What is new with hand hygiene?

Effectiveness of infection prevention and control interventions in health care facilities in Africa: A systematic review

BACKGROUND

Health care-associated infections (HAIs) are a major threat to patient safety and quality care. However, they are avoidable by implementing evidence-based infection prevention and control (IPC) measures. This review evaluated the evidence of the effectiveness of IPC interventions in reducing rates of HAIs in health care settings in Africa.

METHODS

We searched several databases: CENTRAL, EMBASE, PUBMED, CINAHL, WHO IRIS, and AJOL for primary studies reporting rates of the 4 most frequent HAIs: surgical site infections, central line--associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumoniae, and increase in hand hygiene compliance. Two reviewers appraised the studies and PRISMA guidelines were followed.

RESULTS

Out of 4,624 studies identified from databases and additional sources, 15 studies were finally included in the review. The majority of studies were of pre- and post-test study design. All the studies implemented a combination of interventions and not as stand-alone components. Across all included studies, an improvement was reported in at least 1 primary outcome.

CONCLUSIONS

Our review highlights the potential of IPC interventions in reducing HAIs and improving compliance with hand hygiene in health care facilities in Africa. For future research, we recommend more pragmatic study designs with improved methodological rigor.

Hand hygiene compliance in a Brazilian COVID-19 unit: the impact of moments and contact precautions

BACKGROUND

Healthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU).

METHODS

An observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use.

RESULTS

We observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments "before" tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments "after" tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed.

CONCLUSIONS

HH compliance was very low. Inappropriate glove use was associated with low compliance and the unit's infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety.

Hand Sanitizer Gels: Classification, Challenges, and the Future of Multipurpose Hand Hygiene Products

Hand hygiene is a crucial measure in the prevention and control of infections, and there is a growing awareness among individuals who are making a conscious effort to maintain hand cleanliness. With the advent of the SARS-CoV-2 outbreak, the demand for hand hygiene products has also gradually shifted towards those with antimicrobial properties. Among these products, hand sanitizer gels (HSGs) have gained considerable popularity as an efficient method of hand cleaning, due to their rapid drying and sustained antimicrobial efficacy. Concurrently, there has been a growing interest in novel HSGs that offer additional functions such as skin whitening, moisturizing, and anti-inflammatory effects. These novel HSGs effectively address concerns associated with the ingestion of antimicrobial ingredients and demonstrate reduced skin irritation, thereby alleviating hand dermatological issues. This review provides an extensive overview of the application scenarios, classification, and challenges associated with HSGs while emphasizing the emergence of novel components with biological functions, aiming to contribute to the advancement of hand hygiene practices and offer novel insights for the development of novel HSGs with outstanding antimicrobial properties with other multiple biological functions and desirable biosafety profiles.

Nursing Students' Medication Administration: A Focus on Hand Hygiene and Patient Identification

BACKGROUND

Procedural failures during medication administration include a lack of appropriate hand hygiene and failure to verify patient identification prior to administration of medication. Procedural failures are common among nurses and nursing students and can lead to serious patient harm.

METHOD

A descriptive cross-sectional research design was used to collect observational data from a simulation-based experience of a medication administration scenario.

RESULTS

Thirty-five senior baccalaureate nursing students from two geographically distant universities in the United States participated in the study. All of the participants made at least one procedural failure during the simulated experience. Hand hygiene compliance was 40.3%, and patient identification compliance was 43.8%.

CONCLUSION

Students often failed to comply with medication administration safety guidelines. Nursing programs must make changes to the methods used to teach safe medication administration to prepare students for this critical skill. [J Nurs Educ. 2023;62(7):403-407.].

[Interest in disinterestedness in the epidemiology of health systems and services]

This article intends to critique of the cultural authority of the medical sciences, opening up a discussion on its publicization from a political standpoint. At the same time, from a more technical standpoint, it proposes the implementation of an epidemiology of health systems and services. Based on Pierre Bourdieu's concept of interest in disinterestedness and Joseph Gusfield's notion of the cultural authority of public problems, it analyzes why epidemiological information is so rarely used in the evaluation and monitoring of clinical, population, institutional, and territorial practices. That is, why does the dominant culture of decision making eschew epidemiological information? Within this conceptual framework, a body of documental evidence is analyzed that sheds light on the weak scientific basis that upholds or that has underpinned certain practices in the health field at different historical moments. The discussion is organized around three major themes: assistentialist professional practice, medication, and biomedical technologies.

