Hand Hygiene Performance Research Articles

ASSESSING KNOWLEDGE, ATTITUDES, AND PRACTICES OF HEALTHCARE PROFESSIONALS REGARDING HOSPITAL ACQUIRED INFECTION IN TERTIARY CARE TEACHING HOSPITAL AT EASTERN NEPAL: CROSS-SECTIONAL STUDY

Hospital-acquired infections (HAIs) are a common problem and represent significant challenges to the effective delivery of healthcare services faced by hospitals in all countries around the world. Healthcare workers (HCWs) are an important part of the healthcare team that plays a unique role in the control of HAIs. Compliance on the part of healthcare workers (HCWs) with standard precautions has been recognized as being an efficient means to prevent and control HAIs. Objective: The present study was conducted with objective of understanding the level of Knowledge, attitude and practice (KAP) regarding Hospital-acquired infections (HAIs) among health care workers in the Eastern region of Nepal. Method:This descriptive cross-sectional study was conducted among healthcare workers posted in different wards of hospitals of BPKIHS. A self administered questionnaire containing different set of questions regarding knowledge, attitude and practice on HAI were used for data collection. Simple random sampling method was employed. Statistical package for social sciences (SPSS) was used to analyze the data and presented in frequency tables and graph. Results: Regarding knowledge of the participants: Among the total participants in the study, 97% of the participants had good knowledge regarding Hospital acquired infections (HAIs) but only 72% of the participants had received formal training regarding hand hygiene. 97 % participants agreed on the fact that hand hygiene act should be performed before and after direct patient contact. Highest proportions of the participants (97%) were aware of the fact that washing hands with antiseptic decreases the risk of transmission of hospital acquired pathogens. Large proportion of the respondents ( 95%) were aware of the fact that Gloves should be worn if blood or body fluid exposure is anticipated and still considered that gloves provided complete protection against acquiring/ transmitting infections. Hand hygiene (89%) and Personal protective equipment 68%) were common preventive measures of transmission of hospital acquired infection. The common sources of acquiring infections was uniform (59%) whereas commonly hospital acquired infection (HAIs) were reproductive tract infection (86%) and gastro -intestinal tract (GIT) infection (76%) and most susceptible group to hospital acquired infections (HAIs) were OT assistants (74%), Lab technicians(69%) etc. Regarding attitude of the participants, 91% of the participants felt that they would be less likely to transmit infection to the patient if they performed hand-hygiene. Regarding various hindrances in adoption of hand hygiene, few of the respondents (48%) identified that hand hygiene agents were not readily available in our current settings. 31% of the health care workers reported that they often forgot to perform hand hygiene.42% of health care workers found that Gloves are always available when they wanted. 25% of health workers believed that there was very low risk of acquiring infections from my patients.79 % participants thought that all patients are potentially contagious while 88% transmission of hospital acquired infections occurred through unsterilized use of needles and sharp objects. Regarding practice of the participants , majority of respondents (more than 90%) performed hand hygiene before patient contact, after patient contact and caring for wound.95% of the participants practiced hand hygiene after removal of gloves. Majority of the participants (97%) washed their hands after handling every patient. 74% participants practiced of using reusable instruments while 86% respondents practiced of using pre-sterilized instruments. 82 % of the participants exposed to patients blood. Conclusion: All health workers had good knowledge regarding Hospital-acquired infections (HAIs) that was reflected in their attitude and practice on hand hygiene for the prevention of HAIs. However there is the need of regular training and performance feedback regarding hand hygiene and the hospital environment should be hand-hygiene friendly with easily accessible to sinks and other facilities. Improving sustainable supplies like personal protective equipment, water supply and hand washing facilities at patient care site is vital to reduce nosocomial infection. Therefore health workers should strictly follow hospital acquired infection prevention guidelines to reduce infections.

