Hand Coverage Research Articles

Special-form radial collateral artery perforator flaps for the reconstruction of complex hand defects

BackgroundThe reconstruction of complex wounds of the hand still has challenges in achieving aesthetic, functional and sensory recovery. We presented our experience of using the polyfoliate and chimeric radial collateral artery perforator flaps (RCAPF) to repair complex hand defects, aiming to explore the feasibility of special-form RCAPFs in hand coverage and enhance the comprehension of their respective indications.MethodsFrom June 2014 to March 2021, 26 cases (19 males and 7 females, mean 44.4 years) underwent defect and sensation reconstruction of their hands with special-form RCAPFs, which manifested as multiple adjacent or irregular single wounds and composite tissue defects complicated with a degree of nerve injury. The clinical effects of the free RCAPFs were evaluated by integrating the postoperative and long-term follow-up outcomes of all cases.ResultsAltogether 8 polyfoliate flaps, 17 chimeric flaps and 1 polyfoliate-chimeric flap were harvested. Of them, 23 flaps survived uneventfully in one stage. Venous congestion occurred in 3 cases, two of which survived through vascular exploration and another one was finally repaired by the contralateral RCAPF. The follow-up results showed that the appearance of both the recipient and donor sites mostly recovered satisfactory. All the bone flaps properly healed. The BMRC sensory evaluation results of all skin flaps were S4 in 8 flaps, S3 in 18 flaps, and S2 in 9 flaps.ConclusionsThe free RCAPFs can be designed in various forms with a reliable blood supply, contributing to reconstructing simple and multiple wounds of the hand with or without bone defects and dead space.

Artificial age-independent seismic anisotropy, slab thickening and shallowing due to limited resolving power of (an)isotropic tomography

SUMMARY Seismic anisotropy is key to constrain mantle flow, but it is challenging to image and interpret it. Existing large-scale tomography models of seismic anisotropy typically show large discrepancies, which can lead to completely distinct geodynamical interpretations. To better quantify the robustness of anisotropy tomography, we create a 2-D ridge-to-slab geodynamic model and compute the associated fabrics. Using the resulting 21 elastic constants, we compute seismic full waveforms, which are inverted for isotropic and radially anisotropic structure. We test the effects of different data coverage and levels of regularization on the resulting images and on their geodynamical interpretation. Within the context of our specific imposed conditions and source–receiver configuration, the retrieved isotropic images exhibit substantial artificial slab thickening and loss of the slab’s high-velocity signature below ∼100 km depth. Our results also show that the first-order features of radial anisotropy are well retrieved despite strong azimuthal anisotropy (up to 2.7 per cent) in the input model. On the other hand, regularization and data coverage strongly control the detailed characteristics of the retrieved anisotropy, notably the depth–age dependency of anisotropy, leading to an artificial flat depth–age trend shown in existing anisotropy tomography models. Greater data coverage and additional complementary data types are needed to improve the resolution of (an)isotropic tomography models.

Preventing Healthcare-Associated Infections: Hand Disinfection Monitoring Using an Automated System in an Italian Neurological Hospital

Hand hygiene plays a pivotal role in preventing Healthcare-Associated Infections (HAIs). Nevertheless, the quality of hand disinfection techniques remains suboptimal, and the reliability of assessment methodologies is notably lacking. This study aimed to evaluate hand disinfection techniques using an automated system in an Italian research hospital. Hospital employees underwent automated hand-disinfection technique assessment, according to the World Health Organization’s six-step protocol, at a basal time and two further times. Detection was carried out with a scanner that evaluated the effective hand disinfectant coverage through a fluorescent dye present in the hydro-alcoholic gel rub. The hand-hygiene technique of 222 employees was analyzed by HandInScan®. At the initial assessment of hand coverage with the hydro-alcoholic gel, the mean palm coverage was 82.2%, mean back coverage was 66.8%, and overall mean hand coverage was 74.5%. Then, two measurements were performed in June (t1) and December 2022 (t2). The third measurement showed an increase in hand coverage, with a mean palm coverage of 97.2%, a mean back coverage of 91.8%, and a mean hand coverage of 94.5% (p < 0.05). Moreover, the mean coverage of the hand-back was lower than that of the hand-palm at all times (p < 0.001). The automated scanner provided evidence supporting its effectiveness in enhancing hand hygiene among hospital employees. These findings have motivated researchers to conduct long-term studies, given the potential effects on HAI prevention—including their impact on HAI trends.

