureus. Demographic, household and clinical features appear to have little or no relationship with S. aureus and MRSA colonization in the study children.
Collapse
Affiliation(s)
- Eric S Donkor
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
| | - Fleischer C N Kotey
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
- FleRhoLife Research Consult, P. O. Box TS 853, Teshie, Accra, Ghana.
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Samuel Duodu
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
| | - Patience B Tetteh-Quarcoo
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Edem M A Tette
- Department of Community Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana.
| |
Collapse
|
32
|
Meric De Bellefon L, Lazarou I. US-Guided Biopsies: Overarching Principles. Front Med (Lausanne) 2019; 6:1. [PMID: 30723716 PMCID: PMC6349745 DOI: 10.3389/fmed.2019.00001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/02/2019] [Indexed: 11/23/2022] Open
Abstract
Gathering synovial tissue from any swollen joint especially in early arthritis patients is critical for good quality research and to obtain further insight into the pathophysiology of inflammatory joint diseases. Multiplying biopsy sites is a challenge in terms of the techniques needed for each different joint but also in terms of safety and tolerability. It is important to provide the best care especially in very early arthritis patients who have only had the disease for a few months. This review discusses the minimal requirements applying to antiseptic techniques for the operator's hands, patient preparation, local anesthesia, and post-procedure care.
Collapse
Affiliation(s)
| | - Ilias Lazarou
- Department of Rheumatology, Université de Genève, Geneva, Switzerland
| |
Collapse
|
33
|
Espadale E, Pinchbeck G, Williams NJ, Timofte D, McIntyre KM, Schmidt VM. Are the Hands of Veterinary Staff a Reservoir for Antimicrobial-Resistant Bacteria? A Randomized Study to Evaluate Two Hand Hygiene Rubs in a Veterinary Hospital. Microb Drug Resist 2018; 24:1607-1616. [PMID: 30332336 PMCID: PMC6306656 DOI: 10.1089/mdr.2018.0183] [Citation(s) in RCA: 10] [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] [Indexed: 01/08/2023] Open
Abstract
Hand hygiene (HH) is the most successful intervention for hospital infection control. HH rubs with residual action are desired. This study aimed to compare the efficacy of alcohol (A-HH) and lactic acid (LA-HH) rubs, with the latter being marketed as having residual activity. We investigated reductions in bacterial colony-forming units (CFUs), prevalence of antimicrobial-resistant (AMR) organisms, and risk factors for increased counts on the hands of veterinary staff. A randomized, crossover study (53 individuals) was performed in a referral veterinary teaching hospital. Hand plates were taken before, immediately after, and 6 hours after HH. A blinded investigator counted CFUs per plate. Methicillin-resistant Staphylococcus aureus/pseudintermedius (MRSA/MRSP), Enterobacteriaceae, and Pseudomonas species (spp.) were characterized. Gender, profession, time point, and HH product were included as variables within multivariable analyses. A significant reduction in bacterial CFU was seen immediately after A-HH rub application (p < 0.001); however, neither product showed any significant residual action. Veterinarians had higher bacterial CFUs than nurses (p = 0.005); contact with patients, rather than the environment, was also associated with higher counts (p < 0.001). MRSA, MRSP, Enterobacteriaceae spp., and Pseudomonas spp. were detected on 7%, 2%, 14%, and 2% of study participant's hands (n = 208 samples), respectively. Frequent HH administration using an A-HH rub was effective at reducing bacterial CFU on hands in vivo in this veterinary hospital setting, but its use needs further encouragement in veterinary staff. The high prevalence of antimicrobial bacteria on hands is of concern; they might act as reservoirs for patients, the environment, and in-contact people.
