Personal Hand Hygiene Research Articles

Tomato flu outbreak in India: Evolution, epidemiology, preventive strategies, and way ahead

Abstract Introduction: Just as the world recovers from the throes of the COVID-19 pandemic, there are reports of monkeypox virus infections in previously unaffected regions. To add another communicable and contagious outbreak to the list, India is witnessing many Pediatric cases of Hand Foot, and mouth disease (HFMD) Aim: To explore the key Epidemiological aspects of Tomato flu, including the difference between the current outbreak and classical HFMD. Materials and Methods: Secondary data from official government sites, press information, latest articles, newspapers, and the WHO website was extracted and discussed in the article. The current Epidemiology of the Tomato flu with a difference from the typical hand foot and mouth disease is highlighted in the study. The most probable factors for the starting point of the emergence of communicable diseases like COVID-19, Monkeypox, and the current tomato flu epidemic in Kerala across the country are also highlighted. Results: Total number of thirty-two articles/government/international websites were assessed. The current study highlights the current epidemiology of Tomato flu, including difference from classical HFMD. The most probable reasons for Kerala being starting point of emerging diseases like COVID-19, Monkey pox and Tomato flu are highlighted. Preventive strategies including steps taken by government and way ahead are also discussed. Conclusion: The study highlights that Current Tomato flu presentation is quite different from classical HFMD. Surveillance, Screening, Personal hand hygiene, and isolation of cases are preventive measures that can be adopted. It is imperative to raise awareness and promote personal hygiene among children, parents, and schools with immediate effect.

Knowledge, Attitude and Practice of Hand Hygiene Among Parents: A Post COVID-19 Pandemic Survey

Hand hygiene is one of the effective measures to prevent infectious diseases such as hand, foot and mouth disease and COVID-19. Parents involvement as the child's first educator in establishing the child's sanitary behavior are crucial in nurturing good hand hygiene habit. This study aimed to assess parents' knowledge, attitudes, and practice on hand hygiene in relation to childcare during the endemic phase of COVID-19. This cross-sectional study involved parents of pre-school children from the Sepang district of Selangor, Malaysia. The parents were given a set of pre-tested, self-administered questionnaires about their knowledge, attitude, and practice of personal hand hygiene, hand hygiene practice while caring for children, and diseases caused by inadequate hand hygiene. A total of 179 parents, mostly (62%) were mothers with mean age of 37.55 (SD 21.2) involved in this study. The parents had good knowledge (99.4%), good attitude (92.7%) and good (100%) hand hygiene practice. Good attitude was significantly associated with good practice. Good knowledge, attitude, and practice on hand hygiene among parents might be due to repetitive information about the importance of hand hygiene during the COVID-19 pandemic. Efforts should be made to ensure teachers, children and parents are continuously being educated and reminded about hand hygiene not only during COVID-19.

Anxiety and depression among students in a greek university amidst COVID-19 pandemic

IntroductionThe coronavirus pandemic has challenged the world with an unprecedented situation. Social distancing, self or quarantine isolation, personal hand hygiene, self-protection, and the fear of becoming infected with the virus, come with a psychological fallout. The COVID-19 pandemic has affected students around the world, in terms of their education and lifestyle.ObjectivesTo investigate the impact of COVID-19 pandemic on the students’ mental health and well-being at the University of Patras, in Western Greece.MethodsAn online questionnaire was prepared to collect responses from students during April 2020. Socio-demographic data, academic status, opinions about distance learning, changes in daily routine during the lockdown and anxiety and depression scores, according to the Greek version of the Hospital Anxiety and Depression Scale (HADS), were gathered.ResultsThe total number of responders was 2009, of which 67.3% women. During lockdown, the 68% of the students returned to their family home. Anxiety and depression scores were higher in students with a low income, poor self-rated health, not informed about COVID-19, not satisfied with distance learning and being annoyed at staying home. Prevalence of anxiety and depression was found to be 35.8% and 51.2%, ranging from 26.7% to 48.2% for anxiety and from 36.3% to 60.5% for depression in Health Sciences and Humanities and Social Sciences, respectively.ConclusionsDepression rates among university students in Greece were alarmingly high, denoting the impact of lockdown and changes in students’ life, due to the COVID-19 pandemic.

