Hand Hygiene Technique Research Articles

Interactive hygiene training using free open source software.

Regular hygiene trainings are an important way to refresh and improve knowledge about hygiene measures and the prevention of healthcare-associated infections. We aimed to develop an e-learning course to allow healthcare workers (HCWs) to learn these contents through a self-paced online format. We developed an interactive hygiene training for HCWs of a tertiary care hospital using different content types of the HTML-5 package (H5P) plugin embedded into a Moodle-based learning management system. We evaluated the course using a short online questionnaire. We present various suitable topics for online hygiene trainings as well as their implementation in an e-learning course. Examples include content on hand hygiene indications and techniques, information on multidrug-resistant organisms and other current topics in infection control. HCWs reported high overall satisfaction, perceived increase in knowledge, practical relevance as well as good usability and comprehensibility. Currently available commercial and non-commercial hygiene trainings present a number of specific advantages but also drawbacks. The presented approach combines the advantages of both approaches. The majority of the presented content can be readily adapted to suit various hospitals and care facilities or serve as inspiration for creating similar courses while remaining cost-effective. H5P course presentations are a low-threshold, cost-effective way to implement digital hygiene trainings in a wide variety of clinical settings.

Impact and learner perspectives of a spaced-education platform to assess hand hygiene auditor competency.

To ensure whether spaced education, which increases long-term knowledge retention, could be integrated into auditor competency assessment. Quality improvement project. Academic, freestanding children's hospital. Hand hygiene (HH) auditors. We enrolled trained HH auditors in an online spaced-education platform to assess mastery of knowledge, delivering 46 unique questions at spaced intervals followed by rationale; we retired questions after 3 correct answers. An e-mailed 10-item survey gauged participant satisfaction with the program. The Wilcoxon signed-rank test was used to compare change in median knowledge score from first to final attempt. A total of 12,120 questions were attempted by 126 auditors, and 49 (39%) completed the entire course. Median knowledge score increased significantly by 10.5 percentage points (IQR 4-15) between first and final attempts (P < 0.001). Thirty auditors (27%) responded to the survey. The majority agreed the number and complexity of questions were appropriate (57% and 67%, respectively). Eighty-seven percent reported the platform easy to navigate, and 77% agreed adequate time was provided for completion. Free-text suggestions included delivering fewer questions at a narrower spacing interval over a shorter time frame because of competing work demands. Auditor knowledge of HH indications and technique is critical to ensuring data validity. A spaced-education competency program improved HH auditor knowledge in the short term. Completion rate was low, and some participants expressed a desire for fewer questions over a shorter time frame. This study offers insight into ways to optimize spaced education as a potential tool for HH competency assessment.

Clinical Effectiveness of a 3-Step Versus a 6-Step Hand Hygiene Technique: A Randomized Controlled Cross-over Study

Abstract Background The aim of this study is to assess the clinical effectiveness of the 3-step hand hygiene (HH) technique (3-HT) compared with the 6-step HH technique (6-HT; World Health Organization 6-step technique) using an alcohol-based hand rub. Methods A randomized controlled crossover trial was conducted from November to December 2023 in 10 wards of a tertiary A-level hospital according to CONSORT guidelines. The 240 healthcare workers (HCWs) were randomly divided into the 3-HT intervention group or the 6-HT control group. The trial was conducted in 2 stages, and the effectiveness of each indicator in the 2 groups was compared after a washout period of 2 weeks. Results Compared with the 6-HT, the 3-HT has demonstrated significant superiority in all indicators of HH compliance as well as the accuracy rate of HH practices. The total HH median times for the 3-HT and 6-HT were 16.00 (interquartile range, 15.00–20.00) and 32.50 (30.00–40.00) seconds, respectively (P &amp;lt; .05). The reduction factors for bacterial colony-forming unit counts did not differ and the colony-forming unit counts were not significantly different. Bacillus, Staphylococcus, and Micrococcus were detected before and after the use of hand rubs. HCWs preferred the 3-HT over the 6-HT. There were no significant difference in healthcare-associated infections rate between the 2 techniques. Conclusions The 3-HT was significantly superior to the 6-HT in terms of the HH eligibility rate, compliance, and HH time. The safety and feasibility of the 3-HT were verified by assessing microorganism count.

Evaluation of a Video-Based Concept for Hand Hygiene Education of Parents in a Neonatal Intensive Care Unit.

