ArticleLiterature Review

Role of Hand Hygiene in Healthcare-Associated Infection Prevention

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Abstract

Healthcare workers' hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment. Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections (HCAIs), but healthcare worker compliance with optimal practices remains low in most settings. This paper reviews factors influencing hand hygiene compliance, the impact of hand hygiene promotion on healthcare-associated pathogen cross-transmission and infection rates, and challenging issues related to the universal adoption of alcohol-based hand rub as a critical system change for successful promotion. Available evidence highlights the fact that multimodal intervention strategies lead to improved hand hygiene and a reduction in HCAI. However, further research is needed to evaluate the relative efficacy of each strategy component and to identify the most successful interventions, particularly in settings with limited resources. The main objective of the First Global Patient Safety Challenge, launched by the World Health Organization (WHO), is to achieve an improvement in hand hygiene practices worldwide with the ultimate goal of promoting a strong patient safety culture. We also report considerations and solutions resulting from the implementation of the multimodal strategy proposed in the WHO Guidelines on Hand Hygiene in Health Care.

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... For å redusere forekomsten av helsetjenesteassosierte infeksjoner (HAI) er håndhygiene det mest kostnadseffektive tiltaket. Likevel har internasjonale undersøkelser vist at korrekt håndhygiene ikke alltid blir utført (Allegranzi & Pittet, 2009, WHO 2009a, WHO, 2011. Studier har funnet at etterlevelsen av håndhygiene på sykehus kan variere fra 40 til 78 % (Alsubaie, Maither, Alalmaei, Somily, Alaska, & BinSaeed, 2013, Randle, Arthur, & Vaughan 2010, Randle, Firth, & Vaughan 2013, Scheithauer & Lemmen 2013. ...
... Veilederens fagkunnskap og holdninger har betydning for hvordan studenter laerer, men også hvordan de bygger sin sykepleiekompetanse, ifølge Haugen, et al. (2012). Sykepleiere som har liten 9 forståelse for viktigheten av håndhygiene, utsetter seg selv og andre for helserisiko (Allegranzi & Pittet, 2009, WHO, 2009a, WHO, 2009b, WHO, 2011. Manglende refleksjon over egen praksis (Sharif & Masoumi, 2009) som synliggjør manglende risikovurderinger, men også forsvarer, tolererer og rettferdiggjør brudd på sine håndhygienehandlinger (Elliott, 2003), vil også representere en helserisiko. ...
... Andre studier har rapportert at sykepleiere har kunnskap om håndhygiene, men har behov for oppdatering (Allegranzi & Pittet, 2009, Asadollahi et al. 2015. Selv om sykepleiere har mye kunnskap, erfarte informantene i denne studien at etterlevelsen av håndhygiene var ulik. ...
Article
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En betydelig del av sykepleierutdanningen foregår i de kliniske studiene, veiledet av sykepleiere. Denne studien er utført for å forstå studentopplevelsene, hvordan de lærer å bruke håndhygieniske prinsipper i kliniske studier. Vi brukte et beskrivende og utforskende design med fokusgruppeintervjuer. Dataene ble analysert ved hjelp av kvalitativ innholdsanalyse. Analysen resulterte i to hovedtemaer, både faktorer som fremmet og hemmet studentlæring. Tydelige retningslinjer prosedyrer samt støttende og oppmuntrende tilbakemeldinger fra veiledere fremmet læring. Mangel på håndhygienefasiliteter, tidspress, komplekse læringssituasjoner, tilstrekkelig anerkjennelse og veiledernes manglende overholdelse, var hemmende faktorer. Studien viser at sykepleiere i klinisk praksis var forbilder for studentene og viktig for å lære de riktige håndhygieniske prinsipper i klinisk praksis
... Thirdly, when a regular record is kept of the number of new cases of disease, like cholera and tuberculosis, it is possible to detect an epidemic early. This is another form of secondary prevention called 'surveillance' [3]. ...
... Undoubtedly this can result to epidemic and transmission of diseases among student which will affect effective teaching and learning. Several studies [3,[6][7][8], on how effective practice of personal hygiene can reduce poor personal hygiene induced diseases abound. Report from Rabie and Curtis (2006) shows that improved awareness of personal hygiene especially hand washing among students have effectively reduced gastro intestinal and respiratory tract infections by 50%, the two leading causes of children morbidity and mortality around the world. ...
Article
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Disease prevention is operationally defined in this research as the measures taken to avoid contact with disease pathogens. The indicators of disease prevention measures investigated in this study include: the knowledge and practice of regular hand washing, brushing of teeth, care of the nails and general body cleaning. Maintaining regular hand washing, brushing of teeth, care of the nails and general body cleanliness formed the dependent variables investigated while the habitats of urban and rural settings are the independent variables of the study. The study investigated if the habitat divide of urban and rural settings will have influence on students’ knowledge and practice of cleanliness as disease prevention measure. The sample of the study was 140 Senior Secondary School Two (SS2) students from an urban school and another 140 SS2 students from a rural school making a sample total of 280 SS2 students. Questionnaire containing items indicating understanding of the link between cleanliness and disease prevention using the aforementioned indices was the data collection instrument. The instrument was developed by the researchers and pilot tested; PPMCC of 0.83 indicated that the instrument was reliable. One research question and one hypothesis were posited for the study. Mean and standard deviation was used to answer the research question while t-test was used to test the hypothesis at p < 0.05 level of significance. The study revealed that urban participants in comparison to rural participants demonstrated a better understanding of the link of cleanliness to disease prevention and were also better in the practice of cleanliness. It was therefore recommended that rural schools should intensify the teaching of personal hygiene as well as provision of facilities that will encourage personal hygiene.
... Lastly, differences between results may be due to differences in model structure. There is further evidence from studies of other infectious diseases that interventions focused on reducing ppt (e.g., isolation, hand-hygiene) can reduce transmission risk and final outbreak size [7,[25][26][27][28][29][30][31][32][33][34]. One study estimated that reducing ppt resulted in a 23% reduction in the cumulative influenza attack rate [27]. ...
... It is likely that the risk of exposure changed over time; however, details on exact exposures were unknown. Similarly, since interventions targeting ppt rely on human behaviour, the effects of these interventions likely also vary in time [26,[28][29][30][31]34]. The model could be missing this additional variability. ...
Article
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Objective Person-to-person transmission can occur during outbreaks of verotoxigenic Escherichia coli (VTEC), however the impact of this transmission route is not well understood. This study aimed to examine the role of person-to-person transmission during a VTEC outbreak, and how targeting this route may reduce outbreak size. A deterministic compartmental model describing a VTEC outbreak was constructed and fit to data from a 2008 outbreak in Ontario, Canada. Using the best-fit model, simulations were run to calculate the: reduction in transmission rate after implementing interventions, proportion of cases infected through both transmission routes, and number of cases prevented by interventions. Latin hypercube sensitivity analysis was conducted to examine the sensitivity of the outbreak size to the model parameters. Results Based on the best-fit model, ~ 14.25% of the cases likely arose due to person-to-person transmission. Interventions reduced this transmission rate by ~ 73%, causing a reduction in outbreak size of ~ 17% (47 cases). Sensitivity analysis showed that the model was highly sensitive to changes in all parameters of the model. The model demonstrates that person-to-person could be an important transmission route during VTEC outbreaks. Targeting this route of transmission through hand hygiene and work exclusions could reduce the final outbreak size.
... The health implications of infectious diseases affecting children of school-going age as a result of the low practice of personal hygiene practices and insufficient sanitary facilities in public primary schools is still a concern for worry in most poor and middle-income countries (Venkatesh et al., 2011;Ali et al., 2021). Hand hygiene is fundamental to clinical practice and has been shown to reduce the risk of HAI (Allegranzi and Pittet, 2009). Commonly, HH compliance in ED is poor and initiatives to improve and sustain HH adherence rates are a major challenge (Larson et Hand-washing practice stops the spread of many diseases and infections. ...
... 4 shows the knowledge the knowledge about hand washing 77% was wash their hands and 33 don't have knowledge to wash their hands. Only 49% students know the importance of hand washing to prevent diseases 39% know that its importance to remove germs and 12 % have knowledge to remove for dirt's. ...
Article
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Hand hygiene is fundamental to clinical practice and has been shown to reduce the risk of major diseases. School children and for that matter, primary school pupils are at higher risk the most because of the lack of paying special attention to a simple but very important personal hygiene behavior such as frequently washing hands with soap under running water and also due to insufficient knowledge on good hand washing with soap practice. Between November 2021 and March 2022, this study was conducted in Tehsil Lalian District Chiniot Pakistan. Data on hand washing practiced among primary school children were collected by using questionnaires. Ten students from each school were selected for the questionnaires and 20 schools in urban and 20 schools in rural areas were covered. The study helped us to check the current knowledge about hygiene and the availability of hand washing facilities in the school. Data were collected from above-mentioned schools by using questionnaires. Interviews were taken from the class students to check their knowledge about hygiene which they are given to the students to guide them about their hygiene and how they teach the students to keep them healthy. In rural schools, about 39% students were selected from class 3, 32% from class 4, and 29% students were selected from class 5, while in urban schools, about 35.5% students were taken from class 3, 36.5% from class 4 and 28% students from class 5 were selected. All schools (rural and urban) have the facility of hand washing points. About 96.75% schools have water supply within hand washing point while only 3.25 schools do not have a water supply. They have tissue papers facility instead of water. About 87.75% schools have sign boards of hand washing to guide the students while only 12.25% schools do not have sign boards on hand washing guide the students. About 71.5% students from rural schools wash their hands before eating food while 28.5% students wash their hands after eating. Further, 66.5% students from urban schools wash their hands before eating food while 32.5% students wash their hands after eating. About 74.5% students from rural schools, wash their hands after playing with friends while 25.5% students sometimes wash their hands. About 63.5% students from urban schools wash their hands after playing with friends while 36% students sometimes wash their hands and 0.5% never wash PriMera Scientific Medicine and Public Health https://primerascientific.com/psmph Effect of Hand Washing Practices and Prevalence of Related Diseases among Primary School Children in Tehsil Lalian, District Chiniot, Pakistan 16 their hands after playing with friends. About 77% students know the importance to wash their hands with soap when in school and 23% students do not. About 42.75% students strongly agree that hand hygiene reduces the chances of spreading infections, 28% student only agree, 13% disagree, 12% don't know while 4.25% strongly disagree. About 81% students think proper hand-washing minimizes the risk of germ attack while 19% students do not think so. About 88.75% students know that if they fail to wash their hands properly, they will be exposed to the disease while 11.25% students do not think so. About 80.25% students think that poor hand washing can cause disease while 19.75% students do not think so.
