Hand hygiene practices in a dental teaching center: Measures and improve

Comparing the effectiveness of hand hygiene techniques in reducing the microbial load and covering hand surfaces in healthcare workers: Updated systematic review

BACKGROUND

This review, commissioned by the World Health Organization (WHO), examined the effectiveness of the WHO 6-step hand hygiene (HH) technique in reducing microbial load on hands and covering hand surfaces, and compared its effectiveness to other techniques.

METHODS

Medline, CINAHL, ProQuest, Web of Science, Mednar, and Google Scholar were searched for primary studies, published in English (1978-February 2021), evaluating the microbiological effectiveness or hand surface coverage of HH techniques in healthcare workers. Reviewers independently performed quality assessment using Cochrane tools. The protocol for the narrative review was registered (PROSPERO 2021: CRD42021236138).

RESULTS

Nine studies were included. Evidence demonstrated that the WHO technique reduced microbial load on hands. One study found the WHO technique more effective than the 3-step technique (P = .02), while another found no difference between these 2 techniques (P = .08). An adapted 3-step technique was more effective than the WHO technique in laboratory settings (P = .021), but not in clinical practice (P = .629). One study demonstrated that an adapted 6-step technique was more effective than the WHO technique (P = .001). Evidence was heterogeneous in application time, product, and volume. All studies were high risk of bias.

CONCLUSIONS

Eight studies found that the WHO 6-step technique reduced microbial load on healthcare workers' hands; but the studies were heterogeneous and further research is required to identify the most effective, yet feasible technique.

Evaluation of the Efficiency of Hand Hygiene Technique with Hydroalcoholic Solution by Image Color Summarize

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.

Evaluating the efficacy of handwashing demonstration on hand hygiene among school students - An interventional study

BACKGROUND

Washing of hands and maintenance of appropriate hand hygiene plays a significant role in preventing the spread of many communicable diseases. However, literature demonstrating the efficacy of the World Health Organization (WHO) recommended handwashing procedure among schoolchildren in India is scanty.

AIM

The aim of this study was to assess hand hygiene efficacy through graphical assessment technique utilizing ultraviolet (UV)-sensitive fluorescent lotion before and after handwashing demonstration among students aged 12-18 years.

MATERIALS AND METHODS

This was an interventional study carried out over a period of 5 days among 21 schoolchildren aged 12-18 years in their respective school premises. Participants were requested to rub their hands with an UV-sensitive fluorescent lotion and then wash them. Hands were air-dried and examined under UV rays for blue light emission in a dark room. Emission of blue light highlighted parts of hand where lotion is still present and area not washed properly. Such areas were painted with nontoxic skin-friendly paints. Painted hands were imprinted over graph papers. Hand hygiene demonstration was provided to the participants as per the WHO guidelines by qualified public health dentists using audiovisual aids. Postintervention, the procedure followed at baseline was adopted to obtain imprints of uncovered (not covered during hand hygiene process) parts of hands. The mean percentage of uncovered parts of hand was assessed and compared between baseline and postintervention.

RESULTS

The overall mean percentage score of uncovered hand area significantly reduced from 73.90 ± 19.81 mm² at baseline to 20.05 ± 17.0 mm² after demonstration of proper hand hygiene guidelines (P < 0.001).

CONCLUSION

Hand hygiene demonstration by qualified public health dentists using audio-visual aids has significantly contributed to improving their hand hygiene practice.

Interventions to improve healthcare workers' hand hygiene compliance: A systematic review of systematic reviews

OBJECTIVE

To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC).

METHODS

PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed.

RESULTS

Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness.

CONCLUSIONS

This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.

Educator and Student Hand Hygiene Adherence in Dental Schools: A Systematic Review and Meta-Analysis

Health professionals and their patients are subject to cross-contamination and potential exposure to harmful infectious diseases. A common form of cross-contamination is through dental procedures without proper instrument care and lack of hand hygiene. The aim of this systematic review was to evaluate the published research on the adherence of educators and students in academic dental institutions to hand hygiene procedures. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and included articles collected in the Cochrane, LILACS, PubMed, Science Direct, Scopus, and Web of Science databases. The initial search identified 1,196 articles. Ultimately, three studies were included for qualitative synthesis and two for the meta-analysis. The three articles had similar characteristics of observational hand hygiene research involving educators and dental students. In all three, hand hygiene among dental students did not reach 50% of the total number of opportunities, which is a troubling result. Although the hand hygiene rate of educators was higher than that of dental students, these findings point to a need to further promote hand hygiene to future professionals to avoid cross-contamination between health professionals and patients.

Investigating the effect of preparation for and participation in a hand-sanitizing relay on nursing students' ability to recall the WHO 6-step hand hygiene technique

This study explored whether preparation for a hand-sanitizing relay affected nursing students' ability to recall, 12 months later, the World Health Organization 6-step hand hygiene technique. No significant difference was observed in recall between those who participated in the relay and those who did not (P = .736). The most frequently missed step was Step 3 (palm to palm with fingers interlaced). Our results suggest that regular feedback may be an important additional component in future interventions.

Detection of Visually Imperceptible Blood Contamination in the Oral Surgical Clinic using Forensic Luminol Blood Detection Agent

Aim and Objectives:

Oral surgical procedures can cause spread of infections in the clinics through visually imperceptible, splattered, and aerosolized blood. The aim of this study was to evaluate visually imperceptible blood contamination of clinical surfaces and personal protective equipment (PPE) in an oral surgery clinic using luminol.

