Moments For Hand Hygiene Research Articles

Effects of an Interactive Handwashing Lecture on First-Year Thai Nursing Students: A Pretest-Posttest Study

Background: Hand hygiene is essential in healthcare to prevent infections and ensure patient safety. The World Health Organization highlights hand hygiene as a key measure to reduce healthcare-associated infections. However, adherence to hand hygiene protocols is often inadequate, with a low compliance rate. First-year nursing students are at a critical stage in developing foundational practices. Traditional teaching methods have shown limited success in achieving long-term adherence, necessitating the need for more interactive and engaging teaching methods. Therefore, this study aims to evaluate the effects of an interactive lecture on the handwashing knowledge of first-year nursing students. Methods: This study employed a quasi-experimental one-group pretest-posttest design involving 60 first-year Thai nursing students at Boromarajjonani College of Nursing. After four weeks of interactive lectures, participants completed a pretest and posttest to assess changes in hand hygiene knowledge and understanding of WHO Five Moments for Hand Hygiene. The intervention included visual demonstrations, hands-on practice, and real-time feedback. Data were analyzed using descriptive statistics and paired t-tests to determine the intervention’s effectiveness. Results: The study showed significant improvements in both handwashing knowledge and understanding of WHO Five Moments for Hand Hygiene post-intervention. The mean score for handwashing knowledge increased from 5.41 (SD = 1.06) to 6.62 (SD = 1.10) (t(59) = 7.154, p < 0.001). Similarly, the mean score for understanding WHO Five Moments for Hand Hygiene improved from 4.32 (SD = 0.68) to 4.97 (SD = 0.84) (t(59) = 5.60, p < 0.001). Correct responses to specific handwashing questions also increased significantly. Conclusions: The interactive handwashing lecture intervention significantly improved nursing students’ knowledge and understanding of hand hygiene practices. These findings support the integration of interactive educational strategies in nursing curricula to improve hand hygiene compliance and patient safety. Future research should address study limitations, such as sample size and long-term knowledge retention, to further validate these results.

Enhancing infection prevention and control through hand hygiene compliance in six Ugandan hospitals using quality improvement approaches.

Hand hygiene (HH) plays a crucial role in mitigating healthcare-associated infections. Improving HH compliance in healthcare facilities in resource-limited settings is urgently needed. We implemented the World Health Organization (WHO) HH improvement strategy using a continuous quality improvement (CQI) approach targeting improvement in HH compliance by healthcare workers (HCWs). An intervention was implemented in six hospitals using a longitudinal study design between May 2019 and April 2023. We set up and monitored infection prevention and control (IPC) and HH programs using WHO's infection prevention and control assessment framework at the facility level (IPCAF) and hand hygiene self-assessment framework (HHSAF) tools. We implemented HH interventions using CQI techniques while targeting HCW HH knowledge and compliance with the WHO's Five Moments of HH. By the end of the intervention, IPC and HH capacity improved in all six hospitals, from a median score of 547.0 and 252.5 on IPCAF and HHSAF tools at baseline to an advanced score of 635.0 and 350.0 at endline assessment, respectively. Similarly, HCWs' HH knowledge improved in all hospitals, from a mean score of 45.0% at baseline to 76.0% at endline assessment, most notably among nurses. HH compliance, as assessed using WHO's HH observation tool, at least doubled in all hospitals, rising from 19.9% to 53.8%, with before touching a patient registering the highest (22-fold) improvement. On linear regression analysis, no significant association was observed between HH compliance and IPCAF b = -0.0004 (95% CI -0.093, 0.93) p = 0.990, HHSAF b = 0.009 (95% CI -.0127, 0.145) p = 0.842 and HCW knowledge on HH/IPC b = -0.165 (95% CI 0.815, 0.485) p = 0.519. This is the first documented comprehensive utilization of CQI approaches to implement HH as an entry point for the development of hospital IPC programs, and evaluation of WHO tools and approaches for IPC and HH improvement in Uganda. Implementation of the WHO HH improvement strategy using a CQI approach can lead to remarkable improvement in HH capacity, and HCW compliance and knowledge in hospitals within resource-limited settings.