Evidence-Based Practices of Nurses Regarding Nosocomial Infection in ICU. A Descriptive study

Nosocomial infections influence patients’ lives over lengthy hospitalization, illness, and death, following important costs to both health organizations and society. Evidence-based practice is observed as a system to carry out health care that is additionally effective and important in the current health care setting. Objective: To identify the level of evidence-based practices of nurses regarding nosocomial infection in the intensive care units. Methods: A cross-sectional descriptive study design was used. The population was the ICU staff nurses of the Tertiary Care Hospital, Lahore. The duration of the study with 09 months after the synopsis approval. The sample size of 72 nurses has calculated a population size 95 confidence interval and a margin of error of 5%. A convenient sampling Technique was used in this study. The questionnaire was consisting of 4 items and 31 questions. Ethical Considerations were maintained. Data were kept confidential and secure by coding. Data were analyzed by SPSS version 21. Results: The highest percentage of staff nurses in this study were females (98.6%) and aged between 26-35 years (76.4%) and diploma holder were (69.4%). Nurses who have experience less than 10 years were 45.8%. Most of the participants were performing hand hygiene practicing frequently (59.7%) whereas (16.7%) were performing rarely before contact with patient. Highest percentage of participants (77.8%) were using personal protective equipment’s. Conclusions: Evidence-Based Knowledge related to nosocomial infection is adequate among nurses. Hand hygiene performance is adequate as compared to international standards.

Using patients' observations to evaluate healthcare workers' alcohol-based hand rub with Pulpe'friction audits: a promising approach?

Hand hygiene plays an important role in the transmission of nosocomial infections from healthcare workers (HCW) to patients. Patients could play a key role in improving hand hygiene by sharing their experience of the HCW's practices. Already in 2019, the French national mission of transversal support for actions to prevent healthcare-associated infections proposed the national "Pulpe'friction" audit, to assess HCW's reported practices, social representations, and barriers to using alcohol-based hand rubs (ABHR). This audit consisted of a positive discussion between an auditor and the HCW as well as patients, which led the HCW to declare their real practices and the barriers they faced in the field and the patients to report about the HCW's ABHR practices and the information they received about when they should perform hand hygiene. To assess whether an association existed between HCW's reported ABHR compliance and patients' declarations about HCW's compliance in the Pulpe'friction audit data. Data from Pulpe'friction were collected from 1st January to 31st December 2019, before the COVID-19 pandemic. Mixed linear models were performed to analyze the association between self-reporting by HCW and patients, regarding hand rubs performed by HCW prior to patient care. There was a positive association between patients' observations and HCW's declared practices regarding the frequency of with which professionals performed hand rubs before patient contact. This indicates that professional and patient statements show the same tendency. The positive association was found in hospitals for patients under 45 and over 64 years old and for paramedics, but not for physicians and not in nursing homes or long-term care facilities. Patients felt more motivated to observe and evaluate HCWs' practices if they had received information about how to correctly wash their hands. Patients agreed to be involved in the evaluation or professional practices. The patients' observations were positively associated with HCWs reports. New indicators taking patients' observations into account could be interesting.

PS-P12-11: INFECTION CONTROL PRACTICES OF HEALTHCARE WORKERS INFECTED WITH COVID-19 IN TONDO MEDICAL CENTER FROM MARCH 2020 TO MAY 2021

Background: COVID-19 has put the lives of our healthcare workers at the forefront of the battle against pandemic. Understanding how this pandemic directly affects them is vital in ensuring safe and continuous provision of service to the public. Reviewing their infection control practices is imperative in protecting their health and the patients they serve. This study aimed to determine the infection control practices of healthcare workers infected with COVID-19 in Tondo Medical Center from March 2020 to May 2021. Methodology: This is descriptive retrospective study involving healthcare workers of Tondo Medical Center infected with COVID-19 from March 2020 to May 2021. Demographic data, exposure history, clinical manifestations and infection control practices data were surveyed, encoded and tabulated. Categorical variables were presented as frequencies and percentages. Results: A total of 425 healthcare workers developed COVID-19 from March 2020 to April 2021. Their mean age was 36.4 years; more female (57.4%) and single (56.0%) staff were affected. Most cases (41.4%) came from or low/lowest risk areas. Three clustering of cases were identified. More than half of the respondents (54.4%) had unknown exposure; housemates/relatives (21.0%) were the most common source of known exposure. Three out of 10 respondents were asymptomatic; majority had mild symptoms (62.2%), the most common of which was the loss of taste/smell (26.5%). Adherence to wearing of mask was highest in the community (99.5%) than in the workplace (93.4%) and least at home (78.3%). Majority practiced social distancing in the community (97.9%) and in the workplace (95.5%). Almost half (58.7%) practiced 1-meter social distancing. Respondents practiced frequent handwashing both at home (92.2%) and in the workplace (91.9%). Only 1–2 out of 10 washed their hands for 40 seconds or more. Majority employed hand hygiene with alcohol-based rub for less than 20 seconds in the workplace (71.6%) and at home (69.5%). Majority (98.3%) performed hand hygiene after coughing or sneezing and used tissue (44.4%). Most of the respondents decontaminated their work area before and after work (66.6%). Alcohol was most used in the workplace (70.7%). More than half (59.6%) ate in the pantry, mostly alone (65.5%). Most cleaned their cellphones daily (88.4%). Majority brought alcohol with them (97.2%) and almost half (47.5%) wore a mask for 4–8 hours. Conclusion: Some gaps have been identified in the knowledge and practices of infection control of healthcare workers infected with COVID-19 at Tondo Medical Center; hence reinforcement programs including refresher trainings and policy enhancement are warranted.

