Franca, Sátiro Ribeiro; Marra, Alexandre R; de Oliveira Figueiredo, Rejane Augusta; Pavão dos Santos, Oscar Fernando; Teodoro Ramos, Júlio Cesar; Edmond, Michael B
Hand hygiene is one of the most important interventions to prevent health care-associated infections. We compared hand hygiene compliance among health care workers when patients were in contact precautions to compliance when patients were not in contact precautions. Our study failed to show differences in adherence to hand hygiene practices in the care of contact isolation versus noncontact isolation patients.
Jarrin Tejada, Claudia; Bearman, Gonzalo
Hand hygiene is crucial to prevent transmission of hospital-acquired infections. The WHO recommends five moments for hand hygiene: (1) before patient contact, (2) before performing an aseptic task, (3) after exposure with body fluids, (4) after patient contact, and (5) after contact with patient's surroundings. Nevertheless, hand hygiene compliance rates remain low among healthcare workers. Direct observation is the gold standard method for hand hygiene monitoring; however, it is time consuming and observer dependent. Technology has allowed the development of several other hand hygiene surveillance methods. In this article, we review the different modalities for hand hygiene compliance monitoring.
Healthcare-associated infections (HCAIs) continue to be a challenge in developed and developing countries. Hand hygiene practice is considered to be the most effective strategy to prevent HCAIs, but healthcare workers' compliance is poor. Using a human factors perspective, this article explores elements that affect healthcare workers' hand hygiene compliance. Slips, lapses and mistakes can occur depending on the worker's skills and knowledge levels. Violations of protocols may also occur, and these may be associated with the intention to provide care efficiently. Strong leadership and an understanding of why non-compliance with hand hygiene occurs assists with developing strategies to improve compliance.
Wetzker, W; Bunte-Schönberger, K; Walter, J; Pilarski, G; Gastmeier, P; Reichardt, Ch
Hand hygiene is a key measure to prevent healthcare-associated infection. To promote hand hygiene nationally the German campaign 'Aktion Saubere Hände' was launched in January 2008, based on the World Health Organization's 'Clean Care is Safer Care' initiative. We report the first results from a full year of data collection on hand hygiene compliance recorded with the help of a renewed observation tool. Data were based on submissions from 109 participating hospitals collected from 576 wards between January 1st and December 31st, 2014. The overall median compliance was 73%, ranging from 55% (10th percentile) to 89% (90th percentile). The results demonstrated only small differences between adult and non-adult intensive care units (ICUs) with neonatal ICUs and paediatric non-ICUs maintaining higher compliance than adult care units. Performance among nurses was better than physicians, and overall rates of hand hygiene performance were significantly higher after patient contact than before.
Improvement of compliance in hand hygiene is probably the most effective step in reducing the incidence of nosocomial infections (NI). But improvement of compliance is known to be complex. Six possibilities for improving compliance are available although some of them may be difficult to carry out. Rule 1: Select an alcohol-based hand rub which has a good skin tolerance and is acceptable to health care workers to use. This has been shown to improve compliance. Rule 2: The hand rub shall be easily available. Wall dispensers near the patient and pocket bottles may well help. Other possibilities should be assessed locally. Rule 3: Implement teaching and promotion of hand hygiene, which has been shown to be very effective. This is may be the most effective tool but will cost time and money. If money is a problem, rule 4 may be the solution. Rule 4: Create a hospital budget which covers all costs involved with preventable nosocomial infection. Combine it with the budget for hand hygiene products. Even a small number of prevented NI largely outweighs the cost of effective hand hygiene products. Rule 5: Get senior staff to set a good example in order to motivate junior staff, because negligence in hand hygiene appears to correlate with the number of professional years. Rule 6: Have the patient-staff ratio well balanced. It has been shown that staff shortage decreases hand hygiene compliance. Other factors may be important as well, but implementation of these 6 golden rules could be an effective step into the right direction.
Sansam, Sim; Yamamoto, Eiko; Srun, Sok; Sinath, Yin; Moniborin, Mey; Bun Sim, Kheang; Reyer, Joshua A; Yoshida, Yoshitoku; Hamajima, Nobuyuki
Health care-associated infection (HCAI) is the most frequent adverse event for hospitalized patients. Hand hygiene is a simple and effective solution to protect patients from HCAI. This study aimed to introduce hand hygiene to health care workers based on the World Health Organization guideline for reducing HCAI in Cambodia and to assess their behavioral patterns on hand hygiene. All health care workers at Kampong Cham provincial hospital had lectures and practice on hand hygiene in January 2012. The surveys for hand hygiene compliance (HHC) were performed after 6 months, 1 year and 2 years, respectively. The number of surgical site infections (SSI) was counted in 2011 and 2014. Our analysis used the data of 58 workers, who were observed at all three points, although 139 workers were observed during the study period. The average of HHC at 6 months, 1 year and 2 years were 62.37%, 85.76% and 80.36%, respectively. The improved group (HHC 2 years/1 year≧1) had 32 workers, whereas the worsened group (HHC 2 years/1 year<1) had 26. There was a significant difference in departments of the two groups (P=0.011) but not in sex, age or occupations. The improved group had more workers of General (31.2% vs. 19.2%), Surgical (25.0% vs. 11.5%) and Infection (21.9% vs. 11.5%) categories compared to the worsened group. The incidence of SSI was improved from 32.26% in 2011 to 0.97% in 2014. Our results suggest that the education and the survey on hand hygiene are effective for reducing HCAI in Cambodia.