... By improving hand hygiene adherence, health care associated infections can be significantly reduced. 1,2 COVID-19 caused by SARS-CoV2(severe acute respiratory syndrome coronovirus-2) are transmitted by respiratory droplets by mode of droplet and contact. 3,4 World health organization (WHO) strongly recommends hand hygiene practices to prevent COVID-19 cross transmission and transmission of health care associated infections. ...
Article
Full-text available
Background: Hand hygiene is a significant component involved in preventing transmission of health care associated infections including COVID-19. Compliance to hand hygiene among the health care workers (HCWs) requires evaluation and timely feedback. "You can't improve what you can't measure" is a famous saying and this multicentric study was designed to measure hand hygiene compliance and have birds eye view on hand hygiene compliance in COVID Intensive care units (ICUs) and wards across India. Methods: A prospective multicentric observational study was conducted for a period of 6 months in 92 health care facility across India which included varied type of public and private hospitals. Hand hygiene audit was conducted in COVID ICU and COVID non-ICU wards in all these facilities by their HCWs using the IBHAR mobile application based on WHO's hand hygiene audit tool. Hand hygiene total adherence rate (HHTAR) and hand hygiene complete adherence rate (HHCAR) were analyzed and compared between 2 locations. Adherence rates were analyzed based on the zones, institute type, profession and for each WHO moments. Results: A total of 1,61,056 hand hygiene opportunities were documented and adherence rates were recorded higher in COVID wards (HHTAR-61.4%; HHCAR-28.8%) than COVID ICUs (HHTAR-57.8%; HHCAR-25.6%). Overall, the adherence rates were observed higher in COVID wards (HHTAR-68.1%; HHCAR-38.3%) of private hospitals, COVID wards of the west zone (HHTAR-70.2%; HHCAR-36.8%), cleaning staffs of the COVID ward scores better compliance than all other professions in COVID ICUs and COVID wards. HHTAR was found to be the higher in moment 3 (After body fluid exposure-76.3%) followed by moment 4 (after touching patient-73.7%) done in COVID wards compared to moments done in ICUs. Conclusions: This study highlights the practice of hand hygiene in COVID care locations across India. Effective strategies need to be implemented in COVID ICUs across the facilities to improve the compliance.
... Recognizing the merits of hand hygiene (HH), the World Health Organization (WHO) has accepted it as the single most e ective measure to prevent healthcare-associated infections (HCAIs) [1]. Globally an estimated 2·5 million neonatal deaths occur each year where infection is responsible for about 1.6 million annual deaths among neonates worldwide, 99% of which take place in developing countries [2]. ...
Article
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Background. Healthcare workers’ (HCWs) hands become progressively colonized with potential pathogens during their patient care and act as a vehicle for transmission of microorganisms to other patients. Hand hygiene is undisputedly one of the most effective infection control measures. The objective of this study was to measure the hand hygiene (HH) compliance among the doctors and nurses before and after intervention. Methodology. This quasi-experimental (before and after) study was conducted from July 2019 to July 2020 in the neonatal intensive care unit in a tertiary hospital in Bangladesh. The doctors and nurses were observed for their compliance to HH before and after the intervention. Several group discussions were arranged, and posters on HH were attached as reminders at the workstations during the intervention period. Binary logistic regression analysis of the predictors for the outcome as HH noncompliance was performed. Result. The overall compliance to HH was significantly increased in both before (from 42.9 to 83.8%, p = < 0.0001) and after (28.5 to 95.9%, p = < 0.000) patient contact, in both the case of high-risk and low-risk contacts (p = < 0.000) following the intervention. A significant reduction in the frequency of inadequate HH (20.2 to 9.7%, p = .000) was documented. In logistic regression analysis, compliance to HH was found more after the intervention (aOR = 13.315, 95% CI: 7.248–24.458). Similarly, being a physician (aOR = 0.012, 95% CI: 0.005–0.030) and moments after patient contact (aOR = 0.114, 95% CI: 0.049–0.261), significant positive predictors for compliance to HH were found. Conclusion. Significant improvements in HH compliance were achieved through a systemic, multidimensional intervention approach among the doctors and nurses in an intensive newborn care setting.
... Routine collection and real-time analysis of data across individual institutions is vital if currently available antibiotics are to be safeguarded. In clinical settings, personal hygiene, especially hand hygiene is considered the most important IPC measure [48], but compliance with hand hygiene guidance can be low (around 40%) [49,50] and has been identified as a key area in need of improvement to stop person-to-person transmission of AMR [51]. Technological advancements to monitor hand hygiene technique and compliance and prompt hand hygiene behaviours have been found effective in increasing compliance [52,53]. ...
Preprint
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Antimicrobial resistance (AMR) is a growing public health threat, estimated to cause over 10 million deaths per year and cost the global economy 100 trillion USD by 2050 under status quo projections. These losses would mainly result from an increase in the morbidity and mortality from treatment failure, AMR infections during medical procedures, and a loss of quality of life attributed to AMR. Numerous interventions have been proposed to control the development of AMR and mitigate the risks posed by its spread. This paper reviews key aspects of bacterial AMR management and control which make essential use of data technologies such as artificial intelligence, machine learning, and mathematical and statistical modelling, fields that have seen rapid developments in this century. Although data technologies have become an integral part of biomedical research, their impact on AMR management has remained modest. We outline the use of data technologies to combat AMR, detailing recent advancements in four complementary categories: surveillance, prevention, diagnosis, and treatment. We provide an overview on current AMR control approaches using data technologies within biomedical research, clinical practice, and in the "One Health" context. We discuss the potential impact and challenges wider implementation of data technologies is facing in high-income as well as in low- and middle-income countries, and recommend concrete actions needed to allow these technologies to be more readily integrated within the healthcare and public health sectors.
... These hospital infections are prevalent (Brady, et al, 2007), also known as nosocomial infections and can be transmitted from the patient to the health care provider or vice versa. There is a rise in this hospital acquired infections globally and this has been a source of worry (Palmore, et al, 2010;Allegranzi and Pittet, 2009;Razine et al, 2012). Previous study has shown that one third of all nosocomial infections may be preventable and are caused by organisms acquired within the hospital [Hugh, 1998]. ...
Article
Background: Mobile phones were first introduced in the United Kingdom and have become an important means of communication among doctors, other healthcare workers, patients and the general public. Objectives: This study was aimed at establishing that mobile phones are sources of nosocomial infections in the radiology department of our teaching hospital and also to determine the pathogens that are responsible for these infections. Methods: This was a prospective study that involved collection of swab samples from radiographers’ mobile phones. Three different samples were collected from each mobile phone. Thirty (30) mobile phones were used for this investigation and ninety (90) samples were totally collected. Samples were collected on arrival of the radiographer to the department, after handling patients and after washing hands. Samples collected were sent to the microbiology department for culture analysis. Descriptive data analysis was performed and results presented in frequency tables. Results: On arrival at the department, samples collected revealed that 22 (73.3%) of the phones were contaminated before commencing work for the day while 8 (26.7%) were not contaminated. With direct patient contact, 27 (93.3%) were contaminated and after washing hands it was observed that 16 (53.3%) of the mobile phones were contaminated. The major cause of contamination was staphylococcus aureus especially noted in swabs obtained after direct patient contact. Pseudomonas aeruginosa and Escherichia coli were also identified as contaminants of the phones. Conclusion: Radiographers’ mobile phones harbour bacteria and could act as a source of nosocomial infection in the radiology department.
... 14,15 Some interventions, for example hand hygiene, are in common with the commonly recommended measures for HAI prevention. 25,26 At the study hospital, the increased consumption of 75% alcohol solution in 2020 could reasonably be linked to enhanced hand hygiene. Nevertheless, our results were not in accordance with a decline in VRE HAI, as noted in the Lo's study. ...
Article
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Background Variable control measures for vancomycin-resistant Enterococcus (VRE) infections were adopted among different hospitals and areas. We investigated the burden and patient characteristics of healthcare-associated VRE infections in 2018-2019 and 2020, when multiple preventive measures for COVID-19 were taken. Methods During the COVID-19 pandemic, mask waring and hand hygiene were enforced in the study hospital. The incidence densities of healthcare infections (HAIs), including overall HAIs, methicillin-resistant Staphylococcus aureus (MRSA) HAIs, VRE HAIs, and VRE healthcare-associated bloodstream infections (HABSIs), consumption of broad-spectrum antibiotics and hygiene products, demographic characteristics and medical conditions of affected patients, were compared before and after the pandemic. Results The incidence density of both VRE HAIs and VRE HABSIs did not change statistically significantly, however, the highest in 2020 than that in 2018 and 2019. This was in spite of universal mask waring and increased consumption of 75% alcohol in 2020 and consistent implementation of an antibiotic stewardship program in three observed years. The increased prescriptions of broad-spectrum cephalosporins might partially explain the increase of VRE infection. Conclusion Increased mask wearing and hand hygiene may not result in the decline in the development of VRE HAIs in the hospital during the COVID-19 pandemic, and continued monitoring of the dynamics of HAIs remains indispensable.
... The most signicant reduction in SSI was noted in Gynaecological cases. Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing 8,9 healthcare-associated infection. Masks can reduce outward transmission of infection by individuals which provides protection to 10 others. ...
Article
Introduction: Methods:Surgical site infection (SSI) accounts for major morbidity in post-operative patients. An observational study was carried st out in a tertiary health centre in Kerala, India, where SSI Rates were analyzed for a period of 24 months prior and 24 months after January 2020 (1 case of COVID-19) based on patient records. A drastic reduction in SSI rates was noted in post covid period in Gynaecological casesResults: (2.44%, p=0.004). Signicant reduction in SSI was also noted in Elective LSCS (0.70%, p=0.004) and Emergency LSCS cases (1.51%, p=0.039). Conclusion: The practice of wearing N-95 masks and frequent hand washing can be continued to reduce SSI rates in OBG wards.