Bridging the gap: Differences in hand hygiene compliance between parents and observers

Abstract Hand hygiene is critical in preventing health-care-acquired infections and is an element in patient satisfaction surveys. Programme managers identified discrepancies between compliance documented by hospital observers and parent satisfaction surveys. In 2021, programme managers set out to close the gap. The hand hygiene survey question was too specific. This question was changed to include all staff and methods of performing hand hygiene. Associate education was performed. Within 4 months, the gap between patient survey and observer-reported compliance was approximately 12%. This 12% discrepancy remained steady through 2022. The hand hygiene family engagement educational campaign was minimally successful.

Bacterial Profile and Their Antimicrobial Susceptibility Pattern of Isolates Recovered from Intensive Care Unit Environments at Wachemo University Nigist Ellen Mohammed Memorial Comprehensive Specialized Hospital, Southern Ethiopia.

Bacterial contamination of indoor hospitals, especially in intensive care units is a serious health hazard in the world with a high morbidity and mortality rates. Particularly, multidrug-resistant bacteria can cross-contaminate medical devices, inanimate surfaces, health care providers, and patients in the intensive care unit. This study was aimed to assess the bacterial profile and their antimicrobial susceptibility patterns of bacterial isolates from intensive care unit at WUNEMMCSH (Wachemo University Nigest Ellen Mohammed Memorial Compressive Specialized Hospital), Southern Ethiopia. A hospital-based cross sectional study was conducted on 180 intensive care unit environmental samples at WUNEMMCSH from August 1, 2022, to October 30, 2022. In this study, a total of 180 swab samples were collected from medical devices, inanimate surfaces, patients, and health care providers from the intensive care unit by using sterile cotton-tipped swabs moistened with normal saline. Then, bacterial isolates were identified using the standard culture method, Gram stain, and biochemical tests. Antimicrobial susceptibility tests for bacterial isolates were performed by using the Kirby Bauer disk diffusion method. Data were entered into EpiData Version 4.6 cleanup and exported to SPSS V25 for analysis. A total of 180 swab samples were processed from intensive care unit environments, and 143 (79.4%) were found to have been contaminated by at least one potential pathogenic bacterial isolate. A total of two hundred and thirty-eight bacteria were isolated. Of these, the predominant bacteria were coagulase-negative Staphylococci 72 (30.3%), S. aureus 61 (25.6%), E. coli 41 (17.2%), and K. pneumoniae 30 (12.6%). Seventy (49%) out of all swabbed samples were contaminated with mixed isolates. In the antimicrobial susceptibility tests, 19 (86%) Gram-positive bacteria and 25 (76%) Gram-negative bacterial isolates were susceptible to nitrofurantoin, respectively. Vancomycin was sensitive to 83% of Gram-positive isolates. Gram-positive and Gram-negative isolates from irrespective sources showed multidrug resistance in 56.4% and 76.2%, respectively. The inanimate hospital environments, medical device, health care providers, and patients in ICU rooms of WUNEMMCSH (Wachemo University Nigest Ellen Mohammed Memorial Comprehensive Specialized Hospital) were colonized with 143 (79.4%) of potential pathogenic bacterial isolate, which can cause nosocomial infections with high rates of morbidity and mortality among patients. The frequencies of multidrug-resistant 159 (66.8%) bacterial pathogens were alarmingly high. Therefore, to reduce the risk of bacterial contamination and MDR, strict adherence to hospital infection prevention and control measures should be enforced. These measures include regularly performing hand hygiene, periodic disinfection, and sterilization of medical equipment.