Evaluation of Electronic Hand Hygiene Monitoring Systems in UAE Hospitals

Abstract Introduction/Objective Introduction: Hand hygiene (HH) compliance is pivotal in preventing infections in healthcare settings, necessitating robust monitoring systems. This abstract outlines the assessment of three electronic HH monitoring systems across four United Arab Emirates (UAE) hospitals. Methods/Case Report Methods: A prospective observational study was conducted in four UAE governmental hospitals, evaluating three HH monitoring systems. Sensors were strategically positioned on alcohol-based dispensers, healthcare workers’ ID badges, and patients’ beds in these systems. Additionally, a comparative analysis was performed between direct observation data and automated system data. Results (if a Case Study enter NA) Results: System 1 was evaluated at Hospitals A and B, revealing HH compliance rates of 65% and 46%, respectively, contrasting with direct observation rates of 88% and 80%. Hospital C assessed System 2, reporting a compliance rate of 70%, compared to direct observation’s 94%. System 3, evaluated at Hospital D, showed a compliance rate of 39%, in contrast to the 88% observed directly. Conclusion Conclusion: While electronic monitoring systems offer continuous surveillance and data analysis benefits, they also present limitations. These include challenges in accurately distinguishing HH indications and opportunities, identifying all required HH moments, and capturing technique nuances. Understanding these strengths and limitations is vital for healthcare institutions aiming to implement effective HH monitoring strategies to enhance patient safety and reduce healthcare-associated infections (HAI

The Influence of Workload, Work Stress, and Work Motivation towards Five Moment Hand Hygiene Obedience for the Nurse in Muhammadiyah University Hospital Malang

Hand hygiene is crucial and should be practiced consistently. Nurses who work in hospitals must do five moments of hand washing. Washing hands will prevent the transmission of diseases and microorganisms. Nurses often experience workload and work stress, especially in inpatient rooms. Lack of nursing staff and fatigue are the main factors that trigger this. With nurses' workload and work stress in hospitals, there needs to be work motivation for nurses to live healthily by complying with the five moments of hand washing in hospitals. This study aims to determine the effect of workload, work stress, and work motivation on compliance with the five moments of hand hygiene. The design of this study used cross-sectional research with a group with only one measurement time. The population of this study consisted of nurses in the inpatient room at the University of Muhammadiyah Malang Hospital. The sample used total sampling, namely all 74 nurses who were already employees in the inpatient room of the University of Muhammadiyah Malang Hospital. The percentage result of the influence of workload (X1), work stress (X2), and work motivation (X3) on compliance with five-moment hand hygiene (Y) is 57.1% (Adj R square). In comparison, the remaining 42.9% is influenced by other independent variables that were not studied.

A Study to Assess the Effectiveness of Informative Booklet Regarding Knowledge, Attitude and Practice Among Intensive Care Unit (ICU) Staff Nurses Regarding Prevention of Central Line Associated Blood Stream Infection (CLABSI)

Background: Nurses in Intensive Care Units (ICU) have a vital role in reducing Central line associated blood stream infections (CLABSI) if they are well educated to use strategies to decrease Central line associated blood stream infections (CLABSI) rate which are based on the center for disease control and prevention guidelines (CDC) to improve patient’s outcomes. Health-care-associated infections are a huge concern in the intensive care units (ICUs) across the globe. Nearly 90% of catheter-related bloodstream infections are caused by central venous catheters (CVCs). Central venous catheters (CVC) are commonly inserted in critically ill patients and play an important role for hemodynamic monitoring and delivery of crucial treatments. Central line-associated bloodstream infection (CLABSI) is a laboratory confirmed bloodstream infection occurring in a patient with a CVC in place for >48 hours that is not related to an infection at any other site. Preventing nosocomial infections pose a great challenge in ICU, because of the multi-drug resistant organisms treated with broad-spectrum antibiotics. Clinical practice guidelines from various organizations are available for prevention of vascular catheter related infections. The Institute for Healthcare Improvement has introduced a “central line bundle” that includes the five best evidence-based practices to prevent CLABSI. This bundle includes hand hygiene, maximal barrier precautions during catheter insertion, skin antisepsis with chlorhexidine, optimal selection of the catheter site, with avoidance of the femoral vein and a daily assessment of line necessity, including the removal of an unnecessary line. Of these components, “hand hygiene” (HH) is the most convenient and cost effective to follow. “Hand Hygiene” HH prevents the transmission of pathogens and is a universal strategy to prevent all nosocomial infections. The World Health Organization has proposed a multimodal strategy; which includes five elements called the “Five Moments for Hand Hygiene”, as an evidence-based approach to prevent hospital-acquired infections. The five moments include, before touching the patient, before performing any a clean/aseptic procedure, after exposure/risk of body fluid, after touching the patient and after touching the patient surroundings. Therefore, the researcher was curious to know the effectiveness of informative booklet regarding knowledge, attitude and practice of intensive care unit staff nurses regarding prevention of central line associated blood stream infection (CLABSI).