Current clinical guidelines support family-centered care in Neonatal Intensive Care Units (NICUs). This implies parents should also be involved in the most critical patient safety measures. Hand hygiene is the single most important tool to prevent healthcare-associated infections and related long-term effects. Although often studied in healthcare workers, the hand hygiene compliance of parents is rarely assessed. The aim of this study was to evaluate the effectiveness of an educational video, available in ten different languages, in teaching parents hand hygiene techniques in a NICU, lowering the burden on the staff. Parents in the intervention group were educated through a video; the control group received personal instruction from healthcare workers. The primary outcome parameter was the predicted probability of passing a subsequent hand scan. The quality of hand hygiene among parents educated through the video was at least as good as that of those who received instruction from a healthcare worker, demonstrated by a higher predicted probability of passing the hand scan (43.8% vs. 57.1% in male and 67.9% vs. 75.9% in female participants). The feedback from the intervention group was predominantly positive, with most parents (62%) expressing a preference for video-based education. Implementing a video-based approach seems to be effective for educating parents about hand hygiene in a NICU and was well accepted by the parents. This method offers a consistent standard of hand hygiene education, helps to overcome language barriers, and can also be used as regular reminder of the importance and proper technique of hand hygiene.

Examining the Educational Effects of Hand Hygiene Techniques Using a Fluorescent Application Area Analysis Tool

Examining the Educational Effects of Hand Hygiene Techniques Using a Fluorescent Application Area Analysis Tool

Effectiveness of a hand hygiene training intervention in improving knowledge and compliance rate among healthcare workers in a respiratory disease hospital

BackgroundPracticing hand hygiene (HH) is a crucial element of infection control, with healthcare workers (HCWs) playing a vital role in preventing the spread of infection. However, inadequate knowledge and non-compliance to HH protocols pose significant challenges in healthcare settings. This study aimed to evaluate the effectiveness of an HH training intervention in enhancing knowledge and staff compliance within a respiratory disease hospital. MethodA pre-and post-training study was conducted among the healthcare workers in a respiratory disease treatment facility. The intervention comprised a series of 3-hour training sessions conducted over five days, focusing on the World Health Organization's (WHO) recommended guideline "Your Five Moments For Hand Hygiene." These sessions covered proper HH techniques and underscored the repercussions of inadequate compliance. Educational materials related to HH were displayed in prominent locations throughout the facility. The knowledge levels and compliance rate were assessed before and after the intervention. ResultThe intervention significantly improved HH knowledge levels and compliance rates among the participants. Marking a significant improvement, the compliance rate of HH protocols increased from 66.0% to 88.3% during the pre-to post-training period, with a concurrent increase in the mean knowledge score from 68.6% to 78.9%. ConclusionThis study underscores the potential of training and education in elevating HH compliance and knowledge among healthcare workers. The findings advocate that healthcare facilities routinely incorporate such interventions into their infection control programs, ultimately improving patient and healthcare worker safety.

Adherence to hand hygiene technique: an observational study

Objective: To verify adherence and quality of hand hygiene techniques performed by health professionals at recommended times and identify impacting factors. Methods: This is an observational study, with 41 professionals from the Adult Intensive Care Unit of a Brazilian teaching hospital. Data collection took place from September to December 2021, using a sociodemographic questionnaire and observation form from the World Health Organization. Statistical tests of binomial analysis and mixed-effects logistic regression model were applied, and a significance level of 0.05 was adopted. Results: A total of 1,055 hand hygiene opportunities were observed; the adherence rate was 23.98%; and it can be seen that professionals did not perform the recommended technique. The binomial test verified greater adherence to moments “after” when compared to moments “before” (p&lt; 0.001) and a negative impact of using gloves was found (p&lt; 0.001). The logistical model reinforced greater adherence in moments “after”. Even though adherence is low among all professional categories, the logistical model demonstrated more chances of hand hygiene by nurses. Conclusion: Adherence to hand hygiene was considerably low, especially considering the appropriate technique. A negative impact of using gloves on hand hygiene adherence was verified. Professionals demonstrated greater chances of adhering to hand hygiene in the moments “after” when compared to moments “before”.

