Hand Hygiene Education Research Articles

Hand hygiene

Abstract: The World Health Organization (WHO) defines Health Care-Associated Infection (HCAI) as an infection a patient acquired in health care settings. In Canada, more than 220,000 patients are infected by HCAIs annually, with 8,500 to 12,000 of these patients resulting in death, thus becoming the fourth leading cause of death for Canadians. Hand hygiene practice is the most critical measure to prevent HCAIs, however, research indicates that in hospitals worldwide, just 40% of health care workers abide by the advised hand hygiene guidelines. A new effective HCAI control and prevention program is needed to sustain benefits, building on prior interventions such as including hand hygiene education that stresses the necessity of this practice in the protocol, providing factual proof of the effectiveness of hand hygiene, the acknowledgment by senior staff of their responsibility as role models for all staff, innovative technological methods, and regular auditing/feedback. With the current outbreak of coronavirus disease (COVID-19) that has infected millions around the world, a new HCAI control and prevention program can increase the compliance rate of handwashing with alcohol-based hand rub/sanitizer amongst healthcare professionals thus aiding in prevention and control of spread within the community.

Population-Based Study of the Influence of the COVID-19 Pandemic on Hand Hygiene Behaviors—Polish Adolescents’ COVID-19 Experience (PLACE-19) Study

Due to the COVID-19 pandemic, the World Health Organization and other major authorities recommend frequent hand washing and applying proper hand hygiene procedures as one of the cheapest, easiest, and most important ways to prevent the spread of a virus. For adolescents it is especially important as it should become for them a lifelong habit. The aim of the study was to assess the hand hygiene behaviors during the COVID-19 pandemic in a national Polish sample of secondary school adolescents and to verify the influence of the COVID-19 pandemic on those behaviors. The study was conducted in April 2020 in a national sample of 2323 secondary school students recruited based on secondary school sampling procedure (random quota sampling with quotas for voivodeships). The hand hygiene behaviors that were assessed included: frequency of washing hands, reasons for not washing hands, circumstances of washing hands, and procedure of handwashing. Participants were asked each question twice—for the current period of the COVID-19 pandemic and for the period before the COVID-19 issue. The declared frequency of washing hands during the COVID-19 pandemic was significantly higher than before (p < 0.0001), as the majority of respondents declared doing it 6–15 times a day (58.4%) while before the pandemic, it was 3–10 times a day (68.1%). The share of respondents declaring washing their hands always while it would be needed was significantly higher for the period during the COVID-19 pandemic (54.8%) than it was for the period before (35.6%; p < 0.0001), and there was a lower share of respondents declaring various reasons for not washing hands. For the majority of circumstances of washing hands, including those associated with meals, personal hygiene, leaving home, socializing, health, and household chores, the share of respondents declaring always washing their hands was significantly higher for the period during the COVID-19 pandemic than for the period before (p < 0.0001). For the majority of steps of handwashing procedure, the share of respondents declaring including them always was significantly higher for the period during the COVID-19 pandemic than for the period before (p < 0.0001), but a higher share declared not wearing a watch and bracelet (p = 0.0006), and rings (p = 0.0129). It was concluded that during the COVID-19 pandemic all the assessed hand hygiene behaviors of Polish adolescents were improved, compared with those before, but hand hygiene education is still necessary.

Hand hygiene as an incomplete challenge for developing countries: discussions based on knowledge and perceptions of nurses in North Cyprus example and published studies

Objective: In the contemporary nursing era, nurses play important roles in terms of patient care and the prevention of healthcareassociated infections. Here, we aimed to discuss recommendations for developing countries by describing the level of knowledge andperceptions of hand hygiene among nurses in Northern Cyprus as an example to developing countries.Materials and Methods: Adapted questionnaires of World Health Organization (WHO) were used for data collection and obtaineddata were analyzed using biostatistical methods.Results: Among the nurses, 5.6% had good hand hygiene knowledge. “Country of education” and “in-service education” factors werefound to affect the knowledge level significantly. Positive perception level was demonstrated by 83.2% of the participants. Availabilityof alcohol-based hand-rub and promotion of hand hygiene by leaders were perceived as most useful actions.Conclusion: Our study results highlighted the importance of hand hygiene education both in occupational and in-service education.Improvements are suggested in the existing continuing education programs in countries where WHO-Multimodal hand hygieneimprovement strategy is not implemented.