Using a Human Factors Framework to Assess Clinician Perceptions of and Barriers to High Reliability in Hand Hygiene

Background: Hand hygiene is essential to prevent healthcare-associated infections, but adherence among clinicians remains low. Objective: We used a human factors framework to understand clinician perceptions of and barriers to achieving high reliability in hand hygiene. Methods: The Systems Engineering Initiative for Patient Safety 2.0 model was used to develop a 24-item electronic survey. Perceived barriers to hand hygiene were classified into several domains: technology and tools, person, organization, tasks, environment, and care processes. After pilot testing, the survey was distributed to a stratified random sample of attending physicians, nurse practitioners, and physician assistants in medical specialties and surgery-anesthesia at a quaternary-care pediatric hospital. Frequencies, percentages, and descriptive statistics were used to summarize responses. Results: Of 200 clinicians, 61 (31%) responded to the survey: 74% were attending physicians, 18% were nurse practitioners, and 7% were physician assistants. Moreover, 51% of respondents represented medical specialties, and 49% came from surgical disciplines or anesthesia. Respondents had served a median 12 years (IQR, 5–19 years) in their current role. Overall, 70% perceived hand hygiene to be “essential” among patient safety issues at the institution, and 84% agreed that leadership openly promotes hand hygiene. Additionally, 97% believed personal hand hygiene efforts were effective in preventing healthcare-associated infections. The availability of alcohol-based hand rub and being a good example for colleagues were perceived as “very effective” in permanently improving hand hygiene reliability by most respondents (87% and 67%, respectively). Furthermore, 77% of clinicians reported alcohol-based hand rub dispensers to be “sometimes” or “often” empty; 52% cited distractions in the workplace as hindrances to hand hygiene; and 21% reported that peers do not openly promote hand hygiene. One-quarter of the respondents indicated that the layout of patient care areas was not conducive to performing hand hygiene. Staffing shortages and the pace and demands of work precluded hand hygiene for 15% and 11% of respondents, respectively. Conclusions: Most clinicians view hand hygiene as essential to patient safety, but aspects of organizational culture, environment, tasks, and tools were identified as barriers to high performance reliability. These data can inform efforts to use human factors engineering principles to optimize systems and organizations to more effectively promote hand hygiene.Funding: NoneDisclosures: None

Quantitative Measurement of Hand Hygiene in Ambulatory Surgery Amongst Anesthesiologists and Perioperative Nurses Using an Automated Personal Hand Hygiene System

<h3>Background</h3> Studies have shown that anesthesia providers can reduce cross contamination events of intravenous tubing and stopcocks, medication syringes, anesthesia carts, and transmission of pathogens to the surgical patient, by maintaining an hourly hand hygiene (HH) rate of four to eight hand hygiene events (HHE) per hour, yet to date there has been no automated way to objectively measure HHE during surgery in ambulatory surgery centers (ASC). The purpose for this study was to measure HHE of anesthesia providers, operating room (OR) registered nurses (RN), and post-anesthesia care (PACU) RN with the implementation of an automated personal hand hygiene system (APHHS). <h3>Methods</h3> The APHHS (personal devices with alcohol gel sanitizer, wireless data transfer, and web-based reporting), was deployed to fourteen anesthesiologists, seven OR RN and nine PACU RN over a four-week period in the ASC where on average twenty-five surgeries are performed daily. The APHHS measured total HHE and HHE per hour of clinical time. A multi-modal approach for HH improvement included a shared group performance dashboard, leadership communication, ongoing positive feedback via the personal device, HH education, and recognition of sustained individual performance. <h3>Results</h3> Prior to automation, 30 to 60 HHE were observed per quarter utilizing the direct observation method and an opportunity-based approach. Following APHHS deployment, 1008 HHE were captured per week. Average hourly HHE rates were measured: Anesthesia 3.3, OR RN 3.5, PACU RN 3.5. Compliance rates to a set goal of 8 per hour were measured: Anesthesia 41% and RN 44% compliant to goal. <h3>Conclusions</h3> Implementing an APHHS in ASC with an evidenced based approach provides robust data sets of HHE with continuous individualized performance feedback and provides unbiased measurement of actual HH performance.

