Proper Hand Research Articles

Patient hand hygiene experiences in a primary care centre in Ireland during COVID-19

The implementation of proper hand hygiene (HH) has been shown to reduce the risk of developing healthcare-associated infections. There is an increased awareness of the importance of HH since the onset of COVID-19. This study used an interpretive descriptive qualitative design to explore patients’ experiences of healthc workers’ (HCWs’) HH practices in a primary care centre in Ireland during COVID-19. The data were collected from 12 participants using in-depth, semi-structured interviews and analysed using reflexive thematic analysis. Two themes were constructed, each with two subthemes. Theme 1, ‘Focus and Awareness’, had the subthemes ‘Hand Hygiene and Patient’s Awareness’ and ‘Positive Effects of COVID-19’. Theme 2, ‘Breaking Barriers’, had the subthemes ‘Fear of Repercussions’ and ‘Responsibility and Empowerment’. Patients believed they should have a role when it comes to ensuring correct HH is performed during their episode of care. Barriers to this included the perceived reaction of HCWs to the feedback and a lack of knowledge of the five moments of hand hygiene.

Fighting HAIs by monitoring hand hygiene compliance in the Umberto I teaching Hospital in Rome

Abstract Background Healthcare-associated infections (HAIs) are one of the most common preventable complications in hospitalised patients related to increased morbidity and mortality for patients. Proper hand hygiene (HH) can decrease the prevalence of HAIs within care settings. The aim of the study was to evaluate the effects of a monitoring and feedback system on HH compliance (HHC). Methods Three monitoring and feedback studies have been carried out in Umberto I teaching hospital of Rome since 2021. Healthcare workers (HCWs), were trained on how to carry out the direct observation on the 5 WHO moments on HH. The data collection lasted two weeks each year. Following data collection, they were analysed and discussed annually with HCWs. A multivariable logistic regression model was constructed to identify predictors of HH compliance. Results A total of 15874 HH were observed, of which 40.1% in 2023. The recorded HHC was 71.0% in 2021, 75.4% in 2022 and 71.6% in 2023. Multivariable analyses showed that HHC was positively associated with female sex of observed (aOR:1.3, 95% CI:1.1-1.4), during weekend days or holidays (aOR:1.3 95% CI:1.1-1.4) and all indications with respect to ‘before touching a patient’. Regarding the professional category of the observer, compared to physicians, midwives were more likely to report compliant observations (aOR=2.4, 95% CI: 1.4-4.1). On the other hand, a negative association was found with external ward staff and other HCWs and no-HCWs compared to physicians. Ward area and year of observation did not influence the probability of the outcome. Conclusions The results of this study revealed sub-optimal adherence to HH, with the lowest rates observed prior to patient interaction. That, coupled with the variability seen among HCWs, underlines the difficulties in achieving a uniform level of compliance. Therefore, ongoing training to raise awareness among HCWs and to repeat the survey over time identifying any major problems is essential. Key messages • Monitoring the reasons for non-adherence to hand hygiene in healthcare institutions in order to formulate strategies to improve HH adherence among hospital staff is essential. • Hand hygiene (HH) monitoring systems can produce measurable improvements in HH adherence by healthcare personnel, resulting in a reduction in the incidence of healthcare-associated infections.

Reconstruction of hand surgical wounds after correction of pseudo-syndactyly or squamous cell carcinoma resection in patients affected from epidermolysis bullosa: a monocentric experience with a collagen-elastin dermal matrix dermal substitute