Compliance with face mask use during the COVID-19 pandemic: a community observational study in Singapore.

Widespread mask use is an important intervention for control of the coronavirus disease 2019 pandemic. However, data on the factors affecting mask use are lacking. In this observational study, we evaluated the proportion of and factors influencing face mask use and related hygiene practices. We observed randomly selected members from the public in 367 venues across Singapore, and recorded the proportion of individuals with full compliance with mask use and mask hygiene (hand hygiene before and after touching the mask or face). Logistic regression analyses were used to determine variables associated with mask and hand hygiene compliance. We made 3,821 observations - 2,149 (56.2%) females, 3,569 (93.4%) adults (≥21 years), 212 (5.5%) children (6-20 years) and 40 (1.0%) children (2-5 years). The overall full compliance rate (correct mask use), poor compliance rate (incorrect mask use) and absent mask use were 84.5%, 12.9% and 2.6%, respectively. The factors - male gender, fabric mask usage and crowded indoor venues - were associated with lower mask compliance. Face or mask touching behaviour was observed in 10.7% and 13.7% of individuals observed, respectively. Only one individual performed hand hygiene before and after touching the mask. The rate of mask compliance was high, probably due to legislation mandating mask usage. However, specific factors and crowded indoor venues associated with lower mask compliance were identified. We also noted an issue with the absence of hand hygiene before and after face or mask touching. These issues may benefit from targeted public health messaging.

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit.

Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate. Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.

Implementation of an electronic hand hygiene monitoring system: Learnings on how to maximize the investment

Electronic monitoring systems (EMS) for measuring hand hygiene performance have many advantages. Previous studies have shared results of EMS in individual units or single institutions, without many details of implementation. The implementation steps for house wide use of an EMS in 12 hospitals are described. Hospital resources used in this 3-year implementation included those for installation activities, initial education about the components and function of the EMS, evaluation of healthcare professionals' processes related to hand hygiene, routine data feedback in a variety of methods, continuous coaching and training on the EMS, incentive programs and strong leadership support. Continual process improvement activities resulted in a 23% increase in hand hygiene performance, from 53% at baseline, to 76%. Implementation of an EMS required many resources beyond those for the technology, but resulted in measurable improvement in hand hygiene performance.

Personal and Household Hygiene Measures for Preventing Upper Respiratory Tract Infections among Children: A Cross-Sectional Survey of Parental Knowledge, Attitudes, and Practices.

Personal and household hygiene measures are important for preventing upper respiratory tract infections (URTIs) and other infectious diseases, including coronavirus disease 2019 (COVID-19). An online survey recruited 414 eligible parents in Hong Kong to study their hygiene knowledge, attitudes, and practices (KAPs) regarding the prevention of URTIs among their children. The average knowledge score was high (10.2/12.0), but some misconceptions were identified. The majority of the participants agreed that good personal hygiene (93.5%) and good environmental hygiene (92.8%) can prevent URTIs. The average score for hand hygiene practices was high (3.78/4.00), but only 56.8% of the parents always performed hand hygiene before touching their mouths, noses, or eyes. In terms of environmental hygiene, only some household items were disinfected with disinfectants (door handles in 69.8% of the households, toilet seats in 60.4% of the households, the floor in 42.8% of the households, dining chairs in 24.2% of the households, and dining tables in 20.5% of the households). A higher knowledge score was associated with parents having tertiary educational levels or above, working as healthcare professionals, living in private residential flats or staff quarters, or having household incomes of HKD 70,000 or above. The results of multiple regression analyses also indicated that parents who were healthcare professionals and with higher household income had a better parental knowledge of hygiene measures after adjusting the attitude score. For hand hygiene, parents who achieved higher attitude scores obtained higher practice scores. Under the fifth wave of the COVID-19 epidemic, there were some misconceptions regarding hygiene among parents. Any health promotion program should target parents regarding taking proper personal and household hygienic measures, especially for those who had relatively lower socio-economic status and/or from a non-healthcare background. Motivating attitudes toward hand hygiene can lead to better practices.