Operation of ultrasonography services in a dedicated paediatric hospital and a university hospital in Greece under the COVID-19 pandemic.

Ultrasonography (US) is one of the most common diagnostic imaging tests in children. During the coronavirus disease 2019 (COVID-19) pandemic, it is important to operate with a plan designed to protect health care workers, to prevent transmission of infection from child and parents to another child or an accompanying person in the US suite, and to save valuable protective material and resources. Measures during routine US in children can be challenging both in general hospitals with paediatric units and in dedicated paediatric hospitals. Special considerations include: a) cancellation or rescheduling of unnecessary imaging tests, b) a relevant questionnaire on the request form informing about patient and accompanying person’s symptoms and likely exposure in addition to general triage, c) appropriate patient and parent protective measures, d) recruitment and selection of US machines in different protected areas depending on the possibility or certainty for the infection, e) regular personnel protective measures and personal hand hygiene, f) routine disinfection of probes and adjacent surfaces and g) machine/room deep disinfection, if required. Our purpose is to present the modified US services in children during the COVID-19 pandemic in two hospitals based on the instructions of the national organization of public health in Greece and what is known about the mode of transmission of the virus.

Assessing virus infection probability in an office setting using stochastic simulation

Viral infections are an occupational health concern for office workers and employers. The objectives of this study were to estimate rotavirus, rhinovirus, and influenza A virus infection risks in an office setting and quantify infection risk reductions for two hygiene interventions. In the first intervention, research staff used an ethanol-based spray disinfectant to clean high-touch non-porous surfaces in a shared office space. The second intervention included surface disinfection and also provided workers with alcohol-based hand sanitizer gel and hand sanitizing wipes to promote hand hygiene. Expected changes in surface concentrations due to these interventions were calculated. Human exposure and dose were simulated using a validated, steady-state model incorporated into a Monte Carlo framework. Stochastic inputs representing human behavior, pathogen transfer efficiency, and pathogen fate were utilized, in addition to a mixed distribution that accounted for surface concentrations above and below a limit of detection. Dose-response curves were then used to estimate infection risk. Estimates of percent risk reduction using mean values from baseline and surface disinfection simulations for rotavirus, rhinovirus, and influenza A infection risk were 14.5%, 16.1%, and 32.9%, respectively. For interventions with both surface disinfection and the promotion of personal hand hygiene, reductions based on mean values of infection risk were 58.9%, 60.8%, and 87.8%, respectively. This study demonstrated that surface disinfection and the use of personal hand hygiene products can help decrease virus infection risk in communal offices. Additionally, a variance-based sensitivity analysis revealed a greater relative importance of surface concentrations, assumptions of relevant exposure routes, and inputs representing human behavior in estimating risk reductions.