Treatment of infected soft tissue loss

Hand coverage in infected soft tissue loss (STL) is a challenging clinical condition. Appropriate and well-timed antibiotic therapy and careful debridement are crucial for the success of the subsequent reconstructive procedure. Debridement must be radical, and all nonviable or infected tissue should be removed. Strict medical control and multiple procedures can be required when infection recurrence is observed after primary procedure. Secondary healing of STL is usually necessary in these complex conditions. Negative pressure wound therapy (NPWT) is often used as a temporary instrument to reduce oedema and drainage, facilitating the attainment of a clean wound for subsequent reconstruction. According to the type and size of the defect, multiple options ranging from skin grafts and substitutes to local and free flaps can be selected for the treatment of infected STL. A reconstructive ladder approach and case-by-case decision making should always be considered. Due to the unique function and role of the hand, the surgical strategy must also take into account aesthetic and functional factors. Orthopedic and Plastic surgeons should manage this wide variety of treatment options in a multidisciplinary and high-specialized context including radiologists, microbiologists, infectious disease specialists and physiotherapists, customizing the treatment path to the specific patient's situation.

The Superficial Circumflex Iliac Artery Perforator Flap for Devastating Hand Injuries in the Obese.

Blast injuries to the hand, such as those from fireworks, are debilitating and life altering. Often, because of the nature of the injury, there is a need for soft tissue and skin coverage. However, in the increasingly obese American population, free flaps often are too bulky for functional hand coverage. In this study, we present a series of 7 patients who underwent the superficial circumflex iliac artery perforator (SCIP) flap for upper extremity reconstruction with improvement in cosmesis, including a primarily repaired donor site, as well as an overwhelmingly high return to work with minimal revision surgery necessary. All patients who underwent a SCIP for hand injuries from a blast were included. Flaps were harvested based on previously described methods. A single attending surgeon performed all surgeries. All patients were followed for at least 6 months. Preoperative and postoperative characteristics were described. A total of 7 patients were included in this study. Ages ranged from 16 to 58 years and body mass index from 19 to 48 kg/m2. More than half of the patients had a body mass index greater than 30 kg/m2. All donor sites were primarily closed. Five patients returned to their preinjury work. Three patients had neurotized flaps with return of protective sensation. Three patients required revision surgery; all 3 had liposuction, and 1 had additional flap advancement surgery. The SCIP flap is a versatile flap that can be used in hand reconstruction in blast injuries with good functional outcome and improved cosmesis compared with other perforator flaps for the upper extremity.

Use of thermal imaging to measure the quality of hand hygiene

Hand hygiene has long been promoted as the most effective way to prevent the transmission of infection. However, due to low compliance and low quality of hand hygiene reported in previous studies, constant monitoring of hand hygiene compliance and quality among healthcare workers is crucial. This study investigated the feasibility of using a thermal camera with an RGB camera to detect hand coverage of alcohol-based formulation, thereby monitoring the quality of hand rubbing. In total, 32 participants were recruited to participate in this study. Participants were required to perform four types of hand rubbing to achieve different coverage of the alcohol-based formulation. After each task, participants' hands were photographed under a thermal camera and an RGB camera, while an ultraviolet (UV) test was used to provide the ground truth of hand coverage of alcohol-based formulation. U-Net was used to segment areas exposed to alcohol-based formulation from thermal images, and system performance was evaluated by comparing differences in coverage between thermal images and UV images in terms of accuracy and Dice coefficient. This system found promising results in terms of accuracy (93.5%) and Dice coefficient (87.1%) when observations took place 10s after hand rubbing. At 60s after hand rubbing, accuracy and Dice coefficient were 92.4% and 85.7%. Thermal imaging has potential for accurate, constant and systematic monitoring of the quality of hand hygiene.

