1
|
Lopez TK, Jones K, Roseberry-Lincoln A, Zidek A, MacKinnon L, Marro L. Adult and children's use of hand sanitizer during a pandemic - an observational study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:1004-1012. [PMID: 36153367 PMCID: PMC9510540 DOI: 10.1038/s41370-022-00479-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/02/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The use of hand sanitizers has been one of the key public health measures recommended to reduce the transmission of SARS-CoV-2 during the pandemic. As such, its daily use among the general population has reportedly increased dramatically since the onset of the COVID-19 pandemic. OBJECTIVE To better understand the impact of this recommendation, hand sanitizer use, including the frequency and amount handled, was examined among adults in a non-occupational setting and children in both the home and school/childcare settings. METHODS An online survey of Canadians (conducted from September to October 2021) was employed to estimate use frequency, amount, and pattern of hand sanitizer use. RESULTS Responses were received from 655 adults in the general population and 298 teachers of children up to the age of 18 years. The frequency of hand sanitizer use during the pandemic was found to be as high as 25 times per day in children and over 9 times per day in adults. Notable differences were found when comparing the frequency of hand sanitizer use by children in the home to children in a school or childcare setting. SIGNIFICANCE This is the first study, known to the authors, examining hand sanitizer use among children during the pandemic, including use in a childcare or school setting. This study illustrates the importance of examining the change in consumer behaviors during a pandemic and the need to look beyond the home when attempting to understand product use patterns in children. IMPACT STATEMENT This research explores uses of hand sanitizer, before and during pandemic conditions, in the general population of Canada with a particular focus on use among children. The results can be used to estimate exposure to chemicals in hand sanitizer from non-occupational use in Canada and among similar populations and signal the importance of examining changing consumer behaviors and use of consumer products in school settings, especially among children.
Collapse
Affiliation(s)
- Theresa K Lopez
- Tetra Tech, 10711 Red Run Blvd., Suite 105, Owings Mills, MD, 21117, USA.
| | | | | | - Angelika Zidek
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Leona MacKinnon
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| | - Leonora Marro
- Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON, Canada
| |
Collapse
|
2
|
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
|
3
|
SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:355-376. [PMID: 36751708 PMCID: PMC10015275 DOI: 10.1017/ice.2022.304] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
Collapse
|
4
|
Establishing a Learning Model for Correct Hand Hygiene Technique in a NICU. J Clin Med 2022; 11:jcm11154276. [PMID: 35893364 PMCID: PMC9329762 DOI: 10.3390/jcm11154276] [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] [Received: 06/01/2022] [Revised: 07/08/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022] Open
Abstract
The ability of healthcare workers to learn proper hand hygiene has been an understudied area of research. Generally, hand hygiene skills are regarded as a key contributor to reduce critical infections and healthcare-associated infections. In a clinical setup, at a Neonatal Intensive Care Unit (NICU), the outcome of a multi-modal training initiative was recorded, where objective feedback was provided to the staff. It was hypothesized that staff at the NICU are more sensitive towards applying increased patient safety measures. Outcomes were recorded as the ability to cover all hand surfaces with Alcohol-Based Handrub (ABHR), modelled as a time-series of measurements. The learning ability to rub in with 1.5 mL and with 3 mL was also assessed. As a secondary outcome, handrub consumption and infection numbers were recorded. It has been observed that some staff members were able to quickly learn the proper hand hygiene, even with the limited 1.5 mL, while others were not capable of acquiring the technique even with 3 mL. When analyzing the 1.5 mL group, it was deemed an insufficient ABHR amount, while with 3 mL, the critical necessity of skill training to achieve complete coverage was documented. Identifying these individuals helps the infection control staff to better focus their training efforts. The training led to a 157% increase in handrub consumption. The setting of the study did not allow to show a measurable reduction in the number of hospital infections. It has been concluded that the training method chosen by the staff greatly affects the quality of the outcomes.