Pathogenic microbes contaminating mobile phones in hospital environment in Northeast India: incidence and antibiotic resistance

BackgroundThe present study attempts to identify and determine the pattern of drug susceptibility of the microorganisms present in mobile phones of health care workers (HCWs) and non-HCWs in a hospital environment. Mobile phones of 100 participants including both genders were randomly swabbed from nine different wards/units and the bacterial cultures were characterized using VITEK 2 system.ResultsForty-seven mobile phones were culture positive and a total of 57 isolates were obtained which consisted of 28 Gram-positive organisms and 29 Gram-negative organisms. The predominating organisms were Acinetobacter baumannii and Staphylococcus hominis. Among all the isolates from the mobile phones of HCW and non-HCWs, five isolates had ESBL and three isolates had colistin resistance. Incidentally, MRSA was not found on the mobile phones tested. The isolated organisms showed 100% susceptibility to linezolid, daptomycin, vancomycin, imipenem, meropenem, gentamicin, amikacin, ciprofloxacin and tigecycline, while high resistance was shown against benzylpenicillin (75.0%), cefuroxime and cefuroxime axetil (56.5%). Non-HCWs’ mobile phones were more contaminated as compared to HCWs (P = 0.001) and irrespective of individuals’ gender or toilet habits, both Gram-positive and Gram-negative organisms were present on the mobile phones.ConclusionThis study reports for the first time that the mobile phones of non-health care workers harbour more bacterial diversity and are more prone to cause transmission of pathogens. This study can serve to educate the public on personal hand hygiene practices and on maintaining clean mobile phones through antiseptic measures.

Quantitative Measurement of Hand Hygiene Behavior in Hospice Environments Using An Automated Personal Hand Hygiene System

BACKGROUND Despite regulatory, accreditation, and federal agencies requirements for hand hygiene (HH) across the continuum of care to prevent the spread of healthcare associated infections, the ability to monitor HH performance and provide feedback in hospice settings (home, skilled nursing facility, assisted living, free standing in-patient unit) has been limited to direct observation which is inherently biased by the Hawthorne Effect. To date, there has been no automated method to measure and report hand hygiene events (HHE) that occur in home health settings. The purpose for this study was to measure HHE during patient care with the implementation of an automated personal hand hygiene system (APHHS). METHODS The APHHS (personal devices with alcohol gel sanitizer, wireless data transfer, and web-based reporting), was deployed to 16 home hospice care professionals over a 3-week period. The system measured total HHE and HHE per hour of clinical time. A multi-modal approach included a shared group performance dashboard, periodic individual email performance summaries, leadership communication, ongoing positive feedback via the personal device, HH education, and recognition of sustained individual performance. RESULTS Prior to automation, 60 HHE were observed per month utilizing the direct observation method and an opportunity-based approach. Following system deployment, 1,387 HHE were captured per week on average. Average hourly HHE rates for the home hospice care team were measured at: Medical Doctor 8.6, Nurse Practitioner 3.4, Registered Nurse 3.7, Certified Nursing Assistant 6.5, Social Worker 5.2, and Chaplain 4.8. CONCLUSIONS Implementing an APHHS in home hospice care with an evidenced based approach provides robust data sets of HHE with continuous individualized performance feedback and provides unbiased measurement of HH performance. Despite regulatory, accreditation, and federal agencies requirements for hand hygiene (HH) across the continuum of care to prevent the spread of healthcare associated infections, the ability to monitor HH performance and provide feedback in hospice settings (home, skilled nursing facility, assisted living, free standing in-patient unit) has been limited to direct observation which is inherently biased by the Hawthorne Effect. To date, there has been no automated method to measure and report hand hygiene events (HHE) that occur in home health settings. The purpose for this study was to measure HHE during patient care with the implementation of an automated personal hand hygiene system (APHHS). The APHHS (personal devices with alcohol gel sanitizer, wireless data transfer, and web-based reporting), was deployed to 16 home hospice care professionals over a 3-week period. The system measured total HHE and HHE per hour of clinical time. A multi-modal approach included a shared group performance dashboard, periodic individual email performance summaries, leadership communication, ongoing positive feedback via the personal device, HH education, and recognition of sustained individual performance. Prior to automation, 60 HHE were observed per month utilizing the direct observation method and an opportunity-based approach. Following system deployment, 1,387 HHE were captured per week on average. Average hourly HHE rates for the home hospice care team were measured at: Medical Doctor 8.6, Nurse Practitioner 3.4, Registered Nurse 3.7, Certified Nursing Assistant 6.5, Social Worker 5.2, and Chaplain 4.8. Implementing an APHHS in home hospice care with an evidenced based approach provides robust data sets of HHE with continuous individualized performance feedback and provides unbiased measurement of HH performance.