Hand hygiene compliance in a Brazilian COVID-19 unit: the impact of moments and contact precautions

BackgroundHealthcare-associated infections are among the most common complications during hospitalization. These infections increase morbidity and mortality and they increase length of hospital stay and the cost of healthcare. The aims of our study were to monitor hand hygiene (HH) compliance, HH technique quality and factors related to HH practice among health professionals in a COVID-19 Intensive Care Unit (ICU).MethodsAn observational, prospective study. Between September and December 2021, we observed 69 healthcare professionals in an eight-bed ICU for patients with COVID-19 in midwestern Brazil. We used the WHO observation form to collect data. The dependent variable was HH compliance and independent variables were professional category, sex, HH quality (3-step technique for at least 15 s), number of HH opportunities observed, observation shift and inappropriate glove use.ResultsWe observed 1185 HH opportunities. The overall compliance rate was 26.4%, but only 6.5% were performed with the correct 3-step technique for the minimum time. HH compliance was considerably lower for moments “before” tasks (6.7%; 95% CI 4.8%, 9.2%) compared with moments “after” tasks (43.8%; 95% CI 39.9%, 47.8%). The logistic model found that inappropriate glove use, night shift and physicians (p < 0.001) were associated with low HH compliance. The infrastructure analysis found that the unit had an insufficient number of alcohol-based handrub (ABHR) dispensers at the point of care and that the mechanism for activating them was poorly designed.ConclusionsHH compliance was very low. Inappropriate glove use was associated with low compliance and the unit’s infrastructure did not support good HH practice. The fact that healthcare professionals were more likely to do HH after tasks, suggests that they use HH to protect themselves rather than the patients. Adequate infrastructure and ongoing health education with a focus on HH while caring for patients in contact precautions are essential for improving HH compliance and patient safety.

Evaluating hand hygiene knowledge, attitudes, and practices among healthcare workers in post-pandemic H1N1 influenza control: a cross-sectional study from China.

This study evaluates the knowledge, attitudes, and practices (KAP) of hand hygiene among healthcare workers, crucial for preventing healthcare-associated infections (HAIs) in medical facilities. This cross-sectional study assessed hand hygiene KAP among healthcare workers across various settings in Hubei, China utilizing a stratified random sampling approach from, December 25, 2023-to-April 25, 2024. A bilingual electronic survey, adapted from validated tools, was disseminated via email and social media to ensure a broad reach. Participants included diverse healthcare professionals who met specific inclusion criteria. Responses were analyzed using R software, employing descriptive and inferential statistics to identify key predictors of hand hygiene behavior and to confirm the reliability of the survey instrument. The survey of 2,265 healthcare workers revealed that 77% demonstrated comprehensive knowledge of hand hygiene, 80% exhibited positive attitudes, and 94% practiced effective hand hygiene. Notable findings include a significant understanding of hand hygiene's role in preventing respiratory illnesses (58%) and HAIs (41% agreed, 39% unsure). High compliance in practices like washing hands for at least 20 s was evident (84%), though gaps in confidence about hand hygiene techniques were noted (33% confident, 56% unsure). Binary logistic regression analysis indicated that younger healthcare workers (21-30 years) were more likely to exhibit both knowledge (OR = 7.4, 95% CI = 1.44-136, p = 0.059) and positive attitudes (OR = 4.48, 95% CI = 1.73-11.8, p < 0.001) compared to other age groups. Significant associations were found between higher income levels and positive attitudes toward hand hygiene (OR for ≥80,000 = 3.19, 95% CI = 2.05-5.02, p < 0.001), and between knowledge and practices, suggesting that well-informed individuals are more likely to adhere to recommended practices. The findings reveal robust hand hygiene knowledge but uncover critical confidence gaps among healthcare workers, urging immediate, targeted educational interventions to fortify adherence and prevent infection outbreaks.

The spectrum of parasitic infections with emphasis on the clinico-epidemiological characteristics and risk factors among immunocompromised and immunocompetent patients at a university hospital in Northern India.

