Improve Hand Hygiene Research Articles

Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

Did Clostridioides difficile Testing and Infection Rates Change During the COVID-19 Pandemic?

Background: The COVID-19 pandemic has underscored the importance of ongoing infection prevention efforts. Increased adherence to infection prevention recommendations, increased antibiotic use, improved hand hygiene, and correct donning and doffing of personal protective equipment may have influenced healthcare-associated infections (HAIs) in the United States during the pandemic. In this study, we investigated testing for Clostridioides difficile infection (CDI) and incidence during the initial surge of the pandemic. We hypothesized that strict adherence to contact precautions may have resulted in a decreased incidence of CDI in hospitalized patients during the first peak of the COVID-19 pandemic and that CDI testing may have increased even in the absence of directed diagnostic stewardship efforts. Methods: We conducted a single-center, retrospective, observational study at the Veterans’ Affairs (VA) Hospital in Ann Arbor, Michigan, between January 2019 and June 2020. We compared data on CDI tests from January 2019 through February 2020 to data from March 2020 (the admission of the first patient with COVID-19 at our institution) through June 2020. Pre-peak and peak periods were defined by confirmed cases in Washtenaw County. No novel diagnostic or CDI-focused stewardship interventions were introduced by the antimicrobial stewardship program during the study period. An interrupted time series analysis was performed using STATA version 16.1 software (StataCorp LLC, College Station, TX). Results: There were 6,525 admissions and 34,533 bed days between January 1, 2019, and June 30, 2020. Also, 900 enzyme immunoassay (EIA) tests were obtained and 104 positive cases of CDI were detected between January 2019 and June 2020. A statistically significant decrease in EIA tests occurred after March 1, 2020 (the COVID-19 peak in our region) compared to January 1, 2019–March 1, 2020 (Figure 1). After March 1, 2020, the number of EIA tests obtained decreased by 10.2 each month (95% CI, −18.7 to −1.7; P = .02). No statistically significant change in the incidence of CDI occurred. The use of antibiotics that were defined as high risk for CDI increased in the months of April–June 2020 (Figure 2). Conclusions: In this single-center study, we observed a stable incidence of CDI but decreased testing during the first peak of the COVID-19 pandemic. Understanding local HAI reporting is critical because changes in HAI reporting structures and exemptions during this period may have affected national reporting. Further research should be undertaken to investigate the effect of COVID-19 on other HAI reporting within the US healthcare system.Funding: NoDisclosures: None

Improving hand hygiene standards in the veterinary setting.

Improving hand hygiene standards in the veterinary setting.

Comparing the effects of face-to-face and video-based educations on hand hygiene knowledge and performance among mothers in neonatal intensive care unit: A randomized controlled trial

Background: Hand hygiene is the first step in nosocomial infection control. However, most people have limited knowledge about proper hand hygiene. Objectives: This study aimed at comparing the effects of face-to-face education (FTFE) and video-based education (VBE) on hand hygiene knowledge and performance among mothers in neonatal intensive care unit (NICU). Methods: Using a three-group design, this randomized controlled trial was conducted in March–December 2019 in Al-Zahra University Hospital, Tabriz, Iran. In total, 132 mothers of neonates in NICU were recruited to the study through convenient sampling and were randomly allocated to either an FTFE group, a VBE group, or a control group. Data were collected before and 3 days after the intervention using a Maternal Hand Hygiene Knowledge Questionnaire and a Maternal Hand Hygiene Performance checklist. Data analysis was performed using the Chi-square test, paired-samples t-test, one-way analysis of variance, and analysis of covariance. Results: The mean scores of hand hygiene knowledge and performance significantly increased in both the intervention groups (P 0.05). There were no significant differences among the groups regarding the pretest mean scores of hand hygiene knowledge (P = 0.24) and performance (P = 0.26), while the posttest mean scores of hand hygiene knowledge and performance in both the intervention groups were significantly greater than the control group (P < 0.05). Conclusion: Both FTFE and VBE are effective in significantly improving hand hygiene knowledge and performance among the mothers of neonates in NICU.