In patients with Epidermolysis Bullosa (EB), surgery may be required to remove Squamous Cell Carcinoma (SCC) of the hands or to correct pseudo-syndactyly. Dermal substitutes may represent a suitable tool to promote the healing of surgical wounds in EB. We review our experience with a collagen-elastin dermal matrix to promote surgical wound healing due to hand surgery to correct pseudo-syndactyly or SCC resection in patients affected by EB. Overall, 12 patients (mean age, 29±11 years, range 13-51; four females) with EB were considered, with a total of 25 different interventions (16 SCC removals; three amputations for recurrent infiltrating SCC; six pseudo-syndactyly corrections). All patients received a collagen-elastin dermal matrix sheet. Neodermis was achieved in all patients, and no adverse events potentially associated with the graft occurred. No SCC recurrence was reported at sites operated for either SCC resection or amputation. The opening of the first or second commissure appears to be maintained for over 1 year after the procedure, preserving digital function. We believe that the application of a dermal substitute, together with a close dressing protocol, may represent a suitable strategy for obtaining physiological tissue regeneration and maintaining proper hand function in patients with EB.

Preventing perioperative infections: a call to action for anesthesiologists

Purpose of review Surgical site infections (SSI) are one of the most costly complications and hospital organizations are promoting multidisciplinary approaches to address this harm. Anesthesiologists are increasingly recognized as key players influencing surgical outcomes and patient safety, and play a key role in preventing SSIs. Recent findings Recent guidelines and strategies to prevent SSI are focused on the areas which anesthesiologists can impact including antimicrobial prophylaxis, proper hand hygiene, decontamination of environmental surfaces and operating room equipment coming in direct contact with patients. Summary Timely interventions, including appropriate antibiotics’ administration, practicing sterile and aseptic techniques when performing intraoperative procedures and handling medications are impactful steps in the process of improving rates of SSIs. Multidisciplinary participation in local and regional collaborative initiatives to improve adherence to best practices as well as integrated education of all the stakeholders are some of the principles of patient-centered care described in our review.

Removal of virus from hands: a study on the role of washing and drying

Proper hand hygiene is highly important to control pathogens' transmission. Although the effect of washing and drying on hands' bacterial contamination has been reported, studies on viruses are scarce. To assess the viral load of artificially contaminated hands after washing and after drying. 30 volunteers filled a questionnaire about hand hygiene and participated in microbial assays, testing five different drying approaches, using the whole hand methodology to quantify viruses on hands. Bacterial assays were also performed for comparison purposes. For both virus and bacteria contaminations, the washing step promoted a significant reduction of the microbial load, while the drying step only promoted slight reductions regardless of the drying method used. Moreover, hand dryers and paper towels didn't induce the re-contamination of washed hands. Hand washing promoted a reduction of the microbial load in hands, while none of the different drying methods significantly reduced hands microbial load.

Food Hygiene Practices and the Risk of Diarrhea in Children of Working Mothers in Rural Bangladesh

Background: This study addresses the imperative role of maternal personal and household hygiene in safeguarding young children from diarrhea in rural Bangladesh. With young children facing heightened susceptibility to diarrhea during weaning, potential sources of contamination include traditional weaning foods, water quality, and utensil hygiene. This study aims to investigate the influence of maternal hygiene practices on the prevalence of diarrhea among young children in rural area of Khulna, Bangladesh. Materials and methods: A cross-sectional study was conducted in rural areas of Bangladesh from January to June 2023, focusing on under-five children and their working mothers. Results: The study revealed significant associations between hygiene practices and diarrhea prevalence. Proper hand washing by mothers before food preparation exhibited a protective effect (OR: 1.83, 95% CI: 1.03 - 3.24). Ensuring utensil hygiene was correlated with lower diarrhea risk (OR: 11.29, 95% CI: 5.19 - 24.55). Moreover, consistent maternal hand washing after using the toilet (OR: 6.92, 95% CI: 3.08 - 15.55) and before feeding (OR:2.38, 95% CI: 1.17 - 4.82) significantly reduced diarrhea risk among children. Conclusion: The study underscores the critical role of maternal personal and household hygiene practices in preventing diarrhea among young children in rural Bangladesh. IAHS Medical Journal Volume 6(2) December 2023; 73-77

Antibiotic resistance pattern of bacterial strains emerged using frequent hand sanitizers during corona pandemic.

