World Health Organization Hand Hygiene Research Articles

Limiting spread of COVID-19 in Ghana: Compliance audit of selected transportation stations in the Greater Accra region of Ghana.

Globally, little evidence exists on transmission patterns of COVID-19. Recommendations to prevent infection include appropriate and frequent handwashing plus physical and social distancing. We conducted an exploratory observational study to assess compliance with these recommendations in selected transportation stations in Ghana. A one-hour audit of 45 public transport stations in the Greater Accra region was carried out between 27th and 29th March 2020. Using an adapted World Health Organization (WHO) hand hygiene assessment scale, the availability and use of handwashing facilities, social distancing, and ongoing public education on COVID-19 prevention measures were assessed, weighted and scored to determine the level of compliance of stations. Compliance with recommendations was categorized as "inadequate" "basic", "intermediate" and "advanced", based on the overall score. Majority (80%) of stations in Accra have at least one Veronica Bucket with flowing water and soap, but the number of washing places at each station is not adequate. Only a small minority (18%) of stations were communicating the need to wash hands frequently and appropriately, and to practice social/physical distancing while at the station. In most stations (95%), hand washing practice was either not observed, or only infrequently. Almost all stations (93%) did not have alcohol-based hand sanitizers available for public use, while social distancing was rarely practiced (only 2%). In over 90% of the stations, face masks were either not worn or only worn by a few passengers. Compliance with COVID-19 prevention measures was inadequate in 13 stations, basic in 16 stations, intermediate in 7 stations, and advanced in 9 stations. Compliance with COVID-19 prevention measures in public transportation stations in the Greater Accra region remains a challenge. Awareness creation should aim to elevate COVID-19 risk perception of transportation operators and clients. Transport operators and stations need support and guidance to enforce hand washing and social distancing.

Using an ultraviolet cabinet improves compliance with the World Health Organization\u2019s hand hygiene recommendations by undergraduate medical students: a randomized controlled trial

BackgroundAppropriate hand hygiene (HH) is key to reducing healthcare-acquired infections. The World Health Organization (WHO) recommends education and training to improve HH knowledge and compliance. Physicians are ranked among the worst of all healthcare workers for compliant handrubbing with its origin probably being the failure to learn this essential behavior during undergraduate medical studies. This study evaluated if the use of Ultraviolet-cabinets (UVc) for fluorescent-alcohol-based handrubs (AHR) during an undergraduate medical student training improved the compliance rate to the WHO hand hygiene recommendations (completeness of AHR application and HH opportunities).MethodsThis randomized trial compared a HH training with personal feedback (using UVc) to a control group. The first year, the students (2nd degree) were convened by groups (clusters) of 6–9 for a demonstration of the correct execution of WHO procedure. Randomization by cluster was done prior HH training. In the control group, the students hand rubbed under visual supervision of a tutor. In the intervention group after the same visual supervision, completeness of fluorescent-AHR hand application was recorded under UVc and was shown to the student. The intervention group had free access to the UVc until complete application. HH practices were included in simulation sessions for the both groups. One year after (3rd degree), all the students were asked to hand rub with fluorescent-AHR. A tutor (blinded to the study group) assessed the completeness of hand application under UVc and the compliance with the WHO opportunities. Complete application of AHR was defined as fluorescence for all the surfaces of hands and wrists.Results242 students participated (140 in the intervention group and 102 in the control group). One year after the initial training, the rate of complete application of AHR was doubled in the intervention group (60.0% vs. 30.4%, p < 0.001). In a multivariate analysis which included gender, additional HH or UVc training, surgical traineeship and regular use of AHR, the hazard ratio for the intervention was 3.84 (95%CI: 2.09–7.06). The compliance with the HH WHO’s opportunities was increased in the intervention group (58.1% vs. 42.4%, p < 0.018).ConclusionUsing UVc for undergraduate medical students education to hand hygiene improves their technique and compliance with WHO recommendations.