Sansam, Sim; Yamamoto, Eiko; Srun, Sok; Sinath, Yin; Moniborin, Mey; Bun Sim, Kheang; Reyer, Joshua A.; Yoshida, Yoshitoku; Hamajima, Nobuyuki
ABSTRACT Health care-associated infection (HCAI) is the most frequent adverse event for hospitalized patients. Hand hygiene is a simple and effective solution to protect patients from HCAI. This study aimed to introduce hand hygiene to health care workers based on the World Health Organization guideline for reducing HCAI in Cambodia and to assess their behavioral patterns on hand hygiene. All health care workers at Kampong Cham provincial hospital had lectures and practice on hand hygiene in January 2012. The surveys for hand hygiene compliance (HHC) were performed after 6 months, 1 year and 2 years, respectively. The number of surgical site infections (SSI) was counted in 2011 and 2014. Our analysis used the data of 58 workers, who were observed at all three points, although 139 workers were observed during the study period. The average of HHC at 6 months, 1 year and 2 years were 62.37%, 85.76% and 80.36%, respectively. The improved group (HHC 2 years/1 year≧1) had 32 workers, whereas the worsened group (HHC 2 years/1 year<1) had 26. There was a significant difference in departments of the two groups (P=0.011) but not in sex, age or occupations. The improved group had more workers of General (31.2% vs. 19.2%), Surgical (25.0% vs. 11.5%) and Infection (21.9% vs. 11.5%) categories compared to the worsened group. The incidence of SSI was improved from 32.26% in 2011 to 0.97% in 2014. Our results suggest that the education and the survey on hand hygiene are effective for reducing HCAI in Cambodia. PMID:27303102
Buffet-Bataillon, S; Leray, E; Poisson, M; Michelet, C; Bonnaure-Mallet, M; Cormier, M
Hand hygiene compliance was evaluated by direct observation in 2006 and 2007. In 2007, data on characteristics such as job seniority, hand hygiene education, and patient-to-nurse ratio during direct observations were collected. A hand hygiene promotional programme was performed between the two evaluations. Univariate and multivariate analysis identified factors associated with improved hand hygiene compliance. Between 2006 and 2007, from 761 hand hygiene opportunities, overall and partial compliance improved from 44.9% to 58% (P<0.001) and from 73.5% to 88.4% (P<0.001), respectively. In 2007, improvements in hand hygiene overall or partial compliance were seen when senior healthcare workers (HCWs) were present in the clinical area under investigation (P=0.04 or P=0.08, respectively). Partial hand hygiene compliance was significantly better in 2007 after a hand hygiene educational programme had been presented (P<0.015). Similar rates of compliance were observed whatever the patient-to-nurse ratio during the observation. Multivariate analysis identified job seniority as an independent predictor of hand hygiene compliance. Our results suggest that hand hygiene compliance is influenced by education on hand hygiene and that a senior HCW could act as a role model for other HCWs. These data should be considered when developing future hygiene interventions.
Sobrequés, Jordi; Espuñes, Jordi; Bañeres, Joaquim
Hand hygiene (HM) is the single most important measure and effective in reducing the risk of Healthcare acquired infections (IRAS). Although HM is an effective, simple and cheap measure, it is usual to find results of low compliance among health professionals. The main objective of this strategy has been to give new force to the promotion of HM in hospitals and educate professionals about the importance of this single action. The strategy was planned as a multicenter intervention study to promote HM in health centers of Catalonia in 2009-2010. The intervention is based on 4 main areas: a survey of barriers and facilitators, distribution of graphic material, training at different levels and measure of quality indicators. With this strategy a total of 57% of the number of acute beds in the concerted public and private network of hospitals were reached. The survey revealed that training was perceived as the main facilitator of the HM action. 15,376 professionals registered to the on-line training. The overall compliance with HM indications (based on "five moments for HM") was 56.45% in the acute areas. The campaigns and programs to promote HM carried out in the last four years in Catalonia has helped to achieve an increasing number of hospitals associated to the strategy of the Alliance for Patient Safety in Catalonia. The on-line curse acceptance was very high and seems a powerful tool to improve hand hygiene knowledge and compliance among health professionals. The compliance of HM seems to increase in the hospitals of Catalonia evaluated.
The toll of health care-associated infections on patients and the seeming ease of the procedure thought best able to prevent them have focused a spotlight onto hand hygiene performance. Poor performance of hand hygiene by health care workers inspires outrage in the general public. Much is understood regarding barriers to and motivators of hand hygiene performance. Guidelines encouraging use of alcohol-based hand hygiene agents have facilitated hand hygiene improvement efforts. These efforts and evidence that improved hand hygiene performance is associated with a reduction in health care-associated infections should encourage those in the hand hygiene campaigns.
Lohiniva, A-L; Bassim, H; Hafez, S; Kamel, E; Ahmed, E; Saeed, T; Talaat, M
Hand hygiene of health-care staff is one of the most important interventions in reducing transmission of nosocomial infections. This qualitative study aimed to understand the behavioural determinants of hand hygiene in order to develop sustainable interventions to promote hand hygiene in hospitals. Fourteen focus group discussions were conducted with nurses in 2 university hospitals in Egypt. The interviews were tape recorded and transcribed. Thematic analysis was conducted by 2 independent investigators. The findings highlighted that nurses did not perceive the benefits of hand hygiene, and that they linked the need to wash hands to a sense of dirtiness. Knowledge of hand hygiene and related products was limited and preference for water and soap was obvious. Environmental constraints, lack of role models and social control were identified as barriers for compliance with hand hygiene. A multi-faceted hand hygiene strategy was developed based on existing cultural concepts valued by the hospital staff.
Sickbert-Bennett, Emily E; DiBiase, Lauren M; Schade Willis, Tina M; Wolak, Eric S; Weber, David J; Rutala, William A
Hand hygiene is a key intervention for preventing health care-associated infections; however, maintaining high compliance is a challenge, and accurate measurement of compliance can be difficult. A novel program that engaged all health care personnel to measure compliance and provide real-time interventions overcame many barriers for compliance measurement and proved effective for sustaining high compliance and reducing health care-associated infections.
Background Hand hygiene is the most effective measure for preventing infections related to healthcare, and its impact on the reduction of these infections is estimated at 50%. Non-compliance has been highlighted in several studies in hospitals, although none have been carried out in primary healthcare. Main objective To evaluated the effect of a "Hand Hygiene for the reduction of healthcare-associated infections" training program for primary healthcare workers, measured by variation from correct hand hygiene compliance, according to regulatory and specific criteria, 6 months after the baseline, in the intervention group (group receiving a training program) and in the control group (a usual clinical practice). Secondary objectives -To describe knowledges, attitudes and behaviors as regards hand hygiene among the professionals, and their possible association with "professional burnout", stratifying the results by type of group (intervention and usual clinical practice). -To estimate the logistic regression model that best explains hand hygiene compliance. Methods/Design Experimental study of parallel groups, with a control group, and random assignment by Health Center. Area of study.- Health centers in north-eastern Madrid (Spain). Sample studied.- Healthcare workers (physicians, odontostomatologists, pediatricians, nurses, dental hygienists, midwife and nursing auxiliaries). Intervention.- A hand hygiene training program, including a theoretical-practical workshop, provision of alcohol-based solutions and a reminder strategy in the workplace. Other variables: sociodemographic and professional knowledges, attitudes, and behaviors with regard to hand hygiene. Statistical Analysis: descriptive and inferential, using multivariate methods (covariance analysis and logistic regression). Discussion This study will provide valuable information on the prevalence of hand hygiene non-compliance, and improve healthcare. PMID:20015368
Girou, E; Chai, S H T; Oppein, F; Legrand, P; Ducellier, D; Cizeau, F; Brun-Buisson, C
Improvement in hand hygiene compliance is important for reducing cross-infection by micro-organisms. The objective of this prospective observational study was to measure how the improper use of gloves limits compliance to hand hygiene and exposes patient's to infection. The study was conducted in five wards (three intensive care units and two medical wards) in a French university hospital. Staff-patient and staff-environment contacts were observed in 120 healthcare workers caring for patients colonized or infected with pathogenic bacteria. Hand hygiene was not undertaken due to improper gloving in 64.4% (95%CI, 64.1% to 65.1%) of instances. Possible microbial transmission might have occurred in 18.3% (95%CI, 17.8% to 18.8%) of all contacts because used gloves were not removed before performing care activities that necessitated strict aseptic precautions. Failure to change or remove contaminated gloves was a major component in the poor compliance with hand hygiene and carried a high-risk of microbial transmission. Improving hand hygiene compliance will require changing healthcare workers behaviour towards glove use.
