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Face touching: A frequent habit that has implications for hand hygiene


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There is limited literature on the frequency of face-touching behavior as a potential vector for the self-inoculation and transmission of Staphylococcus aureus and other common respiratory infections. A behavioral observation study was undertaken involving medical students at the University of New South Wales. Their face-touching behavior was observed via videotape recording. Using standardized scoring sheets, the frequency of hand-to-face contacts with mucosal or nonmucosal areas was tallied and analyzed. On average, each of the 26 observed students touched their face 23 times per hour. Of all face touches, 44% (1,024/2,346) involved contact with a mucous membrane, whereas 56% (1,322/2,346) of contacts involved nonmucosal areas. Of mucous membrane touches observed, 36% (372) involved the mouth, 31% (318) involved the nose, 27% (273) involved the eyes, and 6% (61) were a combination of these regions. Increasing medical students' awareness of their habituated face-touching behavior and improving their understanding of self-inoculation as a route of transmission may help to improve hand hygiene compliance. Hand hygiene programs aiming to improve compliance with before and after patient contact should include a message that mouth and nose touching is a common practice. Hand hygiene is therefore an essential and inexpensive preventive method to break the colonization and transmission cycle associated with self-inoculation. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.
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Major article
Face touching: A frequent habit that has implications
for hand hygiene
Yen Lee Angela Kwok MBBS, MPH, MHM, PhD, Jan Gralton BSc (Hons), PhD,
Mary-Louise McLaws DipTropPubHlth, MPHlth, PhD *
School of Public Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW, Australia
Key Words:
Face touching
Medical students
Hand hygiene compliance
Background: There is limited literature on the frequency of face-touching behavior as a potential vector
for the self-inoculation and transmission of Staphylococcus aureus and other common respiratory
Methods: A behavioral observation study was undertaken involving medical students at the University of
New South Wales. Their face-touching behavior was observed via videotape recording. Using stan-
dardized scoring sheets, the frequency of hand-to-face contacts with mucosal or nonmucosal areas was
tallied and analyzed.
Results: On average, each of the 26 observed students touched their face 23 times per hour. Of all face
touches, 44% (1,024/2,346) involved contact with a mucous membrane, whereas 56% (1,322/2,346) of
contacts involved nonmucosal areas. Of mucous membrane touches observed, 36% (372) involved the
mouth, 31% (318) involved the nose, 27% (273) involved the eyes, and 6% (61) were a combination of
these regions.
Conclusion: Increasing medical studentsawareness of their habituated face-touching behavior and
improving their understanding of self-inoculation as a route of transmission may help to improve hand
hygiene compliance. Hand hygiene programs aiming to improve compliance with before and after pa-
tient contact should include a message that mouth and nose touching is a common practice. Hand hy-
giene is therefore an essential and inexpensive preventive method to break the colonization and
transmission cycle associated with self-inoculation.
Crown Copyright Ó2015 Published by Elsevier Inc. on behalf of the Association for Professionals in
Infection Control and Epidemiology, Inc. All rights reserved.
Infections may be transmitted by self-inoculation. Self-inoculation
is a type of contact transmission where a personscontaminated
hands makes subsequent contact with other body sites on oneself and
introduces contaminated material to those sites.
Although the
literature on the mechanisms of self-inoculation of common respira-
tory infections (eg, inuenza, coronavirus) is limited,
hands have been reported as having potential to disseminate respi-
ratory infections.
Staphylococcus aureus is carried in the nasal mucosa
in approximately 25% of the community
and, may be self-inocu-
lated, via face touching, by individuals who are frequently exposed to
During the inuenza A (H1N1) pandemic, face-touching behavior in
the community was commonly observed with individuals touching
their faces on average 3.3 times per hour.
frequent face touching, particularly during periods of seasonal ende-
micity or outbreak, has the theoretical potential to be a mechanism of
acquisition and transmission.
However, quantifying the role of face
touching in the spread of respiratory infections or S aureus coloniza-
tion is difcult for several reasons. First, such a study would require
enrollment, screening, and prospective follow-up of a large popula-
tion to identify a signicant causal link. Second, the study would need
to observe transmission occurring in community settings, rather than
in isolation or under laboratory conditions, which would be ethically
challenging. Finally, there are likely to be confounding factors, such as
virulence of pathogens, varying susceptibility of the study population,
and effects of modes of transmission other than hand to face
contamination, that cannot easily be controlled.