Hand hygiene in surgery in Benin: opportunities and challenges

BackgroundHand Hygiene (HH) has been described as the cornerstone and starting point in all infection control. Compliance to HH is a fundamental quality indicator. The aim of this study was to investigate the HH compliance among Health-care Workers (HCWs) in Benin surgical care units.MethodsA multicenter prospective observational study was conducted for two months. The World Health Organization (WHO) Hand Hygiene Observation Tool was used in obstetric and gastrointestinal surgery through six public hospitals in Benin. HH compliance was calculated by dividing the number of times HH was performed by the total number of opportunities. HH technique and duration were also observed.ResultsA total of 1315 HH opportunities were identified during observation period. Overall, the compliance rate was 33.3% (438/1315), without significant difference between professional categories (nurses =34.2%; auxiliaries =32.7%; and physicians =32.4%; p = 0.705). However, compliance rates differed (p < 0.001) between obstetric (49.4%) and gastrointestinal surgery (24.3%). Generally, HCWs were more compliant after body fluid exposure (54.5%) and after touching patient (37.5%), but less before patient contact (25.9%) and after touching patient surroundings (29.1%).HCWs were more likely to use soap and water (72.1%) compared to the alcohol based hand rub solution (27.9%). For all of the WHO five moments, hand washing was the most preferred action. For instance, hand rub only was observed 3.9% after body fluid exposure and 16.3% before aseptic action compared to hand washing at 50.6 and 16.7% respectively. Duration of HH performance was not correctly adhered to 94% of alcohol hand rub cases (mean duration 9 ± 6 s instead of 20 to 30 s) and 99.5% of hand washing cases (10 ± 7 s instead of the recommended 40 to 60 s). Of the 432 HCWs observed, 77.3% followed HH prerequisites (i.e. no artificial fingernails, no jewellery). We also noted a lack of permanent hand hygiene infrastructures such as sink, soap, towels and clean water.ConclusionCompliance in surgery was found to be low in Benin hospitals. They missed two opportunities out of three to apply HH and when HH was applied, technique and duration were not appropriate. HH practices should be a priority to improve patient safety in Benin.

Healthcare Workers' Knowledge and Attitudes Regarding the World Health Organization's "My 5 Moments for Hand Hygiene": Evidence From a Vietnamese Central General Hospital.

Objectives:Although the World Health Organization (WHO) initiative “My 5 Moments for Hand Hygiene” has been lauded as effective in preventing hospital-associated infections, little is known about healthcare workers (HCWs)’ hand hygiene behavior. In this study, we sought to assess knowledge and attitudes towards the concepts in this initiative, as well as associated factors, among Vietnamese HCWs at a general hospital.Methods:A structured questionnaire was administered to HCWs at a central Vietnamese general hospital in 2015. Multiple logistic regression analysis was used to identify factors associated with HCWs’ knowledge and attitudes towards hand hygiene.Results:Of 120 respondents, 65.8% and 67.5% demonstrated appropriate knowledge and a positive attitude, respectively, regarding all 5 hand hygiene moments. Logistic regression indicated better knowledge of hand hygiene in workers who were over 30 years old, who were direct HCWs (rather than managers), who had frequent access to clinical information, and who received their clinical information from training. Those who worked in infectious and tropical disease wards, who had frequent access to clinical information, and who received information from training were more likely to have a positive attitude towards hand hygiene than their counterparts.Conclusions:Although many Vietnamese HCWs displayed moderate knowledge and positive attitudes towards the WHO hand hygiene guidelines, a key gap remained. Regular education and training programs are needed to increase knowledge and to improve attitudes and practices towards hand hygiene. Furthermore, a combination of multimodal strategies and locally-adapted interventions is needed for sustainable hand hygiene adherence.