Scheithauer, Simone; Häfner, Helga; Schröder, Jörg; Nowicki, Katharina; Lemmen, Sebastian
To assess the influence of signal colors on hand disinfectant dispenser activities, health care workers (HCWs) at a medical intensive care unit were analyzed for a total of 20 weeks with 8 weeks before and 12 weeks after exchange to signal color. No significant increase in hand rubs (HRs) per patient day (PD) was observed (about 40 HRs/PD); however, HCW-adjusted compliance showed a 6% increase with signal colored devices. Therefore, colored devices may help to improve hand hygiene compliance.
Background The National University Hospital, Singapore routinely undertakes standardized Hand Hygiene auditing with results produced by ward and by staff type. In 2010 concern was raised over consistently low compliance by nursing students averaging 45% (95% CI 42%–48%) prompting us to explore novel approaches to educating our next generation of nurses to improve their hand hygiene practice. We introduced an experiential learning assignment to final year student nurses on attachment to NUH inclusive of hand hygiene auditor training followed by a period of hand hygiene observation. The training was based on the World Health Organisation (WHO) “My 5 moments for hand hygiene” approach. Upon completion students completed an anonymous questionnaire to evaluate their learning experience. Findings By 2012, nursing students were 40% (RR: 1.4, 95% CI 1.3–1.5, p<0.001) more likely to comply with hand hygiene practices. 97.5% (359/368) of nursing students felt that the experience would enhance their own hand hygiene practice and would recommend participating in audits as a learning instrument. Conclusions With consideration of all stakeholders a sustainable, flexible, programme was implemented. Experiential learning of hand hygiene was a highly valued educational tool and in our project was directly associated with improved hand hygiene compliance. Feedback demonstrated popularity amongst participants and success in achieving its program objectives. While this does not guarantee long term behavioural change it is intuitive that instilling good habits and messages at the early stages of a career will potentially have significant long-term impact. PMID:23721611
Al Salman, J M; Hani, S; de Marcellis-Warin, N; Isa, Sister Fatima
Hand hygiene is a growing concern among populations and is a crucial element in ensuring patient safety in a healthcare environment. Numerous management efforts have been conducted in that regard, including education, awareness and observations. To better evaluate the possible impact of technology on a healthcare setting, we observed the impact of a particular niche technology developed as an answer to the growing hand hygiene concerns. A study was conducted at Salmaniya Medical Complex (SMC) in Bahrain on a total of 16 Coronary Care Unit (CCU) beds where the system was installed, and the hand hygiene activity of healthcare workers (HCWs) in this area was monitored for a total period of 28 days. Comments, remarks and suggestions were noted, and improvements were made to the technology during the course of the trial. While resistance to change was significant, overall results were satisfactory. Compliance with hand hygiene techniques went from 38-42% to 60% at the beginning of the trial and then increased to an average of 75% at the end of the 28-day trial. In some cases, compliance peaked at 85% or even at 100%. Our case study demonstrates that technology can be used effectively in promoting and improving hand hygiene compliance in hospitals, which is one way to prevent cross-infections, especially in critical care areas.
Practice is usually based on tradition, rituals and outdated information; there is often an additional gap between theoretical knowledge and its application in practice. This theory-practice gap has long existed (Allmark, 1995; Hewison et al, 1996). It often arises when theory is ignored because it is seen as idealistic and impractical, even if it is practical and beneficial. Most research relating to the lack of integration between theory and practice has concluded that environmental factors are responsible and will affect learning and practice outcomes. The author believes an additional dimension of ethics is required to bridge the gap between theory and practice. This would be a moral obligation to ensure theory and practice are integrated. To implement new practices effectively, healthcare practitioners must deem these practices worthwhile and relevant to their role. This introduces a new concept that the author calls the theory-practice-ethics gap. This theory-practice-ethics gap must be considered when examining some of the unacceptable outcomes in healthcare practice (Mortell, 2009). The literature suggests that there is a crisis of ethics where theory and practice integrate, and practitioners are failing to fulfil their duty as providers of healthcare and as patient advocates. This article examines the theory-practice-ethics gap when applied to hand hygiene. Non-compliance exists in hand hygiene among practitioners, which may increase patient mortality and morbidity rates, and raise healthcare costs. Infection prevention and control programmes to improve hand hygiene among staff include: ongoing education and training; easy access to facilities such as wash basins; antiseptic/alcohol handgels that are convenient, effective, and skin- and user-friendly; and organisational recognition and support for clinicians in hand washing and handgel practices. Yet these all appear to have failed to achieve the required and desired compliance in hand hygiene.
Lapão, Luís Velez; Marques, Rita; Gregório, João; Pinheiro, Fernando; Póvoa, Pedro; Mira da Silva, Miguel
Healthcare acquired infections are among the biggest unsolved problems in healthcare, implying an increasing number of deaths, extra-days of hospital stay and hospital costs. Performing hand hygiene is a simple and inexpensive prevention measure, but healthcare workers compliance with it is still far from optimal. Recognized hurdles are lack of time, forgetfulness, wrong technique and lack of motivation. This study aims at exploring gamification to promote nurses' HH compliance self-awareness and action. Real-time data collected from an indoor location system will provide feedback information to a group of nurses working in an ICU ward. In this paper both the research's motivation and methods is presented, along with the first round of results and its discussion.
Monistrol, Olga; López, M Liboria; Riera, Montserrat; Font, Roser; Nicolás, Carme; Escobar, Miguel Angel; Freixas, Núria; Garau, Javier; Calbo, Esther
The hands of healthcare workers (HCWs) are the most common vehicle for the transmission of micro-organisms from patient to patient and within the healthcare environment. The aim of this study was to evaluate the impact of a multimodal campaign on the type and amount of resident and transient flora and the presence of potential risk factors for hand contamination during routine care. A before-after (PRE and POST periods) interventional study was carried out in medical wards of a tertiary care hospital. Eighty-nine samples were analysed. Samples were cultured immediately before patient contact using a glove-juice method. Data collected included socio-demographic and risk factors for hand contamination. Flora was measured as log10 c.f.u. ml(-1) and evaluated by comparing median values in the PRE and POST periods. Transient flora was isolated from the hands of 67.4 and 46.1 % of HCWs in the PRE and POST periods, respectively (P<0.001). Enterobacteriaceae, Pseudomonas spp. and meticillin-sensitive Staphylococcus aureus were the predominant contaminants. Resident flora was isolated from 92.1 % of HCWs in the PRE period and from 70.8 % in the POST period (P<0.001). The meticillin-resistant coagulase-negative staphylococci log10 c.f.u. count ml(-1) decreased from 1.96 ± 1.2 to 0.89 ± 1.2 (mean ± s d; P<0.001), and the global flora count decreased from 2.77 ± 1.1 to 1.56 ± 1.4 (P<0.001). In the POST period, the wearing of fewer rings (P<0.001), shorter fingernail length (P = 0.008), a shorter time since recent hand hygiene (HH) (P = 0.007) and an increased use of alcohol-based hand rub instead of soap (P<0.001) were documented. The HH multimodal strategy reduced the number of risk factors and the level of HCW hand contamination.