... A study conducted by the Soapbox Collaborative found that across India, Bangladesh, and The Gambia, less than one-third of the HCFs provided formal training to their cleaning staff (Cross et al. 2019). Consistent, reliable training of cleaning staff in IPC procedures has the potential to limit the transmission of disease and reduce HAIs (Allegranzi & Pittet 2009). One study found, with the introduction of training and ensuring the appropriate type of cleaning materials, the reduction of contamination on hospital mattresses to those comparable in a high-income setting (Hopman et al. 2016). ...
Article
Full-text available
Healthcare facility (HCF) cleaners play an important role in preventing healthcare-acquired infections and promoting a safe and clean healthcare environment. There is little evidence describing cleaner roles in HCFs in low-income countries and factors facilitating and constraining their roles and responsibilities. We analyzed qualitative and quantitative data from 57 in-depth interviews with cleaners in 44 government-run HCFs in Malawi. Cleaner constraints included inadequate training on infection prevention and control (IPC), personal protective equipment (PPE), hand hygiene, and waste management; insufficient PPE and hand hygiene resources; assignment of tasks that are unrelated to core responsibilities and their job description; risk of work-related injuries; and disrespect and stigma from medical staff, patients, and guardians. Facilitators included the positive collaboration and communication with medical staff, high job satisfaction, and a positive working attitude. We recommend the provision of more robust IPC, PPE, hand hygiene, and waste management training (including orientation and refresher). PPE resources must be made available to ensure HCF cleanliness and to keep cleaners, staff, patients, and guardians safe. Clearly defined job descriptions for cleaners will clarify their roles, describe bounds of their work, and ensure cleaners are viewed as essential frontline workers who ensure the safety of staff and patients.
... For Sur Hospital, ABHR had significant reduction on CRAb incidence when its use exceeded certain thresholds. The value of ABHR on reducing healthcare-acquired infections has been demonstrated in several studies [32][33][34]. ...
Article
Full-text available
Abstract: Solutions are needed to inform antimicrobial stewardship (AMS) regarding balancingthe access to effective antimicrobials with the need to control antimicrobial resistance. Theoreticaland mathematical models suggest a non-linear relationship between antibiotic use and resistance,indicating the existence of thresholds of antibiotic use beyond which resistance would be triggered.It is anticipated that thresholds may vary across populations depending on host, environment, andorganism factors. Further research is needed to evaluate thresholds in antibiotic use for a specificpathogen across different settings. The objective of this study is to identify thresholds of populationantibiotic use associated with the incidence of carbapenem-resistant Acinetobacter baumannii (CRAb)across six hospital sites in Oman. The study was an ecological, multi-centre evaluation that involvedcollecting historical antibiotic use and CRAb incidence over the period from January 2015 to December2019. By using non-linear time-series analysis, we identified different thresholds in the use of third-generation cephalosporins, piperacillin-tazobactam, aminoglycoside, and fluoroquinolones acrossparticipating hospitals. The identification of different thresholds emphasises the need for tailoredanalysis based on modelling data from each hospital. The determined thresholds can be used toset targets for each hospital AMS, providing a balance between access to these antibiotics versuscontrolling CRAb incidence.
... For Sur Hospital, ABHR had significant reduction on CRAb incidence when its use exceeded certain thresholds. The value of ABHR on reducing healthcare-acquired infections has been demonstrated in several studies [32][33][34]. ...
... For Sur Hospital, ABHR had significant reduction on CRAb incidence when its use exceeded certain thresholds. The value of ABHR on reducing healthcare-acquired infections has been demonstrated in several studies [32][33][34]. ...
Article
Full-text available
Solutions are needed to inform antimicrobial stewardship (AMS) regarding balancing the access to effective antimicrobials with the need to control antimicrobial resistance. Theoretical and mathematical models suggest a non-linear relationship between antibiotic use and resistance, indicating the existence of thresholds of antibiotic use beyond which resistance would be triggered. It is anticipated that thresholds may vary across populations depending on host, environment, and organism factors. Further research is needed to evaluate thresholds in antibiotic use for a specific pathogen across different settings. The objective of this study is to identify thresholds of population antibiotic use associated with the incidence of carbapenem-resistant Acinetobacter baumannii (CRAb) across six hospital sites in Oman. The study was an ecological, multi-centre evaluation that involved collecting historical antibiotic use and CRAb incidence over the period from January 2015 to December 2019. By using non-linear time-series analysis, we identified different thresholds in the use of third- generation cephalosporins, piperacillin-tazobactam, aminoglycoside, and fluoroquinolones across participating hospitals. The identification of different thresholds emphasises the need for tailored analysis based on modelling data from each hospital. The determined thresholds can be used to set targets for each hospital AMS, providing a balance between access to these antibiotics versus controlling CRAb incidence.
... For Sur Hospital, ABHR had significant reduction on CRAb incidence when its use exceeded certain thresholds. The value of ABHR on reducing healthcare-acquired infections has been demonstrated in several studies [32][33][34]. ...
Article
Full-text available
Solutions are needed to inform antimicrobial stewardship (AMS) regarding balancing the access to effective antimicrobials with the need to control antimicrobial resistance. Theoretical and mathematical models suggest a non-linear relationship between antibiotic use and resistance, indicating the existence of thresholds of antibiotic use beyond which resistance would be triggered. It is anticipated that thresholds may vary across populations depending on host, environment, and organism factors. Further research is needed to evaluate thresholds in antibiotic use for a specific pathogen across different settings. The objective of this study is to identify thresholds of population antibiotic use associated with the incidence of carbapenem-resistant Acinetobacter baumannii (CRAb) across six hospital sites in Oman. The study was an ecological, multi-centre evaluation that involved collecting historical antibiotic use and CRAb incidence over the period from January 2015 to December 2019. By using non-linear time-series analysis, we identified different thresholds in the use of third-generation cephalosporins, piperacillin-tazobactam, aminoglycoside, and fluoroquinolones across participating hospitals. The identification of different thresholds emphasises the need for tailored analysis based on modelling data from each hospital. The determined thresholds can be used to set targets for each hospital AMS, providing a balance between access to these antibiotics versus controlling CRAb incidence.
... In developed countries, HAI affects about 5-15% of hospitalized patients. The rate is higher among those in intensive care units (ICUs), between 937% [3,4]. The incriminating organisms are often microbial isolates of Resistant to organisms. ...
... One of the most effective and established practices that helps to prevent healthcare-associated infections (HCAIs) that has gained great significance in this era is hand hygiene (HH). The hands of the healthcare workers (HCW) are the most common vehicle for transmission of HCAIs [1]. Pathogenic microorganisms can stay for 2-60 minutes on HCW's hands if HH is not performed. ...
Research
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Introduction: Proper hand hygiene (HH) is a proven, simple, and most effective method to
... By improving hand hygiene adherence, health care associated infections can be significantly reduced. 1,2 COVID-19 caused by SARS-CoV2(severe acute respiratory syndrome coronovirus-2) are transmitted by respiratory droplets by mode of droplet and contact. 3,4 World health organization (WHO) strongly recommends hand hygiene practices to prevent COVID-19 cross transmission and transmission of health care associated infections. ...
Article
Full-text available
Background: Hand hygiene is a significant component involved in preventing transmission of healthcare associated infections including COVID-19. Compliance to hand hygiene among the healthcare workers (HCWs) requires evaluation and timely feedback. “You can't improve what you can't measure” is a famous saying and this multicentric study was designed to measure hand hygiene compliance and have birds eye view on hand hygiene compliance in COVID Intensive care units (ICUs) and wards across India. Methods: A prospective multicentric observational study was conducted for a period of 6 months in ninety-two healthcare facility across India which included varied type of public and private hospitals. Hand hygiene audit was conducted in COVID ICU and COVID non-ICU wards in all these facilities by their HCWs using the IBHAR mobile application based on WHO's hand hygiene audit tool. Hand hygiene total adherence rate (HHTAR) and hand hygiene complete adherence rate (HHCAR) were analysed and compared between two locations. Adherence rates were analysed based on the zones, institute type, profession and for each WHO moments. Results: A total of 1,61,056 hand hygiene opportunities were documented and adherence rates were recorded higher in COVID wards (HHTAR-61.4%; HHCAR-28.8%) than COVID ICUs (HHTAR-57.8%; HHCAR-25.6%). Overall, the adherence rates were observed higher in COVID wards (HHTAR- 68.1%; HHCAR-38.3%) of private hospitals, COVID wards of the west zone (HHTAR- 70.2%; HHCAR-36.8%), cleaning staffs of the COVID ward scores better compliance than all other professions in COVID ICUs and COVID wards. HHTAR was found to be the higher in moment 3 (After body fluid exposure-76.3%) followed by moment 4 (after touching patient-73.7%) done in COVID wards compared to moments done in ICUs. Conclusion: This study highlights the practice of hand hygiene in COVID care locations across India. Effective strategies need to be implemented in COVID ICUs across the facilities to improve the compliance.
... Healthcare-associated infections are among the most frequent adverse events affecting patients worldwide (Harbarth et al. 2003;Sax et al. 2020). A significant proportion of these infections may be avoided through the use of preventative measures, such as hand hygiene with alcohol-based hand rub (Allegranzi and Pittet 2009;Harbarth et al. 2002;Rupp et al. 2008). Indeed, the hands of healthcare providers may play a role in the direct and indirect transmission of microorganisms between objects and patients (Clack et al. 2014). ...
Article
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Training medical professionals for hand hygiene is challenging, especially due to the invisibility of microorganisms to the human eye. As the use of virtual reality (VR) in medical training is still novel, this exploratory study investigated how preexisting technology acceptance and in-training engagement predict VR hand hygiene performance scores. The effect of training in the VR environment on the behavioral intention to further use this type of training device (a component of technology acceptance) was also investigated. Participants completed a VR hand hygiene training comprising three levels of the same task with increasing difficulty. We measured technology acceptance, composed of performance expectancy, effort expectancy, and behavioral intention, pre- and post-training, and in-training engagement using adaptations of existing questionnaires. We used linear regression models to determine predictors of performance in level-3 and of behavioral intention to further use VR training. Forty-three medical students participated in this exploratory study. In-training performance significantly increased between level-1 and level-3. Performance in level-3 was predicted by prior performance expectancy and engagement during the training session. Intention to further use VR to learn medical procedures was predicted by both prior effort expectancy and engagement. Our results provide clarification on the relationship between VR training, engagement, and technology acceptance. Future research should assess the long-term effectiveness of hand hygiene VR training and the transferability of VR training to actual patient care in natural settings. A more complete VR training could also be developed, with additional levels including more increased difficulty and additional medical tasks.