Evidence-based hand hygiene: Liquid or gel handrub, does it matter?

BackgroundRecent studies put under scrutiny the prevailing hand hygiene guidelines, which incorporate quantitative parameters regarding handrub volume and hand size. Understanding the criticality of complete (i.e., efficient) hand hygiene in healthcare, objectivization of hand hygiene related parameters are paramount, including the formulation of the ABHR. Complete coverage can be achieved with optimal Alcohol-Based Hand Rub (ABHR) provided. The literature is limited regarding ABHR formulation variances to antimicrobial efficiency and healthcare workers’ preference, while public data on clinically relevant typical application differences is not available. This study was designed and performed to compare gel and liquid format ABHRs (the two most popular types in Europe) by measuring several parameters, including application time, spillage and coverage.MethodologySenior medical students were invited, and randomly assigned to receive pre-determined ABHR volumes (1.5 or 3 ml). All the 340 participants were given equal amounts of gel and liquid on two separate hand hygiene occasions, which occurred two weeks apart. During the hand hygiene events, by employing a digital, fully automated system paired with fluorescent-traced ABHRs, disinfectant hand coverage was objectively investigated. Furthermore, hand coverage in relation to the participants’ hand sizes was also calculated. Additional data collection was performed regarding volume differences and their effect on application time, participants’ volume awareness (consciousness) and disinfectant spillage during the hand hygiene events.ResultsThe 1.5 ml ABHR volume (commonly applied in healthcare settings) is insufficient in either formulation, as the non-covered areas exceeded significant (5%+) of the total hand surface area. 3 ml, on the contrary, resulted in almost complete coverage (uncovered areas remained below 1.5%). Participants typically underestimated the volume which they needed to apply. While the liquid ABHR spreads better in the lower, 1.5 ml volume compared to the gel, the latter was easier handled at larger volume. Drying times were 30/32 s (gel and liquid formats, respectively) when 1.5 ml handrub was applied, and 40/42 s when 3 ml was used. As the evaporation rates of the ABHR used in the study are similar to those available on the market, one can presume that the results presented in the study apply for most WHO conform ABHRs.ConclusionThe results show that applying 1.5 ml volume was insufficient, as large part of the hand surface remained uncovered (7.0 ± 0.7% and 5.8 ± 1.0% of the hand surface in the case of gel and liquid, respectively) When 3 ml handrub was applied drying times were 40 and 42 s (gel and liquid, respectively), which is a very long time in daily clinical practice. It looks like we cannot find a volume that fits for everyone. Personalized, hand size based ABHR volumes may be the solution to find an optimal balance between maximize coverage and minimise spillage and drying time. 3 ml can be a good volume for those who have medium size hands. Large handed people should use more handrub to reach appropriate coverage, while small-handed ones may apply less to avoid massive spillage and not to take unrealistically long to dry.

Usefulness of Reverse Radial Forearm Flaps in Covering Soft Tissue Defects of Hand and Wrist