A self-inoculation event may occur if a health care worker
(HCW) fails to comply with hand hygiene after patient contact
* Address correspondence to Mary-Louise McLaws, Level 3, School of Public
Health and Community Medicine, UNSW Medicine, UNSW Australia, Sydney, NSW
2052, Australia.
E-mail address: (M.-L. McLaws).
Conicts of interest: An unfunded project and the authors declared have no
conict of interest.
Contents lists available at ScienceDirect
American Journal of Infection Control
journal homepage:
American Journal of
Infection Control
0196-6553/$36.00 - Crown Copyright Ó2015 Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.
American Journal of Infection Control 43 (2015) 112-4
(moment 4)
or after contact with the contaminated environment
of the patients zone (moment 5) (Fig 1) and makes subsequent
physical contact with susceptible sites on their own bodies. To
better understand the dynamic between face touching and the
implications for hand hygiene among clinicians, we explored the
prevalence of face-touching behavior in medical students.
In May 2010, a behavioral observation study was undertaken
involving phase 3 medical students at the University of New South
Wales (UNSW). Ethical approval was obtained from the UNSW Hu-
man Research Ethics Committee prior to the commencement of the
study. The student cohort had completed a one 4-hour infection
control course in the previous 12 months. The infection control
course included education on hand hygiene, aseptic technique,
standard precautions, and transmission-based precautions. The
same student cohort attended two 2-hour lectures unrelated
to infection control, on 2 separate occasions. One week before the
2-hour lecture commenced, students were informed that a behav-
ioral observation study was being conducted during the lecture and
required the students to be videotaped while they listened to the
lecture. Students were not informed about which behaviors were
under observation to blind them from the aims of the study; this was
necessary to minimize the potential for a change in behavior as a
result of being observed.
To participate in the study, students were
instructed to move to a marked area on the left side of the lecture
theatre and complete a participant consent form. To opt out of the
study, students were instructed to move to the right side of the
lecture theatre outside of the videotape recording range. Students
were also informed that they could withdraw from the study once
recording commenced by simply moving to the other side of the
theatre. All participants consented prior to videotape recording.
A digital videotape recording was made of the consenting
participants and was viewed by investigators to record the face-
touching behavior of every participant. For the purposes of preci-
sion, the digital recording was viewed multiple times after the
lectures had taken place by 1 researcher (Y.L.A.K.). A standardized
scoring sheet was used to tally the frequency of hand-to-face
contacts, the area of the face that was touched, whether a
mucosal area (eyes, nose, mouth) or nonmucosal area (ears, cheeks,
chin, forehead, hair) was touched, and the time in seconds of each
contact. Descriptive statistics were performed to determine the
frequency and duration of touches per hour using SPSS version 21
for Windows (SPSS Inc, Chicago, IL).
A total of 26 students were observed making 2,346 touches to
the face over 240 minutes. Of the face touches, 56% (1,322/2,346)
involved nonmucosal regions, whereas 44% (1,024/2,346) involved
contact with mucosal membranes. Of the 1,322 nonmucosal
membrane touches, most involved the chin (31%; 409/1,322), fol-
lowed by the cheek (29%; 383/1,322), hair (28%; 369/1,322), neck
(8%; 104/1,322), and ear (4%; 57/1,322). Of the 1,024 touches
involving a mucosal membrane region, 36% (372/1,024) involved
the mouth, 31% (318/1,024) involved the nose, 27% (273/1,024)
involved the eyes, and 6% (61/1,024) involved a combination of the
mucosal membranes.
During an average hour participants touched their face 23 times
(median, 29.0 times; LQ (lower quartile), 42.2; UQ, 108.2; range, 4-
153). The average duration of mouth touching was 2 seconds
(median, 1 second; LQ, 3.0; UQ (upper quartile), 24.0; range, 1-
12 seconds), the average nose touching duration was 1 second
(median, <1 second; LQ, 0.09; UQ,1.2; range,1-10 seconds), and the
average eye touching duration was 1 second (median, <1 second;
LQ, 3.0; UQ, 11.5; range, 1-5 seconds).
Hands are considered a common vector for the transmission of
health careeassociated infections
7,14,1 5
and have been implicated in
the transmission of respiratory infections.
Good hand hygiene
before and after patient contact is imperative to prevent trans-
mission of infection. This is particularly so during the symptomatic
or asymptomatic prodromal stages of infections when patients
shed infectious material.