Assessment of Hand Hygiene Practices and Barriers to hand Hygiene among Healthcare workers of Government Medical College Hospital Jammu

Introduction: Hand hygiene is most effective interventions to reduce spread of pathogens and prevent Hospital Acquired Infections (HIAs). Compliance of healthcare workers with hand hygiene practices is vital in preventing transmission of HIAs.Aims: To assess practices and barriers of hand hygiene among healthcare workers of GMCH Jammu.Methodology: Cross sectional study was conducted among healthcare workers of Government Medical College Hospital Jammu. Simple random sampling was used to interview 250 participants. Data was collected using pretested, validated and semi structured questionnaire. Details like products used for hand hygiene, moments of hand hygiene, barriers to hand hygiene practices and knowledge about hand hygiene were asked. Appropriate statistical tests were appliedResults: Out of 250 healthcare workers majority were using soap and water 203(81%) and alcohol based sanitizers 202(80%).Majority 234(93.6%) were always performing hand hygiene after touching blood, body fluids and secretions,222(88.8%) and after contact with the patients but only 138(55.2%) were following hand hygiene practices while switching from one patient to other.Most common barrier to wash hands was lack of soap/water115(46%) and inconvenient location of sinks 112(44.8%). Only 117(46.8%) were following six steps of hand wash. The association between designation of health care worker and steps of handwashing was found to be statistical significant. Conclusion: Observed compliance to hand hygiene practices is low. There is lack of knowledge to perform six steps of hand washing and lack of facilities to maintain hand hygiene.

1213. The Effect of a Prospective Intervention Program with Automated Monitoring on Hand Hygiene Performance in Long-term and Acute Care Units at a Veteran Affairs Medical Center

Abstract Background There is emerging evidence that implementation of an automated hand hygiene monitoring system (AHHMS) must be part of a multimodal hand hygiene (HH) program that includes complementary strategies. There are few published studies describing in detail the intervention strategies used with an AHHMS. Methods An AHHMS that provides group HH performance rates (100 x HH product dispenses divided by the number of room entries plus exits) was implemented on two Acute Care (AC) units and six long-term care (LTC) units at a Veterans Affairs Medical Center from March 2021 through April 2022. After a 4-week baseline period and 2.5-week washout period, the 52-week intervention period included many components, such as weekly huddles, unit nurse manager engagement, vendor provided clinician-based training and feedback, leadership support, unit recognition, signage and development of a new slogan to remind colleagues to perform HH. Statistical analysis was performed with a Poisson general additive mixed model. Results During the 4-week baseline period, the median HH performance rate was 18.6 (95% CI: [16.5, 21.0]) for all 8 units. During the intervention period, the median HH rate increased to 21.6 [19.1, 24.4], and during the last 4 weeks of the intervention period (exactly 1 year after baseline), the 8 units exhibited a median HH rate of 25.1 [22.2, 28.4], (p < 0.0001) [Figure 1]. The median HH rate increased from 17.5 to 20.0 (p < 0.0001) in LTC units and from 22.9 to 27.2 (p < 0.0001) in AC units. The intervention increased the use of hand sanitizer from 57.5% during baseline to 65.1% (p < 0.0001). The increase in HH rates was due to HH events increasing from 88,758 dispenses during the baseline to 123,722 dispenses during the last 4 weeks of the intervention. Direct observation results during the same periods showed HH compliance ranging from 61-86%. Figure 1- Monthly Hand Hygiene Performance Rates for all Units The green curve shows the change in the median HH rate during the intervention period compared to the baseline and washout periods, with vertical bars showing 95% confidence intervals for the monthly HH rate. Conclusion The intervention increased hand sanitizer usage and HH performance rates for all units. AC units were consistently better than LTC units, which have more visitors and more mobile veterans. Further HH improvement will rely on continued implementation of complementary strategies and long-term monitoring. Disclosures James W. Arbogast, PhD, GOJO Industries, Inc.: employee Pamela Wagner, RN MSN CPPS, GOJO Industries, Inc: Employee of GOJO Gregory A. Robbins, BS, GOJO Industries, Inc.: Current employee of GOJO Industries, Inc. Albert E. Parker, PhD, GOJO Industries: Advisor/Consultant John M. Boyce, MD, Diversey: Advisor/Consultant|Diversey: Expert Testimony|Diversey: Travel support|GOJO Industries: Advisor/Consultant|GOJO Industries: Expert Testimony|GOJO Industries: Travel support|Sodexo Healthcare: Advisor/Consultant.

