Hygiene Monitoring Research Articles

Surface Hygiene Evaluation Method in Food Trucks as an Important Factor in the Assessment of Microbiological Risks in Mobile Gastronomy.

Street food outlets are characterised by poor microbiological quality of the food and poor hygiene practices that pose a risk to consumer health. The aim of the study was to evaluate the hygiene of surfaces in food trucks (FT) using the reference method together with alternatives such as PetrifilmTM and the bioluminescence method. TVC, S. aureus, Enterobacteriaceae, E. coli, L. monocytogenes, and Salmonella spp. were assessed. The material for the study consisted of swabs and prints taken from five surfaces (refrigeration, knife, cutting board, serving board, and working board) in 20 food trucks in Poland. In 13 food trucks, the visual assessment of hygiene was very good or good, but in 6 FTs, TVC was found to exceed log 3 CFU/100 cm2 on various surfaces. The assessment of surface hygiene using various methods in the food trucks did not demonstrate the substitutability of culture methods. PetrifilmTM tests were shown to be a convenient and reliable tool for the monitoring of mobile catering hygiene. No correlation was found between the subjective visual method and the measurement of adenosine 5-triphosphate. In order to reduce the risk of food infections caused by bacteria in food trucks, it is important to introduce detailed requirements for the hygiene practices used in food trucks, including techniques for monitoring the cleanliness of surfaces coming into contact with food, in particular cutting boards and work surfaces. Efforts should be focused on introducing mandatory, certified training for food truck personnel in the field of microbiological hazards, appropriate methods of hygienisation, and hygiene monitoring.

Penile gangrene due to improper application of a condom catheter: a case report

BackgroundFournier’s gangrene is a rare, fulminant, and usually localized necrotizing soft tissue polymicrobial infection of the perineum, with occasional extension up to the abdominal wall.Case presentationWe describe an unusual case of penile gangrene in a 64-year-old Tunisian man suffering from urinary incontinence secondary to cerebrovascular accident. Gangrene developed due to continuous tourniquet effect on the penis caused by a condom catheter. Although source control was achieved with aggressive debridement, careful wound care, and wide-spectrum antibiotherapy, the patient died due to septic shock.ConclusionUse of condom catheters is not without complications. Careful placement, strict hygiene, and regular monitoring of the local condition are necessary.

659 - Implementing an electronic hand hygiene monitoring system across a large healthcare system during the COVID-19 pandemic

659 - Implementing an electronic hand hygiene monitoring system across a large healthcare system during the COVID-19 pandemic

Robust hand hygiene monitoring for food safety using hand images

Hand hygiene is essential for food safety and food handlers. Maintaining proper hand hygiene can improve food safety and promote public welfare. However, traditional methods of evaluating hygiene during food handling process, such as visual auditing by human experts, can be costly and inefficient compared to a computer vision system. Because of the varying conditions and locations of real-world food processing sites, computer vision systems for recognizing handwashing actions can be susceptible to changes in lighting and environments. Therefore, we design a robust and generalizable video system that is based on ResNet50 that includes a hand extraction method and a 2-stream network for classifying handwashing actions. More specifically, our hand extraction method eliminates the background and helps the classifier focus on hand regions under changing lighting conditions and environments. Our results demonstrate our system with the hand extraction method can improve action recognition accuracy and be more generalizable when evaluated on completely unseen data by achieving over 20% improvement on the overall classification accuracy.

Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study

BackgroundThe purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). Methods and materialsThis was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. ResultsWe identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). ConclusionIn this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.

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

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

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

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

Hand hygiene monitoring: Comparison between app and paper forms for direct observation.