"Did you wash your hands?": a prospective study of patient empowerment to prompt hand washing by healthcare providers.

Hand hygiene is paramount in preventing the spread of healthcare-associated infections especially during disease epidemics. Compliance rates with hand hygiene policies remain below 50% internationally and may be lower in the outpatient care setting. This study assessed the impact of the patient empowerment model on hand hygiene compliance among healthcare providers. From October 2016 to May 2017, patients from a large ambulatory oncology centre were prospectively enrolled. Patients were instructed to observe healthcare providers for hand hygiene compliance and to remind healthcare providers where it was not observed during at least three consecutive encounters. Healthcare provider reactions to this intervention were rated by patients. Patients' hand hygiene knowledge and beliefs were objectively elicited pre and post-study. Thirty patients with a median age of 52 years (range 5-91) completed the study for a total of 190 healthcare provider encounters. When initial hand hygiene was not observed, patients offered a reminder in 71 (37.4%) encounters, did not offer a reminder in 73 (38.4%) encounters and forgot to offer a reminder in 24 (14.2%) encounters. Patients perceived positive or neutral reactions in 76.8% of encounters and negative or surprised reactions in 23.2% of encounters. Healthcare provider compliance improved from 11.6% to 48.9% with intervention. Patient hand hygiene knowledge improved by 16% following the study. Patient-empowered hand hygiene may be a useful adjunct for improving hand hygiene compliance among healthcare providers and improving patient hand hygiene knowledge, although it may confer an emotional burden on patients.

Impact of a Multimodal Improvement Strategy to Promote Hand Hygiene at a Hospital in Mauritius.

IntroductionLimited data is available on which interventions are likely to improve compliance to hand hygiene, especially in underdeveloped countries. The objective of this study is to explore whether the introduction of a particular bundle of strategies to improve hand hygiene is effective.Material and methodsIn this pre-post study, a multimodal strategy comprised of educating healthcare staff, using reminders, providing feedback and increasing the availability of soap and alcohol, was implemented over a period of one year from 2019 to 2020. Trained observers assessed compliance to hand hygiene before and after the intervention.ResultsA total of 143 hand hygiene opportunities were observed. Hand hygiene compliance rate did not improve despite the introduction of multiple measures.ConclusionsOther approaches should be considered to promote hand hygiene. The choice of which strategies to use should be adapted to the local setting. For instance, in some healthcare facilities, emphasis should be placed on leadership support and on the training of hand hygiene champions.

Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study

BackgroundDespite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of a facility –based hand hygiene behaviour change intervention in Kampong Chhnang, Cambodia, a theory-driven formative research study was conducted to investigate the context specific behaviours and determinants of handwashing during labour and delivery among birth attendants.MethodsThis formative mixed-methods research followed a sequential explanatory design and was conducted across eight healthcare facilities. The hand hygiene practices of all birth attendants present during the labour and delivery of 45 women were directly observed and compliance with hand hygiene protocols assessed in analysis. Semi-structured, interactive interviews were subsequently conducted with 20 key healthcare workers to explore the corresponding cognitive, emotional, and environmental drivers of hand hygiene behaviours.ResultsBirth attendants’ compliance with hand hygiene protocol was 18% prior to performing labour, delivery and newborn aftercare procedures. Hand hygiene compliance did not differ by facility type or attendants’ qualification, but differed by shift with adequate hand hygiene less likely to be observed during the night shift (p = 0.03). The midwives’ hand hygiene practices were influenced by cognitive, psychological, environmental and contextual factors including habits, gloving norms, time, workload, inadequate knowledge and infection risk perception.ConclusionThe resulting insights from formative research suggest a multi-component improvement intervention that addresses the different key behaviour determinants to be designed for the labour and delivery room. A combination of disruption of the physical environment via nudges and cues, participatory education to the midwives and the promotion of new norms using social influence and affiliation may increase the birth attendants’ hand hygiene compliance in our study settings.