... 48,49 This reinforces the need to employ multiple strategies within a workplace to maximise behaviour change and acceptance. [50][51][52] Engaging Nurse Champions to drive the change, with strong executive leadership and support, will help drive the initiative and improve infection control practice. 1,23 This HH pilot trial highlighted that the core business of providing veterinary care supersedes other activities, such as continuing education. ...
Article
ABSTRACT Hand hygiene is one of the most important infection prevention and control strategies to reduce pathogen transfer in healthcare settings. While there are dedicated evidence-based hand hygiene interventions and protocols to support human healthcare providers, there are no comparable resources to support veterinary care. A pilot trial for the implementation of a hand hygiene education and compliance program was conducted in six heterogenous small animal veterinary practices. Hand hygiene compliance was evaluated using a standardised and validated program, based on the World Health Organization’s 5 Moments for Hand Hygiene program. Veterinary Nurse Champions undertook dedicated hand hygiene training and were supported by the first author throughout the pilot trial. Hand hygiene compliance was low (14%) pre-trial, improved to 46% after the six-week trial period and remained at 35% six months after conclusion of the trial. Compliance for all five Moments improved compared to the pre-trial period in the immediate post-trial period. Of the five Moments, there was a statistically significant increase in compliance with Moments 3 (after a procedure/body fluid risk), 4 (after touching a patient) and 5 (after touching a patient’s surroundings) in the immediate post-trial period, however, by 6 months post-trial, only Moment 5 showed a significant improvement. Barriers to improvement included poor availability of hand hygiene products, lack of time due to clinical workload requirements, lack of awareness, and an ingrained workplace culture.
... Hand hygiene is the leading measure of preventing the spread of resistant microorganisms and a mechanism to reduce the Health Care Associated Infections (HCAI) among nurses and healthcare workers. 1 Hand washing seems to be the most important precautionary method to control the transmission of infections from health care workers to environment. There are no specific monitoring tools established to verify the level of compliance about the hand hygiene, hence hand washing has not been adopted well. 2 Amongst the Health Care Workers nurses are more prone to spread cross infections due to noncompliance of hand washing practices and the reasons were dense working conditions and insufficient materials. ...
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Objective: To determine the Knowledge and Perception of Hand Hygiene in Health Care Providers in less developed areas. Study Design: Cross-Sectional and Descriptive Study. Settings: Study was conducted at Tehsil Headquarter Hospital Kot-Addu Muzaffargarh located in South Punjab. Duration: Data was collection between August 2019 and September 2019. Methods: The setting for this research will be all clinical care areas. All the registered doctors and nurses in the hospital will be involved in this research and they are 85 in counts. Data collection is done through questionnaires. Results: Out of 85 respondents, 30 (35.7%) were male and 54 (64.3%) were females. Including 40 (47.6%) nurses and 44 (52.4%) doctors. Average marks obtained by the respondents were 4.22 ± 1.28, for male respondents results were 3.87 ± 0.90 and for female respondents, the obtained marks were 4.43 ± 1.44. Conclusion: Knowledge and perception of hand hygiene in less developed areas are good.
... Hand hygiene with alcohol-based handrub (ABHR) is the gold standard for most care given in healthcare settings; it prevents both healthcare-associated infections and antimicrobial resistance spread [1,2]. Good tolerability and acceptability of hand hygiene agents are key to successful adoption of hand hygiene implementation strategies and high compliance [2]. ...
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Introduction Healthcare workers often experience skin dryness and irritation from performing hand hygiene frequently. Low acceptability and tolerability of a formulation are barriers to hand hygiene compliance, though little research has been conducted on what specific types of formulation have higher acceptability than others. Objective To compare the acceptability and tolerability of an ethanol-based handrub gel with superfatting agents to the isopropanol-based formulations (a rub and a gel formulation) currently used by healthcare workers at the University of Geneva Hospitals, Geneva, Switzerland. Methods Forty-two participants were randomized to two sequences, testing the isopropanol-based formulation that they are using currently (Hopirub® or Hopigel®), and the ethanol-based formulation containing superfatting agents (Saniswiss Sanitizer Hands H1). Participants tested each of the formulations over 7–10 day work shifts, after which skin condition was assessed and feedback was collected. Results H1 scored significantly better than the control formulations for skin dryness ( P = 0.0209), and participants felt less discomfort in their hands when using that formulation ( P = 0.0448). H1 caused less skin dryness than Hopirub®/Hopigel® ( P = 0.0210). Though overall preference was quite polarized, 21 participants preferred H1 intervention formulation and 17 preferred the Hopirub®/Hopigel® formulation that they normally used in their care activities. Conclusion We observed a difference in acceptability and strongly polarized preferences among the participants' reactions to the formulations tested. These results indicate that giving healthcare workers a choice between different high-quality products is important to ensure maximum acceptability.
... On the contrary, MacDonald et al. [32] found that institutional guidelines mandating widespread use of alcohol hand scrubbing prior to any patient contact in a 600-bed plastic surgery ward were associated with substantially lower nosocomial MRSA SSIs compared to previous years. Many other studies support the findings of the research of MacDonald et al. [32] and have demonstrated that widespread institutional guidelines promoting hand hygiene with hand washing or alcohol-based hand scrubs reduces SSI rates in a variety of surgical subspecialties [33][34][35][36][37]. ...
Article
Background: The impact of the coronavirus 2019 (COVID-19) pandemic on the rate of primary total joint arthroplasty (TJA) peri-prosthetic joint infection (PJI) and superficial surgical site infections (SSI) is currently unknown. The purpose of this multicenter study was to evaluate any changes in the rates of 90-day PJI or 30-day SSI, including trends in microbiology of the infections, during the COVID-19 pandemic compared to the three years prior. Patients and Methods: An Institutional Review Board-approved, multicenter, retrospective study was conducted with five participating academic institutions across two healthcare systems in the northeastern United States. Primary TJA patients from the years 2017-2019 were grouped as a pre-COVID-19 pandemic cohort and patients from the year 2020 were grouped as a COVID-19 pandemic cohort. Differences in patient demographics, PJI, SSI, and microbiology between the two cohorts were assessed. Results: A total of 14,844 TJAs in the pre-COVID-19 pandemic cohort and 5,453 TJAs in the COVID-19 pandemic cohort were evaluated. There were no substantial differences of the combined 90-day PJI and 30-day superficial SSI rates between the pre-COVID-19 pandemic cohort (0.35%) compared with the COVID-19 pandemic cohort (0.26%; p = 0.303). Conclusions: This study did not find any change in the rates of 90-day PJI or 30-day superficial SSI in patients undergoing primary TJA between a pre-COVID-19 pandemic and COVID-19 pandemic cohort. Larger national database studies may identify small but substantial differences in 90-day PJI and 30-day superficial SSI rates between these two time periods. Our data may support continued efforts to maintain high compliance with hand hygiene, use of personal protective equipment, and limited hospital visitation whenever possible.
... Hand hygiene (HH) plays a key role in preventing hospital-acquired infections, as it prevents the spread of infectious organisms from patient to patient through the contamination of healthcare workers' hands [1][2][3]. HH by alcohol-based hand rub (ABHR) is widely recommended in Japan; however, national or subnational HH initiatives that are guideline-based or evidencebased still do not exist. Most Japanese healthcare workers (HCWs) take "one push" of ABHR and refer to the diagram shown on the website of the Japanese Ministry of Health, Labour and Welfare [4] to practice the hand rubbing procedure. ...
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Background The adapted 6-step without interlock (A6Sw/oI) hand rub technique, commonly practiced in Japan, adds the “wrist” but omits the “interlock” step compared to the WHO 6-step technique (WHO6S). The first objective of this study was to assess the differences of the two techniques regarding surface coverage. The second objective was to analyze the coverage differences between hand sizes. Methods Hospital workers went under stratified quasi-randomization by glove size. The overall mean coverage, and the coverage of the sections of the hands were evaluated by fluorescent dye-based coverage assessment using a digital device with artificial intelligence technology. Results Total of 427 workers were randomly allocated to WHO6S (N = 215) or the A6Sw/oI (N = 212). The overall mean dorsum coverage by WHO6S and A6Sw/oI was 90.6% versus 88.4% (p < 0.01), and the percentage of the participants with insufficient coverage of the backs of the four fingers ranged from 0.0–7.4% versus 28.2–51.4% (p < 0.001). Dorsum coverage varied largely between hand size for both techniques, and significant differences were found between small and large hands. Conclusion The WHO6S was superior to the locally adapted technique regarding hand surface coverage. Hand size should be considered when assessing coverage differences between procedures. No trial registrations or fundings.
... Scientific evidence suggests that hand hygiene as one of the most effective measures to control infection [11]. For example a recent Cochrane review and meta-analysis found sufficient evidence to conclude hand hygiene practice as cost effective control measure in reducing gastrointestinal and respiratory tract infection [3,12,13]. Theoretically, hand hygiene to prevent IPIs could require washing/ sanitizing of hand using water and soap (anti-bacterial, non-antibacterial soap) or with waterless hand sanitizer (alcohol based hand sanitizer),on regular basis, at appropriate critical time, for correct time and following standard step by step procedure [14]. The evidence on the literature also indicate hand hygiene intervention for decreasing infection achieved by mechanical removal of disease-causing organisms; and or chemically killing both at home and community setting [15][16][17][18]. ...