Implementation of Five Moments of Hand Hygiene in the Inpatient Wards of Aceh Government General Hospital

Implementation of Five Moments of Hand Hygiene in the Inpatient Wards of Aceh Government General Hospital

Adapting the WHO hand hygiene ‘reminders in the workplace’ to improve acceptability for healthcare workers in maternity settings worldwide: a mixed methods study

IntroductionHand hygiene is key in preventing healthcare-associated infections, but it is challenging in maternity settings due to high patient turnover, frequent emergencies and volume of aseptic procedures. We sought to...

Impact of Direct Observation on Hand Hygiene Compliance in a Dental University Hospital: A Retrospective Cohort Study.

Introduction Hand hygiene is crucial for preventing healthcare-associated infections in dental settings. Despite its importance, the hand hygiene compliance rates remain unclear, particularly in dental university hospitals where teaching, research, and clinical practice intersect. This study aimed to establish a baseline of hand hygiene compliance rates in a dental university hospital, evaluate the effectiveness of direct observation in improving compliance, and compare practices among different categories of healthcare workers. Materials and methods This retrospective cohort study was conducted at Kanagawa Dental University Hospital from April 2022 to March 2023. The design included four blinded direct observations to establish baseline compliance rates, followed by educational training and four unannounced explicit observations. Compliance was assessed based on the World Health Organization's "Your 5 Moments for Hand Hygiene: Dental Care," adapted for dental outpatient services. The study focused on hand hygiene using alcohol-based hand sanitizers, and compliance rates were calculated for dentists, dental hygienists, dental assistants, and trainee dentists. Monthly consumption of hand sanitizer per patient was tracked from January 2019 as a secondary measure. Statistical analysis included Fisher's exact test, unpaired t-tests, and analysis of variance (ANOVA). Results The baseline hand hygiene compliance rate was low at 15.6%, with the highest compliance (25.0%) for "After touching patient surroundings." Post-intervention, the overall compliance rate increased significantly to 36.0% (p < 0.001). Significant improvements were observed in moments "After body fluid exposure risk" (11.1% to 31.3%, p = 0.004), "After touching a patient" (12.0% to 52.9%, p = 0.006), and "After touching patient surroundings" (25.0% to 73.3%, p = 0.001). Dental hygienists, assistants, and trainee dentists showed significant increases in hand hygiene compliance, while dentists did not. Hand sanitizer consumption increased significantly from 2019 (2.38 ± 0.29 mL per patient) to 2020 (3.47 ± 0.49 mL, p < 0.001) and remained elevated through 2023. Conclusions This study revealed low baseline hand hygiene compliance in a dental university hospital setting. While direct observation and education led to significant short-term improvements, especially among allied health professionals, the disconnect between observed compliance rates and hand sanitizer consumption suggests these changes may not represent sustainable behavioral shifts. The varying improvement rates among different healthcare workers and the challenges in maintaining long-term adherence highlight the need for tailored, continuous interventions in dental education and practice settings to enhance hand hygiene compliance.

Evaluating the tolerability and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among health workers in Sierra Leone: a longitudinal hospital-based intervention study

BackgroundAlcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers.MethodsA longitudinal hospital-based intervention study was conducted in accordance with the WHO’s standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3–5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures.ResultsObjective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants’ self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product’s drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml).ConclusionThe WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.

