Healthcare Worker Hand Hygiene Research Articles

Empowering Patient Hand Hygiene and Reducing Infection in the Oncology Population

Background: Significant focus has been placed on healthcare worker hand hygiene, but little attention is has been assigned to the role of patient hand hygiene (HH) in reducing hospital acquired infections. Therefore, in this quality improvement study, we examined the impact of providing patients with hand hygiene products around mealtime on increasing patient HH adherence and on reducing acquisition of nosocomial antibiotic resistant organisms. Methods: Patients on two inpatient leukemia units at a tertiary oncologic center were provided with a single use pre-packaged alcohol wipe on their meal trays prior to every meal (three times daily). Additionally, an information card explaining to patients how and when to use the alcohol wipe was provided on the meal trays three times a week. Both the wipe and instructions were designed with input from patient representatives at the hospital. Two oncologic control units were selected where no specific intervention for patient hand hygiene was conducted. Patient hand hygiene adherence on the control and intervention units were measured through once monthly patient interviews conducted after meals where patients were asked to recall whether they washed their hands prior to eating (using any product). Vancomycin Resistant Enterococcus (VRE) incidence was compared on the intervention and control units during the 7 months prior and 7 months following initiating the intervention. Results: During the seven-month intervention period, more than 15 000 wipes were dispensed to patients on the intervention units. Through interview, 91% of 87 patients on the intervention units reported cleaning their hands before eating a meal using any cleaning product compared to 72% of 68 patients on the control units (X2 = 9.32, p = 0.002). Furthermore, on the intervention units, 30 (38%) patients endorsed using the provided hand hygiene product. During intervention period, the combined incidence rate of VRE the intervention units was 1.85 case/1000 patient-days compared to 5.35 cases/1000 patient-days during the 7 months prior to intervention (t = 3.24, p=0.007)(Figure 1). Conclusions: This patient-centered quality improvement intervention increased patient hand hygiene and potentially reduced VRE incidence in a vulnerable oncologic population. This practical intervention that incorporated the patient perspective provided accessible hand hygiene products with simple instruction and reminders required minimal participation of unit staff. Further application of the intervention in non-oncologic populations is needed to further establish the relationship between patient hand hygiene and the acquisition of nosocomial infections.

Staff Perspectives on Barriers & Facilitators to Meeting Hand Hygiene Goals in a Multicenter Academic Hospital System

Background: Proper hand hygiene is the most important practice to reduce the transmission of infections in healthcare settings. Despite this, healthcare institutions continue to struggle to achieve and maintain high rates of hand hygiene compliance among healthcare workers with some studies estimating national healthcare worker hand hygiene compliance to be approximately 50%. Methods: We conducted an anonymous one-time survey of our Lifespan Hospital System employees to evaluate barriers and facilitators to performing hand hygiene as well as interventions to improve hand hygiene compliance. The survey was designed with guidance from the Consolidated Framework for Implementation Research and input from Lifespan infection prevention staff. Result: Over four weeks 985 (6%) Lifespan employees completed the survey. Figure 1 shows the aggregate results of the first 4 survey questions which focused on hand hygiene infrastructure at Lifespan, including availability of sanitizer, staff to manage hand hygiene supplies, and educational materials/reminders. One significant finding was >70% of respondents reported that they either did not know if their unit/department has a person assigned to replace/monitor hand hygiene supplies, or if so, who that person is. We also asked employees to rate how effective different interventions would be at improving hand hygiene compliance. Figure 2 shows of five proposed interventions, three were rated as either “moderately effective” or “very effective” by >50% of respondents. These included displaying hand hygiene instructions, making hand hygiene data available to employees, and displaying materials/reminders promoting hand hygiene. There were also 977 free-text responses regarding “barriers or facilitators to proper hand hygiene”. Major barriers identified were a lack of staff to monitor and refill supplies, slow replacement of hand hygiene products, lack of sanitizer dispensers and sinks, inconsistency of sink location and dispenser placement, lack of hand hygiene reminders/educational materials, time constraints, skin irritation from sanitizer, and an inability to have dispensers in behavioral health units. Survey responses led us to enhance the following: educational materials and reminders in work areas; staff education; leadership involvement in hand hygiene initiatives; routine auditing and feedback; conveniently placed sanitizer dispensers and sinks at the point of care; and making hand hygiene compliance data readily available to staff. Conclusion: This survey identifies important barriers and facilitators to achieving high rates of hand hygiene compliance among healthcare workers and provides the basis for interventions aimed at improving hand hygiene compliance in a large multicenter academic hospital system.