Understanding the Predictors that Contribute to Liberian Health Care Workers Feeling Protected From Ebola While at Work.

To assess Liberian health care workers' feelings around safety in returning to work in the setting of the Ebola virus disease outbreak of 2014-2015 after receiving infection prevention and control (IPC) training. Academic Consortium Combating Ebola in Liberia (ACCEL) training surveys were done at 21 public, Liberian hospitals to understand health care workers' attitudes surrounding Ebola and whether they felt safe while at work based on multiple factors. Logistic regression was used for analysis. We found that health care workers feeling safe at work during the Ebola outbreak was primarily predicted by the number of IPC/Ebola trainings received pre-ACCEL interventions. Health care workers felt increasingly safer and motivated to return to work as trainings approached 3 (OR 8, p-value < 0.001); however, more than 3 trainings resulted in decreased safety and motivation. In addition, health care workers who reported washing their hands before and after patient contact were 3.4 times more likely to understand how to protect themselves from Ebola. These results help to better understand the utility of repeated trainings on health care worker practice attitudes and the importance of IPC policies within hospitals, such as hand hygiene promotion and education, when coordinating humanitarian efforts.

Cross-sectional study to assess knowledge and practice of hand hygiene among 1st year Bachelor of Naturopathy and Yogic Science students

Background: Hand hygiene is recognized as the leading measure to prevent health care associated infections. WHO has introduced evidence-based guideline on hand hygiene practice among healthcare professionals. But, knowledge and practice of hand hygiene remains poor among students. Therefore, the present study was planned to study knowledge and practice of hand hygiene among Bachelor of Naturopathy and Yogic Science (BNYS) students.Methods: A cross-sectional study was conducted among 79 first year BNYS students. Knowledge of students was assessed using WHO hand hygiene questionnaire; practices were evaluated by using another self-structured questionnaire. Descriptive statistics was used to calculate percentages for knowledge and practice of hand hygiene among study subjects.Results: 35 (44%) of the students had moderate level of knowledge and 25 (32%) students had poor knowledge of hand hygiene. 73 (92%) students had correct knowledge that hand hygiene action before touching a patient prevented transmission of germs to the patient. Only 11 (14%) had knowledge that artificial nails should be avoided. Only 19 (24%) students were aware that hand rubbing was required before palpation of abdomen. Only 34 (43%) students adhered to hand hygiene practices regularly.Conclusions: Hand hygiene is an important tool for prevention of hospital acquired infections. The overall knowledge and practice of hand hygiene was not good among study subjects and a few numbers of students had attended formal training about hand hygiene. These findings indicate that the BNYS students require increased emphasis on hand hygiene education and training in their curriculum.

Associations Among School Absenteeism, Gastrointestinal and Respiratory Illness, and Income - United States, 2010-2016.

Control of communicable diseases in children, including respiratory and diarrheal illnesses that affect U.S. school-aged children, might require public health preventive efforts both in the home and at school, a primary setting for transmission. National Health Interview Survey (NHIS) data on school absenteeism and gastrointestinal and respiratory illnesses in the United States during 2010-2016 were analyzed to examine their associations with income. Prevalence of gastrointestinal and respiratory illnesses (queried for the 2 weeks preceding the survey) increased as income decreased. The likelihood of missing any school days during the past year decreased with reduced income. However, among children who missed school, those from low-income households missed more days of school than did children from higher income households. Although the reason for absenteeism cannot be ascertained from this analysis, these data underscore the importance of preventive measures (e.g. hand hygiene promotion and education) and the opportunity for both homes and schools to serve as important points for implementation of public health preventive measures, including improved hand hygiene practices.

Assessment on Hand Hygiene Knowledge and Practices Among Pre-school Children in Klang Valley.