Prevalence and associated factors of wheeze in early infancy.

The aim of this study was to assess the prevalence of wheeze in early childhood and to characterize associated factors for wheeze that could identify potentially feasible interventions for the future prevention of wheeze. We performed a cross-sectional analysis of the data from the International Study of Asthma and Allergies in Childhood (ISAAC)-modified self-administered questionnaire of parents of 4-month-old infants at well-child visits (mandatory health check-ups) in Nagoya City, Japan, between April 2016 and March 2017 (development dataset) and between April 2017 and March 2018 (validation dataset). We used a multivariable, multilevel analysis to identify significant (P<0.05), associated factors (Bonferroni correction was applied as necessary) after adjustment for local outbreaks of virus-transmitted diseases, access to medical facilities, and socioeconomic status. Among the 20362 questionnaires given to families of infants living in Nagoya City (development dataset), 19104 questionnaires (93.8%) were analyzed after data cleaning. In all, 1,446 (7.6%) infants experienced wheeze at least once within 4months of age, 991 (5.2%) visited the clinic/hospital with wheeze, and 244 (1.3%) underwent hospitalization at that time. In the multilevel, multivariable model for hospitalization with wheeze, significant associated factors were male sex (adjusted odds ratio 1.8; 95% confidence interval 1.4-2.3), maternal current smoking (3.3; 2.0-5.5), and having at least one sibling (3.0; 2.2-4.1). These factors were also associated with wheeze and clinic/hospital visit with wheeze, and the results were confirmed in the validation dataset. Our study highlights that smoking cessation among mothers and improved hand hygiene at home are two interventions that could potentially decrease wheeze in early infancy.

Identifying interventions to improve hand hygiene compliance in the intensive care unit through co-design with stakeholders.

Background: Despite the effectiveness of hand hygiene (HH) for infection control, there is a lack of robust scientific data to guide how HH can be improved in intensive care units (ICUs). The aim of this study is to use the literature, researcher, and stakeholder opinion to explicate potential interventions for improving HH compliance in the ICU, and provide an indication of the suitability of these interventions. Methods: A four-phase co-design study was designed. First, data from a previously completed systematic literature review was used in order to identify unique components of existing interventions to improve HH in ICUs. Second, a workshop was held with a panel of 10 experts to identify additional intervention components. Third, the 91 intervention components resulting from the literature review and workshop were synthesised into a final list of 21 hand hygiene interventions. Finally, the affordability, practicability, effectiveness, acceptability, side-effects/safety, and equity of each intervention was rated by 39 stakeholders (health services researchers, ICU staff, and the public). Results: Ensuring the availability of essential supplies for HH compliance was the intervention that received most approval from stakeholders. Interventions involving role models and peer-to-peer accountability and support were also well regarded by stakeholders. Education/training interventions were commonplace and popular. Punitive interventions were poorly regarded. Conclusions: Hospitals and regulators must make decisions regarding how to improve HH compliance in the absence of scientific consensus on effective methods. Using collective input and a co-design approach, the guidance developed herein may usefully support implementation of HH interventions that are considered to be effective and acceptable by stakeholders.