Hand Hygiene among Anesthesiologists and Microorganisms Contamination in Anesthesia Environments: A Single-Center Observational Study

ObjectiveTo investigate the baseline levels of microorganisms' growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital. MethodsThis study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital. Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination. ResultsMicroorganisms' growth results showed that 20% (5/25) of anesthesiologists' hands carried microorganisms (> 10 CFU/cm2) before patient contact began. Female anesthesiologists performed hand hygiene better than did their male counterparts, with fewer CFUs (P = 0.0069) and fewer species (P = 0.0202). Our study also found that 55.6% (5/9) of ready-to-use operating rooms carried microorganisms (> 5 CFU/cm2). Microorganisms regrowth began quickly (1 hour) after disinfection, and increased gradually over time, reaching the threshold at 4 hours after disinfection. Staphylococcus aureus was isolated from the hands of 20% (5/25) of anesthesiologists and 33.3% (3/9) of operating rooms. ConclusionOur study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene, daily cleaning rate of the operating room may be insufficient, and we would suggest that there should be a repeat cleaning every four hours.

Cross-Infection Control Practices among Dental Undergraduates and Graduates in Prosthodontics- A Survey in Dental Colleges of Karachi

Objective: To assess the cross infection control practices among undergraduates and graduates working in the department of Prosthodontics in various public and private dental colleges of Karachi.
 Methods: After approval from IRB, the self-administered questionnaire was sent via emails or social media platforms to undergraduate final year students and graduates currently working in Prosthodontics department of dental colleges of Karachi. Along with demographics, the questionnaire included close ended multiple-choice questions related to participants’ practice regarding cross infection control. A reminder was sent after 2 weeks to help improve response rate. Statistical analysis was performed using SPSS 23.
 Results: Out of total 617 respondents, there were 410(66.5%) final year dental students and 207(33.5%) house officers. Majority of participants 502(82.3%) had attended lecture regarding cross-infection control measures during their academic years, while only 178(28.8%) had attended hands-on workshops on the same. Majority 530(85.9%) recommended autoclave for sterilization for instruments. Almost all participants 603 (97.7%) wear gloves and perform hand hygiene 527(85.4%). More than two-thirds 416 (67.4%) respondents disinfect impressions, trial wax dentures, bite registrations and metal trials before sending to the dental laboratory. Almost 50% of the participants did not disinfect plastic impression trays, shade guide, rubber bowl, wax knife, carver and spatula in between patients.
 Conclusion: Results of this study highlight the need of re-emphasizing cross-infection control measures and practices in the Prosthodontics OPD. Strict administrative protocols should be set to implement cross-infection control practices. Lectures and hands-on workshops regarding cross-infection control, disinfection and sterilization should be a mandatory part of curriculum and be reiterated in continuing dental education seminars.

The relationship between nurses' risk assessment and management, fear perception, and mental wellbeing during the COVID-19 pandemic in Saudi Arabia.