In particular, clinicians caring for infec-
tious pediatric patients with high shedding concentrations
be at risk of acquiring an infection if they have a high level of face-
touching behavior.
S aureus is a common pathogen prevalent in both community
and health care settings. Colonization of the nasal mucous mem-
branes with S aureus is common and ranges from 20%-30% in health
care and community settings.
Nose touching was common among
our participants. This nding supports the importance of hand
hygiene as a means of preventing occupationally acquired coloni-
zation with S aureus from patients or the contaminated environ-
S aureus can survive for up to 5 years on hard surfaces,
and no obvious role has yet been attributed to colonized staff.
When mixed with hospital dust, S aureus can still survive for >1
year until it is picked up from the environment.
hands may act as a vector, transmitting the bacteria from a
contaminated surface to the HCWs nasopharynx via face touching.
High hand hygiene compliance before and after patient contact
should reduce the likelihood of transferring pathogens through
Fig 1. Average number of face touches observed in a 60-minute period.
Y.L.A. Kwok et al. / American Journal of Infection Control 43 (2015) 112-4 113
self-inoculation and in turn prevent inoculation of patients.
Pathogens found on stethoscopes have also been recovered from
physicians hands.
Given the habitual face-touching behavior
observed in our study, it is possible that the inoculation of
stethoscopes and other contaminated medical equipment may
have been the result of inoculation from nose touching to hands
and subsequently to the stethoscope. Given the frequency of face-
touching behavior observed in this study, clinicians must practice
hand hygiene before and after using such equipment to ensure that
patient equipment is kept clean prior to use.
Given the highfrequency of mouth and nose touching observed, 4
times perhour on averagefor mouth touching and3 times per hour on
average for nose touching, performing hand hygiene is an essential
and inexpensive preventivemethod for breakingthe colonizationand
transmission cycle. Models of infection transmission and comparison
of transmission efciency of self-inoculation against other trans-
mission routes are required to further expand our knowledge on the
role of face touching for self-inoculation. Meanwhile, raising aware-
ness thatface-touching behavior is commonand is a possible vectorin
self-inoculation could result in HCWs accepting the message that
hand hygiene before and after patient contact is an effective method
of reducing colonization and infection transmission for themselves
and their patients.
We thank Professor Gary Velan for providing us access to the
UNSW medical students prior to his lecture and to Professor Wil-
liam Rawlinson for providing recording equipment.
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Y.L.A. Kwok et al. / American Journal of Infection Control 43 (2015) 112-4114
... Self-contact prediction can enable numerous applications, and we only reference a few here. Kwok, Gralton, and McLaws (2015) study hygiene and virus transmission, by monitoring how often students touch their face with their hands. Yet, data is gathered manually with multiple investigators annotating videotape recordings. ...
... Assistants can rely on self-contact signatures to reason about a person's internal state including emotional response, and could provide feedback to that person over a period of time, for increase awareness or for positively changing habits. Our work can also be potentially relevant to detect and correct the unconscious behaviour of touching one's mouth or face with the hand (Kwok, Gralton, and McLaws 2015), in order to avoid infections with various pathogens, if proper hygiene is not maintained. In this regard, the models can be potentially used in hospitals in order to monitor hygiene of both patients and medical personnel. ...
Monocular estimation of three dimensional human self-contact is fundamental for detailed scene analysis including body language understanding and behaviour modeling. Existing 3d reconstruction methods do not focus on body regions in self-contact and consequently recover configurations that are either far from each other or self-intersecting, when they should just touch. This leads to perceptually incorrect estimates and limits impact in those very fine-grained analysis domains where detailed 3d models are expected to play an important role. To address such challenges we detect self-contact and design 3d losses to explicitly enforce it. Specifically, we develop a model for Self-Contact Prediction (SCP), that estimates the body surface signature of self-contact, leveraging the localization of self-contact in the image, during both training and inference. We collect two large datasets to support learning and evaluation: (1) HumanSC3D, an accurate 3d motion capture repository containing 1,032 sequences with 5,058 contact events and 1,246,487 ground truth 3d poses synchronized with images collected from multiple views, and (2) FlickrSC3D, a repository of 3,969 images, containing 25,297 surface-to-surface correspondences with annotated image spatial support. We also illustrate how more expressive 3d reconstructions can be recovered under self-contact signature constraints and present monocular detection of face-touch as one of the multiple applications made possible by more accurate self-contact models.