Hands are in fact the main route of transmission of pathogenic infections. By using proper hand sanitization, we can break the virus's transmission chain, which is especially important in the ongoing COVID pandemic outbreaks. The effectiveness of hand sanitization is solely dependent on the use of sufficient antibacterial agents, which come in a variety of levels and types, including antimicrobials commercial, water-based, or alcohol-based hand sanitizer, the latter being widely used during pandemics. Therefore, the sudden overuse of sanitizers also could lead to an increase in the tolerance limit for normal hand flora and the new development of antimicrobial resistance (AMR). In this study, we investigated the relationship between hand sanitizer-tolerant bacteria and their antibiotic resistance profile to multiple antibiotic agents. On a timely basis before and after using different hand sanitizers, bacterial strains were collected from the volunteers of CSIR-Central Salt and Marine Chemicals Research Institute (CSIR-CSMCRI). Sanitizer tolerant bacterial strains were observed also just after the application of sanitizers, which also showed the AMR phenomenon. The resultant sanitizers' resistant microbiome showed the dominant presence of Bacillus sp., Staphyloccocus sp., Paenibacillus sp., Lysinibacillus sp., Exiguobacterium sp. and Leclercia sp. All 36 nos of bacterial strains showed MDR (> 5 nos).

Computer Vision for Assessing Surgical Movements in Neurosurgery.

Objective evaluation of microsurgical technique quality is vital for successful training in neurosurgery. This study aimed to assess the accuracy of automatically detecting a neurosurgeon's proper posture and hand positioning using computer vision. We employed the RTMPose neural network model to identify key anatomical points in the neurosurgeon's projection and calculated various angles formed by connecting these points. By utilizing machine learning on these angles, we were able to classify images of the surgeon's posture and hands into correct positions and various types of errors with an accuracy of at least 0.9. Computer vision enables successful detection and objective assessment of the neurosurgeon's posture and hand positions. The high accuracy of this detection can pave the way for a new training approach in neurosurgery.

EFFORTS TO PREVENT THE SPREAD OF COVID-19 ACCORDING TO THE DOCTRINE OF MUHAMMADIYAH IN INDONESIA: HADITH STUDIES

COVID-19 has emerged as the global challenge confronting the community. The Indonesian government and Muhammadiyah have been engaged in efforts to mitigate the ongoing transmission of COVID-19. Diverse strategies have been employed to combat this disease and prevent its spread and fatalities. This study aims to examine and explain Muhammadiyah’s preventive efforts in Indonesia to combat COVID-19, drawing upon an interpretation of hadiths from the Prophet. A qualitative method was employed to address this issue with a historical, sociological approach to investigate the social conditions during the time of the Prophet and their prevention in relation to contemporary times performed by Muhammadiyah. The study revealed that Muhammadiyah has addressed community and humanitarian issues by implementing efforts to prevent the spread of COVID-19. One such effort was restricting worship activities in mosques and encouraging people to perform them at home until the situation returned to normal. However, in areas deemed safe from COVID-19, worship could still be conducted in mosques while adhering to health protocols such as maintaining social distance, wearing masks, and practicing proper hand hygiene. Furthermore, learning in large group settings has been limited, leading to a shift toward remote online learning from home. Engaging in outdoor muamalah activities, such as working, meetings, religious studies, shopping, and other activities that attract and result in big gatherings, has also been restricted. These efforts aim to disrupt the transmission of COVID-19 as a manifestation of societal care, guided by the teachings of the Prophet as recorded in the hadiths.