Article
Background Intestinal parasitic infection (IPIs) is one of the major health problems in Sub -Saharan Africa where water, sanitation and hygiene practices are inadequate. Taking into account the national level implementation of intensive hand hygiene against COVID-19 pandemic and general protective effect this study assessed its effect on intestinal parasite.Objective This study aim to investigate the effect of compliance to hand hygiene practice on the prevalence of intestinal parasitic infection (IPIs) and intensity of Soil transmitted helminthes (STH) among patients attending tertiary care hospital in southern Ethiopia.Methods Observational study was conducted from June to September 2021. Data on socio demographic, hand hygiene practice and intestinal parasite (prevalence and intensity of helminthic infection) was collected from randomly selected and consented patients. Compliance to hand hygiene practice was assessed using pre-tested questionnaire. Fresh stool sample from each participant was examined by direct wet mount, concentration and Ziehl-Neelson (ZN) staining technique to detect intestinal parasite. Intensity of STH measurements was done through direct egg-count per gram using Kato Katz methods. Data analysis was done using SPSS version 25. Odds ratio with 95% confidence interval was used to measure association and p-value
... Hand Hygiene (HH) among healthcare workers, especially nurses, is the main preventive intervention to control HCAIs [10][11][12][13][14]. Although the techniques involved in HH are simple, compliance with hand hygiene (CwHH) recommendations is poor worldwide [15,16], particularly in Intensive Care Units (ICUs), where CwHH ranges from 64% in high income settings to as low as 9% in low income settings [17,18]. ...
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Background Hand hygiene (HH) among healthcare workers, especially nurses, is the main preventive measure to control healthcare associated infections but compliance with hand hygiene (CwHH) remains low in various settings including Kuwait. This study aimed to assess the knowledge of, attitudes towards, and CwHH among nursing staff in secondary care hospitals in Kuwait. Methods A cross-sectional study was conducted on nursing staff in all six secondary care hospitals in Kuwait. Data on knowledge of, attitudes towards, and self-reported CwHH were collected through a self-administered questionnaire that was developed based on WHO’s questionnaire, while the data on actual compliance were objectively collected through direct observation of nurses during routine care by two independent observers using WHO’s observation form. Results Of 829 nurses approached, 765 (92.2%) responded and participated. Of all participants, 524 (68.5%) were able to list “My Five Moments for Hand Hygiene” fully and appropriately. However, several misconceptions (e.g. air circulation in hospital is the main route of infection) about HH were found among the nurses. CwHH was (25.0%) by direct observation while self-reported compliance was (69.5%) each varied significantly (p < 0.001) between different hospitals. Female nurses compared to male nurses and non-Arab compared to Arab nationalities were more likely to report CwHH in multivariable analysis. Several items on knowledge of and attitudes towards HH were also associated with self-reported CwHH. Conclusion Observed CwHH among nursing staff in secondary care hospitals in Kuwait was low, which highlights the need to make more efforts to improve HH practices. Interventions that have been used elsewhere and found to be effective may be tested in Kuwait. Despite the good overall knowledge on HH among nurses, there are several misconceptions that need to be corrected.
... Infection prevention and control (IPC) interventions, such as hand hygiene and perioperative prophylaxis, can successfully mitigate HAI occurrence. (8,9) However, IPC programs are limited and unevenly distributed worldwide. Data from a system to monitor the status of progress toward the implementation of the AMR global action plan (the Tripartite Antimicrobial Resistance Country Self-assessment Survey -TrACSS) have shown that approximately 34% of countries reported having an IPC program implemented nationwide. ...
... En cuanto a los factores que tienen que ver con la intervención quirúrgica, la higiene prequirúrgica de manos es muy importante porque la contaminación de las manos y su correcta higiene son claves en los programas de prevención de las IRAS (7). La Organización Mundial de la Salud (OMS) recomienda la higiene prequirúrgica de las manos con agua y un jabón antimicrobiano adecuado o con fricción de las manos con una solución hidroalcohólica antes de ponerse guantes estériles (8,9). ...
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Objective: We know the importance of hand hygiene in the prevention of healthcare-associated infections. However, its compliance is still a challenge. Moreover, when it is complied with, as in the case of preoperative hygiene, there are few studies on the proper performance of the technique. The aim of this paper is to assess adequacy of pre-surgical hand hygiene in operating room staff of different surgical specialities at a university teaching hospital in Madrid. Methods: A cross-sectional study was made. Adequacy of pre-surgical hand hygiene was assessed in operating room staff of the different specialities and professional categories by direct covert observation. It was evaluated in 852 opportunities during the months of October, November and December 2020. A specific form was designed for data collection, following the recommendations of the World Health Organisation (WHO). Adequacy was described with frequency distributions of the different groups observed. Whether Chi-square or Fisher's exact tests were used to compare the different categories. Results: Pre-surgical hand hygiene opportunities were evaluated, 75.5% in surgeons and 24.5% in nurses. Overall compliance with pre-surgical hand hygiene technique was 80.5 % (686). The most frequent surgical service evaluated was General Surgery with 240 observations. The professional category with the best adequacy was nursing (86.1%) and the surgical service one was Traumatology (90.2%). An stopwatch was used by some 25.8% of the evaluated professionals, with an adequate hygiene time of 96,8% (p<0,05) for that group. Conclusions: The overall adequacy of pre-surgical hand hygiene in the operating room professionals is high. Significant statistically differences in adequacy are found between professional categories and surgical specialities, with better compliance in nursing staff and in Traumatology. Better results are achieved by the use of an stopwatch.
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Aim The “Five moments of hand hygiene” (World Health Organization 2009) can be classified into moments of hand hygiene before and after patient care. Based on research indicating that hand hygiene compliance differs with regard to moments before and after patient care, this research evaluates the effectiveness of an empathy-based intervention in motivating hand hygiene compliance with regard to moments before patient care which protect vulnerable individuals from contamination and infection. Subjects and method An online experiment involving 68 healthcare professionals working at a German hospital during the first wave of the COVID-19 pandemic investigates whether instructing healthcare professionals to consider consequences for others (vs for themselves) if they contracted SARS-CoV-2 promotes hand hygiene compliance referring to moments before (vs after) patient care. Results In the condition in which healthcare professionals considered consequences for others if they contracted SARS-CoV-2 (other-focus condition), ratings of importance increased ( M = 3.49, SD = 1.30) compared to the condition in which healthcare professionals considered consequences for themselves ( M = 2.68, SD = 1.24), F (1,66) = 6.87, p = .011, part η ² = .09. Participants in the other-focus condition reported more intentions to comply with “before moments” in the future ( M = 3.34, SD = 1.14) compared to participants in the self-focus condition ( M = 2.77, SD = 0.80), F (1,66) = 6.15, p = .016, part η ² = .09. Conclusion Results indicate that activating an empathic focus in the context of the current pandemic promotes perceived importance and motivation of healthcare professionals to comply with moments aiming at protecting vulnerable others.
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The functional support and advancement of our body while preserving inherent naturalness is one of the ultimate goals of bioengineering. Skin protection against infectious pathogens is an application that requires common and long-term wear without discomfort or distortion of the skin functions. However, no antimicrobial method has been introduced to prevent cross-infection while preserving intrinsic skin conditions. Here, we propose an antimicrobial skin protection platform copper nanomesh, which prevents cross-infectionmorphology, temperature change rate, and skin humidity. Copper nanomesh exhibited an inactivation rate of 99.99% for Escherichia coli bacteria and influenza virus A within 1 and 10 min, respectively. The thin and porous nanomesh allows for conformal coating on the fingertips, without significant interference with the rate of skin temperature change and humidity. Efficient cross-infection prevention and thermal transfer of copper nanomesh were demonstrated using direct on-hand experiments.
Chapter
In India the healthcare services can be divided into two categories like public and private healthcare services. The Public Healthcare System (PHC) which is under the control of the government is available in cities and rural areas and provides services mostly primary services. Majority of the private sector healthcare service providers are in metropolis, capital cities and few others cities of the country mostly focused on secondary and tertiary services. India has the competitive advantages in terms of maximum number of experienced medical practitioners. The service quality model dimensions are properly reviewed in this paper. SERVQUAL model dimensions vary from developed to developing countries as the importance of dimensions are different and few new dimensions are being incorporated.
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The study of health care practices of the Gonds of Nuapada district of Odisha is one of significant aspects of the tribal health system of Odisha in Eastern India. As many as 62 types of Tribes are found in the state of Odisha, Among these, Gond is one of important tribes which noticed in the western part of Odisha. The Gond people of Nuapada are not conscious about their health and sanitation, for which they are facing different types diseases in their day to day life. The Gond community living in different eco-systems face heath and genetic problems of varying natural. Nothing is known about the health and nutritional status and also about the medico-genetic problems which are prevalent among the primitive section of the Gond tribe as no comprehensive study of this nature has yet been undertaken among these sections of the Gond tribe. The present study centers round this problem and its coverage is limited to two different sections of the Gond tribe, one residing in Sinapali village of Nuapada areas of Nuapada district and the other residing in Komna village of Boden areas of Nuapada district.
Chapter
The study explores the tracking and practices essentiality in hospitals and health facilities, because related infections, such as higher risks and acceleration of illness, can have significant effects on health care. Human observers tracking and Practices have problems of their own, such as loss of observation concentration, accumulation of human mistake and expert deformation. In this investigation, the results of two internet-based techniques for controlling the hand hygiene of medical personnel during patient visits were carried out and evaluated. As base stations and smart phones, we employed ESP modules as mobile nodes and calculated the range to be located in the patient's room using Bluetooth RSSI values. We analyzed the RSSI in the proximity solution from a sensor host measured on different ESP nodes/module and used the premise that the sensor host is nearest to the ESP node which offers the maximum RSSI values. We utilized the RSSI value to measure the location between mobile nodes and every ESP node in the trilateration method and we applied the trilateration technique to identify the mobile node inside the room. Our tests have shown that 20% of the solution based on proximity was erroneous, whilst the 8% of the solution based on trilateration was erroneous.KeywordsTrackingPracticesHand hygieneIoTControlling’sTrilateration
Article
Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.
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It is the question of determining patterns in big data sets that correlate to helpful data. It involves techniques that are at the confluence of machine learning, statistics, and legacy system, and it is also known as data mining. Machine learning is a branch of artificial intelligence that emerged from the areas of object recognition and artificial intelligence. It is concerned with the research and development of methods that can understand from assessment tools. The study shows financial institutions use of financial data performance and ensure precise management of consumer data in order to identify defaulters, to reduce the number of equipment failures associated, to process transactions quickly and efficiently, to reduce the number of incorrect judgments, to categorize potential customers, and to minimize the wastage of the financial organizations.KeywordsData miningMachine learningFraudRiskFinancial management
Article
Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.