... International guidelines advocate regular hand washing with soap and water and avoiding touching the face, particularly the eyes, nose, and mouth, to avoid infection through transfer of the virus from contaminated surfaces 3 . There is emerging evidence that high rates of adherence to these guidelines is effective in limiting viral transmission 4 , with hand hygiene 5,6 and preventing face touching featuring prominently [7][8][9] . ...
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Until pharmacological measures are rolled out on a global scale, reducing the transmission of COVID-19 and preventing future outbreaks require the continued promotion of behaviors known to effectively limit the spread of infections (e.g., physical distancing, hand hygiene practices). The success of such behavioral measures, however, relies on widespread compliance, highlighting the importance of theory-and evidence-based behavior change interventions targeting COVID-19 preventive behaviors. Theories of social cognition have recently been applied to COVID-19 preventive behaviors to identify the key modifiable determinants of behavior that can be targeted by strategies or techniques in interventions. The identification of key modifiable determinants of COVID-19 preventive behaviors permits the matching of evidence-based behavior change strategies or techniques proposed to affect change in the targeted determinants. The goal of this chapter is to provide an overview of the social cognition literature and interventions targeting key psychological constructs as means to adopt and maintain COVID-19 preventive behaviors. The chapter also provides example materials used in behavior change interventions based on social cognition theory, which may have application across a broad range of COVID-19 preventive behaviors. First, the chapter provides an overview of social cognition theories that have been used to explain and predict health and social behavior and how behavior change occurs. Next, the emerging research evidence of potentially modifiable social cognition determinants of COVID-19 preventive behaviors are reviewed. Finally, a step-by-step example of how interventionists might develop a theory-based intervention targeting change in an important COVID-19 preventive behavior is provided. The chapter concludes with a summary of some key challenges and future directions in moving forward behavior change research in this area. Overall, this chapter provides information useful to the design and development of effective behavior change interventions targeting the adoption and maintenance of COVID-19 preventive behaviors which are relevant to current and future pandemic contexts.KeywordsSocial cognitionCOVID-19Preventive behaviorsPsychological theoryDeterminantsBehavior change
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Pandemi COVID-19 akibat virus corona tipe baru SARS COV-2 telah menular melalui kontak fisik antar manusia. Perilaku hidup bersih dan sehat menjadi elemen penting dalam pencegahan infeksi virus ini. Penelitian ini bertujuan untuk melakukan tinjauan naratif terhadap aspek-aspek perubahan perilaku kesehatan selama masa pandemi COVID-19. Analisis akan dilakukan pada penelitian yang telah dipublikasikan sejak Januari 2020 hingga akhir April 2020 dengan metode narrative review. Perubahan perilaku yang telah ditunjukkan selama pandemi di sebagian besar penelitian adalah praktik Perilaku Hidup Bersih dan Sehat (PHBS), cuci tangan, penerapan batuk, penggunaan antiseptik, penggunaan masker di tempat umum, dan penggunaan teknologi informasi. untuk mengakses berita dan layanan kesehatan selama masa pandemi..Pandemi COVID-19 membawa perubahan pengetahuan, persepsi, dan perilaku dalam rangka pencegahan. Adanya kebijakan yang mendukung sebagai salah satu faktor yang memungkinkan terjadinya pencegahan perilaku. Pencegahan penyakit akibat COVID-19 sebagian besar pada praktik higiene sanitasi untuk mencegah penularan penyakit sebagai perilaku normal baru.
... Currently, one of the most significant pathways for the spread of respiratory infectious diseases is by airborne transmission . These airborne microorganisms may be propagated by fine mist, dust, aerosols, or liquids, that are subsequently transported over a large region by air currents Inadequate hand hygiene or inability to follow disease control guidelines can result in selfinoculation (Kwok et al., 2015). Figure 2 illustrates the viral transmission method of SARS-CoV-2. ...
