High Touch Research Articles

Anti-viral organic coatings for high touch surfaces based on smart-release, Cu2+ containing pigments

Viruses such as SARS-CoV-2 can remain viable on solid surfaces for up to one week, hence fomites are a potential route of exposure to infectious virus. Copper has well documented antiviral properties that could limit this problem, however practical deployment of copper surfaces has been limited due to the associated costs and the incompatibility of copper metal in specific environments and conditions. We therefore developed an organic coating containing an intelligent-release Cu2+ pigment based on a cation exchange resin. Organic coatings containing a 50 % weight or higher loading of smart-release pigment were capable of completely inactivating (>6 log reduction in titre) SARS-CoV-2 within 4 h of incubation. Importantly these organic coatings demonstrated a significantly enhanced ability to inactivate SARS-CoV-2 compared to metallic copper and un-pigmented material. Furthermore, the presence of contaminating proteins inhibited the antiviral activity of metallic copper, but the intelligent-release Cu2+ pigment was unaffected. The approach of using a very basic paint system, based on a polymer binder embedded with “smart release” pigment containing an anti-viral agent which is liberated by ion-exchange, holds significant promise as a cost effective and rapidly deployed coating to confer virus inactivating capability to high touch surfaces.

Evaluation of adenosine triphosphate bioluminescence-based system in rooms occupied by patients with methicillin resistant Staphylococcus aureus

BackgroundAdenosine triphosphate (ATP)-based monitoring systems can detect the amount of organic matter that remains on hospital surfaces after cleaning. We evaluated an ATP-based monitoring system in assessing contamination of high touched objects in rooms occupied by patients on methicillin resistant S. aureus precautions. MethodsWe compared the ATP to standard aerobic cultures as well as to gloved hand culture to predict risk of healthcare-worker hand contamination. ResultsMore than a third of high touch object surfaces were measured unclean with ATP yet only reflects about 5% chance of contaminating healthcare-workers’ hands. ConclusionsOur study emphasizes the shortcomings of using the ATP system even in pathogen specific environment such as surfaces in methicillin resistant S. aureus rooms.

High touch, high trust: Using community health advocates and lawyers to address ED high utilizers

BackgroundEmergency department (ED) high utilizers are a costly group of patients due to their higher utilzation of acute care costs. At a safety-net hospital, we enrolled patients in a program which partnered with lawyers and community health advocates (CHAs) to navigate patients' social, medical and legal needs. Our aim was to decrease costs and utilization and address the patient's social determinants of heath (SDOH). MethodsWe enrolled patients with 4 or more ED visits in the prior 6 months and gave them SDOH and medical questionnaires. Patients were followed for 6 months on a weekly, then bi-monthly basis. All utilization and cost data were obtained through an internal data warehouse and evaluated using a pre-post analysis and broken down into quartiles. ResultsED, admission, and total costs did not differ significantly between the 12 months pre-enrollment and the 12 months post-enrollment. Outpatient costs did increase ($2182 increase, p < 0.005). ED visits declined significantly in the post-enrollment period (IRR = 0.84, p = 0.048), with the highest impact on those with <7 ED visits. Total admissions did not decline (IRR 0.84, p = 0.059). But, among those with 4 or 5 ED visits, admission costs and visits decreased. On average, six SDOH issues were identified. Of these, approximately 30.3% were mitigated with up to 17% requiring legal help. ConclusionWhile outpatient costs did increase, total costs did not decrease in this program. This type of non-clinical intervention may be best served for patients who are less clinically complex but significant social needs.