Healthcare-associated infections (HAIs) are a global public health threat. Italy is one of the countries with the highest prevalence of HAI. Hand hygiene (HH) is a pillar of infection prevention and control. Monitoring HH is necessary to improve HH compliance, and direct observation is considered the gold standard. Transcription and analysis of data collected during direct observation of HH compliance with the WHO paper form are time-consuming. We collected, during a 9-day observation period, HH opportunities and compliance both with a smartphone application (SpeedyAudit) and with the WHO paper form. Then, we investigated the difference in the requiredtime for data transcription and analysis between the WHO paper form and the use of the app. The difference in the required time for data transcription and analysis was significant with a mean time of 2 s using the app and about 14-54 min/day using paper form (p=.004) while no significant difference was found in measured compliance rates between the two data collecting methods. HH monitoring with an app is time-saving, and the app we used was easy to use.

Impact of an intervention on the surface of cellular telephones in a hospital in Salta

Introduction: Cell phones, especially those used by healthcare personnel, have high levels of bacterial contamination, including multidrug-resistant nosocomial pathogens, posing a significant risk of disease transmission in hospital and community settings. Studies reveal that these often uncleaned and widely used devices can be a major source of cross-infection. Methods: In this observational, quasi-experimental epidemiological study, we analyzed bacterial contamination on cell phones of healthcare personnel (N=80) in three stages: pre-intervention, intervention and post-intervention. An educational strategy, monitoring of cleanliness, hand hygiene and use of glass bottles was implemented, and the results of the swabs before and after the intervention, carried out between March and April 2022, were compared. Results: The study analyzed the presence of germs in cell phones of health personnel in two phases, obtaining a total of 240 samples. A high prevalence of Escherichia coli and Pseudomonas aeruginosa was observed in the screens and cases, and cleaning and disinfection strategies were implemented that achieved an improvement of more than 90% in the reduction of germs, demonstrating that cell phones can be controllable sources of infection with appropriate measures. Conclusion: The intervention was successful, highlighting the importance of improving hygiene, cleanliness and safety culture in the use of cell phones by healthcare personnel.

Providers’ Experience with Artificial Intelligence-Based System During the COVID-19 Pandemic

Abstract Background As the pandemic continues to spread worldwide, many of healthcare facilities are exploring new methods to keep their patients safe from potential hospital-acquired infections (HAIs) during the pandemic. This study explored the attitudes about artificial intelligence (AI) among providers who utilized AI-based hand hygiene monitoring system (HHMS) at a rural medical center during the pandemic. Methods A self-administered questionnaire was mailed to 48 healthcare providers at a rural medical center in north Texas, with a 75% percent response rate (n = 36). The survey collected information on providers attitudes about AI-based HHMS use. In addition, the study also examined the relationship between provider’s well-being and the level of satisfaction with the AI-based HHMS use. The lessons learned from this study will be used to determine important factors to consider when attempting to advance and expand AI technologies in rural healthcare settings. Results Results revealed that the integration of AI technology within the existing electronic health record (EHR) system remains a challenge for many providers. Plus, the lack of user-centered design approaches to incorporate the AI tool into existing workflows has reduced providers satisfaction about the new technology. Conclusions The findings suggested that although AI technology has great promise to reduce the number of hospital-acquired infections (HAIs), successfully implement of an AI-based tool that meets the expectations of users requires significant levels of consolidation to ensure that it fits within the existing workflows and is accepted by users. Key messages • AI application indirectly affects the well-being of providers, particularly in rural healthcare settings. • A better AI application interface design that meets the expectations of providers is needed.

A multi-centre study of the effects of direct observation of hand hygiene practices on alcohol-based handrub consumption