During this pandemic, it is crucial to implement early interventions to help nurses manage their mental wellbeing by providing them with information regarding coping skills, preventive risk assessment approaches (such as hospital preparedness and rapid risk assessment), and the ability to respond. This study evaluated the effect of fear and risk assessment management on nurses' mental wellbeing during the COVID-19 pandemic in Saudi Arabia. A total of 507 nurses who worked in tertiary public hospitals were asked to take a descriptive design survey. Three survey scales were used to assess the survey: the Risk Assessment Scale, the Fear of COVID-19 Scale, and the Warwick-Edinburgh Mental Wellbeing Scale. Independent t-tests and a one-way ANOVA were used to examine the association between fear of COVID-19 and nurses' demographic characteristics on their mental wellbeing. A multiple regression analysis was performed to examine the predictors associated with mental wellbeing. Findings revealed that almost half of the participants showed moderate positive mental wellbeing, 49.7%, while only 14% had low levels of fear on the Warwick-Edinburgh Mental Well being Scale. Most of the respondents had low levels of fear on the Fear of COVID-19 Scale, 45%, while only 15% had high levels of fear on the scale. Then, some demographic variables, such as "age," "nationality," "total years of experience in the current hospital," and "region you work at" had statistically significant differences with p < 0.5. Meanwhile, risk assessment is also associated with mental wellbeing scores. All items on the Fear of COVID-19 Scale showed no significant difference with a P > 0.05. In conclusion, most nurses providing direct patient care to a patient with COVID-19 emphasized the importance of wearing PPE and performing hand hygiene before and after any clean or aseptic procedure. Meanwhile, although almost all nurses were vaccinated, they were still afraid of a COVID-19 infection. Additionally, the results reported that the older the nurses are, the better their mental wellbeing scores. Non-Saudi nurses had higher perceived mental wellbeing scores than Saudi nurses, and different working environments corresponded to different mental wellbeing scores. Finally, nurses' risk assessment was associated with mental wellbeing scores.

Hand Hygiene and Cross Infection Control among Dental Auxiliaries working in Private and Public Dental Institutes of Punjab

Objectives: To evaluate the knowledge attitude and practices of dental assistants regarding hand hygiene and cross infection control in public and private dental institutes. Methods: Survey was carried out on 240 subjects working in five private and two public dental institutes using online questionnaires developed by the authors, and distributed via E-mail and WhatsApp. The target population were dental assistants and hygienists. Survey included a confidentiality and consent statement. Data was analyzed using the IBM SPSS version 20. Results: There were 240 respondents and majority were male. 71.3% of the participants received formal training in hand hygiene. 51.7% were aware of the presence of cross infection manual at workplace, however, fewer were aware of it contents. There was a significant difference between auxiliaries of private and public dental institutes when it comes to wearing gloves without washing hands, usage of alcohol rub and following recommended steps of hand washing. The auxiliaries of public institutes were performing hand washing before touching the patients only. Majority of the respondents especially from public institutes (38.3%) believe that hand should be dried using paper towel. Conclusion: Auxiliaries of private institutes were more aware about hand hygiene. Public institutes’ auxiliaries were lacking in knowledge and practice especially when it comes to usage of alcohol-based rub, washing hands before wearing gloves and performing hand hygiene before and after touching the patients. Regular workshop and courses should be done to keep their adherence to quality hand hygiene especially in public institutes. Keywords: American Dental Association, Center for Disease Control, Cross Infection, Dental Assistants, Hand Hygiene, Hygienists, World Health Organization

Using virtual reality to train infection prevention: what predicts performance and behavioral intention?

Training medical professionals for hand hygiene is challenging, especially due to the invisibility of microorganisms to the human eye. As the use of virtual reality (VR) in medical training is still novel, this exploratory study investigated how preexisting technology acceptance and in-training engagement predict VR hand hygiene performance scores. The effect of training in the VR environment on the behavioral intention to further use this type of training device (a component of technology acceptance) was also investigated. Participants completed a VR hand hygiene training comprising three levels of the same task with increasing difficulty. We measured technology acceptance, composed of performance expectancy, effort expectancy, and behavioral intention, pre- and post-training, and in-training engagement using adaptations of existing questionnaires. We used linear regression models to determine predictors of performance in level-3 and of behavioral intention to further use VR training. Forty-three medical students participated in this exploratory study. In-training performance significantly increased between level-1 and level-3. Performance in level-3 was predicted by prior performance expectancy and engagement during the training session. Intention to further use VR to learn medical procedures was predicted by both prior effort expectancy and engagement. Our results provide clarification on the relationship between VR training, engagement, and technology acceptance. Future research should assess the long-term effectiveness of hand hygiene VR training and the transferability of VR training to actual patient care in natural settings. A more complete VR training could also be developed, with additional levels including more increased difficulty and additional medical tasks.