SARS-CoV-2 detection in hospital indoor environments, NW Iran

This study aimed to investigate the potential contamination of SARS-CoV-2 in indoor settled dust and surfaces of Amir Al-Muminin hospital in Maragheh, Iran. Samples were taken from surfaces and settled dust using a passive approach and particulate matter (PM) using an active approach from different hospital wards. SARS-CoV-2 was detected in 15% of settled dust samples (N = 4/26) and 10% of surface samples (3/30). SARS-CoV-2 has been detected in 13.8% and 9.1% of the dust samples collected at a distance of fewer than 1 m and more than 3 m from the patient bed, respectively. SARS-CoV-2 was found in 11% of surface samples from low-touch surfaces and 8% from high touch surfaces. The relationship between PM2.5, PM10, humidity, temperature, and positive samples of SARS-CoV-2 was investigated. A positive correlation was observed between relative humidity, PM2.5, and positive SARS-CoV-2 samples. Principal component analysis (PCA) suggested positive correlation between positive SARS-CoV-2 samples, relative humidity, and PM2.5. Risk assessment results indicated that the annual mean infection risk of SARS-CoV-2 for hospital staff with illness and death was 2.6 × 10−2 and 7.7 × 10−4 per person per year. Current findings will help reduce the permanence of viral particles in the COVID 19 tragedy and future similar pandemics e.g., novel influenza viruses.

Crafting an Experience‐Based Master's Program in Systems Engineering

AbstractThe Professional Masters in Applied Systems Engineering (PMASE) program provides students with practical and academic material in a setting like a typical work environment. This paper describes the first course in the two‐year program from the perspective of how a “high touch” course provides learning depth. It describes the approach used to provide students with a realistic environment giving academic and practical experience balancing work and studies in an intensive program which culminates in a capstone project. The paper should be of interest to companies and universities interested in a holistic, condensed systems engineering training program.

The evaluation of electrolyzed water, sodium dichloroisocyanurate, and peracetic acid with hydrogen peroxide for the disinfection of patient room surfaces

Sporicidal disinfectants are necessary to control Clostridioides difficile and Candida auris. Novel application methods such as electrostatic sprayers may increase disinfection effectiveness. We employed a standardized protocol to assess 3 sporicidal disinfectants: electrolyzed water (EW), sodium dichloroisocyanurate (NaDCC) and peracetic acid/hydrogen peroxide (PAA/H2O2). The study was conducted at 2 New York City hospitals (1,082 total beds) over an 18-month period. The 3 chemicals were applied by housekeeping personnel following the hospital protocol; the use of electrostatic sprayers was incorporated into EW and NaDCC. In randomly selected rooms, 5 surfaces were sampled for microbial colony counts after cleaning. Data analyses were performed using negative binomial logistic regression. We collected 774 samples. NaDCC-disinfected surfaces had a lower mean colony count (14 colony forming units [CFU]) compared to PAA/H2O2 (18 CFU, P=.36) and EW (37 CFU, P < .001). PAA/H2O2 and EW had more samples with any growth (both P < .05) compared to NaDCC. NaDCC applied with wipes and an electrostatic sprayer had the lowest number of samples with no growth and <2.5 CFU/cm2 (difference not significant). The use of NaDCC for surface disinfection resulted in the lowest bacterial colony counts on patient room high touch surfaces in our study.

Evaluating a Continuously Active Disinfectant Wipe on High Touch Surfaces in Rooms of Patients with Multidrug-Resistant Organisms (MDROs)

<h3>Background</h3> Recontamination of the patient's environment occurs quickly after thorough disinfection and could contribute to the transmission of healthcare-associated infections. We aimed to determine whether a continuous active disinfectant wipe (CADW) could provide sustained disinfection for rooms of MDRO carriers. <h3>Methods</h3> We sampled a small number of rooms of MDRO carriers in an academic hospital and nursing home setting. Rooms underwent routine cleaning by environmental services immediately followed by additional high-touch cleaning by Infection Preventionists with 1) routine disinfecting wipes (RDW) and 2) CADW on separate days. Five pre-specified high-touch surfaces were cultured with pre-moistened spongesicles 23 hours post-cleaning in four hospital rooms, eight hours post-cleaning in two hospital rooms, and eight hours post-cleaning in three nursing home rooms. Spongesicles were processed at a CLIA-certified laboratory with 40cc of phosphate-buffered saline, stomaching for one minute, centrifuging the liquid, reconstituting in 5cc of fluid, and plating per CLSI standards. <h3>Results</h3> At 23 hours, three of four rooms had MDRO contamination after RDW (two MRSA and one C. auris), with same findings after CADW. Six RDW objects were positive for MRSA and two for C. auris. Five CADW objects were positive for MRSA and one for C. auris. At 8 hours, four of five hospital/nursing home rooms had MDRO contamination after RDW (two MRSA, one C. auris, one VRE) compared to three of five rooms after CADW (2 MRSA and 1 C. auris). Six RDW objects were positive for MRSA, two for C. auris, and one for VRE. Six CADW objects were positive for MRSA and one for C. auris. <h3>Conclusions</h3> In this exploratory analysis, CADW did not provide a clinically meaningful reduction in MDRO contamination of high-touch surfaces at either 8 or 23 hours compared to RDW. Ongoing efforts to demonstrate effective and sustained surface antimicrobial activity to reduce fomites is needed.