An Effect of the World Health Organization's "My Five Moments for Hand Hygiene": An Initiative on Hand-Hygiene Knowledge, Beliefs, Attitudes and Compliance Among Certified Nursing Assistants Working in A Health Care Facility

According to the CDC, an estimated four million Americans reside in long-term care facilities in the United States, among which one to three million life-threatening infections occur every year. These infections at long-term care facilities are a major cause of hospitalizations and death. The purpose of this research project was to provide a nonrandomized pretest/posttest on knowledge, belief, attitudes and compliance to all 45 CNAs selected for this study to improve current hand hygiene practices of certified nursing assistants employed by a health care facility. Pre-test and posttest assessments were in addition to an intervention approach administered after the pretest and before the posttest. The World Health Organization Hand Hygiene Knowledge Questionnaire for Health Care Workers, the Hand Washing Self-Assessment Inventory Scale Questionnaire for belief and attitude and a wall hand sanitizer as a proxy to measure hand compliance were the instruments. The intervention administered was the WHO's My Five Moments for Hand Hygiene approach to improve hand hygiene practice and compliance. The participants included 30 CNAs selected as the intervention group and 15 CNAs as the control group. The results indicated that the mean difference 0.14, 95% CI [0.05-0.23) in Knowledge between the treatment and control groups was significant (p = 0.004). The results of the 2 by 2 factorial ANOVA conducted to determine Belief and Attitude indicated a significant main effect (F1, 43) = 30.55, p<0.001, pη2 = 0.42). The analysis for Attitude indicated a significant main effect (F1, 43) = 29.37, p<0.001, pη2 = 0.42). For the hand sanitizer measurement, there was no significant difference in hand sanitizer use between control and intervention floors at baseline (p = 0.175). After the intervention training, the intervention floors had significantly more hand sanitizer use than the control floors (p = 0.033).

Does Adherence to World Health Organization Hand Hygiene Protocols in the Operating Room Have the Potential to Produce Irritant Contact Dermatitis in Anesthesia Providers?

Anesthesia providers have the burden of constant hand hygiene during task dense periods. The requirement for hand hygiene often demands frequent application of alcohol-based hand rub. To assess whether frequent alcohol-based hand rub use leads to skin changes or irritant contact dermatitis, volunteers cleaned their hands with alcohol-based hand rub every 15 minutes for 8 hours for 5 sequential days. They were examined by a dermatologist before and after and asked about subjective skin changes. Results suggest an increase in irritant contact dermatitis scores and subjective complaints.

Hand Hygiene Compliance in the ICU: A Systematic Review.

To synthesize the literature describing compliance with World Health Organization hand hygiene guidelines in ICUs, to evaluate the quality of extant research, and to examine differences in compliance levels across geographical regions, ICU types, and healthcare worker groups, observation methods, and moments (indications) of hand hygiene. Electronic searches were conducted in August 2018 using Medline, CINAHL, PsycInfo, Embase, and Web of Science. Reference lists of included studies and related review articles were also screened. English-language, peer-reviewed studies measuring hand hygiene compliance by healthcare workers in an ICU setting using direct observation guided by the World Health Organization's "Five Moments for Hand Hygiene," published since 2009, were included. Information was extracted on study location, research design, type of ICU, healthcare workers, measurement procedures, and compliance levels. Sixty-one studies were included. Most were conducted in high-income countries (60.7%) and in adult ICUs (85.2%). Mean hand hygiene compliance was 59.6%. Compliance levels appeared to differ by geographic region (high-income countries 64.5%, low-income countries 9.1%), type of ICU (neonatal 67.0%, pediatric 41.2%, adult 58.2%), and type of healthcare worker (nursing staff 43.4%, physicians 32.6%, other staff 53.8%). Mean hand hygiene compliance appears notably lower than international targets. The data collated may offer useful indicators for those evaluating, and seeking to improve, hand hygiene compliance in ICUs internationally.