Collapse
Affiliation(s)
- Eva Espadale
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
- Address correspondence to: Eva Espadale DVM, Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, United Kingdom
| | - Gina Pinchbeck
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Nicola J. Williams
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Dorina Timofte
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
- Department of Infection Biology, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - K. Marie McIntyre
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Neston, United Kingdom
| | - Vanessa M. Schmidt
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| |
Collapse
|
34
|
Legese H, Kahsay AG, Kahsay A, Araya T, Adhanom G, Muthupandian S, Gebreyesus A. Nasal carriage, risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus among healthcare workers in Adigrat and Wukro hospitals, Tigray, Northern Ethiopia. BMC Res Notes 2018; 11:250. [PMID: 29685170 PMCID: PMC5914064 DOI: 10.1186/s13104-018-3353-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study was to determine nasal carriage, risk factors and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus among health care-workers of Adigrat and Wukro hospitals Northern Ethiopia. Results The overall prevalence of S. aureus and methicillin resistance S. aureus (MRSA) in the present study were 12% (29/242) and 5.8% (14/242) respectively. The rate of MRSA among S. aureus was 48.3%(14/29). In this study, MRSA carriage was particularly higher among nurse professionals (7.8%) and surgical ward (17.1%). None of the MRSA isolates were sensitive to penicillin and ampicillin. However, low resistance was found for chloramphenicol and clindamycin. Being diabetic and use of hands rub was statistically significant with MRSA colonization. Electronic supplementary material The online version of this article (10.1186/s13104-018-3353-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Haftom Legese
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia. .,Department of Medical Laboratory, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia.
| | - Atsebaha Gebrekidan Kahsay
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Amlisha Kahsay
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Tadele Araya
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Gebre Adhanom
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia.,Department of Medical Laboratory, College of Medicine and Health Science, Adigrat University, Adigrat, Ethiopia
| | - Saravanan Muthupandian
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Araya Gebreyesus
- Department of Microbiology and Immunology, Institute of Biomedical Sciences, College of Health Science, Mekelle University, Mekelle, Ethiopia
| |
Collapse
|
35
|
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.
Collapse
|
36
|
Montgomery RL, Agius R, Wilkinson SM, Carder M. UK trends of allergic occupational skin disease attributed to fragrances 1996-2015. Contact Dermatitis 2017; 78:33-40. [DOI: 10.1111/cod.12902] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/21/2017] [Accepted: 09/03/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Rachel L. Montgomery
- Leeds Teaching Hospitals NHS Trust - Centre for Dermatology; Chapel Allerton Hospital; Leeds LS7 4SA UK
| | - Raymond Agius
- Centre for Occupational and Environmental Health; University of Manchester; Manchester M13 9PL UK
| | - Stephen M. Wilkinson
- Leeds Teaching Hospitals NHS Trust - Centre for Dermatology; Chapel Allerton Hospital; Leeds LS7 4SA UK
| | - Melanie Carder
- Centre for Occupational and Environmental Health; University of Manchester; Manchester M13 9PL UK
| |
Collapse
|
37
|
Abstract
The medical field has long recognized the importance of hand hygiene in preventing health care-associated infections, yet studies indicate that this important task is performed only 40% of the time. Health care workers cite several barriers to optimal performance of hand hygiene, but the time required to perform this task is foremost among them. Introduction of alcohol-based hand rubs, bundled interventions, and incorporation of technologies designed to monitor and promote hand hygiene all represent promising advances in this field.
Collapse
|
38
|
Szél B, Reiger Z, Urbán E, Lázár A, Mader K, Damjanova I, Nagy K, Tálosi G. Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit. World J Pediatr 2017; 13:210-216. [PMID: 27878781 DOI: 10.1007/s12519-016-0069-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria are highly dangerous to neonates. At our Neonatal Intensive Care Unit (NICU), the presence of these bacteria became so threatening in 2011 that immediate intervention was required. METHODS This study was conducted during a nearly two-year period consisting of three phases: retrospective (9 months), educational (3 months) and prospective (9 months). Based on retrospective data analysis, a complex management plan was devised involving the introduction of the INSURE protocol, changes to the antibiotic regimen, microbiological screening at short intervals, progressive feeding, a safer bathing protocol, staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients. During these intervals, a total of 355 patients were monitored. RESULTS Both ESBL-producing Enterobacter cloaceae and Klebsiella pneumoniae were found (in both patients and environmental samples). In the prospective period a significant reduction could be seen in the average number of both colonized (26/167 patients; P=0.029) and infected (3/167 patients; P=0.033) patients compared to data from the retrospective period regarding colonized (72/188 patients) and infected (9/188 patients) patients. There was a decrease in the average number of patient-days (from 343.72 to 292.44 days per months), though this difference is not significant (P=0.058). During the prospective period, indirect hand hygiene compliance showed a significant increase (from the previous 26.02 to 33.6 hand hygiene procedures per patient per hospital day, P<0.001). CONCLUSION Colonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.