Intestinal parasitic infections pose a substantial threat to public health and are a huge burden to the economic development of a developing country. We aimed to identify the spectrum of intestinal parasitic infections with an emphasis on demographic and clinical characteristics observed among immunocompromised and immunocompetent patients. This observational study was performed in the Parasitology section of the Department of Microbiology from January 2022 to July 2022. A total of 2628 stool samples were obtained from patients presenting with chief complaints of abdominal pain, distension, vomiting, and foul-smelling feces. All the clinical and diagnostic data of the patients enrolled in the above-mentioned period were extracted from the ward files, hospital electronic records, and laboratory registers. A total of 2628 stool samples were sent to the Parasitology section of the Department of Microbiology. Out of the above-mentioned samples, 70 (70/2628, 2.66%) samples yielded gastrointestinal parasites on microscopic examination. The mean age of the patients included in our cohort study was 32.53 ± 16.21 years with a male predominance of 72.86% (51/70, 72.86%). The most common gastrointestinal parasite identified from stool samples was Giardia lamblia (61/70, 87.14%). All cases of opportunistic gastrointestinal infection caused by Cryptosporidium spp. (4/70, 5.71%) in our study cohort were found to infest the immunocompromised patients. This study determines the spectrum of intestinal parasitic infections among the immunocompromised and immunocompetent individuals and guides physicians in starting appropriate anti-parasitic treatment along with the instillation of strict hand hygiene techniques.

Impact of an educational intervention on hand hygiene practice among nursing students, with a focus on hand drying efficacy.

Hand hygiene and its significance for reducing the spread of infection is well evidenced and has been brought into sharp focus following the COVID-19 pandemic. Although a crucial clinical skill in ensuring safe healthcare, little is known regarding nursing students' effectiveness of hand hygiene practice. The aim of this study was to evaluate the impact of an educational intervention on hand hygiene practice, designed by the research team for first year pre-registration nursing students. Particular emphasis was placed upon hand drying technique and time. 825 nursing students were observed and assessed for their hand hygiene practice in a clinical suite at a university setting. Nursing students were observed for compliance against set outcome measures involving hand hygiene preparation, hand and wrist washing technique, hand drying technique and time. Data were analysed quantitatively using SPSS. The educational intervention had a significant impact on the clinical skills learning of nursing students. 779 students passed the assessment at the first attempt (94.4%). Of the 46 students that failed to meet the necessary criteria, 45 satisfied the criteria at the second attempt; giving an overall optimal compliance of 99.9%. 99.6% of students complied with recommended hand drying standards. This study offers an important contribution to the development and delivery of nursing education programmes. The educational intervention improved compliance with recommended hand hygiene technique and practice. Lack of attention to hand drying may negate effective hand hygiene in healthcare.

CONECTA KIDS: EDUCATING CHILDREN ABOUT INDUSTRIALIZED FOOD

Food industrialization plays a vital role in enhancing the availability of food products, catering to the growing demands of the global population, and ensuring food safety and product variety. With the aim of sparking children’s interest in food industrialization, the second-period class of the Higher Degree in Food Technology at UniSenai (Campus Chapecó) welcomed a visit from a municipal school. This visit served as an evaluative activity for the curricular component of Applied Project I. Initially, a questionnaire was administered to identify students with food allergies or intolerances. The event commenced with a reception, followed by a performance illustrating the evolution and significance of food industrialization. Subsequently, the school students engaged in a hands-on activity where they were taught the appropriate hand hygiene technique. This was followed by a tour of the institution’s educational laboratories, allowing the children to view the equipment used in industrial processing. A “Dare or Double Dare” style Q&amp;A game was then conducted to reinforce the concepts discussed. The event concluded with a gathering among participants. The scholars’ dedication and enthusiasm in taking a central role throughout the process were evident. Concurrently, the children’s infectious joy and keen interest in exploring the realm of food technology were unmistakable.

Game-based training to improve the compliance of hospital pharmacy operators with handwashing guidelines

IntroductionGood hand hygiene techniques (HHTs), like those of the World Health Organization (WHO), prevent microbial contamination of aseptic preparations. Our objective was to assess the efficacy of a game-based training (GBT) tool (the Handtastic Box®) to improve compliance in hospital pharmacy operators (HPOs) practice. MethodsA camera recorded HPOs’ handwashing 1 month before the training, between training and month 1 (M1), and between month 1 and month 3 (M2&3). Movements were scored as fully executed, partially executed, or not executed. We compared each HPO’s compliance rates with HHTs between observation periods. During 1-hour training sessions, pairs of HPO trainees watched videos of someone handwashing and had to note down which of the guidelines’ 5 steps was missing. They examined wooden hands having areas stained with fluorescein under ultraviolet light to find the hand showing the matching contamination. ResultsThe mean compliance score for 9 HPOs rose from 44.6% (before, n=32 videos) to 86.7% (M1, n=40) to 82.5% (M2&3, n=45). Compliance with every step improved from before training to M1 and generally stabilised in M2&3, except for the fingertip washing step, which dropped significantly at M2&3. DiscussionThis study was the first to assess a GBT tool’s efficacy in improving compliance with the WHO’s HHTs in HPOs’ practice. It significantly improved handwashing scores and maintained them at the same level until M3. The separate results for each step highlighted the necessity of training every movement. ConclusionThis GBT tool successfully improved compliance with the WHO’s HHT out to 3 months. This training could be used for other healthcare professionals.