Outcomes of Zone II Flexor Tendon Repair Under General Versus Wide Awake Local Anesthesia: A Randomized Controlled Trial

Wide awake local anesthesia no tourniquet (WALANT) is gaining popularity with flexor tendon repair. We hypothesized that results of zone II flexor tendon repair performed under WALANT would be superior to those performed under general anesthesia (GA). A randomized controlled trial was conducted to compare results of repair of zone II flexor tendon lacerations under WALANT versus GA. Following sample size estimation, 86 digits were included and randomized into two groups. All surgeries were performed by a single surgeon using a six-stranded core stitch and running epitenon suture. All patients followed the same early active rehabilitation protocol. The primary outcome was recovery calculated using the Strickland and Glogovac criteria. Secondary outcomes included rupture rate, complication rate, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. All outcomes were reported at the 6-month visit for all patients. Of the 86 digits, three were lost to follow-up. Analysis was performed on 43 digits in the WALANT group and 40 in the GA group. Demographic characteristics including age and sex were comparable in both groups. Rupture of the repair occurred in two digits in each of the WALANT and GA groups. An excellent or good outcome was achieved in 49% and 56% of the digits in the WALANT and GA groups, respectively. This difference was not statistically significant. DASH scores averaged 12.9 and 8.4 for the WALANT and GA groups, respectively. WALANT may not be superior to GA in regards function, rates of rupture, and patient-reported outcomes in repair of zone II flexor tendon lacerations. Surgeons can be confident in choosing either technique if rigorous patient selection, sound surgical technique, and proper hand therapy are employed. Therapeutic I.

Edukasi Mencuci Tangan yang Baik dan Benar dalam Peningkatan Kemandirian Anak Berkebutuhan Khusus

Children with special needs often face challenges in implementing daily living skills, including hygiene habits such as hand washing. In orphanages, they may not always receive enough individualized attention to learn and master this skill. The purpose of this community service activity is to provide education in the form of knowledge and procedures for proper hand washing and improve the skills of children with special needs so that they can independently wash their own hands. This community service activity uses an individual or small group approach with a direct demonstration method and uses audiovisual aids such as videos and posters. The results of this community service obtained an increase in the knowledge of children with special needs in hand washing skills as many as 9 children (30%) in the category of good independence ability, 18 children (60%) in the category of sufficient independence ability, and 3 children (10%) in the category of less independence ability. It is hoped that this education can be carried out regularly, especially for orphanage assistants. Thus it can further improve the knowledge and skills of children with special needs in washing hands independently to build clean and healthy living habits.

Staff Perspectives on Barriers & Facilitators to Meeting Hand Hygiene Goals in a Multicenter Academic Hospital System

Background: Proper hand hygiene is the most important practice to reduce the transmission of infections in healthcare settings. Despite this, healthcare institutions continue to struggle to achieve and maintain high rates of hand hygiene compliance among healthcare workers with some studies estimating national healthcare worker hand hygiene compliance to be approximately 50%. Methods: We conducted an anonymous one-time survey of our Lifespan Hospital System employees to evaluate barriers and facilitators to performing hand hygiene as well as interventions to improve hand hygiene compliance. The survey was designed with guidance from the Consolidated Framework for Implementation Research and input from Lifespan infection prevention staff. Result: Over four weeks 985 (6%) Lifespan employees completed the survey. Figure 1 shows the aggregate results of the first 4 survey questions which focused on hand hygiene infrastructure at Lifespan, including availability of sanitizer, staff to manage hand hygiene supplies, and educational materials/reminders. One significant finding was >70% of respondents reported that they either did not know if their unit/department has a person assigned to replace/monitor hand hygiene supplies, or if so, who that person is. We also asked employees to rate how effective different interventions would be at improving hand hygiene compliance. Figure 2 shows of five proposed interventions, three were rated as either “moderately effective” or “very effective” by >50% of respondents. These included displaying hand hygiene instructions, making hand hygiene data available to employees, and displaying materials/reminders promoting hand hygiene. There were also 977 free-text responses regarding “barriers or facilitators to proper hand hygiene”. Major barriers identified were a lack of staff to monitor and refill supplies, slow replacement of hand hygiene products, lack of sanitizer dispensers and sinks, inconsistency of sink location and dispenser placement, lack of hand hygiene reminders/educational materials, time constraints, skin irritation from sanitizer, and an inability to have dispensers in behavioral health units. Survey responses led us to enhance the following: educational materials and reminders in work areas; staff education; leadership involvement in hand hygiene initiatives; routine auditing and feedback; conveniently placed sanitizer dispensers and sinks at the point of care; and making hand hygiene compliance data readily available to staff. Conclusion: This survey identifies important barriers and facilitators to achieving high rates of hand hygiene compliance among healthcare workers and provides the basis for interventions aimed at improving hand hygiene compliance in a large multicenter academic hospital system.