Background. Pre-school children are at a higher risk to acquire infectious diseases such as hand, foot and mouth disease due to their immature immune system. Good hand hygiene prevents transmission of infectious diseases. This study aimed to determine the knowledge and practices of hand hygiene among pre-schoolers. Methods. In this prospective, multi-center study, the pre-schools were selected according to the selection criteria. A questionnaire consisting of socio-demographics, knowledge and practices of hand hygiene were administered via face-to-face interview during the pre- and post-intervention period. A total of 435 pre-schoolers aged 5 and 6 years old from 2 pre-schools within Klang Valley, School P (test group) and School C (control group) were involved in this study. The test group was provided with comprehensive hand hygiene education including video on proper handwashing technique during the 2 months intervention period, whereas the control group did not receive any form of intervention. The data were statistically analyzed using descriptive analysis and independent t-test. Results. Majority of pre-schoolers gained knowledge of handwashing from their parents. However, only 63% demonstrated good handwashing technique. Test group were significantly better (P < 0.05) in handwashing technique and hand hygiene routine score. Conclusion. A comprehensive hand hygiene education program should include proper handwashing facilities, resources, and awareness of the care-givers in instilling and sustaining good hand hygiene behavior.

A prospective cohort study on closed-circuit television monitoring and direct observation for hand hygiene compliance in a pediatric intensive care unit

Background: Intensive care patients are at risk for healthcare-associated infections (HCAIs), and hand hygiene (HH) compliance in health-care workers (HCWs) is reportedly low. This study aimed to compare closed-circuit television (CCTV) monitoring to direct observation on the HH compliance and its impact on HCAIs. Methods: In a prospective cohort study, HCWs were observed for HH compliance and HCAIs were studied. The study period was August 1, 2014–December 31, 2014 (direct observation period), and March 1, 2015–July 31, 2015 (CCTV monitoring period), with 2 months washout period. A HH education module (running a video daily, reinforcement of HH everyday evening, 2-weekly classes about HH importance, and posters reinforcing the importance of HH on the prominent sites of pediatric intensive care unit) was implemented in both periods. Each day was divided into blocks of 6-h. One hour from each block was randomly selected stratified by day and night shifts. HH compliance was observed according to the World Health Organization, “My Five Moments of HH.” Results: A total of 751 patients (direct observation period n = 369, CCTV monitoring period n = 382) were admitted. The HH compliance rate was higher in the CCTV monitoring period (56.6%, n = 5953 / 10519) as compared to that of the direct observation period (36.1%, n = 2178 / 6028) (relative risk = 1.57, 95% confidence interval: 1.51 - 1.63, P ≤ 0.001). Ventilator-associated pneumonia (4.7 vs. 12 / 1000 ventilation-day) and central line-associated bloodstream infection (1.9 vs. 6.6 / 1000 central line-day) were lower in the CCTV monitoring period. There was no difference in mortality between the study periods (18.3%, n = 70 / 382 vs. 21.1%, n = 78 / 369, relative risk = 0.87, 95% confidence interval: 0.65–1.16, P = 0.333). Conclusion: CCTV monitoring was associated with improved HH compliance, which was associated with lower HCAIs.

1191. Hand Hygiene Education: Why Is It so Critical to Tissue Banking?

BackgroundIn the United States, the most commonly transplanted tissues are bones, tendons, skin, heart valves, vessels and corneas. Over two million tissue grafts are distributed each year.Efforts to advance tissue transplant safety are less defined compared with organ transplant, and continuously being improved and regulated by national agencies. Environmental contamination, postmortem translocation of microorganisms, cross-contamination, and tissue processing are critical components which can be prevented with hand hygiene education thus preventing the transmission of infectious diseases. Microorganisms from technicians’ skin can potentially result in infection and nontransplantable tissue. This is particularly true of regenerative tissue, such as Vivigen, that undergo no sterilization process.MethodsA review was done of all 2018 ViviGen culture with these organisms: Bacillus, Cornebacterium, Diptheroids, Propionibacterium, Staphylococcus Coagulase negative, and Streptococcus viridians defined as Category 1.ResultsIn 2018, 384 out of 1418 ViviGen donors were discarded due to positive cultures. Of the 384, 190 were due the presence of a Cat. 1 microorganism in post-processing cultures, for a discard rate of 17.6%. In these donors, preprocessing cultures were initially negative, thus indicating contamination was due to technician contamination. In the first quarter of 2019, and since implementation of Hand Hygiene education, we have already start to see a decline in acquisition of Cat 1 organism for a total reduction of 6% from Q1 of 2018 compared with 2019.ConclusionTissue banking is a complex process of many steps to assure quality and safety of the tissue. Contamination is critical even when the microorganisms are considered low-virulent skin flora (i.e., Cat 1). This is especially important if these Cat 1 organisms are found in Post-processing cultures of grafts not terminally irradiated or sterilized. Implementation of proper hand hygiene education and aseptic techniques among tissue recovery and processing staff can significantly reduce the bioburden. Furthermore, a reduction in bioburden equates to higher likelihood in honoring the gift of donation in this selfless act of the donor and their loved one while also decreasing the financial loss due to culture results.Disclosures All authors: No reported disclosures.