Connecting Pathogen Transmission and Performance of the WHO’s ‘My 5 Moments of Hand Hygiene’ in a High-Fidelity Simulation

Background: The World Health Organization launched ‘Your 5 moments for hand hygiene’ to identify when healthcare workers should perform hand hygiene to reduce healthcare-associated infections (HAIs). Performing hand hygiene correctly is necessary to decrease pathogen transfer, though little research has assessed the effectiveness of all 5 moments. Methods: Registered nurses (n=42) participated in a standardized, one-hour high-fidelity patient care simulation that were recorded via a head-mounted camera. The simulation involved two patients, each requiring four clinical care tasks (e.g., indwelling Foley catheter insertion, stool sample collection). Transmission data was obtained from the simulations using four genetic variants of bacteriophage λ. Before each simulation, variants were applied to unique locations on two manikins: patient A’s wound, patient A’s stool, patient B’s groin, and patient B’s stool. After each simulation, we sampled the patients, nurse, and high-touch environmental surfaces to determined bacteriophage identity of positive samples. For each moment, hand hygiene performance was the total time the nurse practiced hand hygiene across opportunities over the total recommended time (15 seconds per opportunity). Positive samples were categorized as 1) nurse contamination, 2) patient critical site(s) contamination, 3) high touch surface contamination from the same patient, or 4) high touch surface contamination from the other patient. To compare nurse’s performance of each of the 5 moments, we used a Friedman test and then a Wilcoxon test for pairwise comparisons. To assess the relationship between the four types of transmission outcomes and hand hygiene performance of the 5 moments, we performed linear regressions and calculated 95% confidence intervals by bootstrapping the original cases. Results: Performance of moments 1 (Before patient contact: 9.49%), 4 (After patient contact: 13.11%), and 5 (After contact with patient’s surroundings: 13.66%) were significantly higher than moments 2 (Before clean or aseptic task: 2.72%) and 3 (After bodily fluid exposure: 4.22%; p &lt; 0 .05). Moment 2 perfomance, furthermore, was significantly lower than moment 3 (Figure 1). Only moment 2’s performance was significantly related to transmission; specifically, performance was negatively related to critical site contamination (B= -0.03, CI 95%: -0.06 – -0.01); Table 1. Conclusions: Moment 2performance was the lowest of all 5 moments and was the only moment that demonstrated evidence of relationship with pathogen transmission, specifically critical site contamination. Of all the 5 moments, this moment is most directly related to HAIs. Further research should investigate why moment 2 performance is so low.

Assessing the quality of Hand Hygiene data produced by Alberta Health Services using a time-in-motion study

Background: Alberta Health Services (AHS) measures hand hygiene compliance through direct observations performed by trained site-based reviewers (SBRs) and facilitated by the Infection Prevention and Control (IPC) program. Within AHS there are &gt;100 acute care facilities, ranging in bed size from four beds to more than 1,000, with catchment populations ranging from one million. A time-in-motion study using trained AHS IPC staff was proposed to validate the completeness and accuracy of data being collected by the SBRs. Methods: The AHS IPC staff performed direct observations at pre-selected facilities across all five zones and four different unit types (emergency, medical, surgical, and intensive care) for four 30-minute periods during weekdays between June and September 2023. An iPad app was used to capture results from all four moments of hand hygiene. The reviewer indicated the day and time of the review and captured as many representative hand hygiene moments and healthcare providers as possible. The distributions of the four moments of hand hygiene, healthcare provider group and overall compliance were compared at the unit type and facility level (tertiary, large urban, regional, pediatric, and small sites) between this time-in-motion study and SBR data collected June-September 2023. Results: The study collected 175 reviews and 4,683 observations from 14 facilities and 48 units. Between June and September 2023, SBRs collected 2,625 reviews and 61,506 observations from these same facility and unit types. Across all facility and unit types, the distribution of the four moments was similar between the study and SBRs. Similar proportions of healthcare providers were also observed. However, the overall hand hygiene compliance collected in the study was approximately 10% lower across all unit types as compared to that collected by the SBRs (study: 63%-84%; SBRs: 75%-92%). Conclusions: In public health surveillance, completeness and accuracy are two characteristics of high-quality data. A time-in-motion study identified that the hand hygiene observations collected by SBRs were complete, as the range of healthcare providers observed, and the distribution of their moments, mirrored that collected in the study. However, the SBRs reported higher compliance than the study participants and the true hand hygiene compliance is likely lower than what is currently being reported. Since this difference was seen consistently across all unit and facility types, trending data over time should still identify areas in need of improvement and may help to suggest causes of the over-reporting.