Employing patient-centric health education for the prevention of parasitic infections.

Soil-transmitted infections such as Ascaris lumbricoides, Hookworm, Trichuris trichiura, and Strongyloides stercoralis are common in South India. Factors such as diet, sanitation, and living conditions play a role in the prevalence of helminthic diseases. Many individuals remain asymptomatic carriers. Timely intervention is essential to prevent these infections. This is a prospective, randomized intervention study that enrolled 52 participants, excluding children, all of whom had parasitic infections. A prevalidated questionnaire was given to assess the risk factors for parasitic diseases, and fecal examinations were conducted to identify parasitic infestations. The World Health Organization's hand hygiene self-assessment framework was used to evaluate handwashing skills. Subsequent posttesting and resampling of patients allowed for score comparison, assessment of reductions in parasitic load, determination of cure rates, and monitoring of patient readmission rates. After the health education intervention, a statistically significant improvement (P < 0.01) was observed in patients' knowledge and attitudes toward parasitic infections, as shown by their posttest scores compared to their pretest scores. In addition, there were notable improvements in handwashing skills following the implementation of the handwashing educational program. This research confirms that health education is vital in promoting proper hand hygiene, reducing parasitic infections, and urging timely medical care for these conditions.

INTESTINAL PARASITE CONTAMINATION OF CIRCULATING MONEY IN THE ADMINISTRATIVE REGION OF RIACHO FUNDO II, FEDERAL DISTRICT, BRAZIL

Introduction: Enteroparasitic infections are a serious public health problem and often represent a burden to the economy of low and middle-income countries. Transmission can occur directly, via personal contact, or indirectly, by means of inadequate handling of objects or poorly sanitized surfaces. Coin and paper money, widely used in commercial areas, constitute a potential vehicle for the transmission of pathogens. Objective: To find out if cash money circulating in the administrative region of Riacho Fundo II, Federal District (Brasília, Brazil), is contaminated with cysts, eggs, or larvae of intestinal parasites. Material and Methods: Banknotes and coins from snack bars, bakeries, grocery stores, restaurants, butchers, and street vendors were parasitologically investigated. Results: Parasitological contamination was detected in 53% of 1,546 coins and in 10.5% of 183 banknotes ​​analyzed. Protozoan cysts were the predominant forms, with different diagnosed species – Entamoeba coli, Entamoeba hartmanni, Endolimax nana and Entamoeba sp. An egg of Ascaris lumbricoides was found in a paper note. Markets presented the highest prevalence of parasitic contamination in the circulating cash. Conclusions: Our data confirm the perception that money is an important vehicle for the transmission of intestinal parasites. Preventive measures, such as educational guidelines on proper hand hygiene and the appropriate use of cash, can have a positive impact in tackling the spread of enteroparasites.