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The threat of epidemic outbreaks like SARS-CoV-2 is growing owing to the exponential growth of the global population and the continual increase in human mobility. Personal protection against viral infections was enforced using ambient air filters, face masks, and other respiratory protective equipment. Available facemasks feature considerable variation in efficacy, materials usage and characteristic properties. Despite their widespread use and importance, face masks pose major potential threats due to the uncontrolled manufacture and disposal techniques. Improper solid waste management enables viral propagation and increases the volume of associated biomedical waste at an alarming rate. Polymers used in single-use face masks include a spectrum of chemical constituents: plasticizers and flame retardants leading to health-related issues over time. Despite ample research in this field, the efficacy of personal protective equipment and its impact post-disposal is yet to be explored satisfactorily. The following review assimilates information on the different forms of personal protective equipment currently in use. Proper waste management techniques pertaining to such special wastes have also been discussed. The study features a holistic overview of innovations made in face masks and their corresponding impact on human health and environment. Strategies with SDG3 and SDG12, outlining safe and proper disposal of solid waste, have also been discussed. Furthermore, employing the CFD paradigm, a 3D model of a face mask was created based on fluid flow during breathing techniques. Lastly, the review concludes with possible future advancements and promising research avenues in personal protective equipment.
Objective: At the start of the COVID-19 pandemic, healthcare workers (HCW) in our ED were advised against and actively discouraged from wearing masks when not seeing respiratory patients, as mask wearing was thought to increase the risk of droplet transmission by face touching. The primary objective of the present study was to determine whether HCW using face masks were more or less likely to touch their faces than those not wearing masks. Methods: We analysed six randomly selected hours of closed circuit television footage from our staff base. Face touches were recorded electronically by trained researchers. Generalised linear mixed models were used to compare the frequency and duration of face touches with and without face masks, controlling for individual clusters, adjusting for time of footage, duration on screen and staff role. Results: Data were collected from 187 HCW. Masks were worn in 231 (36%) of 642 screen sessions. Wearing a mask did not significantly change the odds of face touching (odds ratio 0.55, 95% confidence interval [CI] 0.30-1.01, P = 0.055) or duration of face touch (mean difference -1.45 s, 95% CI -8.84, 5.99, P = 0.71). For mucosal areas, a significant reduction in the odds of face touching was observed for mask wearers (odds ratio 0.21, 95% CI 0.11-0.43, P < 0.001) and on the frequency of mucosal touches (rate ratio 0.45, 95% CI 0.29-0.69, P < 0.001). Conclusions: Mask wearing did not change face touching or the duration of face touches. However, significantly fewer mucosal touches were observed when wearing a mask, which may help to reduce nosocomial droplet transmission of viruses.
Background Promoting the adoption of personal hygiene behaviors known to reduce the transmission of COVID-19, such as avoiding touching one’s face with unwashed hands, is important for limiting the spread of infections. Purpose We aimed to test the efficacy of a theory-based intervention to promote the avoidance of touching one’s face with unwashed hands to reduce the spread of COVID-19. Methods We tested effects of an intervention employing imagery, persuasive communication, and planning techniques in two pre-registered studies adopting randomized controlled designs in samples of Australian (N = 254; Study 1) and US (N = 245; Study 2) residents. Participants were randomly assigned to theory-based intervention or education-only conditions (Study 1), or to theory-based intervention, education-only, and no-intervention control conditions (Study 2). The intervention was delivered online and participants completed measures of behavior and theory-based social cognition constructs pre-intervention and one-week postintervention. Results Mixed-model ANOVAs revealed a significant increase in avoidance of touching the face with unwashed hands from pre-intervention to follow-up irrespective of intervention condition in both studies, but no significant condition effects. Exploratory analyses revealed significant effects of the theory-based intervention on behavior at follow-up in individuals with low pre-intervention risk perceptions in Study 2. Conclusions Results indicate high adoption of avoiding touching one’s face with unwashed hands, with behavior increasing over time independent of the intervention. Future research should confirm risk perceptions as a moderator of the effect theory-based interventions on infection-prevention behaviors.
Background This study aimed to identify the source of infection and medical costs for a respiratory infection outbreak in a facility for patients with severe motor and intellectual disabilities (SMID). Presenteeism refers to a situation wherein a person continues going to work despite being ill. Methods The cohort included 1 healthcare worker and 17 patients who developed a fever of ≥37.5°C with respiratory symptoms for nearly a month. An outbreak investigation was conducted, which determined the initial case of the outbreak to be a single healthcare worker. We performed a univariate analysis to determine the association of the healthcare worker. From the medical records, we evaluated the costs of addition treatment and laboratory tests for the respiratory infection. Results The source of infection was a healthcare worker at the facility (Odds ratio, 17.5; 95% confidential interval, 3.0–101.8). The total medical cost for hospitalized patients due to this outbreak was $12,324. Discussion The source of a respiratory infection outbreak in a facility for SMID was suggested to be a healthcare worker's presenteeism. Conclusions The cause of this outbreak was healthcare workers’ presenteeism. To prevent outbreaks, such facilities should address the causative factors.