Compliance with the five moments for hand hygiene of healthcare workers in a pediatric hospital. A prospective observational study

Introduction: Healthcare-associated infections (HAIs), also known as nosocomial infections or hospital-acquired infections, begin within 48 hours of hospitalization, within 30 days after hospital discharge, or 90 days after undergoing surgical procedures. Objective: The study aimed to describe the compliance with the five moments for hand hygiene (HH) of the healthcare workers (HCWs) in a hospital. Methods: A prospective observational study was conducted from June 1 to 30,2020 in a pediatric hospital. HCWs compliance with the five moments of HH was registered by direct observation blindly to the participants, using the fact sheet for HH of the WHO. In the rows, the five moments of contact with the patients were recorded: before touching a patient, before clean aseptic procedure, after body fluid exposure risk, after touching a patient and after touching patient surroundings. The actions performed, also was registered: hand washing, alcohol hand friction, omission, or use of gloves. Data were analyzed in SPSS V 21. The protocol was approved by the institutional review board. Results: During the study period, 2.595 observations to 104 HCWs were made. They were pediatric residents 38.5 %, nurses 32.7 % and pediatricians 28.8 %. A global compliance with the five moments of HH of the participants were 64.5% (1673/2595). Before touching a patient, the adherence was 86,9%. The nurses adhered in 69%, pediatrician in 68.6 % and the pediatric residents in 57.2%. Discussion: The global percentage of compliance with the five moments of HH of the medical and nursing staff of the pediatric hospital was 64.5%. Nurses had the highest percentage of adherence. Handwashing compliance was higher before contact with the patients.

Investigation of the prevalence of carbapenem resistance genes in faecal carriage of carbapenem resistant Klebsiella spp. isolates by multiplex real-time PCR method.

Increased carbapenem resistance in Klebsiella spp. strains causes high morbidity and mortality. The genes encoded for carbapenemaseare transferrable between different bacterial species. In the present study, we aimed to investigate carbapenem resistance genes in Klebsiella spp. strains. Fifty Klebsiella spp. strains were isolated from rectal swabs of patients hospitalized in the neonatal intensive care unit (NICU). All strains were identified with API20E. The minimum inhibitory concentrations (MICs) of carbapenems were determined by the broth dilution method. The major five carbapenem genes (OXA-48, NDM, VIM, KPC, and IMP) were detected by the multiplex real-time PCR method. It was found that 49 (98%) of the strains were resistant to ertapenem (MIC ≥ 2μg/mL) and imipenem(MIC ≥ 4 μg/mL), and 47 (94%) of the strains were resistant to doripenem (MIC ≥ 4 μg/mL)and meropenem(MIC ≥ 4 μg/mL).NDM was detected in 42%, OXA-48 in 16%, and VIM in one (2%) isolate, and NDM + OXA-48 co-existed in 36% of the isolates. The KPC and IMP genes were not detected. NDM and NDM co-existing with OXA-48 were prevalent in the NICU of Istanbul Medical Faculty Hospital. Paying attention to the hand hygiene of healthcare workers, screening of rectal swabs of hospitalized patients for the presence of carbapenem resistance strains, and isolation of infected patients can effectively control the spread of carbapenem-resistant strains.

Effects of data-driven feedback on nurses' and physicians' hand hygiene in hospitals – a non-resource-intensive intervention in real-life clinical practice