Collapse
|
5
|
Price L, Gozdzielewska L, Alejandre JC, Jorgenson A, Stewart E, Pittet D, Reilly J. Systematic review on factors influencing the effectiveness of alcohol-based hand rubbing in healthcare. Antimicrob Resist Infect Control 2022; 11:16. [PMID: 35073993 PMCID: PMC8785453 DOI: 10.1186/s13756-021-01049-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The effectiveness of hand rubbing with alcohol-based handrub (ABHR) is impacted by several factors. To investigate these, World Health Organization (WHO) commissioned a systematic review. AIM To evaluate the impact of ABHR volume, application time, rubbing friction and hand size on microbiological load reduction, hand surface coverage or drying time. METHODS Medline, CINAHL, Web of Science and ScienceDirect databases were searched for healthcare or laboratory-based primary studies, published in English, (1980- February 2021), investigating the impact of ABHR volume, application time, rubbing friction or hand size on bacterial load reduction, hand coverage or drying time. Two reviewers independently performed data extraction and quality assessment. The results are presented narratively. FINDINGS Twenty studies were included in the review. Categories included: ABHR volume, application time and rubbing friction. Sub-categories: bacterial load reduction, hand size, drying time or hand surface coverage. All used experimental or quasi-experimental designs. Findings showed as ABHR volume increased, bacterial load reduced, and drying times increased. Furthermore, one study showed that the application of sprayed ABHR without hand rubbing resulted in significantly lower bacterial load reduction than poured or sprayed ABHR with hand rubbing (- 0.70; 95%CI: - 1.13 to - 0.28). Evidence was heterogeneous in application time, volume, technique, and product. All studies were assessed as high risk of bias. CONCLUSIONS There is insufficient evidence to change WHO recommendation of a palmful of ABHR in a cupped hand applied for 20-30 s or manufacturer-recommended volume applied for about 20 s (Centers for Disease Control and Prevention). Future hand hygiene research should standardise volume, application time, and consider hand size.
Collapse
Affiliation(s)
- Lesley Price
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| | - Lucyna Gozdzielewska
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK.
| | - Julius Cesar Alejandre
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
- School of Computing, Engineering, and Built Environment, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| | - Annelysse Jorgenson
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| | - Emma Stewart
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley Street, Glasgow, G3 7HR, UK
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Center on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Rue Gabrielle Perret-Gentil, 1211, Geneva 4, Switzerland
| | - Jacqui Reilly
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK
| |
Collapse
|
6
|
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
|
7
|
Voniatis C, Bánsághi S, Ferencz A, Haidegger T. A large-scale investigation of alcohol-based handrub (ABHR) volume: hand coverage correlations utilizing an innovative quantitative evaluation system. Antimicrob Resist Infect Control 2021; 10:49. [PMID: 33678183 PMCID: PMC7937362 DOI: 10.1186/s13756-021-00917-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Current hand hygiene guidelines do not provide recommendations on a specific volume for the clinical hand rubbing procedure. According to recent studies volume should be adjusted in order to achieve complete coverage. However, hand size is a parameter that highly influences the hand coverage quality when using alcohol-based handrubs (ABHR). The purpose of this study was to establish a quantitative correlation between applied ABHR volume and achieved hand coverage. Method ABHR based hand hygiene events were evaluated utilizing a digital health device, the Semmelweis hand hygiene system with respect to coverage achieved on the skin surface. Medical students and surgical residents (N = 356) were randomly selected and given predetermined ABHR volumes. Additionally, hand sizes were calculated using specialized software developed for this purpose. Drying time, ABHR volume awareness, as well spillage awareness were documented for each hand hygiene event. Results Hand coverage achieved during a hand hygiene event strongly depends on the applied ABHR volume. At a 1 ml dose, the uncovered hand area was approximately 7.10%, at 2 ml it decreased to 1.68%, and at 3 ml it further