Aim: To emphasize on the importance of reverse radial forearm flap (RRF flap) in the coverage of soft tissue defects of hand and wrist. Study design: This is a descriptive experimental study. Study place and duration: Study was comprised on the period of six months from January 2022 to June 2022. It was conducted in the plastic surgery department of Allama Iqbal Memorial Teaching Hospital Sialkot Methodology: Patients with the soft tissue defects of hand and wrist due to road traffic accidents, industrial or mechanical trauma and firearm injury were admitted to the plastic surgery ward. After achieving healthy wound with wound debridement, soft tissue coverage was done using reverse radial fasciocutaneous forearm flap. Patients with amputation of thumb and those with partial or complete bone loss were excluded from the study. Ages of the patients were 17-50 years with mean age of 31.42±5.3 years. Donor site of the flap was covered with split thickness skin graft and follow-up of the patients was done for at least three months. Results: 20 cases were included in this study including 16(80%) male and 04(20%) female cases. 15(75%) cases had soft tissue defect on the dorsum of hand, 04(20%) cases had palmar defect and in 01(5%) case there was amputation at transmetacarpal level and flap coverage of the stump was done. Partial loss of the flap happened in one 01(5%) case and it was treated with debridement and skin coverage. In one case superficial epidermolysis was found and managed conservatively. Practical implication Conclusion: Reverse radial forearm fasciocutaneous flap is an excellent option for the coverage of soft tissue defects of hand and wrist due to its greater arc of rotation which makes it easy to apply to the recipient site. Key words: Hand trauma, Soft tissue defects of hand, Reverse Radial Forearm Flap, Flap Coverage of Hand

Access to Reconstructive Hand Surgery in the United States-Investigating the Obstacles: A Scoping Review.

Mechanisms that affect access to surgical hand care appear to be complex and multifaceted. This scoping review aims to investigate the available literature describing such mechanisms and provide direction for future investigation. The methodological framework outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews was used to guide this review. In November 2021, MEDLINE and EMBASE databases were searched. A narrative summary of the characteristics and key findings of each paper is used to present the data to facilitate the integration of diverse evidence. Of 471 initial studies, 49 were included in our final analysis. Of these, 33% were cohort studies; 27% reported that underinsured patients are less likely to get an appointment with a hand specialist or to receive treatment. Overburdened emergency departments accounted for the second-most reported reason (16%) for diminished access to surgical hand care. Elective procedure financial incentives, poor emergency surgical hand coverage, distance to treatment, race, and policy were also notably reported across the literature. This study describes the vast mechanisms that hinder access to surgical hand care and highlights their complexity. Possible solutions and policy changes that may help improve access have been described.

Usage of Dermal Substitutes for Hand Coverage and Reconstruction

Abstract Background Hand coverage and reconstruction gives a challenge for plastic surgery. In this study we introduce a method for hand coverage and reconstruction by dermal substitutes which easy and simple to use. Objectives The aim of this study is to know the versatility of dermal substitutes in reconstruction & coverage of complex hand defects. Patients and Methods This was a cohort study conducted on 20 patients with hand tissue loss; to evaluate the versatility of dermal substitutes in reconstruction & coverage of complex hand defects. Patients attending El Helmeia armed forces hospital (plastic and reconstructive department) & Ain shams university hospital with follow up duration up to 6 months. All patients had clean wound & complex hand defects with exposed tendon and/or bone, Defects post trauma and after tumour excision and Post burn hypertrophic scars, keloid or contractures. Results We found that; the mean age of all patients was (23.5 ± 8.82) years. Regarding gender of the patients, the majority (80%) of patients were males; while (20%) were females. Regarding side of raw area; (55%) of patients had Rt-sided raw area, and (45%) had Lt-sided raw area. Regarding site of raw area; (20%) of patients had Finger-tip raw area, (20%) had Palm raw area, (10%) had Volar surface of little and ring raw area, (10%) had Volar surface of little finger raw area, (25%) had Dorsum raw area, (10%) had Dorsum of lateral 4 fingers raw area, while (5%) had Dorsum of middle finger raw area. Regarding Etiology of raw area; (70%) of raw areas caused by Trauma, (15%) caused after burn keloid removal, (10%) caused after burn contracture, and (5%) caused by donor site. Regarding Intervention data; (50%) of patients used Integra dermal substitute; and (50%) used Pelnac dermal substitute. Regarding follow up data; the average Time of removal was (3.65 ± 0.49) weeks, and the average Time for follow up was (3.25 ± 1.12) months. Comparative study between 20 hand tissue loss patients revealed; highly significant increase in Post-operative STSG satisfaction rate (70%); with highly significant statistical difference (p < 0.01), highly significant increase in Post-operative STSG good movement (80%); with highly significant statistical difference (p < 0.01). Conclusion The use of dermal substitutes cons gives an alternative reconstructive option for managing extended skin avulsion injuries of the upper extremity; it reduces postoperative immobilization, minimizes donor site morbidity and provides good functional and esthetic results in a single surgical procedure.