Hand hygiene (HH) by healthcare workers (HCWs) is one of the most important measures to prevent hospital-acquired infections. However, HCWs struggle to adhere to HH guidelines. We aimed to investigate the effect of a non-resource intensive intervention with group and individual feedback on HCWs HH in a real-life clinical practice during the COVID-19 pandemic. In 2021, an 11-month prospective, interventional study was conducted in two inpatient departments at a Danish university hospital. An automated hand hygiene monitoring system (Sani Nudge™) was used to collect data. HH opportunities and alcohol-based hand rub events were measured. Data were provided as HH compliance (HHC) rates. We compared HHC across 1) a baseline period, 2) an intervention period with weekly feedback in groups, followed by 3) an intervention period with weekly individual feedback on emails, and 4) a follow-up period. We analyzed data from physicians (N=65) and nurses (N=109). In total, 231,022 hygiene opportunities were analyzed. Overall, we observed no significant effect of feedback, regardless of whether it was provided to the group or individuals. We found a trend toward a higher HHC in staff restrooms than in medication rooms and patient rooms. The lowest HHC was found in patient rooms. The automated hand hygiene monitoring system enabled assessment of the interventions. We found no significant effect of group or individual feedback at the two departments. However, other factors may have influenced the results during the pandemic, such as time constraints, workplace culture, and the degree of leadership support.

Impact of COVID-19 pandemic waves on health-care worker hand hygiene activity in department of medicine and ICU as measured by an automated monitoring system.

Hand hygiene (HH) compliance among health-care workers is important for preventing transmission of infectious diseases. To describe health-care worker hand hygiene activity in ICU and non-ICU patients' rooms, using an automated monitoring system (AMS), before and after the onset of the COVID-19 pandemic. At the Intercommunal Hospital of Créteil, near Paris, France, alcohol-based hand sanitizer (ABHS) consumption in the Department of Medicine (DM) and ICU was recorded using an AMS during four periods: before, during, and after the first wave of the COVID-19 pandemic, and during its second wave. From 1st February to 30th November 2020, in the DM, the mean number of doses per patient-day for each of the four periods was, respectively, 5.7 (±0.3), 19.4 (±1.3), 17.6 (±0.7), and 7.9 (±0.2, P<0.0001). In contrast, ICU ABHS consumption remained relatively constant. In the DM, during the pandemic waves, ABHS consumption was higher in rooms of COVID-19 patients than in other patients' rooms. Multivariate analysis showed ABHS consumption was associated with the period in the DM, and with the number of HCWs in the ICU. An AMS allows real-time collection of ABHS consumption data that can be used to adapt training and prevention measures to specific hospital departments.

SG-APSIC1038: Hospital-wide study to evaluate the tolerability and acceptability of alcohol-based hand rubs according to WHO protocol, and healthcare worker hand hygiene behavior during the COVID-19 pandemic

Objectives: To evaluate the tolerability and acceptability of 3 different alcohol-based hand rub (ABHR) products, and to determine factors influencing hand hygiene (HH) behavior among healthcare workers (HCWs) during the COVID-19 pandemic. Methods: A cross-sectional study was conducted in Sarawak General Hospital, a 1,034-bed tertiary-care state hospital. A self-administered 7-point Likert scale questionnaire was adapted from the WHO ‘Protocol for Evaluation of Tolerability and Acceptability of ABHR.’ The study was conducted between November 12 and 26, 2021, based on 3 types of ABHR products. Participation in answering the questionnaire was voluntary, so consent was implied. The Student t test was used to determine the significant differences among the ABHR product. The χ2 distribution test was performed to evaluate the characteristics of ABHR products. Results: We received a response rate of 35% (1,598 of 4,628); 82% of respondents were female, and the overall cohort had a mean age of 35 years. Also, 972 (61%) of 1,598 respondents were nurses, and 1,490 (93%) of 1,598 respondents used ABHR at least 5 days every week. Of 1,598 respondents, 1,156 (72%) indicated that ABHR products were easily accessible at the point of patient care. Evaluation of ABHR products showed that respondents were receptive to all product colors (P &lt; .0114) and had no color preference (P &gt; .05). Comparison among ABHR products yielded no statistical difference (P &gt; .05) for ‘smell,’ ‘stickiness,’ ‘irritation,’ or ‘drying speed.’ ‘Drying effect’ of all products was statistically significant (P &lt; .0252). The overall satisfaction for all products was good (P &lt; .0022). HCWs did not expect their HH compliance to improve even if they were provided with their preferred choice of ABHR. Of 1,598 respondents, 783 (49%) correctly used a palm-full of ABHR for HH, and 1, 275 (80%) indicated that hospital management should organize more HH-related awareness and continuous medical education on HH. Conclusions: A comparison among different ABHR characteristics mostly showed no statistically significant difference regarding tolerability and acceptability. These findings suggest that different ABHR products will not influence HH behavior during COVID-19 pandemic.