The World Health Organization recommends monitoring alcohol-based handrub (ABHR) consumption and direct observation of hand hygiene practices to ensure compliance. In Japan monitoring of ABHR consumption is widely performed. However, direct observation is not common, particularly in small facilities and non-acute-care facilities. Hence, the current study aimed to evaluate the longitudinal effects of direct observation of hand hygiene practices and monitoring of ABHR consumption with provision of feedback to healthcare personnel on ABHR consumption and hand hygiene compliance. We conducted a 4-year prospective intervention study. Monitoring of ABHR consumption and direct observation of hand hygiene practices with monthly feedback to healthcare personnel was implemented in 17 facilities. These consisted of 11 acute-care facilities of varying sizes and six non-acute-care facilities. A generalized linear mixed model analysis was performed to assess factors associated with ABHR consumption. All facilities implemented ABHR consumption monitoring within one month of starting the study. However, the mean time required to implement direct observation of hand hygiene practices was 24.7 (±19.1) months. The ABHR consumption increased significantly (P<0.0001) in all medical facilities after implementing the direct observation. Multivariable regression analysis showed the hospital ward type, duration of ABHR consumption monitoring, and duration of direct observation of hand hygiene practices were independently associated with ABHR consumption. Direct observation of hand hygiene practices with feedback should be implemented more widely in combination with ABHR consumption monitoring to help increase hand hygiene compliance.

Stages of radiation monitoring on the territory of the Tula region affected in consequence of the Chernobyl NPP accident

More than half of the Tula oblast territory was contaminated following the accident at the Chernobyl nuclear power plant. This article describes the stages of radiation hygiene monitoring of objects in the habitat in the Tula region impacted by radioactive contamination. Information is given on changes in radioactively contaminated areas at different periods after the accident. An assessment is made of the radiological situation at the initial “iodic” period of the accident, the subsequent “cesium” period, and at the current stage. A description is given of work done by the oblast’s state sanitary and epidemiological service based on radiation monitoring results for reducing the radiation exposure of the population at different stages of supervision. Information is supplied on high levels of gamma background up to 35 mkSv/h during the “iodic” period. Tabulated data are supplied on exceeding the tentative maximum permissible level of iodine-131 content in dairy products produced in Plavski district, the most contaminated area in the region. Data are given on laboratory tests on food products for total beta activity in 1986-87 and the frequency of exceeding the permissible level of cesium-137 content during 1986. The above permissible content of radionuclides in food products was registered only in 1986 due to surface contamination of plants, while in wild mushrooms this took place as late as 2004. Currently, the proved content of cesium-137 and strontium-90 in food products is determined only by the radio-chemical method. A table is supplied showing results of radio-chemical research on major dose contributing food products from 2010 to 2021. The article supplies a table with numeric values of annual average effective doses of radiation sustained by the population of settlements located in the Chernobyl radioactively contaminated zone during 1986 through 2021. The dose of the population’s exposure to the Chernobyl radiation since 1994 does not exceed 1 mSv/year. In 2021, the population’s annual effective dose in 98.3% of settlements amounted to less than 0.2 mSv/year.

Prospective study on the risk of transmission due to droplets and aerosols during an endoscopic procedure and the usefulness of extraoral suction devices.

Endoscopy poses a high risk of severe acute respiratory syndrome coronavirus 2 infection for medical personnel due to the dispersal of aerosols from the patient. We investigated the location and size of droplets generated during esophagogastroduodenoscopy (EGD) and endoscopic submucosal dissection (ESD), the contamination of the surrounding area before and after the procedures, and the effectiveness of using an extraoral suction device (Free arm arteo; TOKYO GIKEN, Inc., Tokyo, Japan). Patients who consented to the study and underwent EGD or ESD between December 8, 2020, and April 15, 2021, at the National Cancer Center East Hospital were included. Adenosine triphosphate (ATP) hygiene monitoring tests and a particle counter were used for measurements. Assessments were performed on 22 EGD and 15 ESD cases. ATP hygiene monitoring tests showed significant elevations at three sites near the patient, and two sites 1.5 m away, for EGD, and at four sites near the patient and 1.5 m away for ESD. In both ESD and EGD, extraoral suction devices reduced the extent of the contamination. Particles <5 μm in size were generated during endoscopic procedures and dispersed from both the forceps hole and the patient's mouth. The extraoral suction device did not reduce the number of particles generated. During endoscopic procedures, cleaning the surrounding environment is important in addition to standard precautions the endoscopist and caregivers take. The use of extraoral suction devices can also potentially reduce contamination of the surrounding environment.