Materials and Methods:

Following ethical approval, oral surgical procedures were performed under local anesthesia in a disinfected clinic, and PPE was used by the oral surgeon, dental assistant, and patients. After the procedure, clinical surfaces and PPE were evaluated for traces of visually imperceptible blood contamination using luminol. Data regarding blood contamination and the duration of the procedure were collected. Nonparametric tests, with 95% significance level (Epi Info, Stat Calc 7, CDC, Atlanta, USA), were used to identify statistical interactions between the duration of the procedure and the frequency of blood contamination.

Results:

Blood contamination was detected in flooring below surgical field (86.67%), instrument tray, operating light, dental chair, and suction unit (100%). Except head caps and shoe covers, blood contamination was detected in all the PPE used by the clinical personnel, and the eyewear and chest drapes used by patients. An increase in the surgical time beyond 40 min significantly increased the risk of blood contamination in the handcuffs of the clinical personnel (P < 0.01).

Discussion and Conclusion:

Visually imperceptible blood contamination of the clinical surfaces and PPE is associated with minor oral surgical procedures. This mandates the cleaning and disinfection of all clinical surfaces before and after minor oral surgical procedures and PPE for clinicians and patients during every procedure.

A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers

BACKGROUND

Effective hand hygiene prevents healthcare-associated infections. This systematic review evaluates the evidence for the World Health Organization's (WHO) technique in reducing the microbial load on the hands of healthcare workers (HCWs).

METHODS

This study was conducted in accordance with Joanna Briggs Protocol 531. Index and free-text terms for technique, HCW, and microbial load were searched in CINAHL, Medline, Web of Science, Mednar, Proquest, and Google Scholar. Inclusion criteria were articles in English that evaluated the WHO 6-step hand hygiene technique for healthcare staff. Two reviewers independently performed quality assessment and data extraction.

RESULTS

All 7 studies found that the WHO technique reduced bacterial load on HCW hands, but the strongest evidence came from 3 randomized controlled trials, which reported conflicting evidence. One study found no difference in the effectiveness of the WHO 6-step technique compared to the Centers for Disease Control and Prevention's 3-step technique (P = .08); another study found the WHO 6-step technique to be more effective (P = .02); and the third study found that a modified 3-step technique was more effective than the 6-step technique (P = .021).

CONCLUSIONS

This review provides evidence of the effectiveness of the WHO technique but does not identify the most effective hand hygiene technique. Questions to be addressed by further research are identified. Meanwhile, current practices should continue.

Impact of Educational Intervention for Hand Hygiene on Dental Students' Knowledge, Attitude, and Bacterial Contamination Level on Hands

AIM

The present study aimed to investigate the impact of the educational intervention for hand hygiene (HH) on knowledge, attitude, and mean colony-forming bacterial counts and type of bacteria on hands of undergraduate dental students.

MATERIALS AND METHODS

A total of 86 dental students from different clinical grades were included in the study. They were divided into two groups, group I (55 students) received onetime educational session for HH at the start of the academic year and group II (31 students) received an extra reenforce-ment session 6 months later. After 2 weeks of reenforcement session, a self-administrated questionnaire was directed to all participants assessing their knowledge and attitude about HH. Fingertip prints of the five fingers of the dominant hand from every participant were pressed onto blood agar plates in triplets at the same clinical session, before and after HH. Bacterial colony-forming units (CFUs) on each plate were recorded and identified microbiologically.

RESULTS

The overall scores of knowledge and attitude showed higher levels in group II than in group I with nonsignificant differences between both groups as regards knowledge and significant differences (p < 0.05) as regards attitude. Mean CFUs showed extremely significant differences (p < 0.000) between 2nd and 3rd counts and between 1st and 2nd counts except for students of group I where the difference was only significant (p < 0.05). Normal bacterial flora was identified in 94.9% of the plates (92.2% coagulase-negative Staphylococci and 2.7% Micrococcus). Potentially pathogenic bacteria isolated from the other plates were Klebsiella pneumonia, Pseudomonas spp., and spore-forming aerobic nonhemolytic Bacilli.

CONCLUSION

Reenforcement session had a positive impact on HH knowledge, attitude, and reduction of bacterial CFUs.

CLINICAL SIGNIFICANCE

Continuous education with frequent training sessions is recommended to reinforce HH compliance and reduce cross-contamination.

Knowledge of hand hygiene in undergraduate medical, dental, and nursing students: A cross-sectional survey

BACKGROUND

Hand hygiene is of paramount importance for the prevention of healthcare associated infections and the spread of antimicrobial resistance. There is a need to explore the concept of hand hygiene among the cross-disciplinary undergraduate healthcare students.

AIM

To evaluate and compare the knowledge of hand hygiene among medical, dental, and nursing undergraduate students.

MATERIALS AND METHODS

A cross-sectional survey was conducted among 84 medical, 74 dental, and 40 nursing undergraduate students in a Tertiary Care Teaching Institute in Navi Mumbai, Maharashtra, India. Knowledge was assessed using the World Health Organization hand hygiene questionnaire. The scores for each were calculated and compared. The scores were further graded as low, moderate, and good.

RESULTS

Overall, only 7.5% of the participants had good knowledge regarding hand hygiene while majority (69.1%) had moderate knowledge. Medical students' hand hygiene knowledge was significantly (P < 0.01) higher than that of dental and nursing students.

CONCLUSION

The overall low scores on hand hygiene knowledge indicate that undergraduate healthcare students require increased emphasis on hand hygiene education, behavior, and improvement in their current primary training as well as undergraduate curricula.