“The whole experience is still very high touch for parents”: Parent moves to support young children’s remote learning during the COVID-19 pandemic

This qualitative study examined families’ experiences supporting young children’s (ages 3–8) remote learning during the COVID-19 pandemic. Twenty-three participants completed open-ended questions in an online survey and three of those participants shared further in an online, recorded focus-group interview. Parents revealed young children’s challenges with remote learning and the multiple strategies families took up to support their young learners, including many forms of managing and facilitating online work, several forms of communicating to seek support, information, or changes, and multiple forms of motivating their child(ren) to stay engaged and complete activities. Parents also shared the tensions that arose with more unfettered access to their child(ren)’s online classrooms, teachers’ variation in communication, and families differing levels of participation due to multiple responsibilities. The findings demonstrate both the challenges and families’ creative strategies to bolster their child(ren)’s remote learning, and they inform teachers and school personnel of the importance of developing continued recalibration of communication, family support, and family input on home learning experiences when young children cannot engage with in-person learning.

Individual-Level and Neighborhood-Level Factors Associated with Longitudinal Changes in Cardiometabolic Measures in Participants of a Clinic-Based Care Coordination Program: A Secondary Data Analysis.

Background: Identifying individual and neighborhood-level factors associated with worsening cardiometabolic risks despite clinic-based care coordination may help identify candidates for supplementary team-based care. Methods: Secondary data analysis of data from a two-year nurse-led care coordination program cohort of Medicare, Medicaid, dual-eligible adults, Leveraging Information Technology to Guide High Tech, High Touch Care (LIGHT2), from ten Midwestern primary care clinics in the U.S. Outcome Measures: Hemoglobin A1C, low-density-lipoprotein (LDL) cholesterol, and blood pressure. Multivariable generalized linear regression models assessed individual and neighborhood-level factors associated with changes in outcome measures from before to after completion of the LIGHT2 program. Results: 6378 participants had pre-and post-intervention levels reported for at least one outcome measure. In adjusted models, higher pre-intervention cardiometabolic measures were associated with worsening of all cardiometabolic measures. Women had worsening LDL-cholesterol compared with men. Women with pre-intervention HbA1c > 6.8% and systolic blood pressure > 131 mm of Hg had worse post-intervention HbA1c and systolic blood pressure compared with men. Adding individual’s neighborhood-level risks did not change effect sizes significantly. Conclusions: Increased cardiometabolic risks and gender were associated with worsening cardiometabolic outcomes. Understanding unresolved gender-specific needs and preferences of patients with increased cardiometabolic risks may aid in tailoring clinic-community-linked care planning.

Experiential Teaching Learning of Humanities in Health Professions Education

Humanities are an integral part of health professions. However, with educational focus shifting gradually toward knowledge, information, evidence-based medicine, and technology, it has taken a back seat and become a part of the “hidden curriculum.” Humanities are hardly ever taught upfront to students of the health profession, let alone its assessment. With the need of its inclusion in health professional education now recognized and established through competency-based education, we need to be aware of the tools and strategies which can be used to teach and assess it. In this article, we share selected tools with relevant readily usable examples for teaching humanities to students of the health profession. Faculty may find it useful to plan sessions around related competencies. Incorporation of such experiential teaching and learning methods can help us achieve the transition from “high-tech” to “high touch” health professions education.