Article
A unified surveillance mechanism for hand hygiene and hospital-acquired infections for pediatric wards is lacking in Europe. We managed to setup such a mechanism in 9 pediatric intensive care units in 7 European countries, using World Health Organization's definitions and common methodology which allows for benchmarking among units and countries. Median hand hygiene compliance was found high 82.3% (interquartile range 71.6-94.5%), but gaps in practices were identified.
Article
Background: A study to evaluate the knowledge and practice of class four workers regarding hand washing in selected hospital was conducted. Objectives: The objective of the study to identify level of the knowledge of class four workers regarding hand washing and to find the association of knowledge and practice of hand washes with selected demographic variables. Method: Research method adapted for the study was quantitative approach. The research design used was non experimental survey research design. The sample size of study was 100 class four workers in selected hospitals. The purposive sampling technique is used to select the sample. Questionnaire was used to find out the knowledge of class four workers. Results: In the present study 72% of the class four workers had good knowledge (score 14-20) and 28% of them had average knowledge (score 7-13) regarding hand washing. All of class four workers had good hand washing practices. In this study the 21% of highly satisfied class four workers with hand washing materials had average knowledge and 27% of them had good knowledge, and the satisfied class four workers had 21% had average knowledge and 45% of them had good knowledge regarding hand washing. Conclusion: Association of knowledge and practice of class four workers shows that all the p-values are large (greater than 0.05), none of the demographic variable was found 0 have significant association with the knowledge of the class four workers regarding hand washing. All of the class four workers were found to have good practices irrespective of their demography.
Article
Hand hygiene is an essential component of infection prevention in the health care setting. Despite diligent efforts, clinicians can be susceptible to hand hygiene misses in fast-paced, complex environments such as the operating room due to systemic factors such as the physical environment, workflow, and sporadic interactions with other personnel. Through the use of human factors and resilience engineering concepts, work-as-done were studied to identify barriers to hand hygiene compliance in the operating rooms of a pediatric hospital in an urban area. The saliency, effort, expectancy, value model was applied to design a multifaceted intervention that resulted in a sustained 95% hand hygiene compliance.
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Prevention of hospital-acquired infections (HAI) is central to providing safe and high quality healthcare. Transmission of infection between patients by health workers, and the irrational use of antibiotics have been identified as preventable aetiological factors for HAIs. Few studies have addressed this in developing countries. To assess the effectiveness of a multifaceted infection control and antibiotic stewardship programme on HAIs and antibiotic use. A retrospective study was conducted for a study period of 11months (June 2021-April 2022) in Vydehi Hospital, Bangalore. All patients admitted to the intensive care unit and wards were included in the study. Intervention period was 6 months (June 2021-Nov 2021) and post-intervention period was 5 months (Dec 2021- April 2022). Assessment of HAIs was made based on the criteria from the Centers for Disease Control and Prevention. The multifaceted intervention consisted of hand hygiene campaign, isolation of multidrug resistance organism’s patients, water and air quality analysis, training of health care workers in infection control practices, and antibiotic stewardship. Data was collected using an identical method in the intervention and post intervention periods. We observed a major reduction in HAIs, from 89% (198/222 patients) in the intervention period to 10.8% (24/222 patients) in the post intervention period (relative risk (RR) (95% CI) 0.48 (0.31 to 0.56). Antibiotic use in ICUs declined from 58% (780/1347) to 44% (442/995) (RR 0.44 (0.40 to 0.55). Overall, hand hygiene compliance among the health- care workers was maintained at 100% during both the periods. Multifaceted infection control interventions are effective in reducing HAI rates, improving the rational use of antibiotics, increasing hand hygiene compliance, and may reduce mortality in hospitalised patients in developing countries.
Article
We describe a novel approach for quality assessment of hand hygiene process based on combination of ordinary differential equation (ODE) neural network and random forest. The continuous-time recurrent neural network (RNN) with ODE hidden nodes is utilized. Unlike traditional continuous-time RNNs, the ODE network in this scheme applies an input-dependent varying time-constant models referred as liquid time-constant (LTC) RNN. It expresses stable and bounded behavior and yields superior expressivity. The random forest is attractive for findings of multiple trees in classification. It is built from multiple LTC networks, each network is corresponding to each tree. The experimental results showed that the proposed approach attains the recognition accuracy of 98.9% for single handwashing step and 78% for the whole handwashing process.
Conference Paper
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The year 2020 saw the pronouncement by the World Health Organisation (WHO) of the SARS-CoV2 / Covid-19 pandemic. Against unknown clinical factors, limited resources, fear among the local population and limited local guidance available, one organisation stood out in Trinidad in the performance of Infection, Prevention and Control (IPC) support to the two designated hospitals for the most severe cases of Covid-19. To have a more thorough understanding of what contributed to the effectiveness of this company an examination of the socio-technical system (STS) was undertaken. The nature of the examination including interrelationships among a fluid regulatory environment, unstable areas of operations regarding resource availability, and high stress among stakeholders required the use of a framework to guide this complexity.
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Background: Healthcare-associated infections are associated with increased patient mortality. Hand hygiene is the most effective method to reduce these infections. Despite simplification of this easy intervention, compliance with hand disinfection remains low. Current assessment of hand hygiene is mainly based on observation by hygiene specialists. The aim of this study was to investigate additional benefits of eye-tracking during the analysis of hand hygiene compliance of healthcare professionals in the intensive care unit. Methods: In a simulated, randomised cross-over study conducted at the interdisciplinary intensive care unit of the University Hospital Zurich (Switzerland), doctors and nurses underwent eye-tracking and completed two everyday tasks (injection of 10 micrograms of norepinephrine via a central venous line, blood removal from the central line) in two scenarios where alcoholic dispenser locations differed ("in-sight" and "out-of-sight"). The primary outcomes were dwell time, revisits, first fixation duration and average fixation time on three areas of interest (central venous line, alcohol dispenser, protective glove box) for both scenarios. Compliance with hand hygiene guidelines was analysed. Findings: 49 participants (35 nurses, 14 doctors) were included. Eye-tracking provided additional useful information compared to conventional observations. Dwell time, revisits, first fixation duration and average fixation time did not differ between the two scenarios for all areas of interest. Overall compliance with recommended hand hygiene measures was low in both doctors (mean 20%) and nurses (mean 42.9%). Conclusion: Compared to conventional observations offered additional helpful insights and provided an in-depth analysis of gaze patterns during the recording of hand hygiene compliance in the intensive care unit.
Article
Purpose This paper evaluates a theory-driven, interactive hand hygiene (HH) intervention, the Safe Hands project, based on theories of organizational learning and culture including leadership support, dialogue and co-creation. Design This prospective quasi-experimental study used unobtrusive overt observations to evaluate adherence to HH recommendations after implementing an infection-prevention intervention. Methods The primary outcome was differences in HH practices “Before aseptic/clean procedure” (WHO moment 2), “After body fluid exposure risk” (WHO moment 3) and performance of aseptic techniques. One operating room (OR) department served as the study hospital and the other as the control hospital, both at Swedish university hospitals. Adherence to HH guidelines was measured 4 times during 2015 to 2017. Findings The intervention site displayed a significant improvement in adherence to HH guidelines and aseptic techniques. WHO 2; from 23.8% to 36.2%, (P = .014), WHO 3; from 22.2% to 42.3%, (P = .002), and aseptic techniques; from 17.5% to 31.6%, (P = .003). No changes in adherence were identified at the control site. The use of contaminated gloves decreased post intervention at the study operating department. Conclusions This study shows that implementing tailored interventions that are underpinned by theories from organizational learning and culture can improve adherence to hand hygiene in a complex setting as the OR up to 6 months post-intervention. The interprofessional co-creation of standards operating procedures addressing specific care procedures and emphasizing the importance of aseptic techniques can be an acceptable and feasible way to reduce the risks of contaminating medical devices and patients during perioperative care.
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We studied the acquisition and transmission of Clostridium difficile infection prospectively on a general medical ward by serially culturing rectal-swab specimens from 428 patients admitted over an 11-month period. Immunoblot typing was used to differentiate individual strains of C. difficile. Seven percent of the patients (29) had positive cultures at admission. Eighty-three (21 percent) of the 399 patients with negative cultures acquired C. difficile during their hospitalizations. Of these patients, 52 (63 percent) remained asymptomatic and 31 (37 percent) had diarrhea; none had colitis. Patient-to-patient transmission of C. difficile was evidenced by time-space clustering of incident cases with identical immunoblot types and by significantly more frequent and earlier acquisition of C. difficile among patients exposed to roommates with positive cultures. Of the hospital personnel caring for patients with positive cultures, 59 percent (20) had positive cultures for C. difficile from their hands. The hospital rooms occupied by symptomatic patients (49 percent) as well as those occupied by asymptomatic patients (29 percent) were frequently contaminated. Eighty-two percent of the infected cohort still had positive cultures at hospital discharge, and such patients were significantly more likely to be discharged to a long-term care facility. We conclude that nosocomial C. difficile infection, which was associated with diarrhea in about one third of cases, is frequently transmitted among hospitalized patients and that the organism is often present on the hands of hospital personnel caring for such patients. Effective preventive measures are needed to reduce nosocomial acquisition of C. difficile.
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To evaluate the effects of a hand hygiene program on compliance with hand hygiene and the rate of nosocomial infections in a neonatal intensive care unit (NICU). Open trial. A level-III NICU in a teaching hospital. Nurses, physicians, and other healthcare workers in the NICU. A multimodal campaign for hand hygiene promotion was conducted beginning in September 1998. This program consisted of formal lectures, written instructions and posted reminders regarding hand hygiene and proper handwashing techniques, covert observation, financial incentives, and regular group feedback on compliance. Surveillance of handwashing compliance and nosocomial infections before and during the program was analyzed. Overall compliance with hand hygiene improved from 43% at baseline to 80% during the promotion program. The rate of nosocomial infections decreased from 15.13 to 10.69 per 1,000 patient-days (P = .003) with improved handwashing compliance. In particular, respiratory tract infections decreased from 3.35 to 1.06 per 1,000 patient-days during the handwashing campaign (P = .002). Furthermore, the correlation between nosocomial infection of the respiratory tract and handwashing compliance also reached statistical significance (r = -0.385; P = .014). Improved compliance with handwashing was associated with a significant decrease in overall rates of nosocomial infection and respiratory infections in particular. Washing hands is a simple, economical, and effective method for preventing nosocomial infections in the NICU.