Newspaper representations of hand, foot and mouth disease (HFMD) and cancer in a Malaysian newspaper

The present study examines newspaper coverage of hand, food and mouth disease (HFMD) and cancer, to compare how infectious and non-infectious diseases are represented in Malaysia. The Health Belief Model was used as the framework for selecting themes relevant to health actions for the content analysis of 69 articles (32,808 words in total) from the New Straits Times. It was found that more emphasis was given to HFMD (51 articles) than to cancer (18 articles). The information most frequently included in the articles was recommended health actions (3.8 mentions per article for HFMD; 1.1 for cancer). The articles represented HFMD as posing a greater threat than cancer, as more information on susceptibility (1.6 for HFMD; 0.3 for cancer) was included compared to severity (0.5 for HFMD; 0.2 for cancer). The HFMD articles stressed the outbreak of HFMD: incidence and deaths, symptoms, causes and preventive measures. However, the cancer articles were usually not incident-specific and focused on promoting a healthy lifestyle to avoid cancer and to warn readers of cancer prevalence. Only 17% of the cancer articles carried treatment themes. The findings suggest that news coverage of cancer should include medical research and advances to create better awareness of cancer.

Hand Trauma Network in the United States: ASSH Member Perspective Over the Last Decade

Upper extremity trauma is common, however the provision of emergency call for hand trauma can be challenging for hospital systems and hand surgeons. Over the past decade, the American Society for Surgery of the Hand (ASSH) has developed the Hand Trauma Network and an Emergency Hand Care Committee to refine care for hand trauma patients. The ASSH administered surveys to members about the provision of emergency hand call in 2010 and 2019. Demographic information was collected including surgeon age, years in practice, board certification, practice setting, and ACS trauma level. Other survey questions included willingness and obligation to take call, as well as barriers to providing emergency call. Financial aspects of call were also queried. Survey responses were obtained from 672 surgeons in 2010 and 1005 surgeons in 2019. There was a decrease in surgeons with obligatory hand call from 2010 to 2019 (70% vs 50%, P < .05) and an increase in the number of surgeons not taking hand call in 2019 (34%) compared to 2010 (18%, P < .05). In both surveys, the main barrier for providing hand call was "lifestyle considerations," 39% (2010) and 47% (2019). There was no change in the percentage of surgeons working at facilities that provide 24/7 emergency hand call services or the percentage of hand surgeons paid to take call. Certain aspects of providing emergency hand surgery care have not changed substantially in the past decade, including the number of centers that provide emergency hand coverage. A greater number of surgeons are not taking any hand call. Further efforts are required to promulgate advances in hand trauma call by the ASSH. The development of the ASSH Hand Trauma Network has not yet resulted insubstantive improvement in the number of facilities that provide emergency hand coverageor the number of hand surgeons providing emergency hand care.

