Associations Between Hand Hygiene Education and Self-Reported Hand-Washing Behaviors Among Korean Adults During MERS-CoV Outbreak

Area-level deprivation and handwashing behavior during the COVID-19 pandemic: A multilevel analysis on a nationwide survey in Korea

This study investigated the association between area deprivation level and performance of handwashing behavior during the COVID-19 pandemic in Korean adults. This study used data from the 2015 Population and Housing Census data to measure area deprivation level. The 2020 Korea Community Health Survey was used for all other variables, including hand hygiene behavior (August through November 2020). The association between area deprivation level and practice of handwashing behavior was examined using multilevel logistic regression analysis. The study population comprised 215,676 adults aged 19 years or above. Compared to the least area deprived group, the most deprived group was more likely to not wash hands after using the restroom (OR 1.43, 95% CI 1.13-1.82), after coming home (OR 1.85, 95% CI 1.43-2.39), and using soap (OR 1.55, 95% CI 1.29-1.84). The findings suggest the importance of considering area deprivation in implementing policies that promote handwashing, particularly during a pandemic.

COVID-19 on the spectrum: a scoping review of hygienic standards

The emergence of COVID-19 in Wuhan, China, rapidly escalated into a worldwide public health crisis. Despite numerous clinical treatment endeavors, initial defenses against the virus primarily relied on hygiene practices like mask-wearing, meticulous hand hygiene (using soap or antiseptic solutions), and maintaining social distancing. Even with the subsequent advent of vaccines and the commencement of mass vaccination campaigns, these hygiene measures persistently remain in effect, aiming to curb virus transmission until the achievement of herd immunity. In this scoping review, we delve into the effectiveness of these measures and the diverse transmission pathways, focusing on the intricate interplay within the food network. Furthermore, we explore the virus's pathophysiology, considering its survival on droplets of varying sizes, each endowed with distinct aerodynamic attributes that influence disease dispersion dynamics. While respiratory transmission remains the predominant route, the potential for oral-fecal transmission should not be disregarded, given the protracted presence of viral RNA in patients' feces after the infection period. Addressing concerns about food as a potential viral vector, uncertainties shroud the virus's survivability and potential to contaminate consumers indirectly. Hence, a meticulous and comprehensive hygienic strategy remains paramount in our collective efforts to combat this pandemic.

Hand hygiene practice and associated factors among rural communities in northwest Ethiopia

This community-based cross-sectional study was conducted among 1190 randomly selected rural households in northwest Ethiopia to assess hand hygiene practice and associated factors. Frequent handwashing with rubbing agents, drying mechanisms; and condition of fingernails were used to assess hand hygiene practice. Multivariable binary logistic regression analysis was used to identify factors associated with hand hygiene and statistically significant association was declared on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-values < 0.05. Results showed that 28.8% (95% CI 26.2, 31.4%) of the households had good hand hygiene practice. Good hand hygiene practice was significantly associated with formal education attended household heads (AOR 1.79, 95% CI 1.33, 2.40), family discussion on sanitation (AOR 1.56, 95% CI 1.08, 2.26), provision of health education (AOR 2.23, 95% CI 1.62, 3.06), and availability of water (AOR 3.51, 95% CI 1.02, 12.05). In conclusion, about one-third of the rural households had good hand hygiene practice and more than two-third had poor hand hygiene practice in the study area, and this may imply that hands in the area may play roles in spreading infections in the community. Therefore, people need to be informed to always keep their hand hygiene good.

Exploring factors influencing the compliance of patients and family carers with infection prevention and control recommendations across Bangladesh, Indonesia, and South Korea

Background

Poor compliance with infection prevention and control (IPC) measures has been a longstanding issue globally. To date, healthcare workers (HCWs) have been the primary target for policy and strategy revisions. Recent studies exploring the contributing factors to the spread of COVID-19 across countries in Asia have suggested that the scope of focus should be extended to family carers who provide patient care activities. This study aimed to explore factors affecting patients' and their family carers' IPC compliance in hospitals in Bangladesh, Indonesia, and South Korea.

Method

A qualitative study incorporating 57 semi-structured interviews was conducted in five tertiary-level hospitals across the three focus countries between July 2019 and February 2020. Interviews were undertaken with: (1) patients, family carers and private carers; and (2) healthcare workers, including nurses, doctors, and hospital managers. Drawing upon the principles of grounded theory, data were inductively analyzed using thematic analysis.

Results

A total of three main themes and eight subthemes are identified. Key themes focused on the assumptions made by healthcare workers regarding the family/private carers' level of understanding about IPC and training received; uncertainty and miscommunication regarding the roles of family/private carers; variations in carer knowledge toward IPC and healthcare-associated infections, and the impact of cultural values and social norms.