Innovative Surveillance and Execution of the World Health Organization's 5 Moments of Hand Hygiene in an Acute-care Hospital

BACKGROUND Hand hygiene (HH) is critical to the prevention of serious infections in the healthcare setting. Caregivers have been found to have suboptimal HH practices. The World Health Organization (WHO) 5 Moments of HH program was implemented in an acute-care hospital in an effort to increase caregiver participation, renew interest, and raise visibility. METHODS Over a four month period in 2018, 128 participants were surveyed with an abbreviated WHO HH Perception Survey for Health-Care Workers in an acute-care and critical access hospital. Of the respondents, 67% were from nursing or ancillary nursing services. The abbreviated WHO HH Perception survey was utilized as a way to understand and improve caregiver perceptions and practices related to HH. A question highlighting HH improvement and the receipt of regular results regarding HH performance was targeted. RESULTS On the WHO HH Self-Assessment Framework (SAF) the acute-care hospital scored 280 (range of 0 – 500), intermediate, for HH facility level and obtained a satisfactory level of 12 for HH Leadership. On a scale of 1 – 7, 73% of overall participants rated “receiving regular feedback regarding HH performance” ≥ 5 on the WHO HH perceptions survey. Based on this feedback and the WHO HHSAF, the acute-care hospital implemented a multimodal approach to HH practices through a novel framework. CONCLUSIONS This targeted approach illuminated participant values regarding regular feedback on HH performance. In response, infection prevention implemented secret shopper HH cameras that rotate departments in conjunction with frequent rounding on units to provide immediate feedback on HH compliance and missed opportunities. Feedback was provided to floor nurses, nurse managers, and assistant nurse managers. Additionally, a dynamic traveling HH campaign was implemented to socialize the WHO 5 Moments. The campaign asked all staff to participate in HH activities and to renew their commitment to HH through unit specific posters and signatures. Hand hygiene (HH) is critical to the prevention of serious infections in the healthcare setting. Caregivers have been found to have suboptimal HH practices. The World Health Organization (WHO) 5 Moments of HH program was implemented in an acute-care hospital in an effort to increase caregiver participation, renew interest, and raise visibility. Over a four month period in 2018, 128 participants were surveyed with an abbreviated WHO HH Perception Survey for Health-Care Workers in an acute-care and critical access hospital. Of the respondents, 67% were from nursing or ancillary nursing services. The abbreviated WHO HH Perception survey was utilized as a way to understand and improve caregiver perceptions and practices related to HH. A question highlighting HH improvement and the receipt of regular results regarding HH performance was targeted. On the WHO HH Self-Assessment Framework (SAF) the acute-care hospital scored 280 (range of 0 – 500), intermediate, for HH facility level and obtained a satisfactory level of 12 for HH Leadership. On a scale of 1 – 7, 73% of overall participants rated “receiving regular feedback regarding HH performance” ≥ 5 on the WHO HH perceptions survey. Based on this feedback and the WHO HHSAF, the acute-care hospital implemented a multimodal approach to HH practices through a novel framework. This targeted approach illuminated participant values regarding regular feedback on HH performance. In response, infection prevention implemented secret shopper HH cameras that rotate departments in conjunction with frequent rounding on units to provide immediate feedback on HH compliance and missed opportunities. Feedback was provided to floor nurses, nurse managers, and assistant nurse managers. Additionally, a dynamic traveling HH campaign was implemented to socialize the WHO 5 Moments. The campaign asked all staff to participate in HH activities and to renew their commitment to HH through unit specific posters and signatures.