Collapse
Affiliation(s)
- Borbála Szél
- Infection Control Unit, University of Szeged, Szeged, Hungary.
| | - Zsolt Reiger
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Edit Urbán
- Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary
| | - Andrea Lázár
- Institute of Clinical Microbiology, University of Szeged, Szeged, Hungary
| | - Krisztina Mader
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| | - Ivelina Damjanova
- Department of Bacteriology, National Center for Epidemiology, Budapest, Hungary
| | - Kamilla Nagy
- Infection Control Unit, University of Szeged, Szeged, Hungary
| | - Gyula Tálosi
- Department of Pediatrics, University of Szeged, Szeged, Hungary
| |
Collapse
|
39
|
Conrad CC, Stanford K, Narvaez-Bravo C, Callaway T, McAllister T. Farm Fairs and Petting Zoos: A Review of Animal Contact as a Source of Zoonotic Enteric Disease. Foodborne Pathog Dis 2017; 14:59-73. [DOI: 10.1089/fpd.2016.2185] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Cheyenne C. Conrad
- Lethbridge Agricultural Research Centre, Lethbridge, Alberta, Canada
- Alberta Agriculture and Forestry, Lethbridge, Alberta, Canada
- Canadian Association of Fairs and Exhibitions, Brandon, Manitoba, Canada
| | - Kim Stanford
- Alberta Agriculture and Forestry, Lethbridge, Alberta, Canada
| | | | - Todd Callaway
- United States Department of Agriculture, Agricultural Research Service, College Station, Texas
| | - Tim McAllister
- Agriculture and Agri-Food Canada, Lethbridge Research Centre, Lethbridge, Alberta, Canada
| |
Collapse
|
40
|
Hussein J, Fortney JA. Puerperal sepsis and maternal mortality: what role can new technologies play? Int J Gynaecol Obstet 2017; 85 Suppl 1:S52-61. [PMID: 15147854 DOI: 10.1016/j.ijgo.2004.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify new and underutilized technologies to reduce maternal mortality related to puerperal sepsis in developing countries. METHOD Review of current medical literature. RESULT The literature indicates that infection-control protocols and evidence-based procedures--including prophylactic antibiotics for cesarean section or preterm rupture of membranes, and updated antibiotic regimens--should be widely adopted. Devices such as hand rubs, needle-disposal systems, and rapid microbiological diagnostic tests can improve compliance and efficiency. Operational research on promising developments like vaginal cleansing with antiseptics, vitamin A supplementation, and prophylactic antibiotics in high-risk women is needed. CONCLUSION Sepsis management continues to depend on good implementation of established technologies. Program-based approaches are required to improve uptake.
Collapse
Affiliation(s)
- J Hussein
- Dugald Baird Centre for Research on Women's Health, Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Scotland, UK.
| | | |
Collapse
|
41
|
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.
Collapse
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
| |
Collapse
|
42
|
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)
Collapse
Affiliation(s)
- Fred M Gordin
- Veterans Affairs Medical Center, Washington, DC 20422, USA.
| | | | | | | |
Collapse
|
43
|
Jain VM, Karibasappa GN, Dodamani AS, Prashanth VK, Mali GV. Comparative assessment of antimicrobial efficacy of different hand sanitizers: An in vitro study. Dent Res J (Isfahan) 2016; 13:424-431. [PMID: 27857768 PMCID: PMC5091001 DOI: 10.4103/1735-3327.192283] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: To evaluate the antimicrobial efficacy of four different hand sanitizers against Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli, and Enterococcus faecalis as well as to assess and compare the antimicrobial effectiveness among four different hand sanitizers. Materials and Methods: The present study is an in vitro study to evaluate antimicrobial efficacy of Dettol, Lifebuoy, PureHands, and Sterillium hand sanitizers against clinical isolates of the aforementioned test organisms. The well variant of agar disk diffusion test using Mueller-Hinton agar was used for evaluating the antimicrobial efficacy of hand sanitizers. McFarland 0.5 turbidity standard was taken as reference to adjust the turbidity of bacterial suspensions. Fifty microliters of the hand sanitizer was introduced into each of the 4 wells while the 5th well incorporated with sterile water served as a control. This was done for all the test organisms and plates were incubated in an incubator for 24 h at 37C. After incubation, antimicrobial effectiveness was determined using digital caliper (mm) by measuring the zone of inhibition. Results: The mean diameters of zones of inhibition (in mm) observed in Group A (Sterillium), Group B (PureHands), Group C (Lifebuoy), and Group D (Dettol) were 22 ± 6, 7.5 ± 0.5, 9.5 ± 1.5, and 8 ± 1, respectively. Maximum inhibition was found with Group A against all the tested organisms. Data were statistically analyzed using analysis of variance, followed by post hoc test for group-wise comparisons. The difference in the values of different sanitizers was statistically significant at P < 0.001. Conclusion: Sterillium was the most effective hand sanitizer to maintain the hand hygiene.