Spatio-Temporal Dynamic of Land Use and Land Cover in Andit Tid Watershed, Wet Frost/Afro-Alpine Highland of Ethiopia

Spatial and temporal dynamics of land use/land covers (LULC) are the results of human activities and population growth. The LULC change is caused by both, natural and anthropogenic factors. The objective of this study was to detect LULC changes in Andit Tid watershed. The study has used ArcGIS 10.5 and Landsat images of 1984, 1996, 2008, and 2017 to see LULC changes of Andit Tid watershed. The result indicated that the plantation forest and cultivated land have been increased by 41.94 ha and 33.39 ha, respectively from 1984 to 2017 due to the population increase and improper agricultural activity. On the other hand, the bushland and grassland coverage has been decreased by -7.29 and -67.95 ha, between the study periods respectively. This shows the tempo-spatial dynamic conditions of LULC change in the study watershed. The change of LULC was related mainly to anthropogenic factors such rapid population growth which consequence high demand land for cultivation practices, settlement and grazing land. Thus, attention must give to increase of intensified agricultural activities that increase land productivity to satisfy the ever-increasing demand of cultivated land of high population in the study watershed. A further search on the impact of these LULC changes on the livelihood and ecosystem services is recommended.

A large-scale investigation of alcohol-based handrub (ABHR) volume: hand coverage correlations utilizing an innovative quantitative evaluation system

BackgroundCurrent hand hygiene guidelines do not provide recommendations on a specific volume for the clinical hand rubbing procedure. According to recent studies volume should be adjusted in order to achieve complete coverage. However, hand size is a parameter that highly influences the hand coverage quality when using alcohol-based handrubs (ABHR). The purpose of this study was to establish a quantitative correlation between applied ABHR volume and achieved hand coverage.MethodABHR based hand hygiene events were evaluated utilizing a digital health device, the Semmelweis hand hygiene system with respect to coverage achieved on the skin surface. Medical students and surgical residents (N = 356) were randomly selected and given predetermined ABHR volumes. Additionally, hand sizes were calculated using specialized software developed for this purpose. Drying time, ABHR volume awareness, as well spillage awareness were documented for each hand hygiene event.ResultsHand coverage achieved during a hand hygiene event strongly depends on the applied ABHR volume. At a 1 ml dose, the uncovered hand area was approximately 7.10%, at 2 ml it decreased to 1.68%, and at 3 ml it further decreased to 1.02%. The achieved coverage is strongly correlated to hand size, nevertheless, a 3 ml applied volume proved sufficient for most hand hygiene events (84%). When applying a lower amount of ABHR (1.5 ml), even people with smaller hands failed to cover their entire hand surface. Furthermore, a 3 ml volume requires more than the guideline prescribed 20–30 s to dry. In addition, results suggest that drying time is not only affected by hand size, but perhaps other factors may be involved as well (e.g., skin temperature and degree of hydration). ABHR volumes of 3.5 ml or more were inefficient, as the disinfectant spilled while the additional rubbing time did not improve hand coverage.ConclusionsHand sizes differ a lot among HCWs. After objectively measuring participants, the surface of the smallest hand was just over half compared to the largest hand (259 cm2 and 498 cm2, respectively). While a 3 ml ABHR volume is reasonable for medium-size hands, the need for an optimized volume of handrub for each individual is critical, as it offers several advantages. Not only it can ensure adequate hand hygiene quality, but also prevent unnecessary costs. Bluntly increasing the volume also increases spillage and therefore waste of disinfectant in the case of smaller hands. In addition, adherence could potentially decrease due to the required longer drying time, therefore, adjusting the dosage according to hand size may also increase the overall hand hygiene compliance.

Effectiveness of “Hand Hygiene Fun Month” for Kindergarten Children: A Pilot Quasi-Experimental Study

Early childhood is a formative period during which healthy habits are developed, including proper hand hygiene practices. The aim of this quasi-experimental study was to determine the effectiveness of a 4-week series of educational sessions that consider the cognitive developmental stage of children on increasing their knowledge and promoting hand hygiene practices. The intervention group (n = 33) observed the hand hygiene program, whereas another group served as the waitlist control (n = 20). Creative activities were planned for the illustration of hand hygiene concepts in terms of “right moments”, “right steps”, and “right duration”. Hand sanitizer coverage was evaluated using a hand scanner. After the intervention, the experimental group had higher knowledge level toward hand hygiene than the control group (p < 0.001). Significant improvements in hand hygiene performance at the left palm and dorsum (p < 0.05), right palm (p < 0.05), and overall hand coverage (p < 0.05) were observed in the experimental group. The study demonstrated that the knowledge and proper hand hygiene (HH) practice of children can be positively influenced by the use of an age-appropriate education program. The results of this study have implications for school health educators and parents for promoting HH practices among children at home and at the school level.