Pan, Sung-Ching; Tien, Kuei-Lien; Hung, I-Chen; Lin, Yu-Jiun; Sheng, Wang-Huei; Wang, Ming-Jiuh; Chang, Shan-Chwen; Kunin, Calvin M.; Chen, Yee-Chun
Background Evaluation and feedback of hand hygiene (HH) compliance are important elements of the WHO multimodal strategy for hospital infection control. Overt observation is recommended, but it may be confounded by Hawthorne effect. Covert observation offers the opportunity to decrease observer bias. In this study we conducted a one year hospital-wide HH promotion program that included medical students (MS) as covert observers. Methods HH compliance for the five WHO indications was determined by trained and validated observers. The overt observers consisted of eleven infection control nurses (ICNs) and two unit HH ambassadors (UAs) in each of 83 wards. The covert observers consisted of nine MS during their rotating clinical clerkships. Feedback was provided to department heads and staff each quarter. Results Of the 23,333 HH observations 76.0% were by MS, 5.3% by ICNs and 18.7% by UAs. The annual compliance rates were MS 44.1%, ICNs 74.4% and UAs 94.1%; P<0.001. The MS found significantly lower annual compliance rates for 4/5 HH indications compared to ICNs and UAs; P<0.05. The ICNs reported significantly improvement from the first to the fourth quarter; P<0.001. This was associated with feedback from the MS of very poor compliance by nurses during the first quarter. Conclusions Based on these findings we recommend a two-pronged approach to HH programs. The role of ICNs and UAs is to educate, serve as role models, establish, sustain good HH practices and provide direct feedback. The role of the covert observers is to measure compliance and provide independent feedback. PMID:23341991
Boyce, John M
Recent developments related to hand hygiene include new test methods for evaluating hand hygiene products, improvements in alcohol-based hand rubs, novel methods of hand antisepsis, and new strategies and technologies for monitoring hand hygiene practices among health care personnel.
Goldberg, Judith L
Performing proper hand hygiene and surgical hand antisepsis is essential to reducing the rates of health care-associated infections, including surgical site infections. The updated AORN "Guideline for hand hygiene" provides guidance on hand hygiene and surgical hand antisepsis, the wearing of fingernail polish and artificial nails, proper skin care to prevent dermatitis, the wearing of jewelry, hand hygiene product selection, and quality assurance and performance improvement considerations. This article focuses on key points of the guideline to help perioperative personnel make informed decisions about hand hygiene and surgical hand antisepsis. The key points address the necessity of keeping fingernails and skin healthy, not wearing jewelry on the hands or wrists in the perioperative area, properly performing hand hygiene and surgical hand antisepsis, and involving patients and visitors in hand hygiene initiatives. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.
Chang, Nai-Chung N; Reisinger, Heather S; Jesson, Andrew R; Schweizer, Marin L; Morgan, Daniel J; Forrest, Graeme N; Perencevich, Eli N
We compared the ability to observe hand hygiene opportunities using the World Health Organization My 5 Moments method to the Entry/Exit method. Under covert direct observation, Entry/Exit method opportunities were observed at all times. My 5 Moments were observable in 32.3% of episodes, with a lower rate in wards versus intensive care units (28.0% vs 39.4%; P < .01). In US hospitals, the Entry/Exit method appears to be more feasible for directly observed hand hygiene compliance monitoring due to line-of-sight issues and other barriers.
Eveillard, Matthieu; Joly-Guillou, Marie-Laure; Brunel, P
In a study conducted in 11 health care settings for elderly patients, we demonstrated a significant negative correlation between the proportion of glove use outside any risk of exposure to body fluids and compliance with hand hygiene (P < .02). This result underscores a major limitation of strategies for controlling the spread of multidrug-resistant bacteria that recommend systematic glove use for each contact with carriers or their environment.
Camargo, Luis Fernando Aranha; Marra, Alexandre Rodrigues; Silva, Cláudia Vallone; Laselva, Cláudia Regina; Moura Junior, Denis Faria; Cal, Ruy Guilherme G; Yamashita, Maria Aparecida; Knobel, Elias
Although the introduction of alcohol based products have increased compliance with hand hygiene in intensive care units (ICU), no comparative studies with other products in the same unit and in the same period have been conducted. We performed a two-month-observational prospective study comparing three units in an adult ICU, according to hand hygiene practices (chlorhexidine alone-unit A, both chlorhexidine and alcohol gel-unit B, and alcohol gel alone-unit C, respectively). Opportunities for hand hygiene were considered according to an institutional guideline. Patients were randomly allocated in the 3 units and data on hand hygiene compliance was collected without the knowledge of the health care staff. TISS score (used for measuring patient complexity) was similar between the three different units. Overall compliance with hand hygiene was 46.7% (659/1410). Compliance was significantly higher after patient care in unit A when compared to units B and C. On the other hand, compliance was significantly higher only between units A (32.1%) and C (23.1%) before patient care (p=0.02). Higher compliance rates were observed for general opportunities for hand hygiene (patient bathing, vital sign controls, etc), while very low compliance rates were observed for opportunities related to skin and gastroenteral care. One of the reasons for not using alcohol gel according to health care workers was the necessity for water contact (35.3%, 12/20). Although the use of alcohol based products is now the standard practice for hand hygiene the abrupt abolition of hand hygiene with traditional products may not be recommended for specific services.
Marra, A R; Edmond, M B
Compliance with hand hygiene is a good quality indicator for hospital patient safety programmes. Hand hygiene is a major infection control prevention intervention, but in many medical centres compliance rates are only c. 50%. Given the enormous number of hand hygiene opportunities in hospitals, direct observation to monitor compliance is very inefficient. However, technologies are emerging to obviate the need for direct observation. These new technologies for monitoring hand hygiene compliance are discussed in this article.