Effect of SARs-CoV-2 pandemic on infection prevention behaviors and bacterial burden of high touch surfaces in a medical/surgical setting

This study aimed to determine the longitudinal efficacy of ultraviolet germicidal disinfection (UV-C) in a non-terminal disinfection context. Moreover, factors influencing enhanced infection prevention behaviors during the SARS-CoV-2 pandemic were evaluated. Sixty nursing staff from three medical/surgical wards in a large military hospital were recruited for a survey and microbiological sampling of high-touch surfaces (stethoscope, personal electronic device, common access card, and hospital ID badge) and portable medical equipment (wheelchairs and mobile commodes). Surveys included hand hygiene estimates, frequency/method of cleaning items of interest, perception of UV-C, and factors influencing the use of enhanced disinfection tools. Surveys and microbiological samples were performed prior to and after the installation of a rapid, automated ultraviolet disinfection enclosure for staff use. Both time points preceded the SARS-CoV-2 pandemic in the United States. A final survey/sampling time point was carried out eight months after the declaration of the COVID-19 pandemic. Participants’ hand hygiene frequency did not increase throughout the study, with > 80% reporting a minimum of 4 hand hygiene events per patient hour. The cleaning frequency of high-touch surfaces (non-clinical) but not portable medical equipment increased after installation of a UV-C disinfection tool and was sustained eight months into the COVID-19 pandemic. While a modest decrease in bacterial burden was observed after UV-C intervention, a more significant reduction was observed across all surfaces during pandemic time sampling, though no detectable decrease in pathogenic contamination was observed at either time point. Motivators of UV-C use included fear of SARS-CoV-2 contamination and transmission, ease of device use, and access to rapid, automated disinfection tools while deterrents reported included technical concerns, lack of time, and preference for other disinfection methods. Automated, rapid-cycle UV-C disinfection can be efficacious for high-touch surfaces not currently governed by infection prevention and control guidelines. The introduction of enhanced disinfection tools like UV-C can enhance the overall cleaning frequency and is correlated with mild decreases in bacterial burden of high-touch surfaces, this is enhanced during periods of heightened infection threat. Evidence from this study offers insights into the factors which prompt healthcare workers to internalize/dismiss enhanced infection prevention procedures.

Environmental surveillance of ESBL and carbapenemase-producing gram-negative bacteria in a Ghanaian Tertiary Hospital

BackgroundThe burden of antibiotic resistant infection is mainly felt in low-to-middle income countries, where the rate of antimicrobial resistance is largely under-surveyed and under huge pressure from unregulated, disparate and often self-guided access to antimicrobials. Nosocomial infections from hospital environments have been shown to be a particularly prevalent source of multi-drug resistant strains, yet surveillance of hospital environmental contamination is often not investigated.MethodsThe study was prospective, observational and cross-sectional, sampling 231 high and low touch surfaces from 15th March to 13th April 2021, from five wards in the Cape Coast Teaching Hospital, Ghana. Microbial growth in the presence of vancomycin and either meropenem or cefotaxime was examined and bacterial species were identified by MALDI-TOF. The presence of common extended-spectrum β-lactamases (ESBL) and carbapenemase antimicrobial resistance genes (ARG) were identified through PCR screening, which were confirmed by phenotypic antimicrobial susceptibility determination. Isolates positive for carbapenem resistance genes were sequenced using a multi-platform approach.ResultsWe recovered microbial growth from 99% of swabs (n = 229/231) plated on agar in the absence of antimicrobials. Multiple sites were found to be colonised with resistant bacteria throughout the hospital setting. Bacteria with multi-drug resistance and ARG of concern were isolated from high and low touch points with evidence of strain dissemination throughout the environment. A total of 21 differing species of bacteria carrying ARG were isolated. The high prevalence of Acinetobacter baumannii carrying blaNDM-1 observed was further characterised by whole genome sequencing and phylogenetic analysis to determine the relationship between resistant strains found in different wards.ConclusionEvidence of multiple clonal incursions of MDR bacteria of high sepsis risk were found in two separate wards for a regional hospital in Ghana. The prevalence of multiple blaNDM carrying species in combination with combinations of ESBLs was particularly concerning and unexpected in Africa. We also identify strains carrying tet(X3), blaVIM-5 or blaDIM-1 showing a high diversity of carbapenamases present as a reservoir in a hospital setting. Findings of multi-drug resistant bacteria from multiple environmental sites throughout the hospital will inform future IPC practices and aid research prioritisation for AMR in Ghana.