Clinical Issues—April 2017

Patient involvement in hand hygiene Key words: patient engagement, hand hygiene, hand washing stations, hand hygiene promotion. Alcohol-based surgical hand rubs in the OR Key words: hand hygiene, hand rub, dispenser. Personal hand hygiene dispensers Key words: hand hygiene, hand rub, hand rub dispenser, personal dispenser. Hand soap Key words: soap, hand hygiene, hand wash, plain soap, triclosan. Disposal of water used for plaster application in scrub sinks Key words: plaster, pour, sink, scrub sink. Multiple hand hygiene indications Key words: hand hygiene, hand wash, hand rub.

Knowledge, attitudes and practices of hand hygiene among parents of preschool children

Background- Infections spread easily among children in nurseries due to overcrowding and their natural intimacy. Disease transmission via skin (particularly hand) contact is preventable through proper hand hygiene and good sanitation. Parental support and involvement in developing child’s hygienic behavior are essential in promoting child’s well being. This study aimed to determine knowledge, attitudes and practices of parents on hand hygiene, related to the care of their children. Methods- This cross-sectional study involved 240 parents of preschoolers in the Klang Valley, Malaysia. Participants were given self-administered questionnaires consisting statements related to personal hand hygiene, hand hygiene practices during childcare and infections related to poor hand hygiene. Results- The mean score for knowledge of hand hygiene was 2.72(SD 0.26) out of 3.00.Meanwhile, the mean score for attitude and practice of hand hygiene were 4.56(SD 0.58) out of 5.00 and 4.36 (SD 0.65) out of 5.00 respectively. Overall results showed that majority of parents had a good understanding of hand hygiene. However, about two thirds parents did not agree on washing hands before interacting with their children. Of concern, about 76% parents are unaware of correct hand washing techniques. Conclusions- This study highlighted the need for more comprehensive educational programs to create awareness regarding the importance of hand hygiene particularly among parents and children. This is very important for prevention of communicable diseases in the community.

Child Care Provider Awareness and Prevention of Cytomegalovirus and Other Infectious Diseases

Child care facilities are prime locations for the transmission of infectious and communicable diseases. Children and child care providers are at high risk for cytomegalovirus (CMV) infection which causes severe birth defects and developmental delays. The goals of study were: (1) to determine the level of cytomegalovirus awareness and other infectious diseases among child care providers, and (2) to determine what measures providers are taking to prevent the spread of infectious disease. This is a descriptive study. We used the Dillman total design method to survey a random sample of licensed family and residential child care providers. We used a 29-item questionnaire to ask about awareness of cytomegalovirus and other infectious diseases, knowledge of how to control spread of these diseases, sources of information, personal hand hygiene behaviors, and demographics. The response rate was 68.6 %. Awareness of infectious diseases ranged from 12.8 to 99.4 %; 18.5 % ‘had’ heard of CMV. Respondent’s primary sources of information were health care providers and the Internet. Self-report of hand hygiene behavior was high. Providers do not know how to appropriately sanitize surfaces to reduce spread of disease. Awareness of CMV and how to prevent transmission of infectious disease is low. Intervening with child care providers and parents through child care facilities are key opportunities to reduce prevalence of CMV infection and other diseases.