Training to Proficiency in the WHO Hand Hygiene Technique

Objectives:Hand hygiene is critical to patient safety, but low performance in terms of the quantity and quality of hand hygiene is often reported. Training-to-proficiency is common for other clinical skills, but no proficiency-based training program for hand hygiene has been reported in the literature. This study developed a proficiency-based training program to improve hand hygiene quality in line with World Health Organization (WHO) guidelines and assessed the amount of training required to reach proficiency. The training was delivered as part of a 5-day induction for students on the Physician Assistant online program.Methods:A total of 42 students used a simulator to objectively measure hand hygiene technique over a 5-day period. Proficiency was achieved when students demonstrated all 6 steps of the WHO technique in less than 42 seconds. The students also completed a postintervention questionnaire.Results:The average training episode lasted 2.5 minutes and consisted of 4.5 hand hygiene exercises. The average student completed 5 training episodes (1 per day) taking a total of 17 minutes. A total of 40% (17) of the students achieved proficiency within the 5 days. Proficiency was strongly correlated with the number of training exercises completed (r = 0.79, P < .001) and the total time spent training (r = 0.75, P < .001). Linear regression predicted that the 32 hand hygiene exercises or a total of 23-minute training were required to achieve proficiency.Conclusions:This is the first study to develop a train-to-proficiency program for hand hygiene quality and estimate the amount of training required. Given the importance of hand hygiene quality to preventing health care–associated infections (HAIs), medical education programs should consider using proficiency-based training in hand hygiene technique.

Beyond entry and exit: Hand hygiene at the bedside

We aimed to assess compliance, knowledge, and attitudes regarding the World Health Organization (WHO) 5 moments for hand hygiene (HH). We assessed HH compliance from July-August 2016, using a modified WHO HH observation form. A 26-question survey was used to assess health care personnel (HCP) knowledge, opinions, and barriers to HH. A subgroup of HCPs participated in a 2-round focused survey to assign priority to the moments. Three hundred two HH opportunities were observed in 104 unique HCP-patient interactions. HH was performed at 106 (35%) opportunities, 37% (25 of 68) before touching a patient, 9% (6 of 70) before aseptic procedures, 5% (1 of 22) after body fluid exposure or risk, 63% (55 of 88) after touching a patient, and 35% (19 of 54) after touching patient surroundings. Two hundred eighteen HCPs completed the survey; 63 (29%) were familiar with the WHO 5 moments but only 13 (21%) were able to recall all 5 moments. In the focused surveys, 46% (6 of 13) ranked "before aseptic procedure" as the most important HH moment, and 86% (11 of 13) identified "after touching patient surroundings" as the least important. We found frequent opportunities for HH with infrequent compliance. Lack of recognition of opportunities at the bedside and frequent glove use may contribute to lower compliance.

Proceedings of Contributed Presentations 10th World Federation of Chiropractic/Association of Chiropractic Colleges Education Conference

Proceedings of Contributed Presentations 10th World Federation of Chiropractic/Association of Chiropractic Colleges Education Conference

A study on knowledge about hand hygiene among medical, dental and nursing students in Bangalore, Karnataka

Introduction: Hands are the main pathway of germ transmission during health care. Health care associated infections are the major concern when it comes to patient safety. Lack of hand hygiene leads to a serious problem in health care services as they may cause prolonged hospital stay. This study aims at assessing and comparing the knowledge regarding hand hygiene among undergraduate medical, dental and nursing students. Method: A cross-sectional, questionnaire-based study was undertaken among 150 undergraduate medical, dental and nursing students studying in a Tertiary care teaching Institute in Bangalore, Karnataka. Data collection was done using World Health Organization hand hygiene questionnaire for health care workers. Analysis was done using SPSS version 21. Results: A total of 150 students participated in the study. Of these 48 were medical, 50 were dental and 52 were nursing students. Only 87 out of 150 (58%) students had received training in hand hygiene in past 3 yrs. The medical and nursing students had very poor knowledge that unclean hands of health care workers can transmit harmful germs to patients, whereas dental students had better knowledge about the same and the difference was statistically significant. Knowledge regarding washing of hands after exposure to blood was better among nursing students than medical and dental students. Conclusion: The knowledge about hand hygiene was not satisfactory among the students. Hand hygiene training can be made mandatory for medical, dental and nursing students as they handle patients.