Hand hygiene behavior among Sri Lankan medical students during COVID-19 pandemic

BackgroundPoor compliance with hand hygiene practices among medical students poses a risk for cross-infection. It has become more critical during the COVID-19 pandemic than ever before. This study aimed to determine the knowledge, attitudes, practices of hand hygiene among final-year medical students. It also explored reported hand hygiene behavior before the COVID-19 pandemic and the need for educational strategies to correct the deficiencies.MethodsA concurrent mixed-method approach was used. In the quantitative strand, a cross-sectional online survey was carried out via a Google form. Mann-Whitney U test and Chi-squared test were used for comparisons. In the qualitative strand, twelve participants were interviewed, based on a semi-structured interview guide and audio recorded. Transcribed data were evaluated with thematic content analysis.ResultsA total of 225 final-year medical students were studied in the quantitative strand. Most were females. The mean score for knowledge was 3.35 ± 0.795 out of six. Of them, 31.6 % of participants scored below 3 points (< 50 % of the total). Most (78.9 %) had positive attitudes (score of > 80 %). Only 36.4 % reported “adequate” hand hygiene performance in all eight dimensions of the behavior domain. Noticeably, fewer participants reported to clean their hands after checking blood pressure (55.6 %), and only 66.2 % stated carrying a hand sanitizer in their pocket. Significant correlations were not found between reported behavior and attitudes (p = 0.821) or knowledge (p = 0.794). The qualitative strand with 12 respondents revealed the positive influence of both hierarchical and non-hierarchal role models. Time constraints, skin irritation, and workload pressures were the main barriers. Frequent reminders, supervision, and interactive teaching were suggested as methods to improve hand hygiene compliance. They also stated that increased enthusiasm was noted on hand hygiene during the COVID-19 pandemic compared to the pre-pandemic period.Conclusions Most of the participants had positive attitudes towards hand hygiene. Yet, a considerable gap between attitudes and knowledge and reported hand hygiene behavior was evident. Coupling educational programs that use cognitive and behavioral methods, including role modeling, supervision, and frequent reminders, is recommended to bridge the knowledge-attitude-behavior gap.

Clinical Evaluation with Automated Hand Hygiene Monitoring System: A Prospective Observational Study on Compliance Improvement Using Feedback Data

Background Hand hygiene compliance (HHC) among healthcare workers (HCWs) remains suboptimal. Hand hygiene (HH) among HCWs is regarded one of the most effective measures to reduce healthcare-associated infections. We aimed to evaluate HH improvement in HCWs using an automated monitoring system to provide systematic feedback on staff HHC. Methods A prospective observational study was conducted in a Danish medical hospital ward (23 beds) between February-November 2020. Sensors were placed on alcohol-based sanitizers, HCW name tags, and patient beds. The sensors measured HH opportunities and sanitizations to be able to provide compliance feedback to staff groups and individuals. Baseline data were obtained before the reporting of feedback data. HCWs were grouped as caregivers (n=58) and doctors (n=18). Rooms were classified by type e.g., medication room and patient room. Overall data was regularly presented to the staff group and subgroups, caregivers, and doctors. Student's t-test was used for comparisons. A two-tailed value of p Results Baseline was performed twice (at weeks 4 and 5 because the COVID19 pandemic interrupted the study for a period). Both baselines showed similar initial compliance among HCW. Baseline HHC was lowest before patient contact (BPC) compared to after patient contact (APC) for both the doctors (16% vs. 26%) and the nurses (22% vs. 39%). Once data were shown and feedback provided, both the doctors (BPC: 16% vs. 24%, p=0.014; APC: 26% vs. 35% p=0.059) and caregivers (BPC: 22% vs. 37%, p Conclusions Feedback data from the automated hand hygiene monitoring system helped the HCWs to improve their HHC significantly.

Changes in infection-related hospitalizations in children following pandemic restrictions: an interrupted time-series analysis of total population data.