Ofek Shlomai, N; Rao, S; Patole, S
Healthcare-associated infections (HCAIs) cause significant morbidity and mortality in neonatal intensive care units (NICUs). Meticulous hand hygiene is the most effective strategy to prevent HCAI. However, hand hygiene compliance (HHC) is low, especially in ICUs. Hence, we aimed to evaluate the efficacy of strategies for improving HHC in NICUs. A systematic review of the literature and meta-analysis were carried out. PubMed, EMBASE, Cochrane CENTRAL and CINAHL were searched in October 2013. PRISMA guidelines were followed. The quality of included studies was assessed by the Newcastle-Ottawa scale (NOS). Sixteen eligible non-randomised studies were included. A total of 27,155 hand hygiene moments were observed. Meta-analysis using a random effects model indicated that a range of strategies, such as educational campaigns, musical parodies, reminders, easy access to hand hygiene sanitisers, UV sensors and performance feedback, improved HHC [odds ratio (OR) 2.04; 95 % confidence interval (CI) 1.40, 2.97]. Significant statistical heterogeneity was noted. Studies which specifically provided performance feedback at either the individual or group levels reported a more significant improvement in HHC compared to those that did not (OR 2.81; 95 % CI 1.32, 5.96 vs. OR 1.55; 95 % CI 1.13-2.11). Strategies to improve HHC in NICUs seem to be more effective when they include performance feedback at the personal or group levels. Randomised controlled trials (RCTs) specifically assessing the benefits of performance feedback in improving HHC are needed.
Chhapola, Viswas; Brar, Rekha
Nosocomial infections are a significant problem in neonatal intensive care units (NICUs) and hand hygiene (HH) has been stated as an effective mean to prevent spread of infections. The aim of study was to assess the baseline compliance HH practices and to evaluate the impact of hand washing educational programme on infection rate in a NICU. Continuous surveillance of nosocomial infections was done. A total of 15,797 and 12 ,29 opportunities for HH were observed in pre-intervention and postintervention phases, respectively. Compliance of health-care workers for all HH opportunities combined was 46% before intervention and improved significantly to 69% in postintervention (RR 1.49, CI 1.46-1.52, P < 0.0001). Compliance for nurses and doctors was similar. Nosocomial sepsis rate showed a significant decline from 96 per 1000 patient-days in pre-intervention to 47 per 1000 patient-days in postintervention phase (RR 0.44, CI 0.33-0.58, P < 0.0001). We conclude that effective HH practices can serve as an economical and effective nosocomial infection control approach especially important in developing nations.
Background MedSense is an electronic hand hygiene compliance monitoring system that provides Infection Control Practitioners with continuous access to hand hygiene compliance information by monitoring Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" guidelines. Unlike previous electronic monitoring systems, MedSense operates in open cubicles with multiple beds and does not disrupt existing workflows. Methods This study was conducted in a 6-bed neurosurgical intensive care unit with technical development and evaluation phases. Healthcare workers (HCWs) wore an electronic device in the style of an identity badge to detect hand hygiene opportunities and compliance. We compared the compliance determined by the system and an infection control nurse. At the same time, the system assessed compliance by time of day, day of week, work shift, professional category of HCWs, and individual subject, while the workload of HCWs was monitored by measuring the amount of time they spent in patient zones. Results During the three-month evaluation phase, the system identified 13,694 hand hygiene opportunities from 17 nurses, 3 physiotherapists, and 1 healthcare assistant, resulting in an overall compliance of 35.1% for the unit. The per-indication compliance for Moment 1, 4, and simultaneous 1 and 4 were 21.3% (95%CI: 19.0, 23.6), 39.6% (95%CI: 37.3, 41.9), and 49.2% (95%CI: 46.6, 51.8), respectively, and were all statistically significantly different (p < 0.001). In the four 20-minute sessions when hand hygiene was monitored concurrently by the system and infection control nurse, the compliance were 88.9% and 95.6% respectively (p = 0.34), and the activity indices were 11.1 and 12.9 opportunities per hour, respectively. The hours from 12:00 to 14:00 had a notably lower compliance (21.3%, 95%CI: 17.2, 25.3) than nearly three quarters of the other periods of the day (p < 0.001). Nurses who used shared badges had significantly (p < 0.01) lower compliance (23.7%, 95%CI: 17
Taylor, Ronald E
Eighty-six infection control specialists evaluated 24 messages promoting hand hygiene (HH). Brief, simple messages using appeals to social situations and to ego (self-efficacy) were rated as most likely to increase HH compliance.
Scheithauer, S; Oberröhrmann, A; Haefner, H; Kopp, R; Schürholz, T; Schwanz, T; Engels, A; Lemmen, S W
Hand hygiene is considered to be the single most effective measure to prevent healthcare-associated infection. Although there have been several reports on hand hygiene compliance, data on patients with multidrug-resistant (MDR) organisms in special isolation conditions are lacking. Therefore, we conducted a prospective observational study of indications for, and compliance with, hand hygiene in patients colonised or infected with meticillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase (ESBL)-producing enterobacteria in surgical intensive and intermediate care units. Hand disinfectant used during care of patients with MRSA was measured. Observed daily hand hygiene indications were higher in MRSA isolation conditions than in ESBL isolation conditions. Observed compliance rates were 47% and 43% for the MRSA group and 54% and 51% for the ESBL group in the surgical intensive care unit and the intermediate care unit, respectively. Compliance rates before patient contact or aseptic tasks were significantly lower (17-47%) than after contact with patient, body fluid or patient's surroundings (31-78%). Glove usage instead of disinfection was employed in up to 100% before patient contact. However, compliance rates calculated from disinfectant usage were two-fold lower (intensive care: 24% vs 47%; intermediate care: 21% vs 43%). This study is the first to provide data on hand hygiene in patients with MDR bacteria and includes a comparison of observed and calculated compliance. Compliance is low in patients under special isolation conditions, even for the indications of greatest impact in preventing healthcare-associated infections. These data may help to focus measures to reduce transmission of MDR bacteria and improve patient safety.