3D-printed graphene polylactic acid devices resistant to SARS-CoV-2: Sunlight-mediated sterilization of additive manufactured objects

Additive manufacturing has played a crucial role in the COVID-19 global emergency allowing for rapid production of medical devices, indispensable tools for hospitals, or personal protection equipment. However, medical devices, especially in nosocomial environments, represent high touch surfaces prone to viral infection and currently used filaments for 3D printing can't inhibit transmission of virus [1].Graphene-family materials are capable of reinforcing mechanical, optical and thermal properties of 3D printed constructs. In particular, graphene can adsorb near-infrared light with high efficiency. Here we demonstrate that the addition of graphene nanoplatelets to PLA filaments (PLA-G) allows the creation of 3D-printed devices that can be sterilized by near-infrared light exposure at power density analog to sunlight. This method has been used to kill SARS-CoV-2 viral particles on the surface of 3D printed PLA-G by 3 min of exposure. 3D-printed PLA-G is highly biocompatible and can represent the ideal material for the production of sterilizable personal protective equipment and daily life objects intended for multiple users.

Inactivation of MS2 bacteriophage on copper film deployed in high touch areas of a public transport system.

Although SARS-CoV-2 is primarily an airborne risk, the COVID-19 pandemic also highlighted the need for self-disinfection surfaces that could withstand the demand of high occupant densities characteristic of public transportation systems. The aim of this study was to evaluate the durability and antiviral activity of a copper film deployed for 90 days in two high touch locations within an active metropolitan bus and railcar. The antiviral efficacy of this copper film after being deployed in transit vehicles for 90 days (deployed copper film) was then compared to new (unused) copper film to determine if frequent touches and cleaning protocols could decrease the efficacy of the copper films. Deployed copper film, new copper film, and aluminium foil (positive control) coupons were inoculated with ~1 × 106 MS2 virus particles, allowed a contact time of either 5- or 10-min, and analysed for residual viral infectiousness. On both new and deployed copper films, MS2 was completely inactivated (≥5 log reduction) at both time points. These results suggest that the copper film may provide the durability demanded by high touch public spaces while maintaining the antiviral activity necessary to reduce exposure risk and viral transmission via surfaces in public transportation settings.

Recent Advances in Metal-Based Antimicrobial Coatings for High-Touch Surfaces.

International interest in metal-based antimicrobial coatings to control the spread of bacteria, fungi, and viruses via high contact human touch surfaces are growing at an exponential rate. This interest recently reached an all-time high with the outbreak of the deadly COVID-19 disease, which has already claimed the lives of more than 5 million people worldwide. This global pandemic has highlighted the major role that antimicrobial coatings can play in controlling the spread of deadly viruses such as SARS-CoV-2 and scientists and engineers are now working harder than ever to develop the next generation of antimicrobial materials. This article begins with a review of three discrete microorganism-killing phenomena of contact-killing surfaces, nanoprotrusions, and superhydrophobic surfaces. The antimicrobial properties of metals such as copper (Cu), silver (Ag), and zinc (Zn) are reviewed along with the effects of combining them with titanium dioxide (TiO2) to create a binary or ternary contact-killing surface coatings. The self-cleaning and bacterial resistance of purely structural superhydrophobic surfaces and the potential of physical surface nanoprotrusions to damage microbial cells are then considered. The article then gives a detailed discussion on recent advances in attempting to combine these individual phenomena to create super-antimicrobial metal-based coatings with binary or ternary killing potential against a broad range of microorganisms, including SARS-CoV-2, for high-touch surface applications such as hand rails, door plates, and water fittings on public transport and in healthcare, care home and leisure settings as well as personal protective equipment commonly used in hospitals and in the current COVID-19 pandemic.