decreased to 1.02%. The achieved coverage is strongly correlated to hand size, nevertheless, a 3 ml applied volume proved sufficient for most hand hygiene events (84%). When applying a lower amount of ABHR (1.5 ml), even people with smaller hands failed to cover their entire hand surface. Furthermore, a 3 ml volume requires more than the guideline prescribed 20–30 s to dry. In addition, results suggest that drying time is not only affected by hand size, but perhaps other factors may be involved as well (e.g., skin temperature and degree of hydration). ABHR volumes of 3.5 ml or more were inefficient, as the disinfectant spilled while the additional rubbing time did not improve hand coverage. Conclusions Hand sizes differ a lot among HCWs. After objectively measuring participants, the surface of the smallest hand was just over half compared to the largest hand (259 cm2 and 498 cm2, respectively). While a 3 ml ABHR volume is reasonable for medium-size hands, the need for an optimized volume of handrub for each individual is critical, as it offers several advantages. Not only it can ensure adequate hand hygiene quality, but also prevent unnecessary costs. Bluntly increasing the volume also increases spillage and therefore waste of disinfectant in the case of smaller hands. In addition, adherence could potentially decrease due to the required longer drying time, therefore, adjusting the dosage according to hand size may also increase the overall hand hygiene compliance.
Collapse
Affiliation(s)
- Constantinos Voniatis
- Laboratory of Nanochemistry, Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.,Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Száva Bánsághi
- Department of Epidemiology, Semmelweis University, Budapest, Hungary
| | - Andrea Ferencz
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Tamás Haidegger
- University Research and Innovation Centre (EKIK), Óbuda University, Budapest, Hungary. .,Austrian Center for Medical Innovation and Technology (ACMIT), Wiener Neustadt, Austria.
| |
Collapse
|
8
|
Wichaidit W, Naknual S, Kleangkert N, Liabsuetrakul T. Installation of pedal-operated alcohol gel dispensers with behavioral nudges and changes in hand hygiene behaviors during the COVID-19 pandemic: A hospital-based quasi-experimental study. J Public Health Res 2020; 9:1863. [PMID: 33150146 PMCID: PMC7607228 DOI: 10.4081/jphr.2020.1863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/28/2020] [Indexed: 12/31/2022] Open
Abstract
We conducted a quasi-experimental study and compared hand hygiene behaviors at potential pathogen transmission events among outpatient visitors (according to structured observations a trained enumerator) before and after installation of 12 pedal-operated alcohol gel dispensers with behavioral nudges (signs attached to the dispensers) at a tertiary hospital in southern Thailand during the COVID-19 pandemic. The enumerator observed 243 events during the pre-intervention period and 223 events during the postintervention period. Prevalence of hand hygiene was significantly different between the pre-intervention and post-intervention periods (0 vs 24 events, or 0% vs 11%, respectively; p-value <0.001). However, 21 of 24 hand hygiene events were of participants who came from outside the observation area, used the dispensers, then left. Nonetheless, the intervention might have helped to increase access to hand hygiene materials and created opportunities for hand hygiene among hospital visitors in general. Significance for public health This study compared hand hygiene behaviors after installation of pedal-operated alcohol gel dispensers compared to hand hygiene behaviors before the installation. Prevalence of observed hand hygiene was higher after installation compared to before installation, which suggested that the installation might have eliminated some barriers to hand hygiene. However, use of the alcohol gel might not necessarily indicate proper hand disinfection, and the prevalence of hand hygiene remained low, which highlighted the ongoing need to improve hand hygiene at potential pathogen transmission events (including transmission of COVID-19) at health facilities. Future studies should aim to understand the reasons(s) for missed hand hygiene opportunities and consider incorporating interventions that have shown effectiveness in improving hand hygiene behaviors among healthcare workers, as well as materials from the World Health Organization’s Guidelines on hand hygiene in health care.
Collapse
Affiliation(s)
- Wit Wichaidit
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai
| | | | | | | |
Collapse
|