Specific Personal Hygiene Procedures and Practices in Food Handlers—A Cross-Sectional Study in Butcher and Fishmonger Shops in Almada

Good manufacturing practices play an important role in obtaining safe food and preventing foodborne diseases. To achieve this goal, food handlers must receive appropriate training to be aware of their responsibilities. In this work, compliance with specific personal hygiene requirements by food handlers was assessed in a cross-sectional study of traditional small retail establishments, namely butcher (n = 56) and fishmonger (n = 17) shops in Almada, Portugal. Food handlers (n = 140, of which 113 worked in butcher shops, and 27 worked in fishmonger shops) were interviewed for data collection, and retail establishments were audited considering specific hygiene requisites. In fishmonger shops, most food handlers are women (89%), aged 18 to 45 years (70%), with a high school degree, having worked for less than 5 years in this activity, while in butcher shops most food handlers are men (90%) over 45 years old (58%), with a basic education level, and more than 26 years of experience. Most food handlers (&gt;95%) attended recent food safety and hygiene training courses and were able to recognize that hand sanitizers cannot replace a proper hand wash, and to identify Staphylococcus aureus transmission routes to food. However, approximately 23% of retail establishments failed to provide hot water in the handwashing basin and exhibited improper placement of handwashing instructions. Furthermore, these establishments did not implement corrective actions following non-conforming microbiological results of hand hygiene monitoring. These findings reinforce the need for consistent management commitment, and for providing food handlers with regular training, which is crucial for maintaining a strong food safety and hygiene culture in these traditional small retail establishments.

Analysis of the relationship between fear of coronavirus and hand hygiene beliefs and practices of surgical nurses: A descriptive and cross-sectional study.

This study aimed to analyse the relationship between fear of COVID-19 and hand hygiene beliefs and practices of surgical nurses. This article is a descriptive correlational study. It was conducted between February and May 2021 with 306 surgical nurses working at public and private hospitals in Northern Cyprus. A personal information form, Fear of COVID-19 Scale, Hand Hygiene Belief Scale and Hand Hygiene Practices Inventory were used for data collection. Of the participants in the study, 25.41% were 29 years old or younger and 85.15% were female. The mean scores obtained from the Fear of COVID-19 Scale, Hand Hygiene Belief Scale and the Hand Hygiene Practices Inventory were 23.12 ± 8.03, 81.33 ± 7.67 and 69.15 ± 1.94, respectively. The Fear of COVID-19 Scale scores were negatively correlated with the Hand Hygiene Belief Scale scores and positively correlated with the Hand Hygiene Practices Inventory scores. Hand hygiene practices were better for nurses with higher level of COVID-19 fear. Therefore, a high level of seriousness and awareness of nurses about hand hygiene, which was achieved during the COVID-19 pandemic, should be sustained to maintain proper hand hygiene practices.

Virtual Mouse

Now a days the use of hand gesture recognition became popular due to the advance technology of artificial Intelligence (AI). In recent years, there has been a growing interest in developing alternative methods for human-computer interaction (HCI) that go beyond traditional input devices like keyboards and mouse. Hand gesture recognition has emerged as a promising approach, offering intuitive and natural ways for users to interact with digital interfaces. The proposed system utilizes computer vision techniques to detect and track hand gestures in real-time. By mapping specific gestures to mouse control commands, users can navigate and interact with graphical user interfaces (GUIs) without the need for physical input devices. In this paper A hand gesture- controlled virtual mouse system utilizes the AI and Machine learning algorithms to recognize the proper hand gestures and translate them into the mouse movements. The system we are designed that the people who have problems or difficulty using a traditional mouse or keyboard it will be appropriate for them. For this we are using camera that capture images of the user’s hand, which are processed by an AI and ML algorithm to recognize the gesture of hands being made. We trained the system by using a dataset of hand gestures. Keywords — Hand gesture recognition, Machine Learning, Artificial Intelligence, Virtual Mouse, Python, Media Pipe

Assessment of Post-Covid-19 Hand Hygiene Compliance Among Nigeria Certificate in Education Biology Students in Zaria, Nigeria