Conclusion

This exploratory study offers novel findings regarding the factors influencing IPC compliance among patients and their family/private carers across various cultural settings, irrespective of resource availability. The role of cultural values and social norms and their impact on IPC compliance must be acknowledged when updating or revising IPC policies and guidelines.

The Effect of Correct Handwashing and Mask Wearing Training on Cardiac Patients' COVID-19 Fear and Anxiety

PURPOSE

This study was conducted to determine the effect of correct handwashing and mask-wearing training on COVID-19 fear and generalized anxiety in cardiac patients.

METHODS

Randomized controlled experimental study with the formation of intervention and control groups.

DESIGN

The study (triple-blind) was conducted between August 11 and November 17, 2020, in the cardiology clinic of a tertiary hospital in western Turkey. The pre-study sample size was calculated as a minimum 45 at 80% strength, 0.05 significance level, and 0.60 influence quantity for each group. 112 volunteers meeting the criteria were included in the study. The study was completed with a total of 105 individuals in the intervention group (n=50) and control group (n=53). The post-study strength was (1- β) =1. This study was performed in five stages: (1) collection of data, (2) randomization, (3) providing training, (4) contacting the intervention and control groups for follow-up a month later, and (5) collection of the follow-up data.

FINDINGS

The training provided to cardiac patients increased the correct handwashing technique (U=36.00; p<0.001) and the correct mask-wearing technique (U=99.00; p<0.001) and decreased COVID-19 fear (U=883.5; p<0.001) and anxiety (U=751.0; p<0.001) (p <.05).

CONCLUSION

It can be considered that the training provided to the cardiac patients in preventing COVID-19 may also be suitable for other risk groups.

CLINICAL EVIDENCE

Practical training at the individual level can be used to train cardiac patients.

The effect of hand hygiene frequency on reducing acute respiratory infections in the community: a meta-analysis

Hand hygiene is a simple, low-cost intervention that may lead to substantial population-level effects in suppressing acute respiratory infection epidemics. However, quantification of the efficacy of hand hygiene on respiratory infection in the community is lacking. We searched PubMed for randomised controlled trials on the effect of hand hygiene for reducing acute respiratory infections in the community published before 11 March 2021. We performed a meta-regression analysis using a Bayesian mixed-effects model. A total of 105 publications were identified, out of which six studies reported hand hygiene frequencies. Four studies were performed in household settings and two were in schools. The average number of handwashing events per day ranged from one to eight in the control arms, and four to 17 in the intervention arms. We estimated that a single hand hygiene event is associated with a 3% (80% credible interval (-1% to 7%)) decrease in the daily probability of an acute respiratory infection. Three of these six studies were potentially at high risk of bias because the primary outcome depended on self-reporting of upper respiratory tract symptoms. Well-designed trials with an emphasis on monitoring hand hygiene adherence are needed to confirm these findings.

Association among the exposure to giving knowledge, attitude and practice for handwashing in people residing in Seoul, South Korea: a retrospective cross-sectional study

OBJECTIVES

Handwashing is known as the most preventive method for various infectious diseases. Health authorities have conducted various campaigns and public relations targeting the general population but few evaluations of these long-term interventions. This study aimed to investigate the association between experience of educational events or public relations (EXEP), attitude towards the effectiveness of handwashing (AEHW) and handwashing practice (HWP).

SETTING

Using a population-based cross-sectional study with a complex sample design, we explored the response outcomes of handwashing. Those outcomes were collected biennially using Community Health Survey among the years 2013, 2015, 2017 and 2019. We applied multivariate logistic regression for the association among sociodemographic factors, health conditions, EXEP, AEHW and HWP.

PARTICIPANTS

Total participants residing in Seoul were 23 139 (men 44.2%), 23 004 (men 44.4%), 22 955 (men 44.8%) and 22 930 (men 43.9%), in 2013, 2015, 2017 and 2019, respectively.

RESULTS

Overall, participants with EXEP are more likely to be women, aged between the 30s and 60s, and with a higher educational level. Particularly, participants with EXEP had an increased association with HWP (OR 1.21, 95% CI 1.19 to 1.33) and AEHW (OR 1.50, 95% CI 1.38 to 1.63). In addition, AEHW also had an increased association with HWP (OR 1.67, 95% CI 1.53 to 1.81). The mediated effect of AEHW to HWP is not determined evidently.

CONCLUSION

The results showed that EXEP is positively associated with HWP and AEHW among community-dwelling people. Our results confirm that educational activity can lead to more pronounced behavioural changes only when it forms a positive attitude.