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COVID-19 is a respiratory disease of worldwide importance as it has brought enormous health problems to the world’s population. The best-known way of transmission of the virus is through aerosolization. However, research is needed to explore other transmission routes. Researchers hypothesized that arthropods could transmit SARs-CoV-2. This study is aimed at reviewing research on arthropods as possible reservoirs and/or vectors of SARS-CoV-2, the causative agent of COVID-19. Following PRISMA guidelines, we conducted a systematic review using several electronic databases/academic searches with the search terms “arthropods,” “coronavirus,” and “transmission.” A total of 64 unique articles were identified, of which 58 were included in the review. The SARS-CoV-2 virus is tiny and invisible to the naked eye, and its presence in stools, droplets, and surfaces was detected. One doubt is whether insects can transmit the virus from one place to another. Thus, a healthy carrier of the COVID-19 virus can be at the root of the contamination of their community or their family through the transport of the virus by insects from the interior (flies, cockroaches, etc.) from their feces and food surfaces. Hygiene care within communities and families becomes a prime factor. Coronavirus infection is a significant public health problem around the world. The prevention and control of outbreaks remain very important, even with the production of new vaccines. The main option to achieve this is the proper management of the transmission of the virus. The registry of infected people is currently the basis for the transmission of COVID-19. However, questions about the possibility of infection from other sources and its prevention are not receiving adequate attention. Numerous studies have shown the possibility that SARS-COV-2 fragments could have a longer life than shed respiratory droplets. Also, this virus is larger than those of other coronavirus families.
Background : The purpose of this study is to analyze face touching patterns with and without face mask. Methods : The behavior of face touching with and without a mask during an interview was assessed in forty individuals. The frequency of touching in different areas of the face covered by the mask was compared to areas not covered by the face mask. Results : There was an increase in the number of individuals who touched the hair and the eye, when they were not wearing the mask. There was an increase in the number of touches on the lips and hair when individuals were not wearing the face mask. When analysing the area covered by face mask, no difference was observed on the number of touches while using or not using masks. However, when area not covered by face mask was analysed, higher number of touches in individuals without masks was observed when compared to individuals wearing masks. Conclusion : The use of face mask can reduce or change the face touching patterns in normal individuals, especially in areas not covered by the mask. The use of face mask can possibly reduce the chances of being infected by auto-inoculation.
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Family medicine offices may play an important role in the transmission of common illnesses such as upper respiratory tract infections (URTIs). There has, however, been little study of whether physicians teach patients about URTI transmission and what their own actions are to prevent infection. The purpose of this study was to assess the quality of hand hygiene and the frequency with which family physicians and staff touch their eyes, nose, and mouth (the T-zone) as well as physician and staff self-reported behaviors and recommendations given to patients regarding URTI prevention. We observed family physicians and staff at 7 offices of the Cincinnati Area Research and Improvement Group (CARInG) practice-based research network for the quality of hand hygiene and number of T-zone touches. After observations, participants completed surveys about personal habits and recommendations given to patients to prevent URTIs. A total of 31 clinicians and 48 staff participated. They touched their T-zones a mean of 19 times in 2 hours (range, 0-105 times); clinicians did so significantly less often than staff (P < .001). We observed 123 episodes of hand washing and 288 uses of alcohol-based cleanser. Only 11 hand washings (9%) met Centers for Disease Control and Prevention criteria for effective hand washing. Alcohol cleansers were used more appropriately, with 243 (84%) meeting ideal use. Participants who were observed using better hand hygiene and who touched their T-zone less report the same personal habits and recommendations to patients as those with poorer URTI prevention hygiene. Clinicians and staff in family medicine offices frequently touch their T-zone and demonstrate mixed quality of hand cleansing. Participants' self-rated URTI prevention behaviors were not associated with how well they actually perform hand hygiene and how often they touch their T-zone. The relationship between self-reported and observed behaviors and URTIs in family medicine office settings needs further study.