Model-based Assessment of the Effect of Contact Precautions Applied to Surveillance-detected Carriers of Carbapenemase-producing Enterobacteriaceae in Long-term Acute Care Hospitals.

BackgroundAn intervention that successfully reduced colonization and infection with carbapenemase-producing Enterobacteriaceae (CPE) in Chicago-area long-term acute-care hospitals included active surveillance and contact precautions. However, the specific effects of contact precautions applied to surveillance-detected carriers on patient-to-patient transmission are unknown, as other, concurrent intervention components or changes in facility patient dynamics also could have affected the observed outcomes.MethodsUsing previously published data from before and after the CPE intervention, we designed a mathematical model with an explicit representation of postintervention surveillance. We estimated preintervention to postintervention changes of 3 parameters: , the baseline transmission rate excluding contact precaution effects; , the rate of a CPE carrier progressing to bacteremia; and , the progression rate to nonbacteremia clinical detection.ResultsAssuming that CPE carriers under contact precautions transmit carriage to other patients at half the rate of undetected carriers, the model produced no convincing evidence for a postintervention change in the baseline transmission rate (+2.1% [95% confidence interval {CI}, −18% to +28%]). The model did find evidence of a postintervention decrease for (−41% [95% CI, −60% to −18%]), but not for (−7% [95% CI, −28% to +19%]).ConclusionsOur results suggest that contact precautions for surveillance-detected CPE carriers could potentially explain the observed decrease in colonization by itself, even under conservative assumptions for the effectiveness of those precautions for reducing cross-transmission. Other intervention components such as daily chlorhexidine gluconate bathing of all patients and hand-hygiene education and adherence monitoring may have contributed primarily to reducing rates of colonized patients progressing to bacteremia.

Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review.

Background: Patient safety is a priority of any healthcare system, and one of the most effective measures is hand hygiene. For this, it is important that health staff have correct adherence and perform the technique properly. Otherwise, the incidence of nosocomial infections can increase, with consequent complications. The aim here was to analyze hand hygiene training and the effectiveness of different methods and educational strategies among nurses and whether they maintained correct adherence over time. Methods: A systematic review was conducted in the sources CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Lilacs (Latin American and Caribbean Health Sciences Literature), ProQuest (Proquest Health and Medical Complete), Medline, SciELO (Scientific Electronic Library Online), and Scopus. The search equation with Medical Subject Headings (MeSH) descriptors was “Nurs* AND (handwashing OR hand hygiene) AND clinical trial”. The review was performed following the recommendations of the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: n = 17 clinical trials were included, with a total of 5747 nurses and nursing students. Strategies such as reminder sounds, practical simulations, videos, and audiovisual media improved handwashing compliance. Adherence overtime increased by up to 60%. The greatest effectiveness was related to the use of povidone–iodine, which reduced colony formation compared Hand hygiene teaching strategies among nursing staff: a systematic review to soap. Conclusions: The strategies that go beyond teaching techniques such as lectures may be more effective at increasing hand hygiene compliance. Combined approaches to learning/instruction improve user satisfaction by enabling self-management, flexibility, and repetition.