Opposite-Running Double Abdominal Flap on Single Pivot Point (Udaipur Flap) for Circumferential Coverage of Wrist and Hand.

Complete or near circumferential defects over wrist and hand are difficult situations. They need flaps so long that available adjacent, distant or free flaps often seem inadequate. Hence, this innovative solution was designed. Twin axial flaps were elevated along an oblique axis over abdomen, extending in opposite directions while being pedicled and pivoted at about the same transverse plane. The flaps wrapped the limb from either side and gave complete coverage. Donor sites were closed directly or skin grafted. Three weeks later flap division was done, often after a delay procedure. The technique was used in 6 cases. All patients were young males with history of electrical burns or trauma resulting in total or near circumferential defect. Required length of flaps ranged from 15 to 26 cm with length/breadth ratio ranging from 3:1 to 5:1. Double abdominal flaps could cover all the exposed structures. Limb positioning was comfortable. All flaps survived; all limbs were salvaged. The cover was soft, supple, and pinchable. This is a simple yet effective flap design to address the difficult problem of circumferential defects at hand. The conceptualization and success of this flap system may be attributed to the understanding of patterns of cutaneous vasculature discovered by Ian Taylor. When the vascular axes in a region are known, the same can be exploited to design more than 1 flap in desired orientation. In conclusion, this "Undulate-design Double Abdominal flaps Insertion-Pouch for Upper limb Reconstruction" is a new and effective solution for circumferential defects of wrist and hand.

Hand sanitizers: A review of ingredients, mechanisms of action, modes of delivery, and efficacy against coronaviruses

BackgroundThe emergence of the novel virus, SARS-CoV-2, has posed unprecedented challenges to public health around the world. Currently, strategies to deal with COVID-19 are purely supportive and preventative, aimed at reducing transmission. An effective and simple method for reducing transmission of infections in public or healthcare settings is hand hygiene. Unfortunately, little is known regarding the efficacy of hand sanitizers against SARS-CoV-2.MethodsIn this review, an extensive literature search was performed to succinctly summarize the primary active ingredients and mechanisms of action of hand sanitizers, compare the effectiveness and compliance of gel and foam sanitizers, and predict whether alcohol and non-alcohol hand sanitizers would be effective against SARS-CoV-2.ResultsMost alcohol-based hand sanitizers are effective at inactivating enveloped viruses, including coronaviruses. With what is currently known in the literature, one may not confidently suggest one mode of hand sanitizing delivery over the other. When hand washing with soap and water is unavailable, a sufficient volume of sanitizer is necessary to ensure complete hand coverage, and compliance is critical for appropriate hand hygiene.ConclusionsBy extrapolating effectiveness of hand sanitizers on viruses of similar structure to SARS-CoV-2, this virus should be effectively inactivated with current hand hygiene products, though future research should attempt to determine this directly.