BackgroundInfectious diseases are a leading cause of hospitalization during childhood. The various mitigation strategies implemented to control the coronavirus disease (COVID-19) pandemic could have additional, unintended benefits for limiting the spread of other infectious diseases and their associated burden on the health care system.MethodsWe conducted an interrupted time-series analysis using population-wide hospitalization data for the state of Victoria, Australia. Infection-related hospitalizations for children and adolescents (aged <18 years, total source population ∼1.4 million) were extracted using pre-defined International Classification of Diseases 10th Revision Australian Modification (ICD-10-AM) codes. The change in weekly hospitalization rates (incidence rate ratio, IRR) for all infections following the introduction of pandemic-related restrictions from 15 March 2020 was estimated.ResultsOver 2015–19, the mean annual incidence of hospitalization with infection among children less than 18 years was 37 per 1000 population. There was an estimated 65% (95% CI 62-67%) reduction in the incidence of overall infection-related hospitalizations associated with the introduction of pandemic restrictions. The reduction was most marked in younger children (at least 66% in those less than 5 years of age) and for lower respiratory tract infections (relative reduction 85%, 95% CI 85-86%).ConclusionsThe wider impacts of pandemic mitigation strategies on non-COVID-19 infection-related hospitalizations are poorly understood. We observed marked and rapid decreases in hospitalized childhood infection. In tandem with broader consequences, sustainable measures, such as improved hand hygiene, could reduce the burden of severe childhood infection post-pandemic and the social and economic costs of hospitalization.

Improving hand hygiene practice recommendations for acute-care hospitals.

Improving hand hygiene practice recommendations for acute-care hospitals.

Standardized aseptic dressing change procedure: Optimizations and adherence in a prospective pre- and postintervention cohort study

The "HygArzt" project investigated the effectiveness of hygiene measures introduced by an infection prevention link physician (PLP). To investigate whether the introduction of a standardized aseptic dressing change concept (ADCC) by a PLP can increase hand hygiene adherence and adherence to specific process steps during an aseptic dressing change (ADC) in a trauma surgery and orthopedic department. We defined 4 required hand disinfection indications: (1) before the preparation of ADC equipment, (2) immediately before the ADC, (3) before the clean phase, and (4) after the ADC. A process analysis of the preintervention phase (331 ADCs) was used to develop a standardized ADCC. The ADCC was introduced and iteratively adopted during the intervention phase. The effect was evaluated during the postintervention phase (374 ADCs). Hand hygiene adherence was significantly increased by the introduction of the ADCC for all indications: (1) before the preparation of the ADC equipment (from 34% before to 85% after, P <.001), (2) immediately before an ADC (from 32% before to 85% after; P < .001), (3) before the clean phase (from 42% before to 96% after; P < .001), and (4) after an ADC (from 74% before to 99% after; P < .001). Overall hand hygiene adherence was analyzed before the indications for an ADC (from 9.6% before to 74% after; P < .001). The same strategy was applied to the following process parameters: use of a clean work surface, clean withdrawal of equipment from the dressing trolley, and appropriate waste disposal. A PLP sufficiently implemented a standardized concept for aseptic dressing change during an iterative improvement process, which resulted in a significant improvement in hand hygiene and adherence to other specific ADCC process steps.

The effect of a hand hygiene intervention on infections in residents of nursing homes: a cluster randomized controlled trial

BackgroundThe primary goal of hand hygiene is to reduce infectious disease rates. We examined if a nursing home’s participation in a hand hygiene intervention resulted in residents having fewer healthcare associated infections (HAIs) when compared to nursing homes without the hand hygiene intervention.MethodsThis study is a part of a cluster randomized controlled trial (RCT) in 33 nursing homes to improve hand hygiene (HANDSOME). The incidence of five illnesses was followed over 13 months: gastroenteritis, influenza-like illness, pneumonia, urinary tract infections and infections from methicillin-resistant Staphylococcus aureus (MRSA). Incidence rates per study arm were reported for baseline (October–December 2016) and two follow-up periods (January–April 2017, May–October 2017). HAI rates were compared in a Poisson multilevel analysis, correcting for baseline differences (the baseline infection incidence and the size of the nursing home), clustering of observations within nursing homes, and period in the study.ResultsThere was statistically significantly more gastroenteritis (p < 0.001) and statistically significantly less influenza-like illness (p < 0.01) in the intervention arm when compared to the control arm. There were no statistically significant differences or pneumonia, urinary tract infections, and MRSA infections in the intervention arm when compared to the control arm. In a sensitivity analysis, gastroenteritis was no longer statistically significantly higher in the intervention arm (p = 0.92).ConclusionsAs in comparable studies, we could not conclusively demonstrate the effectiveness of an HH intervention in reducing HAIs among residents of nursing homes, despite the use of clearly defined outcome measures, a standardized reporting instrument, and directly observed HH in a multicenter cluster RCT. Trial registration Netherlands Trial Register, trial NL6049 (NTR6188). Registered October 25, 2016, https://www.trialregister.nl/trial/6049.