Implementation of multimodal infection control and hand hygiene strategies in acute-care hospitals in Greece: A cross-sectional benchmarking survey

In this first attempt to suggest achievable standards for improvement in hospital infection prevention and control (IPC) in Greece, we assessed main IPC structure and process indicators emphasizing hand hygiene. Acute-care hospitals across the country participated in a cross-sectional survey by completing the World Health Organization Hand Hygiene Self-assessment Framework (HHSAF) and by providing hospital-level IPC indicators. Seventeen hospitals completed the survey, comprising 14% of the country's public hospitals. Median IPC staffing levels were 0.8 nurses and 0.5 doctors per 250 beds. Few hospitals implemented full multimodal IPC programs. The HHSAF indicated that appropriate hand hygiene practices and promotion strategies were in place in most hospitals, but the mean HHSAF score of 289 was lower compared with studies in Italy (mean, 332; P = .040) and the United States (mean, 373; P < .001). Presence of 1 additional IPC nurse was independently associated with increases of 53% in the HHSAF median score for training-education (P = .035) and by 38% in the lower 30th percentile HHSAF score for safety climate (P = .049). Surveyed hospitals are, on average, at an intermediate level in hand hygiene practice but require improvements on training-education, evaluation-feedback, and safety climate. Ensuring adequate IPC nurse staffing levels and systematically implementing multimodal IPC programs may lead to substantial improvements.

Global hand hygiene improvement progress: two surveys using the WHO Hand Hygiene Self-Assessment Framework

The World Health Organization (WHO) conducted two global surveys in 2011 and 2015 using the Hand Hygiene Self-Assessment Framework. In 2011, 2119 health facilities from 69 countries participated, and in 2015, 807 health facilities from 91 countries participated. In total, 86 facilities submitted results for both surveys; their overall score increased significantly (P<0.001) from 335.1 [standard deviation (SD) 7.5] to 374.4 (SD 90.5). In terms of WHO regions, the scores for the Eastern Mediterranean, Europe and Western Pacific regions all improved significantly (P<0.01). This represents a snapshot of the current position of global hand hygiene improvement efforts, outlining facility progress and highlighting the value of such an assessment tool.

Healthcare-associated infections in paediatric and neonatal wards: A point prevalence survey at four South African hospitals.

Healthcare-associated infections (HAIs) cause substantial morbidity, mortality and healthcare costs. The prevalence of neonatal/paediatric HAI at South African (SA) district and regional hospitals is unknown. To document HAI rates, antimicrobial use for HAI, infection prevention staffing, hand hygiene (HH) provisions and HH compliance rates in neonatal and paediatric wards in two district and two regional hospitals in the Western Cape Province, SA. An HAI point prevalence survey (PPS) was conducted in neonatal and paediatric wards at two district and two regional hospitals in the Western Cape during December 2016, applying National Healthcare Safety Network HAI definitions. HAI events and antimicrobial therapy active at 08h00 on the PPS day and during the preceding 7 days (period prevalence) were documented. Provisions for HH and HH compliance rates were observed on each ward using the World Health Organization's HH surveillance tool. Pooled point and period HAI prevalence were 9.9% (15/151; 95% confidence interval (CI) 6 - 15.8) and 12.6% (19/151; 95% CI8 - 18.9), respectively. Hospital-acquired pneumonia (5/15, 33.3%), bloodstream infection (3/15, 20.0%) and urinary tract infection (3/15, 20.0%) were predominant HAI types. Risk factors for HAI were a history of recent hospitalisation (8/19, 42.1% v. 17/132, 12.9%; p&lt;0.001) and underlying comorbidity (17/19, 89.5% v. 72/132, 54.5%; p&lt;0.004). HH provisions (handwash basins/alcohol hand rub) were available and functional. HH compliance was higher in neonatal than in paediatric wards (125/243, 51.4% v. 25/250, 10.0%; p&lt;0.001). Overall HH compliance rates were higher among mothers (46/107, 43.0%) than nurses (73/265, 27.8%) and doctors (29/106, 27.4%). Neonatal and paediatric HAIs are common adverse events at district and regional hospitals. This at-risk population should be prioritised for HAI surveillance and prevention through improved infection prevention practices and HH compliance.