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Background: Although many catheter-related bloodstream infections (CR-BSIs) are preventable, measures to reduce these infections are not uniformly implemented. Objective: To update an existing evidenced-based guideline that promotes strategies to prevent CR-BSIs. Data Sources: The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. Studies Included: Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiological investigations. Outcome Measures: Reduction in CR-BSI, catheter colonization, or catheter-related infection. Synthesis: The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e. education and training, maximal sterile barrier precautions and 2% chlorhexidine for skin antisepsis). Conclusion: Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection. (Am J Infect Control 2002;30:476-89.)
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Health care workers' hand hygiene practice is universally sub-optimal. This contributes to the 8% prevalence rate of hospital-acquired infection which is currently costing the National Health Service in England nearly 1 billion per annum. It is estimated that about 30% of hospital-acquired infections could be prevented if health care workers adhered to hand hygiene guidelines. The aim of the study was to identify psychological constructs predictive of health care workers' hand hygiene behaviour in order to determine ways to improve practice. We used a cross-sectional survey of 104 hospital-based health care workers. Data were analyzed through hierarchical logistic regression. The model correctly classified 79% of cases in intention to perform appropriate hand hygiene and 87% of self-reported hand hygiene behaviour. Attitudes and personal responsibility were significant predictors of intention, whilst perceived behavioural control and intention were significant predictors of behaviour. The theoretical framework shows where future interventions to improve hand hygiene practice should be targeted.
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EXECUTIVE SUMMARYThe “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)’s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1 and 2 Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis. Part II, “Recommendations for Prevention of Surgical Site Infection,” represents the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs.3 Whenever possible, the recommendations in Part II are based on data from well-designed scientific studies. However, there are a limited number of studies that clearly validate risk factors and prevention measures for SSI. By necessity, available studies have often been conducted in narrowly defined patient populations or for specific kinds of operations, making generalization of their findings to all specialties and types of operations potentially problematic. This is especially true regarding the implementation of SSI prevention measures. Finally, some of the infection control practices routinely used by surgical teams cannot be rigorously studied for ethical or logistical reasons (e.g., wearing vs not wearing gloves). Thus, some of the recommendations in Part II are based on a strong theoretical rationale and suggestive evidence in the absence of confirmatory scientific knowledge. It has been estimated that approximately 75% of all operations in the United States will be performed in “ambulatory,” “same-day,” or “outpatient” operating rooms by the turn of the century.4 In recommending various SSI prevention methods, this document makes no distinction between surgical care delivered in such settings and that provided in conventional inpatient operating rooms. This document is primarily intended for use by surgeons, operating room nurses, postoperative inpatient and clinic nurses, infection control professionals, anesthesiologists, healthcare epidemiologists, and other personnel directly responsible for the prevention of nosocomial infections. This document does not:•Specifically address issues unique to burns, trauma, transplant procedures, or transmission of bloodborne pathogens from healthcare worker to patient, nor does it specifically address details of SSI prevention in pediatric surgical practice. It has been recently shown in a multicenter study of pediatric surgical patients that characteristics related to the operations are more important than those related to the physiologic status of the patients.5 In general, all SSI prevention measures effective in adult surgical care are indicated in pediatric surgical care.•Specifically address procedures performed outside of the operating room (e.g., endoscopic procedures), nor does it provide guidance for infection prevention for invasive procedures such as cardiac catheterization or interventional radiology. Nonetheless, it is likely that many SSI prevention strategies also could be applied or adapted to reduce infectious complications associated with these procedures.•Specifically recommend SSI prevention methods unique to minimally invasive operations (i.e., laparoscopic surgery). Available SSI surveillance data indicate that laparoscopic operations generally have a lower or comparable SSI risk when contrasted to open operations.6, 7, 8, 9, 10 and 11 SSI prevention measures applicable in open operations (e.g., open cholecystectomy) are indicated for their laparoscopic counterparts (e.g., laparoscopic cholecystectomy).•Recommend specific antiseptic agents for patient preoperative skin preparations or for healthcare worker hand/forearm antisepsis. Hospitals should choose from products recommended for these activities in the latest Food and Drug Administration (FDA) monograph. 12
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Modern medicine still has to contend with the major problem of infections resulting from patient care. Despite considerable evidence that appropriate hand hygiene is the leading measure to reduce cross-infection, compliance with recommendations remains notoriously low among healthcare workers. In high-demand situations, such as in most critical-care units, or at times of overcrowding or understaffing, promoting hand cleansing with an alcohol-based handrub solution seems to be the most practical means of improving compliance. It requires less time, acts faster, irritates hands less often, and is superior to traditional handwashing or medicated hand antiseptic agents. Furthermore, it was used in the only programme that reported a sustained improvement in hand-hygiene compliance associated with decreased infection rates. Although easy access to fast-acting hand-hygiene agents is the main tool of any campaign to obtain sustained improvement with hand-hygiene practices, a multidisciplinary approach is necessary to produce behavioural change.
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Objective: To compare skin condition and skin microbiology among intensive care unit personnel using one of two randomly assigned hand hygiene regimens: a 2% chlorhexidine gluconate (CHG)-containing traditional antiseptic wash and a waterless hand-rub containing 61% ethanol with emollients (ALC), Design: Prospective, randomized clinical trial. Setting: Two critical care units (medical and surgical) in a large, metropolitan academic health center in Manhattan. Subjects: Fifty staff members (physicians, nurses, housekeepers, respiratory therapists) working full time in the intensive care unit. Interventions: One of two hand hygiene regimens randomly assigned for four consecutive weeks. Measurements and Main Results: The two outcomes were skin condition (measured by two tools: Hand Skin Assessment form and Visual Skin Scaling form) and skin microbiology. Samples were obtained at baseline, on day 1, and at the end of wks 2 and 4. Participants in the ALC group had significant improvements in the Hand Skin Assessment scores at wk 4 (p = 0.04) and in Visual Skin Scaling scores at wks 3 (p = 0.01) and 4 (p = 0.005), There were no significant differences in numbers of colony-forming units between participants in the CHG or ALC group at any time period. The ALC regimen required significantly less time than the CHG regimen (mean: 12.7 sees and 21.1 sees, respectively; p 0.000) and resulted in a 50% reduction in material costs. Conclusions: changes in hand hygiene practices in acute care settings from the traditional antiseptic wash to use of plain, mild soap and an alcohol-based product should be considered. Further research is needed to examine the association between use of antiseptic products for hand hygiene of staff and reductions in nosocomial infection rates among patients.
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To determine the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection and Clostridium difficile infection (CDI). Two multivariate time-series analyses were performed that used as dependent variables the monthly incidences of nosocomial MRSA infection and CDI at the Freiburg University Medical Center during the period January 2003 through October 2007. The volume of alcohol-based hand rub solution used per month was quantified in liters per 1,000 patient-days. Antibiotic consumption was calculated in terms of the number of defined daily doses per 1,000 patient-days per month. The use of alcohol-based hand rub was found to have a significant impact on the incidence of nosocomial MRSA infection (P< .001). The multivariate analysis (R2=0.66) showed that a higher volume of use of alcohol-based hand rub was associated with a lower incidence of nosocomial MRSA infection. Conversely, a higher level of consumption of selected antimicrobial agents was associated with a higher incidence of nosocomial MRSA infection. This analysis showed this relationship was the same for the use of second-generation cephalosporins (P= .023), third-generation cephalosporins (P= .05), fluoroquinolones (P= .01), and lincosamides (P= .05). The multivariate analysis (R2=0.55) showed that a higher level of consumption of third-generation cephalosporins (P= .008), fluoroquinolones (P= .084), and/or macrolides (P= .007) was associated with a higher incidence of CDI. A correlation with use of alcohol-based hand rub was not detected. In 2 multivariate time-series analyses, we were able to show the impact of hand hygiene and antibiotic use on the incidence of nosocomial MRSA infection, but we found no association between hand hygiene and incidence of CDI.
Article
To determine the effectiveness of hand hygiene in a developing healthcare setting in reducing nosocomial infections (NIs). Prospective study measuring NI rates in a urology ward in Ho Chi Minh City, Vietnam, before and after implementation of a hand hygiene programme with an alcohol-based decontaminant, and compliance rates of medical staff and carers with hand hygiene using standardised observation sheets. Incidence of NIs fell by 84%, from 13.1% to 2.1%, after implementation of the hand hygiene programme. Extended-spectrum beta-lactamase production was detected in 38.2%-50% of Enterobacteriaceae isolated from clinical samples. Length of patient stay and cost to the patient for antibiotics were reduced after implementation of the hand hygiene programme. The hand hygiene programme was effective in reducing incidence of NIs, leading to shorter inpatient stays and reduced treatment costs. Such programmes with measurable outcomes can be implemented at minimal cost in developing health contexts and should be promoted in all healthcare settings.
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Health care-associated infections affect hundreds of millions of patients worldwide each year. The World Health Organization's (WHO) First Global Patient Safety Challenge, "Clean Care is Safer Care," is tackling this major patient safety problem, with the promotion of hand hygiene in health care as the project's cornerstone. WHO Guidelines on Hand Hygiene in Healthcare have been prepared by a large group of international experts and are currently in a pilot-test phase to assess feasibility and acceptability in different health care settings worldwide. An extensive literature search was conducted and experts and religious authorities were consulted to investigate religiocultural factors that may potentially influence hand hygiene promotion, offer possible solutions, and suggest areas for future research. Religious faith and culture can strongly influence hand hygiene behavior in health care workers and potentially affect compliance with best practices. Interesting data were retrieved on specific indications for hand cleansing according to the 7 main religions worldwide, interpretation of hand gestures, the concept of "visibly dirty" hands, and the use of alcohol-based hand rubs and prohibition of alcohol use by some religions. The impact of religious faith and cultural specificities must be taken into consideration when implementing a multimodal strategy to promote hand hygiene on a global scale.