The Common Missed Handwashing Instances and Areas after 15 Years of Hand-Hygiene Education

The outbreak of severe acute respiratory syndrome (SARS) claimed the lives of 286 Hong Kong people in 2003. Since then, the Hong Kong government has been promoting the benefits of proper hand hygiene. There are few studies that explore the general quality of handwashing and the hand-hygiene practices of the public of Hong Kong; given this, the aim of this study is to explore this neglected topic. This study is a quantitative study that was conducted in January 2018. The results show that the majority of participants only wash their hands after using the toilet (87%) or handling vomitus or faecal matter (91%). The mean duration of handwashing was 36.54 seconds (SD = 18.57). The areas of the hand most neglected during handwashing were the fingertips (48.1%), medial area (30.5%), and back of the hand (28%). A multiple logistic regression shows that participants who have reached third-level education or higher often tend to be more hand hygienic than those who have not reached third-level education (p ≤ 0.001, B = 1.003). Thus, participants aged 30 and above tend to neglect 5 more areas of the hand than those aged below 30 (p=0.001, B = 4.933).

요양병원 인증제 시행이 환자안전 관리활동에 미치는 영향: 손위생을 중심으로

The purpose of the study is to examine healthcare workers’ hand hygiene perception, knowledge, and self-reported compliance in accreditated long-term care hospitals in Korea. Perceptions on hand hygiene before and after the national accreditation are compared. We further investigated factors associated with perception, knowledge, and compliance. The introduction of national mandatory accreditation on long-term care hospitals since 2013 resulted in improved hand hygiene compliance and perception among hospital workers. Self-reported hand hygiene compliance rate was 89.7%. Perception is strongly in favor of hand hygiene compliance. Additionally, education level, profession department, and hand hygiene education exposure increased the likelihood of self-reported hand hygiene compliance. Results have implications for efforts to increase hand hygiene compliance rate and improve patient safety culture in long-term care hospitals.

Nurses’ peripheral intravenous catheter-related practices: a descriptive study

Background: Peripheral intravenous catheter (PIVC) insertion and maintenance are the procedures most commonly performed by nurses in clinical settings. However, current catheter failure rates are high, thus compromising the patient’s therapeutic plan and well-being. Objective: To understand nurses’ practices during PIVC insertion and maintenance. Methodology: A transversal and descriptive study was conducted in a cardiology ward in central Portugal. Nurses’ (n = 26) practices during PIVC management were observed and recorded by a research nurse during the morning shift, using a checklist based on transnational standard of care (SoC) recommendations. Results: During PIVC insertion (n = 38) the main digressive areas included glove usage (55.2%), use of the aseptic non-touch technique (44.7%), hand hygiene (18.4%-84.2%), and patient education (28.9%). Regarding PIVC maintenance (n = 66), catheter hub disinfection (78.8%), catheter flushing (53.3%- 78.8%), and patient education (24.2%) were the main deviating areas found. Significant PIVC failure rates were found (25.8%). Conclusion: Overall, a substantial number of PIVC-related practices does not comply with current SoC recommendations, which may pose a risk to patient safety and care quality

Knowledge and practice of hand hygiene among hospitalised patients in a tertiary general hospital in China and their attitudes: a cross-sectional survey

ObjectivesWe aimed to gain a better understanding of patients’ practice of hand hygiene (HH) and their knowledge and attitudes.DesignA cross-sectional survey.SettingA 3500-bed university-affiliated medical hospital in China.ParticipantsInpatients and their family...

Quantitative Measurement of Hand Hygiene Behavior in Hospice Environments Using An Automated Personal Hand Hygiene System