Far-UVC Radiation for Disinfecting Hands or Gloves?

(1) Background: Far-UVC radiation in the spectral range 200-230 nm has, according to previous findings, a strong antimicrobial effect on pathogens, but exhibits hardly any harmful effect on human skin. Therefore, the present study will discuss whether such radiation could also be suitable for hand disinfection in the healthcare sector. (2) Methods: Hands and gloves were microbially contaminated and exposed to radiation from a 222 nm krypton-chloride-excimer lamp. The applied doses were 23 mJ/cm2 and 100 mJ/cm2, respectively. Irradiated and non-irradiated hands and gloves were pressed onto agar plates and colonies were counted and compared after 24 h of incubation. For comparison, we also treated hands and gloves with a commercial liquid alcohol-based disinfectant. (3) Results: On the hand, the 23 mJ/cm2 resulted in the reduction of the observed colonies on the agar plates by one log level. For the gloves irradiated with 100 mJ/cm2, a colony reduction of 1.3 log levels was recorded. In the comparative experiments with the commercial disinfectant, a colony reduction of 1.9 and approximately one log level was observed on hand and gloves, respectively. (4) Conclusion: In both cases, far-UVC radiation provided a considerable reduction in microorganisms. However, compared to published far-UVC irradiation results in suspensions, the disinfection success on hands and gloves was rather low. With regard to the irradiation limits currently existing in the European Union, multiple daily hand disinfection with far-UVC radiation is actually legally not possible at present, but the thresholds are currently under discussion and could change in the future. Far-UVC disinfection of hands in gloves seems theoretically possible if attention is paid to potential perforations in the gloves.

DEVELOPMENT AND VALIDATION OF A CHECKLIST FOR THE SAFETY OF HOSPITALIZED CHILDREN

ABSTRACT Objective: to develop and validate a checklist of safety actions for hospitalized children. Method: a methodological research study carried out from March 2017 to March 2020 in two phases: 1) Identification of the themes and elaboration of the checklist through the literature review; 2) Content validation with expert judges by means of the Delphi technique, applying the Content Validity Index (CVI), accepting values >0.8 for the CVI per item and >0.9 for the checklist. The data collection instrument was organized using an ordinal progressive valuation scale, of the Likert type. The content validation stage was performed in three rounds using a Google Forms® electronic form. Fifteen experts participated in the survey in the first round and 14 in the second and third rounds. The statistical analysis of the data was performed with the aid of Google Forms® and of the Excel® software, and the results were presented descriptively and in a table. Results: the final version of the checklist consisted of 6 categories and 23 check items, validated with a Content Validity Index of 0.98. The checklist was also validated in relation to the objectives (0.95) and to the structure and presentation (0.98). Conclusion: validation of the content, objectives, structure and presentation of the checklist allows this tool to be implemented in any pediatric hospitalization unit, contributing to the care practice aimed at the safety of hospitalized children.

Hand hygiene by the nursing team in home care: a cross-sectional study

OBJECTIVE

to identify whether nursing professionals carry out hand hygiene, how they do it, and what resources are available for this practice during home visits.

METHOD

cross-sectional study conducted in a public Home Care service. The World Health Organization instrument was used to observe the hand hygiene technique, the time of performance, and the product used.

RESULTS

a total of 940 hand hygiene opportunities taking place in 231 home visits were observed. Overall adherence was 14.4%, with the practice of hand hygiene being higher after contact with the patient (53.7%). Before aseptic procedures, after risk/exposure to body fluids, after contact with the patient's environment, and before contact with the patient, adherence was 0.4%. Regarding the quality of the technique, in none of the 135 practices the recommended steps were followed. As for the structure available in the households, 35 (15.2%) had accessible sinks and none had liquid soap and alcohol-based formulation.

CONCLUSION

adherence to hand hygiene by nursing professionals in home care was low, the technique was not performed, and households did not have resources for the practice.