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Objectives To compare the contamination level of physicians’ hands and stethoscopes and to explore the risk of cross-transmission of microorganisms through the use of stethoscopes. Patients and Methods We conducted a structured prospective study between January 1, 2009, and May 31, 2009, involving 83 inpatients at a Swiss university teaching hospital. After a standardized physical examination, 4 regions of the physician’s gloved or ungloved dominant hand and 2 sections of the stethoscopes were pressed onto selective and nonselective media; 489 surfaces were sampled. Total aerobic colony counts (ACCs) and total methicillin-resistant Staphylococcus aureus (MRSA) colony-forming unit (CFU) counts were assessed. Results Median total ACCs (interquartile range) for fingertips, thenar eminence, hypothenar eminence, hand dorsum, stethoscope diaphragm, and tube were 467, 37, 34, 8, 89, and 18, respectively. The contamination level of the diaphragm was lower than the contamination level of the fingertips (P<.001) but higher than the contamination level of the thenar eminence (P=.004). The MRSA contamination level of the diaphragm was higher than the MRSA contamination level of the thenar eminence (7 CFUs/25 cm2 vs 4 CFUs/25 cm2; P=.004). The correlation analysis for both total ACCs and MRSA CFU counts revealed that the contamination level of the diaphragm was associated with the contamination level of the fingertips (Spearman’s rank correlation coefficient, ρ=0.80; P<.001 and ρ=0.76; P<.001, respectively). Similarly, the contamination level of the stethoscope tube increased with the increase in the contamination level of the fingertips for both total ACCs and MRSA CFU counts (ρ=0.56; P<.001 and ρ=.59; P<.001, respectively). Conclusion These results suggest that the contamination level of the stethoscope is substantial after a single physical examination and comparable to the contamination of parts of the physician’s dominant hand.
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Background: The recent years have witnessed the increasing resistance of Staphylococcus aureus to many antimicrobial agents. The most notable example is the emergence of Methicillin- resistant Staphylococcus aureus (MRSA), which was reported just one year after the launch of methicillin. The ecological niches of the S. aureus strains are the anterior nares. The identification of Staphylococcus aureus by using a proper antibiogram and the detection of methicillin resistant Staphylococcus aureus greatly contribute towards the effective treatment of the patients. Aims and Objectives: To isolate Staphylococcus aureus from the nasal swabs of healthcare workers (HCWs) and to study their antimicrobial susceptibility patterns, which include methicillin resistance. Materials and Methods: Nasal swabs were collected from the healthcare workers of various clinical departments of the hospital over a period of one year. The isolation of Staphylococcus aureus and their antimicrobial susceptibility patterns were carried out by standard bacteriological procedures. Results: Staphylococcus aureus was isolated in 70 cases (22.22%). The prevalence of the S.aureus nasal carriage was higher among the male HCWs (54.28%) than among the female HCWs (45.71%). The carriage rate was the highest in the orthopaedics department, followed by those in the surgery and the gynaecology departments. All the Staphylococcus aureus isolates were sensitive to vancomycin and linezolid (100%). Penicillin and ampicillin were the most resistant, (90% and 88.6%) respectively. Methicillin resistance was seen in11.43% of the S.aureus isolates, both by the disc diffusion test and by the Oxacillin Resistance Screen Agar (ORSA) test. Conclusions: The compliance with the sanitary and the antibacterial guidelines of the health professionals is the single most important factor in preventing nosocomial infections. Simple preventive measures like hand washing before and after the patient examination, the use of sterile aprons and masks in the postoperative wards, awareness during the examination of the immunocompromised patients, and avoiding touching one’s nose during work, can reduce the disease transmission rate considerably.
Staphylococci remain the most important cause of hospital-acquired infections in the U.S. and MRSA has become the most common cause of skin and soft tissue infection in many parts of the world. There is now a much greater understanding of the physiology and evolution of the staphylococci and this new edition reflects the rapid advancements in knowledge about this pathogen and provides a comprehensive review from both clinical and basic science perspectives. The first section addresses the basic biology of the staphylococci, their molecular genetics, host defenses and host evasion, virulence determinants, mechanisms of antibiotic resistance, and laboratory techniques. The second section deals with epidemiology, and the third section provides an overview of the varied clinical manifestations of human staphylococcal infections. The fourth section covers prevention and treatment of these often life-threatening infections. Written by experts from around the globe, this book is essential reading for all clinicians and basic scientists studying the staphylococci.