Perilaku Hand Hygiene dalam Pencegahan Covid-19 pada Perawat

Health workers are on the front line, especially as nurses who are always next to patients 1 x 24 hours. We must take precautions by means of hand hygiene before and after carrying out nursing care, where the COVID-19 outbreak is spreading very quickly resulting in an increase in the number of patients in the whole world. To reduce and prevent the transmission of this virus, we as nurses in providing nursing care must carry out hand hygiene and comply with WHO's 5 moments of hand hygiene, namely before touching a patient, before a clean or aseptic procedure, after exposure to or risk of body fluids. This study aims to determine the analysis of hand hygiene behavior in preventing COVID-19 among nurses at the Labuang Baji Regional General Hospital, Makassar City. The research design used is a quantitative research design with a crosssectional approach. The sample determination was carried out using a random sampling research method with a sample size of 83 respondents. The relationship test was carried out using the chi-square statistical test with a significance level (ρ) ≤ 0.05. The research results showed that the level of knowledge of nurses in the good category was 27 people (32.5%); the attitude of nurses in the positive category was 59 people (71.1%); there is no relationship between knowledge and hand hygiene behavior (p=0.786); and there is no relationship between attitude and hand hygiene behavior (p=0.372). The conclusion of this research is that there is no influence of nurses' knowledge and attitudes about hand hygiene on COVID-19 prevention measures at the Labuang Baji Regional General Hospital, Makassar City. It is recommended for future researchers to improve the implementation of hand hygiene among nurses in the motivation and work of PPI.

Assessing the incorporation of the 'Five Moments for Hand Hygiene' into nursing procedure textbooks

AimOur aim was to conduct a thorough comparison between the hand hygiene information included in international nursing textbooks and the Slovenian nursing textbook's equivalent content as it relates to nursing procedures. BackgroundHand hygiene practices are crucial in preventing healthcare-associated infections, which affect millions of patients annually. The idea behind "Five Moments for Hand Hygiene" is to encourage assessing success and boosting self-efficacy. DesignComparison of hand hygiene content in international nursing textbooks with the content in a Slovenian nursing textbook. MethodsA study was conducted between March 2023 and March 2024 to compare hand hygiene content in international nursing textbooks. The study included textbooks from the USA and UK, as well as Slovenian (SI) textbooks. The final phase involved comparing hand hygiene performance practices against the WHO Five Moments for Hand Hygiene. ResultsThe study reviewed 470 nursing procedures across three textbooks, identifying four common ones: female indwelling urinary catheterisation, small-bore feeding tube insertion, enema administration and subcutaneous injections. The USA textbook had the highest number of steps, while the UK textbook had the lowest. Clean protective gloves are not recommended for all nursing procedures, only for small-bore feeding tube insertion and enema administration. The US textbook omitted 12 steps for the female indwelling urinary catheter procedure, while the UK textbook included 10 steps. The SI textbook omitted 8 steps. ConclusionsHand hygiene is crucial for healthcare infections prevention and control. The study found differences in the frequency of hand hygiene in these nursing procedures. WHO's Five Moments for Hand Hygiene guidelines are not universally accepted, with inadequate hygiene often observed before patient contact. Future research should review foreign textbooks and update existing ones.

Hand hygiene compliance of respiratory physiotherapists: An analysis of trends over eight years including the COVID-19 pandemic period