Small Tech, High Touch: A Permutation

In an earlier paper published in a neutrosophic math journal (IJNS), we discussed a new approach to technology, which may be called as ‘opti-realism’ or ‘pess-optimism’ as alternative to utopianism based on technocracy, which may lead the world into global techno totalitarianism. In this article, we submit a new approach to Nature and technology, which is more modest and humble, rather than a techno-utopianism version of reality that most futurists argue for. Our proposed approach resembles more to Myer-Briggs 16 types of personality, including IJNS, IFNS etc. In our scheme, there are 8 characters of approach toward technology which can lead to many variations or we call it ‘Permutation.” Of course, if the readers ask one variation that we prefer, we would answer: Small Tech, High Touch.

The ‘fintech revolution’ is here! The disruptive impact of fintech on retail financial practices

AbstractFintech is celebrated for its disruptive and democratizing qualities that dis/reintermediates the finance value chain. Claims of a ‘fintech revolution’ assume that fintech is ‘disruptive’ because of its innovative capabilities, but the extent to which these disruptive forces have reconfigured consumer financial knowledge and practices is not well understood. Using a questionnaire to survey retail consumers in Singapore on their use of fintech in performing different financial tasks, this article critically examines these claims of disruption and democratization by grounding them in the financial behaviors of consumers as informed by a financial ecologies approach. The results show a limited impact of fintech in shaping consumer financial behaviors. Respondents use fintech mainly for basic transactional purposes like making mobile payments and account management, but not so much for more complex matters like savings, investing and credit. The findings also reveal a ‘stickiness’ in financial behaviors that emphasizes the high touch points of human interaction. This study illustrates fintech's variegated material outcomes by highlighting the unevenness in consumption of digital financial services and the enduring importance of human relationality in financial decision making.

Balancing the high tech and high touch in education: the implementation of humanistic approach on edu-recreation concept in politeknik pariwisata bali

The implementation of a humanistic approach in educational institutions could be guidance in balancing High Tech and High Touch. The humanistic approach is defined as a physical and spiritual activity to maximize the development process, as well as an effort to master the treasures of knowledge in a series of overall personality formations. This research is qualitative research that analyzes the application of the humanistic approach in the design of the Edu-Recreation concept at the Bali Tourism Polytechnic (Politeknik Pariwisata Bali) through the study of documents and other literature, and also observation and interview. The results of the research are proposed as input for developing existing designs so that they can have a more significant influence in improving the quality of education at the Bali Tourism Polytechnic. As the result, the Edu-Recreation concept design at the Bali Tourism Polytechnic has implemented values in the humanistic education approach, namely the development of the affective aspects of students and the freedom to develop self-potential.

Developing a High Touch Model for Misconduct Processes

Using principles of restorative justice and best practices, we developed a new administrative model for misconduct procedures, with some significant success in reducing recidivism and increasing awareness amongst faculty and students. Key aspects included low barriers for instructors to report issues and semi-scripted student interviews for each offense. Though this 'high touch' model may not be fully scalable to all academic units, the interviewing process was particularly effective at identifying issues with student well being and academic struggles, allowing us to put students in touch with additional resources. We were also able to identify issues with instructions to students on exams and mistakes by instructors, which we used to inform faculty and prevent possible future harm to students. For these reasons, we advocate for a high touch approach to misconduct at an early stage of reporting.

Essential Oil Disinfectant Efficacy Against SARS-CoV-2 Microbial Surrogates.

Reports of COVID-19 cases potentially attributed to fomite transmission led to the extensive use of various disinfectants to control viral spread. Alternative disinfectants, such as essential oils, have emerged as a potential antimicrobial. Four essential oil blends were tested on three different surfaces inoculated with a coronavirus surrogate, bacteriophage Phi 6, and a bacterial indicator, Staphylococcus aureus. Log10 concentration reductions were analyzed using GraphPad Prism software. Data collected in this study show that the application of dilute essential oil disinfectants using a spray delivery device is an effective way to reduce concentrations of bacterial and viral microorganisms on ceramic, stainless steel, and laminate surfaces. Surrogate viruses were reduced up to 6 log10 PFU and bacterial were reduced up to 4 log10 CFU. Although surfaces are no longer considered a high risk fomite for COVID-19 transmission, the disinfection of microorganisms on surfaces remains an important consideration for high touch areas in hospitals, waiting rooms, etc. The application of spray disinfectants, based on essential oil blends, provides a rapid and effective means to reduce microbial contamination on high-touched surfaces.