Collapse
Affiliation(s)
| | | | - Arun Suresh Dodamani
- Department of Public Health Dentistry, ACPM Dental College, Dhule, Maharashtra, India
| | | | - Gaurao Vasant Mali
- Department of Public Health Dentistry, ACPM Dental College, Dhule, Maharashtra, India
| |
Collapse
|
44
|
Tartari E, Allegranzi B, Ang B, Calleja N, Collignon P, Hopman J, Lang L, Lee LC, Ling ML, Mehtar S, Tambyah PA, Widmer A, Voss A. Preparedness of institutions around the world for managing patients with Ebola virus disease: an infection control readiness checklist. Antimicrob Resist Infect Control 2015; 4:22. [PMID: 26056563 PMCID: PMC4459682 DOI: 10.1186/s13756-015-0061-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In response to global concerns about the largest Ebola virus disease (EVD), outbreak to-date in West Africa documented healthcare associated transmission and the risk of global spread, the International Society of Chemotherapy (ISC) Infection Control Working Group created an Ebola Infection Control Readiness Checklist to assess the preparedness of institutions around the globe. We report data from the electronic checklist that was disseminated to medical professionals from October to December 2014 and identify action needed towards better preparedness levels. FINDINGS Data from 192 medical professionals (one third from Africa) representing 125 hospitals in 45 countries around the globe were obtained through a specifically developed electronic survey. The survey contained 76 specific questions in 7 major sections: Administrative/operational support; Communications; Education and audit; Human resources, Supplies, Infection Prevention and Control practices and Clinical management of patients. The majority of respondents were infectious disease specialists/infection control consultants/clinical microbiologists (75; 39 %), followed by infection control professionals (59; 31 %) and medical doctors of other specialties (17; 9 %). Nearly all (149; 92 %) were directly involved in Ebola preparedness activities. Whilst, 54 % indicated that their hospital would need to handle suspected and proven Ebola cases, the others would subsequently transfer suspected cases to a specialized centre. CONCLUSION The results from our survey reveal that the general preparedness levels for management of potentially suspected cases of Ebola virus disease is only partially adequate in hospitals. Hospitals designated for admitting EVD suspected and proven patients had more frequently implemented Infection Control preparedness activities than hospitals that would subsequently transfer potential EVD cases to other centres. Results from this first international survey provide a framework for future efforts to improve hospital preparedness worldwide.
Collapse
Affiliation(s)
- Ermira Tartari
- />Infection Control Unit, Mater Dei Hospital, Msida, Malta
| | | | - Brenda Ang
- />Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Neville Calleja
- />Department of Health Information and Research, Ministry of Health, Valletta, Malta
| | - Peter Collignon
- />Infectious Diseases Unit and Microbiology, Canberra Hospital, Canberra, Australia
| | - Joost Hopman
- />Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lily Lang
- />National Healthcare Groups Polyclinics, Singapore, Singapore
| | - Lai Chee Lee
- />Infection Control, Singapore General Hospital, Singapore, Singapore
| | - Moi Lin Ling
- />Infection Control, Singapore General Hospital, Singapore, Singapore
| | - Shaheen Mehtar
- />Faculty of Medicine and Health Sciences, Stellenbosch University, Cape town, South Africa
| | - Paul A. Tambyah
- />Division of Infectious Diseases, National University of Singapore, Singapore, Singapore
| | - Andreas Widmer
- />Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Andreas Voss
- />Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
45
|
MacFarlane E, LaMontagne AD, Driscoll T, Nixon RL, Keegel T. Use of antiseptic hand rubs in the health and community services industry: an Australian population-based survey. Contact Dermatitis 2015; 73:157-62. [DOI: 10.1111/cod.12399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/12/2015] [Accepted: 03/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Ewan MacFarlane
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University; Melbourne 3004, Victoria Australia
| | - Anthony D. LaMontagne
- Population Health Strategic Research Centre, School of Health and Social Development, Deakin University; Burwood Victoria 3125 Australia
- McCaughey VicHealth Centre for Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne; Melbourne 3010, Victoria Australia
| | - Tim Driscoll
- School of Public Health, University of Sydney; Sydney New South Wales 2006, Australia
| | - Rosemary L. Nixon
- Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation; Melbourne Victoria 3053, Australia
- Department of Medicine; St Vincent's Hospital, University of Melbourne; Melbourne 3010, Victoria Australia