This study titled Assessment of post-COVID-19 hand hygiene compliance among Nigeria Certificate in Education Biology Students in Zaria, Nigeria was a cross-sectional survey work. The study was guided by three research questions and three research objectives. Three hundred forty-six (346) NCE biology students were chosen at random from a population of three thousand four hundred and forty-one using the random sampling technique. The data collection instrument was a structured questionnaire titled "Students Hand-Hygiene Compliance Questionnaire (SHCQ)" which underwent validation by two science education experts from Ahmadu Bello University, Zaria. Split-half method was adopted to determine reliability which gave the reliability coefficient value of 0.77 with Spearman rank statistics. The researchers administered the instrument to respondents over two weeks. The mean and standard deviation were used to analyse the gathered data. According to the results, the College established hand hygiene compliance during the COVID-19 era (X = 4.00, S.D. = 1.20); NCE Biology students in Zaria had low levels of post-COVID-19 hand hygiene compliance (X = 2.80, S.D. = 1.02); and there weren't many obstacles to post-COVID-19 hand hygiene compliance (X = 3.74, S.D. = 1.08). Recommendations among others include: the College management should continue to prioritize and reinforce a robust infrastructure for handwashing facilities, ensure the availability of soap and sanitizers, and conduct regular educational campaigns on proper hand hygiene practices.

Chemotherapy safe handling practices in Ethiopia: A comprehensive multi-center evaluation.

The increasing incidence of cancer and capacity for cancer care in Ethiopia has led to an upsurge in chemotherapy use in the country; however, studies indicate that there is a gap in the safe handling of chemotherapy by healthcare workers. There exists a need to understand if such unsafe practices occur in Ethiopia and, if so, which areas along the chemotherapy life cycle need the most improvement. This study utilized a multi-method design through an online survey administered to health care professionals and evaluative site visits of eight cancer units in Addis Ababa, Ethiopia to understand the current conditions of chemotherapy handling. In addition, a survey was conducted among Ethiopian health care professionals from across the country. Fifty-five percent of survey participants disagreed or strongly disagreed that there are systems in place to identify, prevent, and address chemotherapy hazards in their workplace, and 71% of respondents denied having an active and effective health and safety committee and/or worker health and safety representative where they work. At evaluative site visits, only 30% of health care workers met the minimum guidelines for proper hand hygiene, and 20% of health care workers used adequate Personal Protective Equipment according to guidelines across the chemotherapy lifecycle. Results of this study indicate an urgent need for implementation of evidence-based interventions to improve chemotherapy handling in Ethiopia so that all patients and health care workers are protected from the hazardous toxicities of these drugs.

Hand hygiene perceptions, preferences, and practices among hospital staff in the Dominican Republic in the context of COVID-19: a qualitative study

Proper hand hygiene (HH), which includes sanitizing with alcohol-based hand rub (ABHR) (or handwashing with soap and water if ABHR is unavailable), is key for preventing healthcare-associated infections (HCAI), including COVID-19. Understanding drivers of HH is key to improving adherence. This study aims to explore drivers and barriers to HH practice at two hospitals in the Dominican Republic in the context of the COVID-19 pandemic to inform development of HH behaviour change interventions. We conducted in-depth interviews with 20 hospital staff during September 2021. We used the COM-B (capability, opportunity, motivation, behaviour) model to explore HH experiences and preferences. Interviews were recorded, transcribed, coded, and analysed using a thematic approach. A total of 11 parent codes and 27 sub-codes were identified, and 1145 coded segments were analysed. Use of handwashing with soap and water and/or sanitizing with ABHR was reported by all participants; handwashing was generally preferred. Participants expressed knowledge of proper HH methods (capability), but inconsistent supplies and lack of time presented HH challenges (opportunity). Interviewees described practicing HH to protect themselves and their families from COVID-19 and other infections (reflective motivation) or out of habit (automatic motivation). By understanding and addressing underlying factors affecting HH, hospitals can decrease the risk of HCAIs. Our findings suggest that interventions implemented to improve HH in these hospitals should target motivation and opportunity. These findings informed a multimodal intervention to increase ABHR access and implement message-tested communications campaigns; end-point assessments will provide insights into the intervention's impact.