BACKGROUND Despite regulatory, accreditation, and federal agencies requirements for hand hygiene (HH) across the continuum of care to prevent the spread of healthcare associated infections, the ability to monitor HH performance and provide feedback in hospice settings (home, skilled nursing facility, assisted living, free standing in-patient unit) has been limited to direct observation which is inherently biased by the Hawthorne Effect. To date, there has been no automated method to measure and report hand hygiene events (HHE) that occur in home health settings. The purpose for this study was to measure HHE during patient care with the implementation of an automated personal hand hygiene system (APHHS). METHODS The APHHS (personal devices with alcohol gel sanitizer, wireless data transfer, and web-based reporting), was deployed to 16 home hospice care professionals over a 3-week period. The system measured total HHE and HHE per hour of clinical time. A multi-modal approach included a shared group performance dashboard, periodic individual email performance summaries, leadership communication, ongoing positive feedback via the personal device, HH education, and recognition of sustained individual performance. RESULTS Prior to automation, 60 HHE were observed per month utilizing the direct observation method and an opportunity-based approach. Following system deployment, 1,387 HHE were captured per week on average. Average hourly HHE rates for the home hospice care team were measured at: Medical Doctor 8.6, Nurse Practitioner 3.4, Registered Nurse 3.7, Certified Nursing Assistant 6.5, Social Worker 5.2, and Chaplain 4.8. CONCLUSIONS Implementing an APHHS in home hospice care with an evidenced based approach provides robust data sets of HHE with continuous individualized performance feedback and provides unbiased measurement of HH performance. Despite regulatory, accreditation, and federal agencies requirements for hand hygiene (HH) across the continuum of care to prevent the spread of healthcare associated infections, the ability to monitor HH performance and provide feedback in hospice settings (home, skilled nursing facility, assisted living, free standing in-patient unit) has been limited to direct observation which is inherently biased by the Hawthorne Effect. To date, there has been no automated method to measure and report hand hygiene events (HHE) that occur in home health settings. The purpose for this study was to measure HHE during patient care with the implementation of an automated personal hand hygiene system (APHHS). The APHHS (personal devices with alcohol gel sanitizer, wireless data transfer, and web-based reporting), was deployed to 16 home hospice care professionals over a 3-week period. The system measured total HHE and HHE per hour of clinical time. A multi-modal approach included a shared group performance dashboard, periodic individual email performance summaries, leadership communication, ongoing positive feedback via the personal device, HH education, and recognition of sustained individual performance. Prior to automation, 60 HHE were observed per month utilizing the direct observation method and an opportunity-based approach. Following system deployment, 1,387 HHE were captured per week on average. Average hourly HHE rates for the home hospice care team were measured at: Medical Doctor 8.6, Nurse Practitioner 3.4, Registered Nurse 3.7, Certified Nursing Assistant 6.5, Social Worker 5.2, and Chaplain 4.8. Implementing an APHHS in home hospice care with an evidenced based approach provides robust data sets of HHE with continuous individualized performance feedback and provides unbiased measurement of HH performance.

Hygiene perception and motivational factors of influence on high-quality hand hygiene performance among emergency medical service providers: Results from an international survey

Background: Hand hygiene a cornerstone in infection prevention and control lacks quality in the EMS. Improvement is complicated and includes both individual and institutional aspects. However, little is known about EMS providers' perception and motivational factors leading to a high-quality hand hygiene. We aimed to describe 1) EMS providers’ perception on hand hygiene, 2) practical measures’ feasibility to improve compliance and 3) motivational factors related to high-quality hand hygiene among the cohort.&#x0D; Methods: A cross-sectional, self-administered questionnaire consisting of 24 items (developed from WHOs Perception Survey for Health-Care Workers) provided information on demographics, improvement feasibility of practical measures, and various subjective, normative and control beliefs among EMS providers from Finland, Sweden, Denmark and Australia.&#x0D; Results: Overall, 933 questionnaires were returned (response rate 15%). Most respondents were advanced-care providers, male and had &gt; 5 years EMS experience. In total, 61% received hand hygiene training &lt; 3 years ago, and 93% perceived hand hygiene a routine. Most perceived access to hand hygiene supplies, and training and education as feasible practical measures to improve overall hand hygiene compliance. The majority acknowledged the scope and severity of health-care associated infections and the preventive effect of hand hygiene. Overall, 55% believed that hand hygiene was an organizational priority, 26% that it was important to their managers, 36% to colleges, and 58% to patients. Also, 44% perceived their colleges' hand hygiene compliance high (≥ 80% compliance rate), 71% perceived hand hygiene relatively easy to perform. Organizational priority, peer pressure, and self-efficacy were separately associated with self-reported high-quality hand hygiene.&#x0D; Conclusions: Hand hygiene supplies, simple and clear instructions, and training and education are highly warranted. Moreover, organizational priority, role models, and self-efficacy are motivational components with the potential to empower hand hygiene compliance within this cohort. Future interventional studies are needed to investigate the effect of a multimodal improvement strategy including both practical and behavioral aspects.