Barnes, Sue; Barron, Dana; Becker, Linda; Canola, Teresa; Salemi, Charles
Objective: Hand hygiene has historically been identified as an important intervention for preventing infection acquired in health care settings. Recently, the advent of waterless, alcohol-based skin degermer and elimination of artificial nails have been recognized as other important interventions for preventing infection. Supplied with this information, the National Infection Control Peer Group convened a KP Hand Hygiene Work Group, which, in August 2001, launched a National Hand Hygiene Program initiative titled “Infection Control: It’s In Our Hands” to increase compliance with hand hygiene throughout the Kaiser Permanente (KP) organization. Design: The infection control initiative was designed to include employee and physician education as well as to implement standard hand hygiene products (eg, alcohol degermers), eliminate use of artificial nails, and monitor outcomes. Results: From 2001 through September 2003, the National KP Hand Hygiene Work Group coordinated implementation of the Hand Hygiene initiative throughout the KP organization. To date, outcome monitoring has shown a 26% increase in compliance with hand hygiene as well as a decrease in the number of bloodstream infections and methycillin-resistant Staphylococcus aureus (MRSA) infections. As of May 2003, use of artificial nails had been reduced by 97% nationwide. Conclusions: Endorsement of this Hand Hygiene Program initiative by KP leadership has led to implementation of the initiative at all medical centers throughout the KP organization. Outcome indicators to date suggest that the initiative has been successful; final outcome monitoring will be completed in December 2003. PMID:26704605
Dunn-Navarra, Ann-Margaret; Cohen, Bevin; Stone, Patricia W.; Pogorzelska, Monika; Jordan, Sarah; Larson, Elaine
This study was a cross sectional descriptive survey of acute care hospitals in California to describe staff hand hygiene compliance and related predictors, and explore the relationship between hand hygiene adherence to health care-associated infections. Although there was a relatively small sample size, institutions with morning huddles reported a significantly higher proportion of ≥95% hand hygiene compliance. Huddles are an organizational tool to improve teamwork and communication and may offer promise to influence hand hygiene adherence. PMID:20489659
Scheithauer, S; Schwanz, T; Lemmen, S
Hand hygiene is considered as the pillar of infection control and prevention. Healthcare-associated infections have a great impact on morbidity, length of hospital stay, and treatment costs. Hand disinfection is considered to be the single most effective tool to prevent healthcare-associated infections and cross-transmission of multi-drug resistant bacteria. The WHO defined "5 moments" for hand hygiene and highlighted the need for new strategies to improve everyday hand hygiene practices on the basis of the current low compliance. Reasons for non-compliance are multifaceted and behavioural, religious, and sociocultural aspects have to be considered when designing intervention programs. Despite all these barriers it is worth the effort to aim at quality of care improvement.
Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol- based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene. PMID:11294714
Møller-Sørensen, H; Korshin, A; Mogensen, T; Høiby, N
The risks to patients from pathogens present on healthcare workers' (HCWs') hands are high; however, compliance with hand hygiene among HCWs is low. We devised a prospective intervention trial of a new hand-hygiene dispensing technology to improve HCWs' compliance with hand hygiene. Baseline hand-hygiene compliance was observed for three months before and after an intervention consisting of implementation of an electronic device that reminds people to comply with hand hygiene after restroom visits. Compliance in hand-hygiene performance after restroom visits increased among HCWs from 66% to 91% after the intervention.
Magiorakos, A P; Leens, E; Drouvot, V; May-Michelangeli, L; Reichardt, C; Gastmeier, P; Wilson, K; Tannahill, M; McFarlane, E; Simon, A
Hand hygiene is the most effective way to stop the spread of microorganisms and to prevent healthcare-associated infections (HAI). The World Health Organization launched the First Global Patient Safety Challenge - Clean Care is Safer Care - in 2005 with the goal to prevent HAI globally. This year, on 5 May, the WHO s initiative SAVE LIVES: Clean Your Hands, which focuses on increasing awareness of and improving compliance with hand hygiene practices, celebrated its second global day. In this article, four Member States of the European Union describe strategies that were implemented as part of their national hand hygiene campaigns and were found to be noteworthy. The strategies were: governmental support, the use of indicators for hand hygiene benchmarking, developing national surveillance systems for auditing alcohol-based hand rub consumption, ensuring seamless coordination of processes between health regions in countries with regionalised healthcare systems, implementing the WHO's My Five Moments for Hand Hygiene, and auditing of hand hygiene compliance.
Bjerke, Nancy B
Handwashing is a fundamental principle and practice in the prevention, control, and reduction of healthcare-acquired infection. Advocated by Semmelweiss (Nursing, The Finest Art: An Illustrated History. St Louis: Mosby; 1985:204) from the 1800s to resolve an obstetric morbidity and mortality occurrence, the simple act of hand cleansing portrays the intuitive benefits to basic hygiene, health continuum, and, most important, disease prevention. According to recently published guidance (MMWR Morb Mortal Wkly Rep. October 25, 2002;51:32-34), the term handwashing is replaced by the new term hand hygiene, which includes hand cleansing, hand disinfecting, and surgical hand scrub. This article focuses on the published guidance, blending the salient aspects of hand hygiene practices from noted champions, reinforcing the aesthetics of meticulous cleansing, to guidance on its practice in healthcare settings. In healthcare, the principle of "clean hands are healing hands" bears value and demands compliance in order to prevent and control infectious processes while protecting the person from acquiring infectious diseases.
Snow, Michelle; White, George L.; Kim, Han S.
Routine hand hygiene has been cited by the World Health Organization and the Centers for Disease Control and Prevention as a cost-effective and important hygiene measure in preventing the spread of infectious diseases. Several studies have explored children's hand hygiene habits, effects of scheduled hand hygiene, hand hygiene environmental…
Rosenthal, Victor D; Viegas, Mónica; Sztokhamer, Daniel; Benchetrit, Guillermo; Santoro, Beatriz; Lastra, Carlos Esteban; Romani, Adriana; Di Núbila, Beatriz Marta Alicia; Lanzetta, Diana; Fernández, Leonardo J; Rossetti, María Adelaida; Migazzi, Claudia; Barolin, Clarisa; Martínez, Estela; Bonaventura, Claudio; Caridi, Maria de Los Ángeles; Messina, Adriana; Ricci, Beatriz; Soroka, Luisa C; Frías, María Laura
We evaluated the impact of the International Nosocomial Infection Control Consortium multidimensional approach to hand hygiene in 11 intensive care units in 4 cities in Argentina and analyzed predictors of poor hand hygiene compliance. We had a baseline period and a follow-up period. We observed 21 100 hand hygiene opportunities. Hand hygiene compliance increased from 28.3% to 64.8% (P = .0001). Males versus females (56.8% vs 66.4%; P < .001) and physicians versus nurses (46.6% vs 67.8%; P < .001) were significantly associated with poor hand hygiene compliance.
The high rate of hand problems associated with the hand hygiene of medical professions is due to a combination of damaging factors: (1) the removal of barrier lipids by detergent cleaning and alcohol antisepsis followed by a loss of moisturizers and stratum corneum water and (2) the overhydration of the stratum corneum by sweat trapped within gloves. Together the facilitate the invasion of irritants and allergens which elicit inflammatory responses in the dermis. Among the lipids and water-soluble substances removed are natural antibacterials. Their loss leads to increased growth of transient and pathogenic micro-organisms which jeapordizes the very intention of skin hygiene. The kinetics of damage and its repair, and epidemiological evidence suggest that modern synthetic detergents as used in foaming liquid cleansers are the major offender. Conversely, the replacement of detergents with non-detergent emulsion cleansers has been shown to be effective in reducing the prevalence of hand problems among hospital staff. Presently recommended hand antisepsis reduces the risks to patients, but puts the burden on the health care provider. Rather than fighting micro-organisms at the expense of the skin's health, the skin and its own defences should be considered a collaborator in combating infectious diseases.