Hand hygiene knowledge, perception, and self-reported performance among nurses in Kelantan, Malaysia: a cross-sectional study

Background

Nurses interact with patients 24 hours a day, and this connection has the potential to raise the risk of infection transmission to patients. Nursing plays a vital role in pre-venting healthcare-associated infections (HCAIs) by ensuring that hand hygiene (HH) practises are followed and maintained. The purpose of this study was to evaluate nurses’ knowledge, perceptions, and self-reported HH performance scores, as well as their correlation, in tertiary care hospitals in Kelantan, Malaysia.

Methods

A cross-sectional study was undertaken in all four Kelantan tertiary care hospitals from December 2019 to February 2020. A stratified random selection method was used to obtain a sample of 438 registered nurses. A validated WHO self-administered HH knowledge and perception questionnaire for healthcare personnel was used to measure HH knowledge, perception, and self-reported HH performance.

Results

The mean (SD) score of knowledge was 15.08 (1.96) out of the total 25. The score of perception participants towards HH was 68.02 (10.14) out of the total 81 and the average self-reported HH performance was 87.58 (12.03) out of 100. Pearson’s correlation analysis showed significant positive correlations between perception and knowledge scores; r (436) =0.17, p<0.001 and Perception and self-reported HH performance scores; r (436) =0.27, p<0.001.

Conclusions

There is a strong link between knowledge and perception scores. Lack of understanding of HH during patient care might lead to a negative perception, which can affect overall self-reported HH performance. The need of monitoring and maintaining HH knowledge among nurses was established in this study.

The role of educating health-care personnel in prevention, diagnosis, or treatment of COVID-19: A narrative mini review

Front-line clinicians and health-care workers need to be educated to provide care in critical situations such as large-scale catastrophes and pandemics. This narrative review is focused on investigating educational strategies in confrontation with coronavirus disease 2019 (COVID-19) pandemic. We conducted a literature search in December 2020 through LitCovid, PubMed, ERIC, and Cochrane Library in order to retrieve relevant studies regarding the role of education in prevention, diagnosis, and treatment of COVID-19. There were 12 reviewed studies related to this specific subject. The articles selected for this study demonstrated that education and training had a positive impact on the knowledge and attitude of the participants and also the educational interventions, whether they were simulation-based or other formats of training, would be deemed crucial for enhancing participants' level of perceptions and confidence. Therefore, it is highly recommended that public health policymakers consider this important issue.

Social inequalities in protective behaviour uptake at the start of the COVID-19 pandemic: results from a national survey

OBJECTIVES

We aimed to assess social patterns of handwashing, social distancing, and working from home at the start of the COVID-19 pandemic in Canada, and determine what proportions of the overall prevalence and social inequalities in handwashing and social distancing are related to inequalities in the opportunity to work from home, to guide pandemic preparedness and response.

METHODS

Using cross-sectional data from the Canadian Perspectives Survey Series, collected between March 29 and April 3, 2020, among Canadian adults (N=4455), we assessed prevalence of not working from home, social distancing in public, or practicing frequent handwashing, according to age, sex, marital status, immigration, education, chronic disease presence, and source of COVID-19 information. Multivariate regression, population attributable fraction estimation, and generalized product mediation analysis were applied.

RESULTS

Absence of frequent handwashing and distancing was more common among those working outside than within the home (prevalence differences of 7% (95% CI: 4, 10) and 7% (95% CI: 3, 10), respectively). Inequalities in handwashing and distancing were observed across education and immigration status. Over 40% of the prevalence of non-uptake of handwashing and distancing was attributable to populations not being able to work from home. If all worked from home, over 40% (95% CI: 8, 70) of education-based inequalities in handwashing and distancing could be eliminated, but differences by immigration status would likely remain.

CONCLUSION

For pandemic response, both workplace safety initiatives and mechanisms to address the inequitable distribution of health risks across socio-economic groups are needed to reduce broader inequalities in transmission risk.

Determinants of health behaviours intended to prevent spread of respiratory pathogens that have pandemic potential: A rapid review

Effective public health messages to encourage behaviours to reduce the spread of COVID-19 should be informed by existing research that identifies the factors that are associated with these preventive behaviours. This rapid review summarises the existing research on the determinants of behaviours that aim to prevent the spread of COVID-19. The review focuses on the body of research (excluding research conducted with health care workers) that was produced in the context of viruses other than SARS CoV-2 that cause severe respiratory illness and are transmitted in a similar way. A total of 58 published peer-reviewed studies included in the review were identified through searches of Medline, Embase, PsychInfo and CINAHL. Most were conducted in the context of the influenza A (H1N1) pandemic in 2009. Most studies examined the determinants of wearing a face covering, handwashing and social or physical distancing. The findings suggest that public health messages to encourage preventive behaviours should emphasise the potential seriousness of COVID-19 to elicit appropriate concern, strengthen perceptions of risk or threat from COVID-19, enhance self-efficacy about preventive behaviours, and improve knowledge about SARS-CoV-2, how it is transmitted, and how preventive behaviours can reduce the risk of transmission.