Assessment of Knowledge, Attitude and Practice of Hand Hygiene among Health Care Workers in Arar City, Saudi Arabia

Background: hygiene before and after each contact with any patient, is simple, easily implemented and an effective practice to prevent hospital acquired infection.This study aimed to assess the knowledge, attitude and practice of hand washing among health care workers (HCW) in health care units in Arar city, Northern Saudi Arabia, based on WHO’s ‘Five Moments of Hygiene Questionnaire’. Methodology: A descriptive cross sectional study was carried out at health care unites in Arar city during the period from July to September 2017. The World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire- revised 2009 edition was used. Results: In total, 116 respondents including 32 residents, 92 nurses and 37 nursing assistants enrolled in this study,68% of them were females and 32% were males, 41% were resident, 32.8% nurses, 12.9% Nursing assistant and 12.9% Technician. The mean score of HH knowledge in residents technicians, nurses and nurse assistants was 18 (±1.8), 17.7(±1.7), 18.3(±1.2) and 18.1(±1.4) respectively. While the mean score of attitude was the highest in nurses 6.9(±1.17) then the technicians 6.8(±1.6), and the lowest score was found in the nursing assistants 6.2(±0.56). The mean score of practice was found to be 4(±1.6) in technicians, 3.9(±1.0) in nurses, 3.8(±0.9) in residents and 3.5(±0.6) in nurse assistants. The majority of the participants (90.5%) had a high level of knowledge of HH. The attitude level was found moderate in 81.9% and high in only 17.2%. Level of practice of HH was high in 23.3%, moderate in 75.9% and almost none of our participants was found with a low level of practice. Conclusion: This study highlighted the importance of applying the multimodal training program addressing providers' knowledge regarding hand hygiene, as well as strategies for emotional and behavioral methods such as patient engagement in hand-hygiene interventions.

The knowledge of hand hygiene among the healthcare workers of two teaching hospitals in Mashhad.

IntroductionHealthcare-associated infections (HAIs) affect millions of patients worldwide annually. Hand hygiene (HH) has been identified as the single most important factor preventing HAIs. The aim of this study was to determine the knowledge regarding hand hygiene practices amongst health care workers, and identifying the areas of gaps in their knowledge.MethodsThis cross-sectional analytic study was conducted in two university hospitals in Mashhad, Iran between May 2014 and September 2015. Data was collected using a translated version of the World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire (revised 2009). The questionnaire contained questions on the participants’ age, gender, profession, year of the course, formal training in HH and 27 multiple choice and “yes” or “no” questions to assess HH knowledge. Data were entered into IBM SPSS Statistics, Version 16. Descriptive statistical methods and also analytical statistical methods include ANOVA and Independent-samples t-test were used in data analyzing.ResultsIn total, 161 respondents including 32 residents, 92 nurses and 37 nursing assistants enrolled in this study. All study groups had a moderate knowledge of HH. The score of 21% was ≤ 50% (poor) and only 10.6% had a good knowledge score (i.e. the score ≥75%). There was no significant difference in the knowledge level of the participants who had received formal training in HH and those who had not (p=0.68). Also, the mean knowledge score was not associated with age (p=0.12), gender (p=0.84), department (p=0.96) or profession (p=0.43).ConclusionThis study highlights the importance of applying the multimodal training program addressing providers’ knowledge regarding hand hygiene, as well as strategies for cognitive, emotional and behavioral methods such as patient engagement in hand-hygiene interventions.

Determinants of success and sustainability of the WHO multimodal hand hygiene promotion campaign, Italy, 2007-2008 and 2014.