The C. auris Epidemic: Understanding its Impact on ICU Patients

Candida species are the most common cause of nosocomial fungal infections and the fourth most common cause of hospital-acquired illnesses. Fungal infection has been known to cause severe complications and even death in immunocompromised patients. With the rise in antibiotic resistance and an increase in invasive medical procedures, ICU patients are becoming more vulnerable to this infection. In order to fight this epidemic, it is essential to comprehend the causes, signs, and available treatments for Candida species. Candida auris is an exceptionally rare type of fungus that first surfaced in 2009 and poses a threat to global health. C auris-associated invasive infections have a greater mortality rate than infections caused by other Candida species. C. auris possesses a tendency to develop antifungal medication resistance, which would make therapy more challenging. While the precise cause of C. auris illnesses is uncertain, it is believed that healthcare workers can contract the illness by touching infected objects or surfaces. Medical professionals, nurses, and various other staff members all contribute significantly to preventing the transmission of C. auris infestations. Utilizing hand hygiene techniques like thorough hand washing or hand sanitizers that contain alcohol can significantly reduce the spread of fungi. It is crucial to provide healthcare workers with ongoing instruction in infection control, the proper use of antifungal medications, and the early identification of C. auris infections.

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 &lt; 0.05). Moreover, the mean coverage of the hand-back was lower than that of the hand-palm at all times (p &lt; 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.

Current issues in hand hygiene

Multiple aspects of hand hygiene have changed in recent years. A PubMed search was conducted to identify recent articles about hand hygiene. The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.

Zero projects: compliance and evaluation of direct observation checklist as surveillance method

Abstract Background The multimodal projects: “Zero Urinary Tract Infection” (Z-UTI), “Zero Resistance” (Z-R), “Zero Pneumonia” (Z-P) and “Zero Bacteraemia” (Z-B) consist in implementing a bundle of evidence-based recommendations to prevent healthcare-associated infections (HAIs) and acquisition of multidrug-resistant bacteria (MDR-B) during patient's intensive care unit stay. They have been instituted in our tertiary hospital for several years and in order to assess compliance, we perform surveillance based on direct observation checklist. The aim was to examine compliance of recommendations and to evaluate direct observation as surveillance method. Methods Descriptive analysis of audits performed between 2020-2022. Compliance was estimated as the average of “yes”-marked percentage. Recommendations with “yes”-marked below 50% were excluded. Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis of direct observation checklist was conducted. Results Regarding Z-R (n = 129 observations) compliance was 86.5%.”Giving information about isolation to family” was excluded registering 55.4% “not seen”-marked. In Z-P (n = 262 obs.) compliance was 82.3%. “Hand hygiene and sterile technique for bronchial secretions aspiration” was excluded registering 48.2% “not seen”-marked. As for Z-UTI (n = 607 obs.) compliance was 92,5% (excluded: 4 standards with 78.2% “not seen”-marked). In Z-B (n = 988 obs.) compliance was 78.5% (excluded: 4 standards with 80.6% “not seen”-marked; 1 standard with 49.5% “not appropriate”-marked). Surveillance of projects by direct observation allows in-the-moment feedback but some recommendations could be checked as “not seen” due to observation's schedule. Lack of time and people involved could threaten surveillance. However, HAIs and MDR-B are a major public health problem to deal with. Conclusions Study demonstrates good compliance of recommendations, existing standards with high “not seen” percentages. SWOT analysis gives guidance on doing effective surveillance. Key messages • Due to increasing concern of MDR-B acquisition and HAIs, is crucial to develop projects including evidence-based recommendations to prevent this major public health problem. • Once we develop a strategy we must become able to monitor it and moreover, evaluate how we are doing surveillance in order to improve and make changes if necessary.

Virtual reality and augmented reality smartphone applications for upskilling care home workers in hand hygiene: a realist multi-site feasibility, usability, acceptability, and efficacy study.