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This quasi-experimental study aimed to identify the impact of a promotion programme on hand hygiene practices and its effect on nosocomial infection rates in a neonatal intensive care unit of a university hospital in Thailand. The study populations were 26 nursing personnel. After implementing a hand hygiene promotion programme, compliance with hand hygiene among nursing personnel improved significantly from 6.3% before the programme to 81.2% 7 months after the programme. Compliance rate did not correlate with the intensity of patient care. Nosocomial infection rate did not decrease after the intervention, probably because of the multifactorial nature of infections. All participants agreed that promotion programme implemented in this project motivated them to practise better hand hygiene. This study indicated that multiple approaches and persistent encouragement are key factors leading to a sustained high level of appropriate hand hygiene practices among nursing personnel.
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This study examined the effects of a standardized hand hygiene program on the rate of nosocomial infection (NI) in very low birth weight (VLBW) infants (birth weight < 1500 g) admitted to our neonatal intensive care unit (NICU). We compared the rate of NI in VLBW infants in 2 separate periods. In the first period, staff were encouraged to perform handwashing using a plain fluid detergent (0.5% triclosan). In the second period, a standardized hand hygiene program was implemented using antimicrobial soap (4% chlorhexidine gluconate) and alcohol-based hand rubs. NI after 72 hours of life was detected in 16 of the 85 VLBW infants in the first period and in 5 of the 80 VLBW infants in the second period. The rate of central venous catheter colonization was significantly lower in the second period (5.8%) than in the first period (16.6%). In our NICU, the incidence of NI in VLBW infants was significantly reduced after the introduction of a standardized handwashing protocol. In our experience, a proper hand hygiene program can save approximately 10 NI episodes/year, at a cost of $10,000 per episode. Therefore, improving hand hygiene practice is a cost-effective program in the NICU.
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Seventeen per cent of the staff of an intensive care ward were found to have Klebsiella spp contaminating their hands, and these strains could be related to serotypes infecting or colonising patients in the ward on the same day. We identified some simple ward procedures that resulted in contamination of nurses' hands with 100-1000 klebsiellae per hand. Klebsiellae survived on artifically inoculated hands for up to 150 minutes. Handwashing with chlorhexidine hand cleanser reliably gave 98-100% reduction in hand counts, and the introduction of routine handwashing by staff before moving from one patient to the next was associated with a significant and sustained reduction in the number of patients colonised or infected with Klebsiella spp. Staff clothing was occasionally contaminated, but ward air and dust rarely contained klebsiellae.
Article
Handwashing is believed to be the most important means of preventing nosocomial infections. Previous studies of healthcare workers (HCWs) have shown that handwashing practices are poor. No one has shown that handwashing practices can be easily improved and that this prevents endemic (nonepidemic) nosocomial infection. Handwashing and infection rates were studied in two intensive care units (ICUs) of a community teaching hospital. Handwashing rates were monitored secretly throughout the study. After six months of observation, we started interventions to increase handwashing. Handwashing increased gradually, but overall rates before (22.0%) and after (29.9%) interventions were not significantly different (p = .071). Handwashing never occurred before intravenous care, whereas it occurred 67.5% for all other indications (p less than .0001). When questioned, nurses felt they were washing appropriately nearly 90% of the time. Infection rates seemed unrelated to handwashing throughout the study, and no clusters of infection were detected. We conclude that handwashing rates, when measured against arbitrary but reasonable standards, are suboptimal, difficult to change and not closely related to evidence of cross-infection. Further, nurses wash hands selectively, depending on the indication for handwashing, and generally believe they are washing much more frequently than an objective observer believes they are.
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The effects on hand decontamination of the introduction of an antiseptic handrub lotion in an intensive care unit was studied. To obtain baseline data, nursing, medical, physiotherapy, radiology, and orderly staff members were observed. Further observations were carried out after the introduction of the handrub lotion. Patient care activities were classified as high or low, according to the degree of contact with the patients or their equipment. A total of 884 patient contacts and 341 hand decontamination episodes was observed: 440 contacts and 140 handwashes in stage one (32%) and 444 contacts and 201 handwashes in stage two (45%). There was an increase of 13% in hand decontamination frequency after the introduction of the handrub lotion. The data indicate that the frequency of hand decontamination is below levels recommended by infection control authorities. Increasing the accessibility of hand decontamination facilities did result in a slight increase in handwashing compliance.
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Handwashing is the single most important procedure in the prevention of nosocomial infections and yet it remains the most violated of all infection control procedures. With a sequential intervention study in an intensive care unit we have demonstrated that poor handwashing practices are associated with a high nosocomial infection rate, whereas good handwashing practices are associated with a low nosocomial infection rate. An educational and enforcement program designed to improve handwashing procedures can significantly reduce endemic nosocomial infection rates.
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Direct inoculation to cefoxitin-cycloserine-fructose agar and broth was compared with alcohol shock-chopped meat broth inoculation for optimal detection of Clostridium difficile in fecal samples. Alcohol shock is significantly more sensitive than cefoxitin-cycloserine-fructose agar or broth and may be the method of choice to detect C. difficile in asymptomatic carriers.
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Microbiology and epidemiology have made significant contributions to the field of Infection Control. Most nosocomial infections which can be prevented are related to inappropriate patient care practices. However, it is extremely difficult to implement new infection control policies. To achieve staff compliance, infection control should learn from the behavioural sciences. Three related fields have been shown to be helpful in this respect: social psychology, consumer behaviour and organizational behaviour. Basic concepts from all three fields can be applied to the work of infection control for achieving staff compliance; the use of social power and the reasoned action model from the field of social psychology; the use of participatory decision-making from organizational behaviour; and the opinion leaders from consumer behaviour.
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Once established in an institution, methicillin-resistant Staphylococcus aureus (MRSA) outbreaks have proved difficult to eradicate, despite intensive infection control measures. This report describes the nosocomial infection with MRSA of 22 male infants in a neonatal nursery during a 7-month period and the infection control procedures that effectively brought this outbreak under control and eliminated recurrence for more than 3 1/2 years. After a single index case of bullous impetigo caused by MRSA in a neonate discharged from the nursery 2 weeks previously, an additional 18 cases of MRSA skin infections were clustered in a 7-week period. Aggressive infection control measures were instituted, including changes in umbilical cord care, circumcision procedures, diapers, handwashing, gloves, gowns, linens, disinfection, placement in cohorts of neonates and staff, surveillance, and monitoring. These measures were not effective in slowing the outbreak. The single additional measure of changing handwashing and bathing soap to a preparation containing 0.3% triclosan (Bacti-Stat) was associated with the immediate termination of the acute phase of the MRSA outbreak. The nursery has remained free of MRSA for more than 3 1/2 years, attesting to the success of our program.
Article
To compare liquid soap versus 4% chlorhexidine gluconate in 4% alcohol for the decontamination of bare or gloved hands inoculated with an epidemic strain of Clostridium difficile. C difficile (6.7 log10 colony-forming units [CFU], 47% spores), was seeded onto bare or latex gloved hands of ten volunteers and allowed to dry. Half the volunteers initially washed with soap and half with chlorhexidine, followed by the other agent 1 week later. Cultures were done with Rodac plates at three sites on the hand: finger/thumbtips, the palmar surfaces of the fingers, and the palm. Statistical comparison was by paired Student's t test. On bare hands, soap and chlorhexidine did not differ in residual bacterial counts on the finger/thumbtips (log10 CFU, 2.0 and 2.1, P = NS) and fingers (log10 CFU, 2.4 and 2.5, P = NS). Counts were too high on bare palms to quantitate. On gloved hands, soap was more effective than chlorhexidine on fingers (log10 CFU 1.3 and 1.7, P < .01) and palms (log10 CFU 1.5 and 2.0, P < .01), but not finger/thumbtips (log10 CFU 1.6 with each, P = NS). Residual C difficile counts were lower on gloved hands than bare hands (P < 0.01 to < 0.0001). The two agents did not differ significantly in residual counts of C difficile on bare hands, but on gloved hands residual counts were lower following soap wash than following chlorhexidine wash. These observations support the use of either soap or chlorhexidine as a handwash for removal of C difficile, but efficacy in the prevention of C difficile transmission must be determined by prospective clinical trials.
Article
Evaluating hand wash products in terms of user acceptability and effectiveness against methicillin-resistant Staphylococcus aureus (MRSA) has been part of a long-term strategy to eliminate endemic MRSA from the neonatal intensive care unit at the Royal Women's Hospital (Brisbane). Following the introduction of a new hand wash disinfectant (triclosan 1% wt/vol), new cases of MRSA colonization were monitored for 12 months. In addition, the use of antibiotics, the incidence of multi-resistant Gram-negative cultures and neonatal infections were noted. No changes were made to any procedures or protocols during the trial. All babies colonized with MRSA had been discharged from the nursery within 7 months of the introduction of triclosan and in the subsequent 9 months no new MRSA isolates had been reported. Reduction in the use of vancomycin has resulted in a cost saving of approximately $A17,000. The total number of Gram-negative isolates has not increased, although Pseudomonas aeruginosa is now reported more often. Compared with the previous 12 months, fewer antibiotics were prescribed and fewer nosocomial infections recorded (P < 0.05).
Article
No single intervention has been successful in improving and sustaining such infection control practices as universal precautions and handwashing by health care professionals. This paper examines several behavioral theories (Health Belief Model, Theory of Reasoned Action and Theory of Planned Behavior, self-efficacy, and the Transtheoretic Model) and relates them to individual factors, also considering interpersonal and organizational factors. Further, this article includes recommendations of individual and organizational components to be addressed when planning a theoretically based intervention for improving infection control practices. A hypothetic framework to enhance handwashing practice is proposed. PIP This article reviews the Health Belief Model, the Theories of Reasoned Action and of Planned Behavior, self-efficacy, and the Transtheoretic Model to determine the application of these theories to attempts to improve infection control practices in the health professions. After a brief introduction, the article offers background information on compliance (the degree to which a person adheres to advice) as it pertains to hand-washing and the use of gloves. This review indicates that interventions to improve compliance must combine institutional and personal variables. Next, the article summarizes the four theoretical frameworks and studies that have sampled various components of the frameworks. The discussion notes that none of the theories consistently predicts behaviors but that constructs some of the theories hold in common (self-efficacy, beliefs, perceived health threat, cues, attitudes, subjective norms, perceived behavioral control, intention, and the stages and processes of change) can be integrated into an intervention to improve infection control practices. A further hypothetical intervention is suggested that addresses individual and organizational components.