Nudges as a suitable and effective intervention to improve hand hygiene compliance among healthcare workers in patient care settings: a narrative review

Hand hygiene among healthcare workers (HCWs) is critical to preventing harm to patients in the process of healthcare delivery by minimising healthcare-associated infections (HCAI) in patient care settings. However, low compliance rates of hand hygiene plague healthcare, making it a global priority. Nudges are potentially a suitable and effective intervention to improve compliance among HCWs. In this review, nudges are defined as a method of intervention that attempts to influence people’s judgement, choice or behaviour in a predictable way, without forbidding any options or significantly changing economic incentives. This review aims to determine whether nudges are a suitable and effective intervention for improving hand hygiene compliance among HCWs in patient care settings. This review finds nudges suitable for inculcating professional handwashing habits as they are a form of ritualistic and automatic behaviour driven by unconscious processes, which can be influenced by social influences and environmental cues. A literature search conducted up until January 2022 identified 19 primary studies – 10 of which belonged to a systematic review – investigating the isolated effect of nudge interventions on improving HCW hand hygiene compliance in patient care settings. There is some indication that performance feedback may be effective, but significant heterogeneity of interventions and study designs make it difficult to conclude any further. Future research should employ study designs with minimal bias, use automated hand hygiene auditing systems and should address structural and resource-related constraints before evaluating nudge interventions.

Hand hygiene compliance and associated factor among nurses working in public hospitals of Hararghe zones, Oromia region, eastern Ethiopia.

Healthcare workers are in constant contact with a wide variety of materials and surfaces, including waste, body fluids, mucous membranes, food, their own bodies, and the skin of patients. As a result, their hands are colonized by different groups of pathogens. Hand hygiene of healthcare workers is recognized to be the main factor in reducing healthcare-associated infections. Therefore, this study aimed to assess hand hygiene adherence and related factors among nurses working in public hospitals in eastern Ethiopia. An institutional based cross-sectional study was conducted in Hospital, Hararghe zone, Eastern Ethiopia from July 1 to 30, 2021. A total of 451 study participants were randomly selected, after the proportional allocation of study participants to each selected hospital. The data was collected using self-administered questionnaire and observation checklist. SPSS version 26 was used to analyze the data. Bivariable and multivariable analysis were employed to assess the association between outcome and independent variables. Finally, a p-value of < 0.05 was used as a cutoff point for statistical significance. Out of 436 eligible nurses, the overall hand hygiene compliance was 37.4% [95% CI (0.33, 0.42)]. The overall compliance among those working in medical, surgical, OR ward, OPD, Gynecology/obstetrics, emergency ward, Intensive care units, Pediatrics, and other wards/departments was 46.8, 44.8, 35.7, 28.2, 20.7, 45.1, 23.1, 40.5, and 29.4%, respectively. The mean knowledge score was 21.6% (SD: 2.08). Furthermore, there was a statistically significant association between hand hygiene compliance and gender, work experience, training in hand hygiene, availability of running water, and knowledge of hand hygiene. The current study found overall compliance with hand hygiene accounted for 34.7%. Therefore, an exemplary worker may initiate others to do so, and strong managerial and leadership commitment may also help the workers stick to the rules and regulations to follow the multimodal hand hygiene practice as per WHO recommendation.

The impacts of self-expectation leadership and organizational commitment on hand hygiene behavior of medical staff based on the theory of implicit leadership.