Realizing healthy culinary tourism through education in the ‘Angkringan’ street vendor community of Yogyakarta city during the COVID-19 pandemic

Angkringan is included in the culinary options of Java, although it involves a simple food stall on the roadside using a wheelbarrow and covered with a plastic tarpaulin as the roof.However, food safety is one of the main factors that influence tourists in choosing Angkringan culinary spots. Therefore, it is necessary to monitor the quality of food management by paying attention to health requirements including hygiene and sanitation procedures. This study aimed to analyze the differences in the food safety scores of Angkringan street vendors in Yogyakarta City before and after an intervention. We conducted a quantitative study with an experimental design from March to May 2021. We intervened with health education through pocketbooks in 49 communities of Angkringan street vendors in Yogyakarta tourism locations with a duration of one month. Data collection was conducted through the Food Safety Score Questionnaire while data analysis used Wilcoxon signed-rank tests. The majority of Angkringan street vendors had a category of Food Safety Score that was vulnerable but safe to consume before and after the pocketbook intervention. However, the influence of the intervention showed significant differences in research results (p-value &lt; 0.05). This study concluded that health education interventions with pocketbooks among the Angkringan street vendors could positively affect food safety scores. We recommend that the government foster food hygiene education and monitoring of Angkringan street vendors, especially during the COVID-19 pandemic.

Why is strict monitoring of hand hygiene required for patient safety in hospitals?

Why is strict monitoring of hand hygiene required for patient safety in hospitals?

Novel care bundle of established basic and practical approaches greatly reduces urinary tract infections in nursing facility residents without indwelling catheters

BackgroundResidents in nursing facilities (NFs) are at greater risk of developing urinary tract infections (UTIs) with higher hospitalizations and costs than people living in communities. These residents also have increased likelihood of uroseptic shock and death. The objective of the study was to prevent UTIs and to reduce UTI-associated costs among NF residents. MethodsQuality assurance performance improvement initiative conducted between April 1, 2018 and March 31, 2022 at a large skilled NF. Participants were 262 residents newly diagnosed with UTIs without indwelling catheters. The initiative consisted of (1) a 12-month baseline; (2) a 12-month intervention; and (3) a 24-month follow-up. A novel care bundle which included staff's hand hygiene monitoring, residents’ hydration status, effective incontinence and perineal care, and in-house UTI treatment was implemented during the intervention. The plan-do-study-act cycle was used to gauge its effectiveness. ResultsQuarterly UTI rates decreased from 4.2% at baseline to 0.9% at follow-up, a 79% reduction (P < .001). All 262 residents were treated in-house with no UTI-related hospitalizations. Antibiotic prescriptions fell from 373 at baseline down to 143 at follow-up, a 62% reduction. Facility costs decreased from $42,188 at baseline to $8,281 at follow-up (P < 0.001). ConclusionThis bundle was very effective in preventing UTIs and reducing UTI-associated costs. Its use in other NFs is encouraged to determine suitability elsewhere.

Serratia marcescens outbreak in a neonatal intensive care unit associated with contaminated donor milk.

Investigation of the origin of a Serratia marcescens outbreak in a neonatal intensive care unit. Retrospective case-control study. Regional level 3 perinatal center in Germany. This study included 4 S. marcescens-positive and 19 S. marcescens-negative neonates treated between February 1 and February 26, 2019, in the neonatal intensive care unit. A case-control study was performed to identify the source of the outbreak. The molecular investigation of S. marcescens isolates collected during the outbreak was performed using pulsed-field gel electrophoresis and next-generation sequencing. The retrospective case-control study showed a significant correlation (P < .0001) between S. marcensens infection or colonization and consumption of donor milk that had tested negative for pathogenic bacteria from a single breast milk donor. Pulsed-field gel electrophoresis and next-generation sequencing retrospectively confirmed an S. marcescens strain isolated from the breast milk of this donor as the possible origin of the initial outbreak. The outbreak was controlled by the implementation of an infection control bundle including a multidisciplinary infection control team, temporary nutrition of infants with formula only and/or their mother's own milk, repeated screening of all inpatients, strict coat and glove care, process observation, retraining of hand hygiene and continuous monitoring of environmental cleaning procedures. Low-level contaminated raw donor milk can be a source of infection and colonization of preterm infants with S. marcescens even if it tests negative for bacteria.