| | - Tessa Keegel
- Monash Centre for Occupational and Environmental Health, School of Public Health and Preventive Medicine, Monash University; Melbourne 3004, Victoria Australia
- Centre for Ergonomics and Human Factors, School of Psychology and Public Health, La Trobe University; Bundoora Victoria 3086 Australia
| |
Collapse
|
46
|
Widmer AE, Dangel M. Alcohol-Based Handrub: Evaluation of Technique and Microbiological Efficacy with International Infection Control Professionals. Infect Control Hosp Epidemiol 2015; 25:207-9. [PMID: 15061411 DOI: 10.1086/502379] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractBackground And Objective:The Centers for Disease Control and Prevention has published a new guideline on hand hygiene promoting the use of the alcohol-based handrub, but the technique was not addressed. The goal of this study was to evaluate the influence of technique on the efficacy of the alcohol-based handrub.Participants:Healthcare workers (HCWs) attending a course in hospital epidemiology.Methods:A fluorescent dye was added to a hand antiseptic, and hands were checked under ultraviolet light after antiseptic cleansing. Data regarding the numbers of predefined fluorescent areas on the skin were collected in addition to demographic data such as age, gender, job description, and job experience. Results of the visualization test were compared with the data from microbiological samples before and after the procedure by the hand plate technique.Results:Sixty HCWs were tested, 63% of whom had worked in infection control for more than 10 years. Sixty-six percent of all participants still had detectable bacteria after antisepsis. The mean log10 CFU reduction was 2.0 (range, 0–3.85). Twenty-five percent of all HCWs achieved less than 1.1 log10 CFU. Staphylococcus aureus was isolated from 13% (one of them being methicillin resistant) and gram-negative bacilli from 6.7%. After using the alcohol handrub, one subject still remained positive for S. aureus. Years of experience was the single most important factor predicting antimicrobial efficacy.Conclusions:Technique is of crucial importance in hand antisepsis. Major deficiencies were detected among even highly trained HCWs. Training should be provided before switching from handwashing to the alcohol handrub.
Collapse
Affiliation(s)
- Andreas E Widmer
- Division of Hospital Epidemiology, University of Basel Hospitals, Basel, Switzerland
| | | |
Collapse
|
47
|
Widmer AF, Rotter M. Effectiveness of Alcohol-Based Hand Hygiene Gels in Reducing Nosocomial Infection Rates. Infect Control Hosp Epidemiol 2015; 29:576; author reply 580-2. [DOI: 10.1086/587808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Widmer AF, Conzelmann M, Tomic M, Frei R, Stranden AM. Introducing Alcohol-Based Hand Rub for Hand Hygiene The Critical Need for Training. Infect Control Hosp Epidemiol 2015; 28:50-4. [PMID: 17230387 DOI: 10.1086/510788] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2005] [Accepted: 12/08/2005] [Indexed: 11/03/2022]
Abstract
Background.Use of an alcohol-based hand rub for hand hygiene has recently been recommended by the Centers for Disease Control and Prevention. However, the proper technique for using hand rub has not been well described and is not routinely taught in hospitals.Objective.To evaluate the impact of training on proper technique as outlined by the European Standard for testing alcohol-based hand rubs (European Norm 1500) in a clinical study.Design, Setting, and Patients.Prospective study including 180 healthcare workers (HCWs) in a 450-bed, university-affiliated geriatric hospital where alcohol-based hand rub was introduced in the late 1970s.Intervention.Structured training program in hand hygiene with alcohol-based hand rub. Technique for using hand rub was tested by the addition of a fluorescent dye to the disinfectant and the number of areas missed was quantified by a validated visual assessment method. In addition, the number of bacteria eradicated was estimated by calculating the difference between the log10 number of colony-forming units (cfu) of bacteria on the fingertips before and after the procedure, and reported as reduction factor (RF).Main Outcome Measure.Log10 cfu bacterial counts on fingertips before and after training in the appropriate technique for using hand rub.Results.At baseline, only 31% of HCWs used proper technique, yielding a low RF of 1.4 log10 cfu bacterial count. Training improved HCW compliance to 74% and increased the RF to 2.2 log10 cfu bacterial count, an increase of almost 50% (P < .001). Several factors, such as applying the proper amount of hand rub, were significantly associated with the increased RF.Conclusion.These results demonstrate that education on the proper technique for using hand rub, as outlined in EN 1500, can significantly increase the degree of bacterial killing.