Understanding the predictors of hand hygiene using aspects of the theory of planned behaviour and temporal self-regulation theory

OBJECTIVE

Adherence to proper hand hygiene practice is relatively low and is particularly salient in light of the current COVID-19 pandemic. Having a greater understanding of the psychosocial predictors of engaging in proper hand hygiene is warranted. One way to do this is through the application of a combined theory of planned behaviour and temporal self-regulation theory model.

DESIGN

A prospective two-part study was conducted between May - November 2020, with N = 232 Australians. At time one, variables from both the theory of planned behaviour (attitude, subjective norm, perceived behavioural control, and intention) and temporal self-regulation theory (habit, environmental cues, and planning) were completed.

MAIN OUTCOME MEASURES

One week later, engagement in proper hand hygiene behaviour over the previous week was assessed.

RESULTS

Two hierarchical multiple regressions were conducted, with 47% of variance accounted for in intention, with subjective norm being the strongest predictor, and 38% of variance accounted for in hand hygiene behaviour, with intention being the strongest predictor. Environmental cues also moderated the relationship between intention and behaviour.

CONCLUSIONS

To increase intention, incorporating subjective norm messages in advertisements may be helpful. Incorporating environmental cues in places where hand washing is recommended may assist in increasing hand hygiene.

Health literacy in the general population in the context of epidemic or pandemic coronavirus outbreak situations: Rapid scoping review

OBJECTIVE

The aim of this rapid scoping review, for which only studies from the general population were considered, was to describe the extent of existing research on HL in the context of previous coronavirus outbreaks (SARS-CoV-1, MERS-CoV and SARS-CoV-2).

METHODS

We searched major databases and included publications of quantitative and qualitative studies in English and German on any type of research on the functional, critical and communicative domains of HL conducted in the context of the three outbreaks in the general population. We extracted and tabulated relevant data and narratively reported where and when the study was conducted, the design and method used, and how HL was measured.

RESULTS

72 studies were included. Three investigated HL or explicitly referred to the concept of HL, 14 were guided by health behaviour theory. We did not find any study designed to develop or psychometrically evaluate pandemic/epidemic HL instruments, or relate pandemic/epidemic or general HL to a pandemic/epidemic outcome, or any controlled intervention study. Type of assessment of the domains of HL varied widely.

CONCLUSION

Theory-driven observational studies and interventions, examining whether pandemic-related HL can be improved are needed.

PRACTICE IMPLICATIONS

The development and validation of instruments that measure pandemic-related HL is desirable.

Compliance measurement and observed influencing factors of hand hygiene based on COVID-19 guidelines in China

BACKGROUND

Higher requirement is put forward in the measurement of hand hygiene (HH) during a pandemic. This study aimed to describe HH compliance measurement and explore observed influencing factors with respect to coronavirus disease 2019 (COVID-19) guidelines in China.

METHODS

Compliance was measured as the percentage of compliant opportunities based on criteria for 17 moments. The criteria for compliance included HH behavior, procedure, duration, hand drying method, and the overall that counts them all. The observed influencing factors included different departments and areas and protection motivation. Descriptive analysis and logistic regression were performed.

RESULTS

The compliance of overall criteria, HH behavior, procedure, duration, and hand drying method were 79.44%, 96.71%, 95.74%, 88.93%, and 88.42%, respectively, which were significantly different from each other (P < .001). Meanwhile, the overall and hand drying method compliance in semi-contaminated areas (odds ratio [OR] = 1.829, P < .001; OR = 2.149, P = .001) and hygienic areas (OR = 1.689, P = .004; OR = 1.959, P = .015) were significantly higher than those in contaminated area. The compliance with HH behavior for the motivation of patient-protection (OR = 0.362, P < .001) was lower than that for the motivation of self-protection.

CONCLUSIONS

HH compliance was firstly measured using different criteria for 17 moments according to COVID-19 guidelines in China. The measurement of HH compliance needs clearer definition and comprehensive practice. Contaminated areas and motivation of patient-protection contribute to lower compliance, which may be addressed by allocating more human resources and increasing supervision and education.

Thoughts on What Chemists Can Contribute to Fighting SARS-CoV-2 - A Short Note on Hand Sanitizers, Drug Candidates and Outreach

The SARS-CoV-2 outbreak causing the respiratory disease COVID-19 has left many chemists in academia without an obvious option to contribute to fighting the pandemic. Some of our recent experiences indicate that there are ways to overcome this dilemma. A three-pronged approach is proposed.