Health, hygiene, and microbial monitoring during long-duration space simulations

The significance of the human-microbe relationship is amplified in long duration space exploration (LDSE), where isolated and confined microbial environments degenerate space habitat integrity, compromise planetary protection goals, and have largely unknown and potentially deleterious effects on astronaut health. While environmental surveillance is assumed to be a key component of future deep space missions, the optimal modality, frequency, and location of such surveillance is not yet defined. In order to investigate strategies of microbial surveillance, a series of experiments, conducted at a long-duration, isolated and confined (ICE) Mars simulation, furthered our understanding of the microbiome sampling challenges presented by food, environment, and crewmembers. Descriptive analyses revealed key considerations for microbial monitoring in future long duration space missions, including special considerations for surface sanitation, previously undocumented potential sources of food-borne toxicity, and a novel outlook on the dynamic human microbiome in isolation.

Development and evaluation of an ultra-wide bandwidth based electronic hand hygiene monitoring system

BackgroundA large variety of electronic hand hygiene monitoring systems (EHHMS) are being developed and applied in health care settings. Monitoring hand hygiene (HH) opportunity at bed-level has been the key technical challenge. Accuracy evaluation needs more attention as the prerequisite upon widespread acceptance and adoption. MethodsFor the first time, we explored, debugged and upgraded an EHHMS based on ultra-wide bandwidth (UWB) which can obtain HH opportunities at bed-level. The real-time positioning and electronic fence of UWB technology was applied for EHHMS. The accuracy of EHHMS was compared with the simultaneous manual direct observations in real-world clinical setting. Sensitivity and specificity were calculated for EHHMS capturing HH action and opportunity. ResultsTwo generations of EHHMS were constructed. For the first generation, the system properly recorded 84% and 78% of the pre-identified HH actions and opportunities performed by experimenters. For the second generation, sensitivity and specificity of the system capturing HH action were 89% (84.83-92.36) and 100% (98.26-100.00), respectively. For capturing HH opportunity, the system showed the sensitivity and specificity of 86.52% (82.52-89.89) and 88.10% (84.14-91.36)), respectively. ConclusionThe EHHMS based on UWB could accurately identify HH action and opportunity with equivalent accuracy compared with simultaneous direct observation.

A Comprehensive Analysis of ATP Tests: Practical Use and Recent Progress in the Total Adenylate Test for the Effective Monitoring of Hygiene

Rapid hygiene monitoring tests based on the presence of ATP have been widely used in the food industry to ensure that adequate cleanliness is maintained. In this study, the practical applications and limitations of these tests and recent technological progress for facilitating more accurate control were evaluated. The presence of ATP on a surface indicates improper cleaning and the presence of contaminants, including organic debris and bacteria. Food residues are indicators of insufficient cleaning and are direct hazards because they may provide safe harbors for bacteria, provide sources of nutrients for bacterial growth, interfere with the antimicrobial activity of disinfectants, and support the formation of biofilms. Residues of allergenic foods on a surface may increase the risk of allergen cross-contact. However, ATP tests cannot detect bacteria or allergenic proteins directly. To ensure efficient use of commercially available ATP tests, in-depth knowledge is needed regarding their practical applications, methods for determining pass-fail limits, and differences in performance. Conventional ATP tests have limitations due to possible hydrolysis of ATP to ADP and AMP, which further hinders the identification of food residues. To overcome this problem, a total adenylate test was developed that could detect ATP+ADP+AMP (A3 test). The A3 test is suitable for the detection of adenylates from food residues and useful for verification of hygiene levels. The A3 test in conjunction with other methods, such as microorganism culture and food allergen tests, may be a useful strategy for identifying contamination sources and facilitating effective hygiene management.