BackgroundRespiratory physiotherapists (RPs) are an integral part of healthcare workers delivering care to intubated patients. Our study aimed to evaluate the effect of awareness campaigns on hand hygiene (HH) compliance among RPs. MethodAn observational single-center study was conducted between 2015 and 2022 in different ICU types in both adult and paediatric settings. The hand hygiene compliance rates were monitored prospectively and the quality improvement interventions included various hand hygiene campaigns and awareness sessions with RPs. Compliance was calculated as a percentage of events over total opportunities observed. ResultsThere was a significant increase in compliance rates for all five moments of HH (p-value: <0.05). Overall, mean compliance rate in ICUs was significantly higher than wards for Moment 1 (p-value: 0.0045), Moment 4 (p-value: 0.0372) and Moment 5 (p-value: 0.0036) by 24.2%, 22.7% and 21.5% respectively. Also, paediatric ICUs had higher HH compliance than adult ICUs for Moment 1 (87.5% vs 61.1%; p-value: 0.0459) and Moment 4 (93.7% vs 79.3%; p-value: 0.0255). A significant increase in HH compliance was observed in post-COVID-19 period compared to pre-COVID-19 period with respect to Moment 1, 2 and 5. ConclusionThis study adds to the almost non-existent literature on this important category of healthcare workers working in respiratory ICUs. Our results project an increase compliance after the HH awareness programmes over the years among RP which is critical to prevent spread infection by multidrug resistant organisms among the hospitals.

Quality improvement initiative ‘S-A-F-H’ to reduce healthcare-associated neonatal sepsis in a tertiary neonatal care unit

BackgroundNeonatal sepsis is a leading cause of morbidity and mortality among admitted neonates. Healthcare-associated infection (HAI) is a significant contributor in this cohort.Local problemIn our unit, 16.1% of the admissions...

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

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

Hand hygiene in emergencies: Multiprofessional perceptions from a mixed methods based online survey in Germany

IntroductionDespite high vulnerability to infection, hand disinfection compliance in emergencies is low. This is regularly justified as the disinfection procedure delays life support, and instead, wearing disposable gloves is preferred. Simulation studies showed higher achievable compliance than detected in real-life situations. This study aimed to explore healthcare providers’ attitudes toward hand disinfection and using gloves in emergencies. MethodsWe conducted an anonymous online survey in Germany on the attitude and subjective behavior in the five moments of hand hygiene in a closed environment and an open convenience sampling survey. Statistics included paired student's t-tests corrected for multiple testing. For qualitative analysis, we employed a single-coder approach. ResultsIn 400 participants, we detected low priority of WHO-1 (before touching a patient) and WHO-2 (before clean/aseptic procedure) hand hygiene moments, despite knowing the risks of omission of hand disinfection. For all moments, self-assessment exceeded the assessment of colleagues (p < 0.001). For WHO-3, we detected a lower disinfection priority for wearing gloves compared to contaminated bare hands. Qualitative analyses revealed five themes: basic conditions, didactic implementations, cognitive load, and uncertainty about feasibility and efficacy. DiscussionConsidering bias, the study's subjective nature, the unknown role of emergency-related infections contributing to hospital-acquired infections, and different experiences of healthcare providers, we conclude that hand disinfection before emergencies is de-prioritized and justified by the emergency situation regardless of the objective feasibility. ConclusionThis study reveals subjective and objective barriers to implementation of WHO-1 and WHO-2 moments of hand disinfection to be further evaluated and addressed in educational programs.

Assessing the Effectiveness of a Multicomponent Intervention on Hand Hygiene and Well-Being in Primary Health Care Centers and Schools Lacking Functional Water Supply in Protracted Conflict Settings: Protocol for a Cluster Randomized Controlled Trial.