Hand hygiene behavior (HHB) in healthcare settings remains suboptimal globally. Self-expectation leadership and organizational commitment are emphasized as important factors influencing HHB. However, there are no studies to support any relationship between self-expectation leadership and organizational commitment to HHB. This study will fill the gap by applying implicit leadership theory (ILT) to support the further promote HHB among medical staff. A cross-sectional study of 23,426 medical staff was conducted in all second-level and third-level hospitals in Hubei province, China. Based on ILT, an online self-administered and anonymous questionnaire was designed for measuring the medical staff's self-expectation leadership, organizational commitment, and HHB based on Offermann's 8 dimensions scale, Chang's 3 dimensions scale, and the specification of hand hygiene for healthcare workers, respectively, in which self-expectation leadership was divided into positive traits and negative traits parts. The structural equation model was used to examine the direct, indirect, and mediating effects of the variables. Positive traits of self-expectation leadership had a positive effect on organizational commitment (β = 0.617, p < 0.001) and HHB (β = 0.180, p < 0.001). Negative traits of self-expectation leadership had a negative effect on organizational commitment (β = -0.032, p < 0.001), while a positive effect on HHB (β = 0.048, p < 0.001). The organizational commitment had a positive effect on HHB (β = 0.419, p < 0.001). The mediating effect of the organizational commitment showed positively between positive traits of self-expectation leadership and HHB (β = 0.259, p < 0.001), while negatively between negative traits of self-expectation leadership and HHB (β = -0.013, p < 0.001). Positive traits of self-expectation leadership are important predictors of promoting organizational commitment and HHB, while negative traits of self-expectation leadership have a limited impact on organizational commitment and HHB in the field of healthcare-associated infection prevention and control. These findings suggest the need to focus on positive traits of self-expectation leadership; although negative traits of self-expectation leadership can also promote HHB to a lesser degree among medical staff, it will reduce their organizational commitment.

Improving knowledge, attitude, and compliance of hand hygiene of Iranian healthcare workers: A pilot study using Reminder Card

Background: Compliance rate of hand hygiene practice by healthcare workers has been observed to be universally low despite its importance, simplicity and cost-effectiveness in preventing the spread of infectious diseases in the healthcare settings. This study aimed to improve healthcare workers’ knowledge, attitudes, and compliance with hand hygiene by using reminder cards displayed by patients.

Hand Hygiene Behaviors Monitored by an Electronic System in the Intensive Care Unit

Background Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. Methods An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. Results A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Conclusions Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance. Hand hygiene (HH) compliance is hard to improve, and underlying behaviors are not clearly understood among healthcare workers. We aim to use an electronic HH system installed in an intensive care unit (ICU) to study healthcare workers’ HH behaviors and underlying reasons. An electronic hand hygiene system was installed in a 10-bed surgical intensive care unit that automatically detected HH opportunities when healthcare workers entered or exited a patient room and tracked the healthcare worker's HH compliance. HH compliance rate and patient contact time were calculated and analyzed at both the ICU and individual levels over time. A total of 27,692 HH opportunities were recorded during this 6-month trial period. The HH compliance rate was significantly higher when healthcare workers exited patient rooms than when they entered rooms (37.3% vs. 26.1%, P < 0.001). The full, partial, and total HH compliance rates of quick in-out of room (in room less than 3 seconds) events were significantly lower than those of long in-out room (in room more than 30 seconds) events (23.45% vs 32.77%, 21.44% vs 35.03%, and 44.88% vs 67.81% respectively) (P-value < 0.001). There were also significantly differences in HH compliance among individual healthcare workers (P < 0.001). No statistically significant difference was found in overall HH compliance rate and patient contact time over hours of the day or days of the week except partial HH compliance rates. Hand hygiene behaviors are complex and healthcare worker dependent. This study showed patterns in healthcare workers’ HH behaviors at both the ICU and individual level, which could facilitate targeted and personalized interventions to improve healthcare workers’ HH compliance.

A Picture and Some Facts about Contact Dermatitis on the Hands

Hand hygiene (HH) is the most important thing health care workers (HCWs) can do to cut down on the spread of health care-related diseases, but only about half of them do it. One of the most common reasons people don't want to use HH is because they get itchy when they use it again and again. Use the WHO's parts of strengthening as a guide when looking for and developing a clinical model to deal with HCW HH and ICD in this writing study

Using video-based surveillance for monitoring hand hygiene compliance according to the World Health Organization (WHO) Five Moments framework: A pragmatic trial.

To examine the utility of video-based monitoring systems (VMSs) for auditing hand hygiene compliance according to the World Health Organization (WHO) Five Moments. Pragmatic quasi-experimental observation trial. The New South Wales Biocontainment Centre, Westmead, New South Wales, Australia. Volunteer healthcare workers (HCWs). Six high-fidelity simulations were recorded and subsequently assessed for their ability to audit hand hygiene compliance according to the WHO Five Moments for hand hygiene criteria using tools provided by the National Hand Hygiene Initiative (NHHI). In total, 206 minutes of recorded footage were reviewed in 120 minutes, yielding 111 moments. Overall HCW hand hygiene compliance was 88% according to the WHO Five Moments framework. The cost per moment was $0.91 AUD ($0.66 USD) and the time required per moment was 64 seconds. Auditing of hand hygiene compliance according to all 5 of the WHO Five Moments from recorded footage is not only possible but provides cost and time savings. In addition, the process may produce output that is less subject to the biases inherent in direct human observational auditing.