The value of hand hygiene for the prevention of cross-infection was first observed in the middle of the 19th century. Since then, which procedure is the most suitable for hand hygiene has been repeatedly discussed and several different guidelines and recommendations have been published. The aim of this review is to compare different recommendations for hand hygiene regarding technique and indication. Medline, the internet and a personal library were searched to obtain as many written recommendations as possible. In addition, a small questionnaire was sent by e-mail to 20 international colleagues. As a result, written recommendations from 10 countries could be compared. Recommended methods of hand hygiene include handwashing (washing hands with plain soap), hygienic handwash (washing hands with medicated soap) and hygienic hand-rub (use of antiseptic rubs). In most countries handwashing and hygienic handwash are the methods of choice and only in central European countries is hygienic hand-rub the preferred technique. Situations in which performance of hand hygiene is recommended are comparable. However, no single indication is recommended in all guidelines. Hand hygiene is most often recommended before performing invasive procedures and after microbial contamination. Guidelines should be clear and easy to follow for them to become standard of care. Thus, guidelines are needed that do not leave to the health care worker a decision as to whether hand hygiene is indicated.
Boyce, John M
Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of multidisciplinary hand hygiene improvement programs. Observational surveys conducted by trained personnel are currently considered the "gold standard" method for establishing compliance rates, but they are time-consuming and have a number of shortcomings. Monitoring hand hygiene product consumption is less time-consuming and can provide useful information regarding the frequency of hand hygiene that can be used to give caregivers feedback. Electronic counting devices placed in hand hygiene product dispensers provide detailed information about hand hygiene frequency over time, by unit and during interventions. Electronic hand hygiene monitoring systems that utilize wireless systems to monitor room entry and exit of healthcare workers and their use of hand hygiene product dispensers can provide individual and unit-based data on compliance with the most common hand hygiene indications. Some systems include badges (tags) that can provide healthcare workers with real-time reminders to clean their hands upon entering and exiting patient rooms. Preliminary studies suggest that use of electronic monitoring systems is associated with increased hand hygiene compliance rates and that such systems may be acceptable to care givers. Although there are many questions remaining about the practicality, accuracy, cost, and long-term impact of electronic monitoring systems on compliance rates, they appear to have considerable promise for improving our efforts to monitor and improve hand hygiene practices among healthcare workers.
Background Healthcare worker hand hygiene is thought to be one of the most important strategies to prevent healthcare-associated infections, but compliance is generally poor. Hand hygiene improvement interventions must include audits of compliance (almost always with feedback), which are most often done by direct observation - a method that is expensive, subjective, and prone to bias. New technologies, including electronic and video hand hygiene monitoring systems, have the potential to provide continuous and objective monitoring of hand hygiene, regular feedback, and for some systems, real-time reminders. We propose a systematic review of the evidence supporting the effectiveness of these systems. The primary objective is to determine whether hand hygiene monitoring systems yield sustainable improvements in hand hygiene compliance when compared to usual care. Methods/Design MEDLINE, EMBASE, CINAHL, and other relevant databases will be searched for randomized control studies and quasi-experimental studies evaluating a video or electronic hand hygiene monitoring system. A standard data collection form will be used to abstract relevant information from included studies. Bias will be assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Assessment Tool. Studies will be reviewed independently by two reviewers, with disputes resolved by a third reviewer. The primary outcome is directly observed hand hygiene compliance. Secondary outcomes include healthcare-associated infection incidence and improvements in hand hygiene compliance as measured by alternative metrics. Results will be qualitatively summarized with comparisons made between study quality, the measured outcome, and study-specific factors that may be expected to affect outcome (for example, study duration, frequency of feedback, use of real-time reminders). Meta-analysis will be performed if there is more than one study of similar systems with comparable outcome definitions
Kingston, L; O'Connell, N H; Dunne, C P
Considerable emphasis is currently placed on reducing healthcare-associated infection through improving hand hygiene compliance among healthcare professionals. There is also increasing discussion in the lay media of perceived poor hand hygiene compliance among healthcare staff. Our aim was to report the outcomes of a systematic search for peer-reviewed, published studies - especially clinical trials - that focused on hand hygiene compliance among healthcare professionals. Literature published between December 2009, after publication of the World Health Organization (WHO) hand hygiene guidelines, and February 2014, which was indexed in PubMed and CINAHL on the topic of hand hygiene compliance, was searched. Following examination of relevance and methodology of the 57 publications initially retrieved, 16 clinical trials were finally included in the review. The majority of studies were conducted in the USA and Europe. The intensive care unit emerged as the predominant focus of studies followed by facilities for care of the elderly. The category of healthcare worker most often the focus of the research was the nurse, followed by the healthcare assistant and the doctor. The unit of analysis reported for hand hygiene compliance was 'hand hygiene opportunity'; four studies adopted the 'my five moments for hand hygiene' framework, as set out in the WHO guidelines, whereas other papers focused on unique multimodal strategies of varying design. We concluded that adopting a multimodal approach to hand hygiene improvement intervention strategies, whether guided by the WHO framework or by another tested multimodal framework, results in moderate improvements in hand hygiene compliance.
Levchenko, Alexander I; Boscart, Veronique M; Fernie, Geoff R
Adequate hand hygiene compliance by healthcare staff is considered an effective method to reduce hospital-acquired infections. The electronic system developed at Toronto Rehabilitation Institute automatically detects hand hygiene opportunities and records hand hygiene actions. It includes an optional visual hand hygiene status indication, generates real-time hand hygiene prompting signals, and enables automated monitoring of individual and aggregated hand hygiene performance. The system was installed on a complex continuous care unit at the entrance to 17 patient rooms and a utility room. A total of 93 alcohol gel and soap dispensers were instrumented and 14 nurses were provided with the personal wearable electronic monitors. The study included three phases with the system operating in three different modes: (1) an inactive mode during the first phase when hand hygiene opportunities and hand hygiene actions were recorded but prompting and visual indication functions were disabled, (2) only hand hygiene status indicators were enabled during the second phase, and (3) both hand hygiene status and real-time hand hygiene prompting signals were enabled during the third phase. Data collection was performed automatically during all of the three phases. The system indicated significantly higher hand hygiene activity rates and compliance during the third phase, with both hand hygiene indication and real-time prompting functions enabled. To increase the efficacy of the technology, its use was supplemented with individual performance reviews of the automatically collected data.
Magiorakos, A P; Suetens, C; Boyd, L; Costa, C; Cunney, R; Drouvot, V; Farrugia, C; Fernandez-Maillo, M M; Iversen, B G; Leens, E; Michael, S; Moro, M L; Reinhardt, C; Serban, R; Vatcheva-Dobrevska, R; Wilson, K; Heisbourg, E; Maltezou, H C; Strauss, R; Borocz, K; Dolinsek, M; Dumpis, U; Erne, S; Gudlaugsson, O; Heczko, P; Hedlova, D; Holt, J; Joe, L; Lyytikainen, O; Riesenfeld-Orn, I; Stefkovikova, M; Valinteliene, R; Voss, A; Monnet, D L
Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.