Universal Inpatient Screening for Methicillin Resistant Staphylococcus Aureus (MRSA) Substantially Reduces Noscomial MRSA Infection Rates: May 2007 to May 2012

do not shave, use depilatories, wax, or apply lotion on leg(s)/hip(s) prior to surgery. Educate patients about personal hand hygiene, inform patient not to touch dressing or incisions unless absolutely necessary, instruct patients to shower the evening before and the morning of surgery using chlorhexidine gluconate (CHG) for 2 days, distribute literature regarding patient education If patient is MRSA/ MSSA positive, instruct patient to shower with CHG for 5 days and use Mupirocin nasal ointment 5 days pre-op. Dressing Protocol: Use silver or specialty dressings, remove after 5 days, if excessive drainage occurs, nursing will change dressing. Discharge Assessment, Teaching and Follow-up: Review home care orders to reinforce understanding regarding physical therapy, medications, and signs and symptoms of infection. RESULTS: Quarterly standardized infection ratios (SIRs) were developed and presented for the system, hospitals, and individual orthopedic surgeons. Overall system and hospitals’ SIRs are reflected graphically. LESSON LEARNED: Due to numerous preventive interventions, total knees’ and total hips’ SIRs decreased below 1.0 during the last four current quarters. Continuation of monitoring compliance with practices in OR with staff is occurring. Feedback of SIRs with orthopedic surgeons happens on a quarterly basis. Opportunities for improvement, including sharing information with infection prevention committees and surgical teams, is ongoing.

The development of antiseptic gel from mangosteen shell extract

Mangosteen (Garcinia mangostana L.) is widely grown throughout the Southeast Asian countries and well known as the queen of fruits. The mangosteen shell extracts have more potential for antibacterial activity. This study was undertaken to develop an antiseptic hand cleansing gel which increased efficiency for killing potentially pathogenic organisms by effect of xanthones in mangosteen shell extracts and to investigate antibacterial activity of this antiseptic gel. The mangosteen shell was extracted by acetone and the xanthones concentrations were analyzed by using HPLC. The result showed that the extract contained the active xanthones: alpha‐mangostin and gamma‐mangostin 34.12 and 5.63 g%, respectively. The optimum formulation of antiseptic gel contained mangosteen shell extract 0.5% of gel. This antiseptic gel showed good effective to control bacteria; Escherichia coli, MRSA, Micrococcus leteus, Pseudomonas aeruginosa, Bacillus subtilis, Staphylococcus aureus, and Candida albicans. Consumer acceptance testing with 20 volunteers who were between 18–30 years old showed that 95% of consumers accepted antiseptic gel with mangosteen shell extract and the overall liking was like slightly. Therefore, this antiseptic hand cleansing gel would be possibly for an alternative product for the personal hand hygiene.

Evaluation of prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in veterinary personnel attending an international equine veterinary conference

Infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) are now increasingly being reported in animals and people who work with animals, including horses and horse personnel. The objectives of this study were to evaluate the prevalence of MRSA colonization in veterinary personnel attending an international equine veterinary conference, and to identify risk factors for MRSA colonization in this group. Volunteers were recruited at the conference to provide a single nasal swab and complete a questionnaire regarding contact with the human health care system, contact with horses, and personal hand hygiene. Colonization with MRSA was found in 26/257 (10.1%) of study participants. Multivariable analysis showed an increased risk of MRSA colonization associated with having been diagnosed with or having treated a patient diagnosed with MRSA colonization or infection in the last year (odds ratio [OR] 8.41, 95% confidence interval [CI] 1.51–49.92, P = 0.015; OR 3.27, 95% CI 1.05–10.11, P = 0.039, respectively), whereas hand washing between infectious cases (OR 0.27, 95% CI 0.11–0.72, P = 0.009) and hand washing between farms (OR 0.35, 95% CI 0.14–0.98, P = 0.047) were protective. The prevalence of MRSA colonization among equine veterinary personnel found in this study was high compared to that of other studies of the general population. These data support previous suggestions that equine veterinary personnel are at increased risk of colonization with MRSA. This is the first study to demonstrate a statistically significant association between hand hygiene practices and a measurable clinical outcome in veterinary medicine.