Knowledge and Perceptions about COVID-19 among Health Care Workers: Evidence from COVID-19 Hospitals during the Second Pandemic Wave.

Health care workers (HCWs) face a higher risk of infection, since they work at the front line of COVID-19 patients’ management. Misinterpretations of current scientific evidence among HCWs may impact the delivery of appropriate care to COVID-19 patients and increase the risk of SARS-CoV-2 transmission in the hospital setting. Moreover, knowledge may affect HCWs perceptions depending on their broad beliefs and past experiences. The aim of this study was to explore the knowledge and perceptions of HCWs regarding COVID-19 issues during the second wave of the pandemic. A cross-sectional survey, involving a printed questionnaire, was conducted from 21 October 2020 to 31 January 2021 in four tertiary care hospitals located at four distant geographical regions in Greece. In total, 294 HCWs participated in this study. The majority of HCWs provided precise responses regarding general knowledge, perceptions, and practices concerning the COVID-19 pandemic. However, responses on hand hygiene and antimicrobial use in HCWs with COVID-19 were mistaken. This study reveals a certain degree of misconceptions and knowledge gaps in HCWs everyday practice, especially regarding hand hygiene and antimicrobial use in COVID-19 patients.

A Study to Assess Hand washing compliance among nursing professionals in General Wards of Pondicherry Institute of Medical Sciences

Hand washing is the practice, which keeps the hands free from pathogens or decrease the amount prior to any procedure or touching the patient. Health Care associated infections (HCAIs) are the major cause of morbidity and mortality. Hospital acquired infections posses a very real and serious threat to all who are admitted in hospitals. Evidence based guidelines for Health Care Workers hand hygiene practice exist, but compliance with these are internationally low (Creedon, 2005)1. The design adopted for the study was Descriptive design. The study was conducted in all the General medical and surgical wards. Census method was used to collect the data. 116 nurses were working in general wards of PIMS out of which 113 nurses participated in the study. Among 113 Nurses, 69.9% (79) had average compliance to hand washing practices, 21.2% (24) had good hand washing practices and 8.8% (10) had poor washing practices and the reasons for non-compliance to hand washing practices. 7.1% said they were too busy, 2.7% just forgot and 1.8% said the materials were not available. The results revealed that compliance to hand washing practices was average among nurses and there is a need to reinforce the use of standard hand washing protocols available in their wards.

Assessment of healthcare worker's hand hygiene and infection prevention practices of their personal belongings in a healthcare setting: a survey in pre COVID-19 era and literature review on standard disinfection practices.

SummaryBackgroundHealthcare workers’ (HCW) hands and personnel belongings are vehicles of transmission of nosocomial infections. Knowledge, attitude, and practice of hand hygiene have been extensively studied suggesting adequate knowledge but poor compliance. Similar data on aprons, mobile phone and stethoscope disinfection practices are lacking. This becomes an extensively important topic of discussion in current COVID-19 pandemic where inadequacy in hygiene practices is devastating.AimTo study the knowledge, attitude, and infection prevention practices of HCWs aprons, electronic devices, stethoscopes, and hands.MethodsA cross sectional questionnaire-based survey was conducted among HCWs of Medicine ward and ICU.ResultsSixty-six HCWs responded to the survey. Awareness that hands, aprons, mobile phones, stethoscopes could cause cross transmission and knowledge of correct practices was present in majority of the respondents. Hand hygiene was performed by 65.2% of the respondents before touching a patient and 54.5% after touching the patient surroundings while 13.6% performed only when it was visibly soiled. Mobile phones and stethoscopes were disinfected by 13.6 and 30.3% of the respondents after each patient encounter, respectively. Aprons were washed after using them at a stretch for a median duration of 5 days (1-30 days). Forgetfulness, lack of reinforcement, lack of time, inadequate awareness on standard disinfection practices and fear of damaging electronic devices from disinfectants use were reasons for poor compliance.ConclusionsThere is an urgent need to spread awareness and formulate standard guidelines on disinfection practices especially for mobile phones, stethoscopes, and aprons in addition to reinforcing hand hygiene practices.

COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices

BackgroundThe coronavirus disease (COVID-19) pandemic has affected healthcare workers (HCWs) in their clinical practice. HCWs were challenged with new guidelines and practices to protect themselves from occupational risks.AimTo determine whether hand hygiene behaviour by real-time measurement was related to the dynamic of the epidemic, and the type of patient being cared for in France.MethodsThis study used an automated hand hygiene recording system to measure HCW hand hygiene on entry to and exit from patient rooms throughout the COVID-19 pandemic. The correlation between hand hygiene compliance and COVID-19 epidemiological data was analysed. Analysis of variance was performed to compare compliance rate during the different periods of the epidemic.FindingsHCW hand hygiene rate on room entry decreased over time; on room exit, it increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, then rebounded by 2.82% during the second wave of the epidemic. Hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic; conversely, hand hygiene on room entry did not depend on the trend of the epidemic, nor on nursing of COVID-19 patients, and it decreased over time.ConclusionHCWs modified their behaviours to face the risk propensity of the pandemic. However, to improve the poor compliance at room entry, reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary; disinfection of gloving hands might solve this issue.

Association of Visitor Contact Precautions With Estimated Hospital-Onset Clostridioides difficile Infection Rates in Acute Care Hospitals

Visitor contact precautions (VCPs) are commonly used to reduce the transmission of Clostridioides difficile at health care institutions. Implementing VCPs requires considerable personnel and personal protective equipment resources. However, it is unknown whether VCPs are associated with reduced hospital-onset C difficile infection (HO-CDI) rates. To estimate the association between VCPs and HO-CDI rates using simulation modeling. This simulation study, conducted between July 27, 2020, and August 11, 2020, used an established agent-based simulation model of C difficile transmission in a 200-bed acute care adult hospital to estimate the association between VCPs and HO-CDI while varying assumptions about factors such as patient susceptibility, behavior, and C difficile transmission. The model simulated hospital activity for 1 year among a homogeneous, simulated adult population. No VCP use vs ideal use of VCPs under different hospital configurations. The rate of HO-CDI per 10 000 patient-days according to the Centers for Disease Control and Prevention's definition of HO-CDI. With use of the simulation model, the baseline rate of HO-CDI was 7.94 10 000 patient-days (95% CI, 7.91-7.98 per 10 000 patient-days) with no VCP use compared with 7.97 per 10 000 patient-days (95% CI, 7.93-8.01 per 10 000 patient-days) with ideal VCP use. Visitor contact precautions were not associated with a reduction of more than 1% in HO-CDI rates in any of the tested scenarios and hospital settings. Independently increasing the hand-hygiene compliance of the average health care worker and environmental cleaning compliance by no more than 2% each was associated with greater HO-CDI reduction compared with all other scenarios, including VCPs. In this simulation study, the association between VCPs and HO-CDI was minimal, but improvements in health care worker hand hygiene and environmental cleaning were associated with greater reductions in estimated HO-CDI. Hospitals may achieve a higher rate of reduction for HO-CDI by focusing on making small improvements in compliance with interventions other than VCP.

Impact of burnout, secondary traumatic stress and compassion satisfaction on hand hygiene of healthcare workers during the COVID-19 pandemic.

AimTo assess the prevalence of burnout, secondary traumatic stress, and compassion satisfaction and explore their impacts on self‐reported hand hygiene among medical aid teams in the COVID‐19 period in Wuhan, China.DesignCross‐sectional study.MethodA total of 1,734 healthcare workers from 17 medical aid teams were surveyed. The survey included burnout, secondary traumatic stress and compassion satisfaction measured by the professional quality of life scale and self‐reported hand hygiene. Data were collected between 5–7 March 2020. Multiple regression analyses were performed.ResultsBurnout and secondary trauma stress were at low and average levels, and compassion satisfaction was at average and high levels. Burnout was negatively associated with hand hygiene, while compassion satisfaction was positively associated. Hospital administrators should pay attention to burnout and compassion satisfaction to improve infection control behaviours. Management of healthcare workers in our study may be constructive in emerging infectious diseases.