Association between social capital and COVID-19 preventive behaviors: Country-level ecological study

BackgroundThe association between social capital and preventive behaviors against COVID-19 remains controversial. We examined the association between social capital and preventive behaviors against COVID-19 at country level. MethodsThe data on country-level social capital (i.e., social trust, group affiliations, civic responsibility, and confidence in state institutions) was obtained from a previous literature based on World Value Survey. Preventive behaviors were calculated as the percentage of people in a country who took COVID-19 preventive behaviors (i.e., physical distancing, hand hygiene, and the use of face mask) from an international survey of Facebook users, from July to October 2020 (207 data points for 9 waves of 23 countries). The scores on social capital were standardized. The association was investigated with multilevel linear regression analysis. ResultsHigh civic responsibility (per 1 standard deviation, SD) was associated with low percentage points of physical distancing (β = −4.66, 95% confidence interval, CI: 7.23, −2.09), hand hygiene (β = −2.88, 95% CI: 3.98, −1.78) and the use of face mask (β = −3.95, 95% CI: 5.29, −2.62). Group affiliations were associated with high percentage points of physical distancing (β = 2.96, 95% CI: 0.35, 5.58) and the use of face mask (β = 1.80, 95% CI: 0.45, 3.16). Social trust had significant positive association with performing hand hygiene (β = 1.22, 95% CI: 0.09, 2.35). ConclusionsThese results suggested that in countries with higher levels of civic responsibility, preventive behaviors should be more intensified during a pandemic.

Importance of education on infection control and on the hand skin health of dental personnel.

Hand hygiene plays a significant role in infection control, yet it is performed correctly only 40% of the time. The daily use of soap, disinfectants and gloves can also affect hand skin health. Periodical educational interventions regarding hand hygiene can improve infection control. The current study aimed to identify the existing hand hygiene practices applied by dental personnel, to evaluate knowledge about infection control, to determine the adverse effects of hand hygiene on the skin, and to assess the effectiveness of the educational interventions concerning these topics. This study was carried out at the Vilnius University Hospital Žalgiris Clinic, Lithuania. At the 1st stage, data was collected by using a self-administered questionnaire. At the 2nd stage, dental personnel underwent an educational intervention and the surveys were redistributed to determine any changes in the level of knowledge. In most cases, dental workers performed hand hygiene when it was needed. The proper method was selected by 53.4% on average. The main mistakes were the excessive use of soap and only occasional use of a disinfectant. The reported hand skin side effects included dryness (68.8%) and fissures (37.5%). Only half (50.5%) of the staff regularly used emollients. After the educational intervention, there was a 24.9% improvement in hand hygiene compliance. The correct procedure for hand hygiene was reported by half of the participants. Washing hands with soap was the preferable choice, while alcohol-based hand rub (ABHR) was avoided. Skin problems were reported by more than 70% of the respondents. Training had a positive impact on the hand hygiene knowledge of the dental personnel.

Pilot study of using thermal imaging to assess hand hygiene technique

Currently, there is no standard method for assessing hand hygiene (HH) technique. We explored the use of thermal imaging to determine if alcohol-based sanitizer (ABHS) has been applied to fingertips and thumbs, areas often missed by healthcare personnel. A FLIR thermal camera attached to an iPhone with FLIR app was used to obtain thermal images of volunteers' dominant hand before and after performing HH with an ABHS. Temperature readings of the mid-palm area, and tips of 3rd finger and thumb were recorded before and at multiple time points after hand hygiene. In 11 of 12 volunteers, thermal images revealed significant decreases in mid-palm, finger and thumb temperatures after performing HH (P < .01 for all sites), confirming visual assessment of coverage. When HH was performed without including the thumb, a lack of colorimetric change in the thumb was visible. For persons with "cold" fingers at baseline, assessing ABHS coverage of the fingers was more difficult. Thermal imaging of HH performance shows promise for assessing HH technique. Additional studies involving a larger number of persons under varying conditions are needed to establish if thermal imaging can be a practical modality for teaching or monitoring HH technique.