Associations Among School Absenteeism, Gastrointestinal and Respiratory Illness, and Income - United States, 2010-2016.

Control of communicable diseases in children, including respiratory and diarrheal illnesses that affect U.S. school-aged children, might require public health preventive efforts both in the home and at school, a primary setting for transmission. National Health Interview Survey (NHIS) data on school absenteeism and gastrointestinal illness in the United States during 2010-2016 were analyzed to identify associations among income, illness, and absenteeism. Prevalence of gastrointestinal and respiratory illnesses in the 2 weeks preceding the survey increased as income decreased. Although the likelihood of missing any school days during the past year decreased with reduced income, among children missing school, those from low-income households missed more days of school than did children from higher income households. Although the reason for absenteeism cannot be ascertained from this analysis, these data underscore the importance of preventive measures, such as hand hygiene promotion and education, and the opportunity for both homes and schools to serve as an important point for implementation of public health preventive measures, including hand hygiene practice and education.

Community-based interventions for preventing diarrhoea in people living with HIV in sub-Sahara Africa: A systematic review.

High prevalence rates of people living with HIV (PLHIV) are more predominant in sub-Saharan Africa compared to any region globally. Nonetheless, many people in the region have little access to safe water and live in poor sanitation environment. This region is, therefore, faced with a challenge in protecting PLHIV from infectious diseases that are transmitted through unhygienic conditions. This systematic review was conducted to identify effective community-based interventions for the prevention of diarrhoea among PLHIV in sub-Saharan Africa. Studies included in this systematic review were sought from PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ, Web of science, WHO Global Index Medicus Library, Cochrane and ProQuest (GeoRef). Articles were appraised using MMAT scale. From a search finding of 3,849 articles, only nine papers whose participants were people living with HIV and had incidence or prevalence of diarrhoea as an outcome met our inclusion criteria. Community-based interventions such as water treatment and safe storage were associated with 20%-53% reduction in diarrhoea episodes among PLHIV. The review has also demonstrated that the impact of hand hygiene and health education on the prevention of diarrhoeal infections is not adequately assessed. Future studies are, therefore, warranted to assess the effect of hand hygiene and health education interventions on prevention and reduction of diarrhoea in PLHIV in Sub-Saharan Africa.

Hand hygiene education, an underutilized tool in preventing emerging, re-emerging infectious diseases and seasonal epidemics

Purpose: A common thread among most emerging infectious diseases is Hand Hygiene. So why isn’t more being done to introduce, educate and bring awareness of this improtant topic among our youngest members in the community. We created a fun scientific experiment with second and third grade students to see if education and intervention will bring about a positive behavioral change that will subsequently decrease the rate of illness during peak influenza and norovirus season. Methods & Materials: Ninety students cultured their “dirty” hands on a petri dish. Proper handwashing technique was demonstrate to all student. They were then divided equally into the hand washing group and the hand sanitizer group. All students then cultured their “clean” hands on a second petri dishes. The students observed, compared and documented their findings daily for a week. We then used a simulation germ that illuminates with black light to test the efficacy of their hand washing and see areas where they could improve. We followed the illumination along the classroom and each other to see how easily the “germ” spread. A light microscope, a microbiologist and slides of common pathogens were brought into the classroom for examination and discussion. Children were happy to share stories of infections they and their families have had.Results:1.91% of the students observed decreased microbial growth from “dirty” to “clean” hands.2.Education improved compliance as 89% had a favorable behaviorial change to clean their hands.3.There was a 71% decrease in incidence of illness related absences 30 days after the hand hygiene intervention.4.Three out of the five classes reported hand sanitizer was more effective when compared to hand washing. Conclusion: Hand Hygiene education is remarkable beneficial, especially in children who are at the greatest risk of illness. It is clearly effective in decreasing infectious disease risk, while teaching a valuable life-long habit. For the impact to be felt as a preventative strategy both for illness and emerging infectious diseses, its implementation into the elementary school curriculum is warranted. In the words of the Benjamin Franklin, “an ounce of prevention is worth a pound of cure”.