This chapter presents a Feature Local Binary Patterns (FLBP) method that encodes both local and feature information, where the feature pixels may be broadly defined by, for example, the edge pixels, the intensity peaks or valleys in an image, or new feature information derived from the local binary patterns or LBP. FLBP thus is expected to perform better than LBP for texture description and pattern recognition. For a given pixel and its nearest feature pixel, a distance vector is first formed by pointing from the given pixel to the feature pixel. A True Center (TC), which is the center pixel of a neighborhood, is then located on the distance vector by a TC parameter. A Virtual Center (VC), which replaces the center pixel of the neighborhood, is specified on the distance vector by a VC parameter. FLBP is then defined by comparing the neighbors of the true center with the virtual center. Note that when both the TC and VC parameters are zero, FLBP degenerates to LBP, which indicates that LBP is a special case of FLBP. Other special cases of FLBP include FLBP1 when the VC parameter is zero and FLBP2 when the TC parameter is zero.
Methicillin resistant Staphylococcus aureus (MRSA) is significant major pathogen responsible for hospital and community based infections. The aim of this study was to assess the nasal and hand carriage of methicillin resistant Staphylococcus aureus in health care workers of Mekelle Hospital The study was carried out during November 2010 to January 2011. Swab samples from both anterior nares and hands were taken. The samples were cultured on mannitol salt agar and incubated aerobically at 37 degrees C for 48 hours. Staphylococcus aureus was identified as nmannitol fermenter and coagulase test positive. Antimicrobial susceptibility test for MRSA was done by disk diffusion method using oxacillin disks. Data were analysed using SPSS version 16 software. Out of the 177 health care workers screened, 36 (20.3%) of them were methicillin resistant Staphylococcus aureus carriers in their hand and anterior nares. More females, 25(14.1%) were colonized by methicillin resistant Staphylococcus aureus than males 11 (6.2%) (P = 0.044). Nasal carriage of MRSA of 25 (14.1%) was higher than hand carriage 11 (6.2%) (p < 0.05). Nurses and medical doctors had methicillin resistant Staphylococcus aureus carriage rates of 26 (13.6%) and 4 (2.3%), respectively. The isolated MRSA were resistant to multiple antibiotics. The highest resistance was observed for ampicillin (88.9%) and tetracycline (86.1%). Two (5.6%) of the nasal isolates were vancomycin resistant. Methicillin resistant Staphylococcus aureus carriage among health care workers in this study was high. The carriage rate was higher among nurses and doctors. The MRSA isolates were multi drug resistant to other antibiotics. So, the result of this study emphasizes the need of regular surveillance of health care workers. It also calls a need for an effective infection prevention and control program.
Indirect transmission of the influenza virus via finger contamination with respiratory mucus droplets has been hypothesized to contribute to transmission in the community. Under laboratory conditions, influenza-infected respiratory droplets were reconstituted as close as possible to natural conditions. We investigated experimentally the survival of influenza A (H3N2) and A (H1N1)pdm09 viruses on human fingers. Infectious virus was easily recoverable on all fingers 1 min after fingertip contamination but then decreased very rapidly. After 30 min, infectious virus was detectable in only a small minority of subjects. Infectious viruses were detected for a longer period of time when droplets of larger size containing a higher number of particles were tested or when the viral concentration increased. A rapid decrease in infectiousness was observed when droplet integrity was disrupted. Our findings could help to set up the promotion of hand hygiene to prevent influenza hand contamination.
Objective: To investigate the level of and factors involved in influenza virus subtype H1N1 (H1N1)-related preventive behaviors and mental distress among university students in Guangzhou. Participants: Self-administered questionnaires were used to collect data for 825 students from 2 universities. Results: A total of 49.7% of the participants held misconception(s) concerning H1N1 transmission. Less than 30% washed their hands >10 times/d; 72.3% did not reduce the frequency of touching their mouths, noses, and eyes; only 9.3% would wear face masks if they had influenza-like symptoms. However, 45% worried that one/one's family would contract H1N1, 10.7% were panicking/feeling depressed/feeling emotionally disturbed as a result of H1N1, and 14.9% were fearful about the WHO's H1N1 pandemic announcement. Almost all cognitive variables of this study were significantly associated with mental distress caused by fear of H1N1 (odds ratio [OR] = 0.29-3.81), but very few were associated with adoption of preventive measures (OR = 0.65-1.90). Conclusions: Preventive measures are warranted to alleviate distress in the population studied via health education and promotion.