Revealing Your Mobile Password via WiFi Signals: Attacks and Countermeasures

In this study, we present WindTalker, a novel and practical keystroke inference framework that can be used to infer the sensitive keystrokes on a mobile device through WiFi-based side-channel information. WindTalker is motivated from an observation that keystrokes on mobile devices will lead to different hand coverage and the finger motions, which will introduce a unique interference to the multi-path signals and can be reflected by the channel state information (CSI). An attacker can exploit the strong correlation between the CSI fluctuation and the keystrokes to infer the user's password input. Compared with the previous keystroke inference approaches, WindTalker neither deploys external equipment physically close to the target device nor compromises the target device. Instead, it employs a more practical setting by deploying a free public WiFi hotspot and collects the CSI data from the target device as long as the device is connected to the hotspot. In addition, to improve inference accuracy and efficiency, it analyzes the WiFi traffic to selectively collect CSI only for the sensitive period where password entering occurs. WindTalker can be implemented without the requirement of visually seeing the target device, or installing any malware on the device. We tested Windtalker on several mobile phones and performed a detailed case study to evaluate the practicality of the password inference towards Alipay, the largest mobile payment platform in the world. Furthermore, we proposed a novel CSI obfuscation countermeasure to thwart the inference attack. The evaluation results show that the performance of WindTalker can be dramatically reduced by adopting the proposed countermeasures.

Product dose considerations for real-world hand sanitiser efficacy

Alcohol based hand rubs (ABHR) are extremely effective at reducing microbial contamination and have an essential role in best practice hand hygiene described by the World Health Organization. We determined ABHR drying time when performing hand hygiene in a laboratory setting. Which was followed by identifying the amount of ABHR needed for complete hand coverage. When the aforementioned was analyzed real-time data were gathered to examine the amount used for hand hygiene in a hospital setting. In parallel hands of healthcare workers (HCWs) were monitored for drying time and perception on ABHR use. In 86% (24,446,397/28,280,383) of the events a single dose of ABHR was used on clinical wards. Twenty-four HCWs expected hand hygiene to take 7.5 seconds (median; range 3-30 seconds). Forty-three HCWs show that 1.5 mL ABHR dose achieves the desired drying time according to World Health Organization guidelines (av. median 26 seconds), but is consistently perceived to have a longer drying time than expected (av. median 18 seconds). In-vivo results (n = 10) indicate that 2.25 mL ABHR is required for adequate coverage (82%-90%) of both sides of the hand. Results indicate that set standards for the use of ABHR do not match "in-vivo" behaviour of HCWs. Perceived drying times are shorter than actual drying time. The needed drying time to reach acceptable antimicrobial efficacy of ABHRs should be revisited.

RECONSTRUCTION OF FOREARM, WRIST AND HAND SKIN DEFECTS WITH LOCAL PERFORATOR FLAPS

Background: During the last decades, anatomical studies on skin vascularization provided the base for the development of flaps nourished by perforating arteries and preserving major vessels. In the last years, perforator flaps have become an appealing option for coverage of a large range of defects as they allow for great freedom in design and for reconstruction of difficult wounds with minimal donor-site morbidity, but doubts regarding their reliability have overshadowed its safety in clinical practice. Aim of the Work: This prospective clinical study is conducted to assess the reliability and efficacy of local perforator flaps in coverage of hand, wrist, and forearm skin defects. Patients and methods: We conducted a prospective study involving 20 patients with hand, wrist, and forearm skin defects and were covered with local radial and ulnar arteries perforator flaps. Postoperative complications were recorded and assessment of patients’ satisfaction as regards donor site morbidity and aesthetic outcome of the flap was done by a questionnaire at the outpatient clinic and the results were classified as unsatisfactory, satisfactory, good, and very good. Vancouver Scar Scale was applied as an objective tool for scar assessment postoperative. Three-month follow up was the end point of this study. Results: Radial artery perforator flaps were done in 11 cases (55 %) and ulnar artery perforator flaps in 9 cases (45%).Temporary venous congestion happened in 19 cases, distal tip necrosis in 10 cases, superficial epidermolysis in 8 cases, and arterial insufficiency in one case. Mean operative time was 63.8 min., 70.64 min. in RA perforator flaps and 55.44 min. in UA perforator flaps. Conclusion: Perforator flaps are a reliable tool for upper extremity coverage, with a low rate of failure and secondary surgery. These flaps are particularly useful for covering small and medium sized defects in the distal one third of the forearm, wrist, and hand; and they represent a reliable and effective alternative to free flaps.