Collapse
Affiliation(s)
- Andreas F Widmer
- Division of Infection Control and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland.
| | | | | | | | | |
Collapse
|
49
|
Weber WP, Reck S, Neff U, Saccilotto R, Dangel M, Rotter ML, Frei R, Oertli D, Marti WR, Widmer AF. Surgical Hand Antisepsis With Alcohol-Based Hand Rub Comparison of Effectiveness After 1.5 and 3 Minutes of Application. Infect Control Hosp Epidemiol 2015; 30:420-6. [DOI: 10.1086/596772] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective.Research has shown 1.5 minutes of surgical hand antisepsis with alcohol-based hand rub to be at least as effective under experimental conditions as the 3-minute reference disinfection recommended by European Norm 12791. The aim of the present study was to validate the effectiveness of 1.5 minutes of surgical hand antisepsis in a clinical setting by comparing the effectiveness of 1.5- and 3-minute applications of alcohol-based hand rub (45% vol/vol 2-propanol, 30% vol/vol 1-propanol, and 0.2% mecetronium ethylsulphate).Design.Prospective crossover trial in which each surgeon served as his or her own control, with individual randomization to the 1.5-or the 3-minute group during the first part of the trial.Setting.Basel University Hospital, Switzerland.Participants.Thirty-two surgeons with different levels of postdoctoral training.Methods.We measured the bactericidal effectiveness of 1.5 minutes and 3 minutes of surgical hand antisepsis with alcohol-based hand rub by assessing the mean (± SD) log10 number of colony-forming units before the application of hand rub (baseline), after the application of hand rub (immediate effect), and after surgery (sustained effect) so as to follow European Norm 12791 as closely as possible.Results.The immediate mean (± SD) log10 reduction in colony-forming units (cfu) was 2.66 ±1.13 log10 cfu for the 1.5-minute group and 3.01 ±1.06 log10 cfu for the 3-minute group (P = .204). Similarly, there was no statistically significant difference between the 2 groups with respect to the sustained effect; the mean ( ± SD) log10 increase in bacterial density during surgery was 1.08 ± 1.13 log10 cfu for the 1.5-minute group and 0.95 ± 1.27 log10 cfu for the 3-minute group (P = .708). No adverse effects were recorded.Conclusion.In this clinical trial, surgical hand antisepsis with alcohol-based hand rub resulted in a similar bacterial reduction, regardless of whether it was applied for 3 or 1.5 minutes, which confirms experimental data generated with healthy volunteers.
Collapse
|
50
|
Raboud J, Saskin R, Wong K, Moore C, Parucha G, Bennett J, Green K, Low D, Loeb M, Simor A, McGeer A. Patterns of Handwashing Behavior and Visits to Patients on a General Medical Ward of Healthcare Workers. Infect Control Hosp Epidemiol 2015; 25:198-202. [PMID: 15061409 DOI: 10.1086/502377] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To obtain accurate data regarding the handwashing behavior and patterns of visits to patients by healthcare workers (HCWs).Methods:All visits by HCWs to selected patient rooms were recorded for 3 days and 2 nights. Additionally, 5 nurses were observed for 1 day each and 2 nurses were observed for 1 night each. Nurses were observed for their entire shifts and all of their activities were recorded.Setting:A general medical ward in a tertiary-care hospital.Participants:Convenience samples of HCWs and patients.Results:Patients were visited every 25 minutes on average. Monitoring rooms and observing nurses resulted in similar rates of patient visits. The highest level of risk was contact with body fluids in 11% of visits and skin in 40% of visits. The overall rate of handwashing was 46%; however, the rate was higher for visits involving contact with body fluids (81%) and skin (61%). Nurses returned immediately to the same patient 45% of the time. The rate of handwashing was higher for the last of a series of visits to a patient's room (53% vs 30%, P < .0001).Conclusions:Nurses adjusted their handwashing rates in accordance with the risk level of each visit. Monitoring patient rooms and observing nurses yielded similar estimates of patient visits and proportions of visits involving contact with skin or body fluids. Education programs about hand hygiene may be more effective if patterns of care and levels of risk are incorporated into recommendations.
Collapse
Affiliation(s)
- Janet Raboud
- Department of Public Health Sciences, University of Toronto and the University Health Network, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|