A national hand hygiene promotion campaign based on the World Health Organization (WHO) multimodal, Clean Care is Safer Care campaign was launched in Italy in 2007. One hundred seventy-five hospitals from 14 of 20 Italian regions participated. Data were collected using methods and tools provided by the WHO campaign, translated into Italian. Hand hygiene compliance, ward infrastructure, and healthcare workers’ knowledge and perception of healthcare-associated infections and hand hygiene were evaluated before and after campaign implementation. Compliance data from the 65 hospitals returning complete data for all implementation tools were analysed using a multilevel approach. Overall, hand hygiene compliance increased in the 65 hospitals from 40% to 63% (absolute increase: 23%, 95% confidence interval: 22–24%). A wide variation in hand hygiene compliance among wards was observed; inter-ward variability significantly decreased after campaign implementation and the level of perception was the only item associated with this. Long-term sustainability in 48 of these 65 hospitals was assessed in 2014 using the WHO Hand Hygiene Self-Assessment Framework tool. Of the 48 hospitals, 44 scored in the advanced/intermediate categories of hand hygiene implementation progress. The median hand hygiene compliance achieved at the end of the 2007–2008 campaign appeared to be sustained in 2014.

Attitudes and practices of Irish hospital-based physicians towards hand hygiene and hand rubbing using alcohol-based hand rub: a comparison between 2007 and 2015

Hand hygiene is the cornerstone of infection prevention and control practices, and reduces healthcare-associated infections significantly. However, international evidence suggests that medical doctors demonstrate poor compliance. To explore and compare practices and attitudes towards hand hygiene, particularly hand rubbing using alcohol-based hand rub (ABHR), among hospital-based physicians in Ireland between 2007 and 2015. In 2007, a random sample of doctors in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all doctors employed in a university hospital group, including the setting of the original study, using an online survey. Data were analysed using SPSS and Survey Monkey. Predominately positive and improving attitudes and practices were found, with 86% of doctors compliant with hand hygiene before patient contact in 2015, compared with 58% in 2007. Ninety-one percent of doctors were compliant after patient contact in 2015, compared with 76% in 2007. In 2015, only 39% of respondents reported that they 'almost always' used ABHR for hand hygiene. However, this represents 13.5% more than in 2007. Stated barriers to use of ABHR included dermatological issues, poor acceptance, tolerance and poor availability of ABHR products. Greater awareness of hand hygiene guidelines and greater governance appear to have had a positive impact on practice. However, despite this, practice remains suboptimal and there is scope for substantial improvement. Continued and sustained efforts are required in order to build on progress achieved since the World Health Organization hand hygiene guidelines were published in 2009.

A Survey of Handwashing Knowledge and Attitudes among the Healthcare Professionals in Lahore, Pakistan

ObjectiveTo evaluate the knowledge and attitudes towards handwashing of clinical year medical and dental students and health-care professionals (HCPs) working in the departments of medicine, surgery, dentistry, nursing, and physiotherapy in Lahore, Pakistan.MethodologyThis was a cross-sectional survey conducted during May and June 2016. After approval from the institutional review board, a modified form of the World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire for Healthcare workers that included 18 items was sent to 400 clinical year students and HCPs from six medical colleges and affiliated hospitals of Lahore. The data obtained was entered and analyzed by using IBM SPSS version 20 (IBM, NY, USA). Chi-square was used as the test of significance. A p-value of <0.05 was considered statistically significant for all purposes.ResultsThe response rate was 79%. Less than half of the respondents (149, 47.9%) were satisfied with their knowledge regarding hand hygiene. Statistically significant associations of various groups of HCPs were observed with their satisfaction regarding knowledge about hand hygiene (p-value = 0.022), their awareness of the proper technique required for handwashing proposed by the WHO (p-value = 0.001), and their awareness about other preventive techniques proposed by the WHO and Centers for Disease Control (CDC) (p-value = 0.021).ConclusionsThe majority of the clinical year students and HCPs were not satisfied with their knowledge regarding hand hygiene. HCPs working in different departments have varying knowledge and attitudes towards hand hygiene. Females were found to be more satisfied with their handwashing practices. Teaching proper technique of handwashing to medical students and starting refresher courses regarding hand hygiene for HCPs are dire needs. The WHO-recommended guidelines should not only be taught but also implemented in the medical field as poor hand hygiene techniques have led to the spread of many diseases around the globe.