To assess the feasibility and implementation, usability, acceptability and efficacy of virtual reality (VR), and augmented reality (AR) smartphone applications for upskilling care home workers in hand hygiene and to explore underlying learning mechanisms. Care homes in Northwest England were recruited. We took a mixed-methods and pre-test and post-test approach by analyzing uptake and completion rates of AR, immersive VR or non-immersive VR training, validated and bespoke questionnaires, observations, videos, and interviews. Quantitative data were analyzed descriptively. Qualitative data were analyzed using a combined inductive and deductive approach. Forty-eight care staff completed AR training (n = 19), immersive VR training (n = 21), or non-immersive VR training (n = 8). The immersive VR and AR training had good usability with System Usability Scale scores of 84.40 and 77.89 (of 100), respectively. They had high acceptability, with 95% of staff supporting further use. The non-immersive VR training had borderline poor usability, scoring 67.19 and only 63% would support further use. There was minimal improved knowledge, with an average of 6% increase to the knowledge questionnaire. Average hand hygiene technique scores increased from 4.77 (of 11) to 7.23 after the training. Repeated practice, task realism, feedback and reminding, and interactivity were important learning mechanisms triggered by AR/VR. Feasibility and implementation considerations included managerial support, physical space, providing support, screen size, lagging Internet, and fitting the headset. AR and immersive VR apps are feasible, usable, and acceptable for delivering training. Future work should explore whether they are more effective than previous training and ensure equity in training opportunities.

The impact of an effective 3-step hand hygiene technique in reducing potentially pathogenic microorganisms found on nursing professionals' hands.

Healthcare-associated infections are concerning adverse events and hand hygiene is considered an essential preventive measure. The objective of the present study was to assess the effect of a correct 3-step hand hygiene technique on reducing of potentially pathogenic microorganisms on hands related to the WHO five moments for hand hygiene. A cross-sectional study was performed by means of direct observation involving 60 Intensive Care Units (ICU) and clinical nursing professionals in a Brazilian hospital. Observations were performed in order to ascertain the adherence rate and the correct technique during health assistance. Additionally, microbiological analysis of material collected from the nursing professional's hands was carried out. Exploratory and inferential analyses were performed on R software and binomial analysis was carried out by using the Z-test. The study was approved by the research ethics committee and covered all the legal principles for the protection of human subjects. Hand hygiene adherence rate was 63.3%. However, only 13.3% of the professionals performed the correct 3-step hand hygiene technique regarding steps and time. Sixty-five microorganisms were isolated, among which 56.9% were coagulase-negative Staphylococcus, 26.2% were Gram-negative bacilli, 7.7% were Enterococcus faecalis, and 6.2% were Candida parapsilosis. There was no presence of potentially pathogenic microorganisms on the nursing professional's hands who performed the correct three-step technique. Overall correct hand hygiene technique was poor. The results indicated the presence of potentially pathogenic microorganisms at moments in which hand hygiene was mandatory but was not executed or was executed incorrectly. The 3-step hand hygiene technique proved to be effective when correctly performed since there were no microorganism growth. Larger studies are needed to test if these results can be replicated at a larger scale, since streamlining hand hygiene technique yielded encouraging results.

Steady amelioration of institutional hand hygiene behavior among health care personnel after 12-year consistent intervention

Institutional hand hygiene (HH) behavior is difficult to monitor and improve consistently, especially over long periods. This study aimed to investigate the long-term effects of HH promotion activities. We launched the HH promotion team in 2010 and conducted interventions including goal setting, observation and feedback, education, reward incentives, and accountability. Optimal HH compliance rates were calculated based on adherence to all 6-step HH technique and appropriate time recommended by the World Health Organization. HH and optimal HH compliance were calculated over 12 years. Poisson regression analysis was used to determine the trend in HH compliance according to year. In 2010, HH and optimal HH compliance were 59.7% and 15.6%, respectively. HH compliance increased by 83.9% in 2013 and remained over 75%. HH compliance increased significantly, with a relative risk (RR) of 1.014 (95% CI 1.002-1.025, P=.018). Optimal HH compliance increased by 67.8% in 2013 and remained over 60%, except in 2016 (58.8%) and 2019 (59.8%). Optimal HH compliance increased with RR 1.033 (95% CI 0.991-1.076, P=.123). HH and optimal HH compliance increased significantly over the 12 years when subgroup analysis was performed by job category. HH promotion team activities improved and maintained optimal HH compliance among HCWs.