Hand hygiene is crucial in health care centers and schools to avoid disease transmission. Currently, little is known about hand hygiene in such facilities in protracted conflict settings. This protocol aims to assess the effectiveness of a multicomponent hand hygiene intervention on handwashing behavior, underlying behavioral factors, and the well-being of health care workers and students. Moreover, we report our methodology and statistical analysis plan transparently. This is a cluster randomized controlled trial with 2 parallel arms taking place in 4 countries for 1 year. In Burkina Faso and Mali, we worked in 24 primary health care centers per country, whereas in Nigeria and Palestine, we focused on 26 primary schools per country. Facilities were eligible if they were not connected to a functioning water source but were deemed accessible to the implementation partners. Moreover, health care centers were eligible if they had a maternity ward and ≥5 employees, and schools if they had ≤7000 students studying in grades 5 to 7. We used covariate-constrained randomization to assign intervention facilities that received a hardware, management and monitoring support, and behavior change. Control facilities will receive the same or improved intervention after endline data collection. To evaluate the intervention, at baseline and endline, we used a self-reported survey, structured handwashing observations, and hand-rinse samples. At follow-up, hand-rinse samples were dropped. Starting from the intervention implementation, we collected longitudinal data on hygiene-related health conditions and absenteeism. We also collected qualitative data with focus group discussions and interviews. Data were analyzed descriptively and with random effect regression models with the random effect at a cluster level. The primary outcome for health centers is the handwashing rate, defined as the number of times health care workers performed good handwashing practice with soap or alcohol-based handrub at one of the World Health Organization 5 moments for hand hygiene, divided by the number of moments for hand hygiene that presented themselves during the patient interaction within an hour of observation. For schools, the primary outcome is the number of students who washed their hands before eating. The baseline data collection across all countries lasted from February to June 2023. We collected data from 135 and 174 health care workers in Burkina Faso and Mali, respectively. In Nigeria, we collected data from 1300 students and in Palestine from 1127 students. The endline data collection began in February 2024. This is one of the first studies investigating hand hygiene in primary health care centers and schools in protracted conflict settings. With our strong study design, we expect to support local policy makers and humanitarian organizations in developing sustainable agendas for hygiene promotion. ClinicalTrials.gov NCT05946980 (Burkina Faso and Mali); https://www.clinicaltrials.gov/study/NCT05946980 and NCT05964478 (Nigeria and Palestine); https://www.clinicaltrials.gov/study/NCT05964478. DERR1-10.2196/52959.

Knowledge and Compliance to Hand Hygiene Among Anesthesiologists in the Operation Room in Sudan 2022

Objectives: This study aims to assess anesthesiology registrars’ knowledge and compliance with Hand hygiene strategies in the operation room and ICU in Sudan in 2022. Materials and Methods: This was a descriptive cross-sectional study conducted among anesthesiology registrars registered in the Sudanese Council of Anaesthesia and Intensive Care. Data was collected by the researcher using a self-administered Google form questionnaire assessing knowledge about patient prevention, self-protection, alcohol-based rubbing, hand washing using soap and water, and compliance with the WHO 5 moments hand hygiene practice, then analyzed by SPSS V 28 software. Results: The study included 150 anesthesiology registrars with a mean age of 31± 4 years and a female majority of 67%. Overall, the majority 88% have a fair knowledge regarding hand hygiene, 12% have poor knowledge, and 65% were compliant with all the recommended 5 moments of hand hygiene. Analysis of Factors affecting participants’ compliance with WHO 5 moments revealed that only experience was associated with the participants’ compliance. Conclusion: Many gaps in knowledge about hand hygiene were identified regarding patients and self-protection, and hand washing and rubbing, thus, anesthesiology registrars had poor to fair knowledge regarding hand hygiene. While 65% of them are compliant with the WHO 5 Moments hand hygiene. Compliance with the WHO 5 Moments hand hygiene was associated with participants’ experience.

Targeted hand hygiene audits and training: an effective tool for improvement in hand hygiene compliance

Background: Hand hygiene (HH) is the simplest, but most effective infection prevention and control measure. This study was aimed to determine HH compliance among health care workers (HCWs) in a cancer hospital and the impact of targeted and phased training over changes in HH compliance and determination of Hawthorne effect among HCWs. Methods: Prospective observational study conducted in two phases by HH trained auditor (Overt observer) and ICN (Covert observer) performing 30 minutes HH audit at ICU, haemato-lymphoid (HL) ward and paediatric ward to observe the pattern of HH compliance among HCW for HH moments and its impact over Hawthorne effect for HH compliance. Results: Highest compliance for HH was observed at HL ward (59.34%) in first phase and at ICU (70.08%) in second phase. Gradual and significant improvement in HH compliance was observed for ICU (52.24% to 70.08%), HL ward (59.34% to 68.48%) and paediatric ward (43.42% to 53.46%). Profession specific Hawthorne effect was observed for nurses with higher compliance in covert observation in first phase and for doctors with higher compliance in overt observation in second phase of the study. Conclusions: Regular targeted HH audit with motivational training is the better influential tool for improving HH compliance. Regular audits also improve efficiency of auditor for effective HH compliance supervision. Decentralization and availability of workstation specific HH auditor is the most of effective cost saving approach for achieving significant progressive improvement in HH adherence.