Effects of a 4-year intervention on hand hygiene compliance and incidence of healthcare associated infections: a longitudinal study

PurposeStudies have demonstrated improvements in hand hygiene (HH) compliance through interventions, noting the negative association of HH and healthcare associated infections (HAIs), but how to sustain long-term improvement is still unknown in the Chinese population. This study sought to determine the extent of change in HH compliance after multimodal HH interventions, and to evaluate the relationship between that change and HAI incidence.MethodsWe conducted a longitudinal study in a general teaching hospital in China from 2017 to 2020. Trained investigators observed HH practices based on the World Health Organization’s 5 moments for HH. We identified the incidence of HAIs using semi-automated constant surveillance software. We used the Cochran–Mantel–Haenszel test to assess the secular trend of HH compliance and HAIs. The Spearman correlation coefficient (rs) was used to evaluate the relationship between the incidence of HAIs and compliance with HH.ResultsThe study made 480,943 observations, where HH was occurring between 2017 and 2020. HH compliance increased from 68.90 to 91.76% during that period (Ptrend < 0.01), while the incidence of HAIs decreased from 1.10 to 0.91%. Compliance also increased for each moment type and for each healthcare worker (Ptrend < 0.01). Lower HH compliance was observed in before-patient contact and after contact with patient surroundings, and among interns and cleaners. We also observed a weak but statistically significant negative correlation between the monthly HH compliance and incidence of HAIs (rs = − 0.27; P = 0.037).ConclusionsThe multimodal HH implementation delivered sustained improvement in HH compliance, and this change was associated with a decline in the incidence of HAIs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s15010-021-01626-5.

Improving hand hygiene in hospitals: comparing the effect of a nudge and a boost on protocol compliance

AbstractNudging has become a well-known policy practice. Recently, ‘boosting’ has been suggested as an alternative to nudging. In contrast to nudges, boosts aim to empower individuals to exert their own agency to make decisions. This article is one of the first to compare a nudging and a boosting intervention, and it does so in a critical field setting: hand hygiene compliance of hospital nurses. During a 4-week quasi-experiment, we tested the effect of a reframing nudge and a risk literacy boost on hand hygiene compliance in three hospital wards. The results show that nudging and boosting were both effective interventions to improve hand hygiene compliance. A tentative finding is that, while the nudge had a stronger immediate effect, the boost effect remained stable for a week, even after the removal of the intervention. We conclude that, besides nudging, researchers and policymakers may consider boosting when they seek to implement or test behavioral interventions in domains such as healthcare.

Improving Hand Hygiene Compliance of Intensive Care Unit by Using Pender's Model.

Hand hygiene (HH) compliance is an effective behavior in controlling hospital-acquired infection because the hand is the main means of transmitting infections in patient-medical staff communication as well as the inanimate environment. This study aimed to explore the effect of applying Pender's Health Promotion Model on the HH compliance of intensive care unit staff. This quasi-experimental study with a single research group was conducted from January to July in 2019. The required data were collected from 90 staff of the intensive care units of Imam Reza Hospital in Mashhad, Iran through 1796 and 2343 opportunity of monitoring before and after the intervention. The data collection instruments were a standard HH observation form and a researcher-made HH questionnaire in the light of Pender's health promotion model. The data were statistically analyzed in SPSS using Paired-samples T-test and Chi-squared test. The mean age of the 90 included participants was 35.92 (± 6.5) years and the mean length of their work experience was 10 (±1.5). The hand hygiene index rose from 23% before the intervention to 41.4% after the intervention (p=0.001). Moreover, statistically significant differences were found in moments after touching surroundings (p=0.001), before and after touching a patient (p=0.001), and also in perceived barriers (p=0.015), interpersonal influences (p=0.008) and situational influences (p<0.001). Pender's model showed to have improved the staff's HH compliance as a professional behavior.

Scientific Evidence Supports the Use of Alcohol-Based Hand Sanitizers as an Effective Alternative to Hand Washing in Retail Food and Food Service Settings When Heavy Soiling Is Not Present on Hands

Suboptimal food worker health and hygiene has been a common contributing factor in foodborne disease outbreaks for many years. Despite clear U.S. Food and Drug Administration (FDA) Model Food Code recommendations for hand washing and glove use, food worker compliance with hand washing recommendations has remained poor for >20 years. Food workers' compliance with recommended hand washing guidelines is adversely impacted by a number of barriers, including complaints of time pressure, inadequate number and/or location of hand washing sinks and hand washing supplies, lack of food knowledge and training regarding hand washing, the belief that wearing gloves obviates the need for hand washing, insufficient management commitment, and adverse skin effects caused by frequent hand washing. Although many of the issues related to poor hand washing practices in food service facilities are the same as those in health care settings, a new approach to health care hand hygiene was deemed necessary >15 years ago due to persistently low compliance rates among health care personnel. Evidence-based hand hygiene guidelines for health care settings were published by both the Centers for Disease Control and Prevention in 2002 and by the World Health Organization in 2009. Despite similar low hand washing compliance rates among retail food establishment workers, no changes in the Food Code guidelines for hand washing have been made since 2001. In direct contrast to health care settings, where frequent use of alcohol-based hand sanitizers (ABHSs) in lieu of hand washing has improved hand hygiene compliance rates and reduced infections, the Food Code continues to permit the use of ABHSs only after hands have been washed with soap and water. This article provides clear evidence to support modifying the FDA Model Food Code to allow the use of ABHSs as an acceptable alternative to hand washing in situations where heavy soiling is not present. Emphasis on the importance of hand washing when hands are heavily soiled and appropriate use of gloves is still indicated.

Vaccinations, Not Vaccines, Save Lives: Quality Improvement for Newborn Vaccination.

Across the world, in medical journals, news media, social media, and personal discussions, one of the hottest topics of discussion is the coronavirus disease 2019 (COVID-19) vaccine. The rapid development of effective vaccines for COVID-19 is a remarkable success story of modern science, and it is a reminder for all of us about the significant health benefits of vaccines in general, benefits we often take for granted. Although the COVID-19 vaccine is the media star of the day, children receive numerous other routine vaccinations, including the hepatitis B vaccine, which significantly reduces the risk of hepatitis B virus infection. However, with all vaccines, including the hepatitis B vaccine, there are significant gaps in coverage, with high percentages of eligible children either not receiving the vaccine at all or receiving it late, thus exposing them to the risk of infectious diseases. A quotation from Orenstein1 has recently surfaced in discussions about the COVID-19 vaccine: “vaccines don’t save lives, vaccinations save lives.” Gaps in vaccine coverage generate the need for quality improvement (QI) projects to close these gaps. In this issue of the journal, Sarathy et al2 describe the results of a QI project in which they aimed to increase the monthly percentage of eligible newborn infants receiving the first dose of the hepatitis B vaccine within 24 hours of life to ≥80% within 9 months of project initiation. This article contains some important lessons that deserve to be highlighted about the conduct, description, and publication of QI projects. In 2008, the Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines were first published. They were updated in 2015 as the SQUIRE …