Health care-associated infections (HAIs) are a significant issue in the United States and throughout the world, but following proper hand hygiene practices is the most effective and least expensive way to prevent HAIs. Hand hygiene is inexpensive and protects patients and health care personnel alike. The four general types of hand hygiene that should be performed in the perioperative environment are washing hands that are visibly soiled, hand hygiene using alcohol-based products, surgical hand scrubs, and surgical hand scrubs using an alcohol-based surgical hand rub product. Barriers to proper hand hygiene may include not thinking about it, forgetting, skin irritation, a lack of role models, or a lack of a safety culture. One strategy for improving hand hygiene practices is monitoring hand hygiene as part of a quality improvement project, but the most important aspect for perioperative team members is to set an example for other team members by following proper hand hygiene practices and reminding each other to perform hand hygiene.
Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 11. Use of antiseptics and sanitizers in community settings and issues of hand hygiene compliance in health care and food industries.
Todd, Ewen C D; Greig, Judy D; Michaels, Barry S; Bartleson, Charles A; Smith, Debra; Holah, John
Hand washing with soap is a practice that has long been recognized as a major barrier to the spread of disease in food production, preparation, and service and in health care settings, including hospitals, child care centers, and elder care facilities. Many of these settings present multiple opportunities for spread of pathogens within at-risk populations, and extra vigilance must be applied. Unfortunately, hand hygiene is not always carried out effectively, and both enteric and respiratory diseases are easily spread in these environments. Where water is limited or frequent hand hygiene is required on a daily basis, such as for many patients in hospitals and astronauts in space travel, instant sanitizers or sanitary wipes are thought to be an effective way of preventing contamination and spread of organisms among coworkers and others. Most concerns regarding compliance are associated with the health care field, but the food industry also must be considered. Specific reasons for not washing hands at appropriate times are laziness, time pressure, inadequate facilities and supplies, lack of accountability, and lack of involvement by companies, managers, and workers in supporting proper hand washing. To facilitate improvements in hand hygiene, measurement of compliant and noncompliant actions is necessary before implementing any procedural changes. Training alone is not sufficient for long-lasting improvement. Multiactivity strategies also must include modification of the organization culture to encourage safe hygienic practices, motivation of employees willing to use peer pressure on noncompliant coworkers, a reward and/or penalty system, and an operational design that facilitates regular hand hygiene.
Background Hand hygiene is the cornerstone of infection control and reduces rates of healthcare associated infection. There are limited data evaluating hand hygiene adherence and hand hygiene campaign effect in resource-limited settings, especially in Sub-Saharan Africa. This study assessed the impact of implementing a World Health Organization (WHO)-recommended multimodal hand hygiene campaign at a hospital in Ethiopia. Methods This study included a before-and-after assessment of health care worker (HCW) adherence with WHO hand hygiene guidelines. It was implemented in three phases: 1) baseline evaluation of hand hygiene adherence and hospital infrastructure; 2) intervention (distribution of commercial hand sanitizer and implementation of an abbreviated WHO-recommended multimodal hand hygiene campaign); and 3) post-intervention evaluation of HCW hand hygiene adherence. HCWs’ perceptions of the campaign and hand sanitizer tolerability were assessed through a survey performed in the post-intervention period. Results At baseline, hand washing materials were infrequently available, with only 20% of sinks having hand-washing materials. There was a significant increase in hand hygiene adherence among HCWs following implementation of a WHO multimodal hand hygiene program. Adherence increased from 2.1% at baseline (21 hand hygiene actions/1000 opportunities for hand hygiene) to 12.7% (127 hand hygiene actions /1000 opportunities for hand hygiene) after the implementation of the hand hygiene campaign (OR = 6.8, 95% CI 4.2-10.9). Hand hygiene rates significantly increased among all HCW types except attending physicians. Independent predictors of HCW hand hygiene compliance included performing hand hygiene in the post-intervention period (aOR = 5.7, 95% CI 3.5-9.3), in the emergency department (aOR = 4.9, 95% CI 2.8-8.6), during patient care that did not involve Attending Physician Rounds (aOR = 2.4, 95% CI 1.2-4.5), and after patient contact (aOR = 2
Duke, Lynsay; Gibbison, Lucy; McMahon, Victoria
Caring for hands tightened by spasticity after stroke, brain injury or other neurological conditions can be challenging for care staff. Opening and cleaning the hand, managing pressure areas, cutting nails and reducing pain becomes more complex if muscles are tight and short. Hand hygiene is key for staff but literature on patients' hand and nail care is lacking, so specialist education and care planning may be needed to help staff ensure these activities are done well. This article outlines the importance of maintaining patients' hand hygiene, explores the barriers to providing effective care and discusses how they might be overcome.
Shobowale, Emmanuel Olushola; Adegunle, Benjamin; Onyedibe, Ken
Background: Hand hygiene has been described as the cornerstone and starting point in all infection control programs, with the hands of healthcare staff being the drivers and promoters of infection in critically ill patients. The objectives of this study were to access healthcare workers compliance with the World Health Organization (WHO) prescribed five moments of hand hygiene as it relates to patient care and to determine the various strata of healthcare workers who are in default of such prescribed practices. Methods: The study was an observational, cross-sectional one. Hand hygiene compliance was monitored using the hand hygiene observation tool developed by the WHO. A nonidentified observer was used for monitoring compliance with hand hygiene. The observational period was over a 60-day period from August 2015 to October 2015. Results: One hundred and seventy-six observations were recorded from healthcare personnel. The highest number of observations were seen in surgery, n = 40. The following were found to be in noncompliance before patient contact – anesthetist P = 0.00 and the Intensive Care Unit P = 0.00 while compliance was seen with senior nurses (certified registered nurse anesthetist [CRNA]) P = 0.04. Concerning hand hygiene after the removal of gloves, the following were areas of noncompliance - the emergency room P = 0.00, CRNA P = 0.00, dental P = 0.04, and compliance was seen with surgery P = 0.01. With regards to compliance after touching the patient, areas of noncompliance were the anesthetists P = 0.00, as opposed to CRNA P = 0.00, dental P = 0.00, and Medicine Department P = 0.02 that were compliant. Overall, the rates of compliance to hand hygiene were low. Discussion: The findings however from our study show that the rates of compliance in our local center are still low. The reasons for this could include lack of an educational program on hand hygiene; unfortunately, healthcare workers in developing settings such as ours regard such programs
Knoll, Martin; Lautenschlaeger, Christine; Borneff-Lipp, Marianne
The objective of this research was to clarify whether external factors (e.g. ward capacity, level of nursing intensity) had an influence on nursing staff compliance with hand hygiene guidelines. The study was conducted at a German hospital (450 beds). Quantitative data were collected prospectively in six trial phases (E1-E6) starting in June 2007 and ending in May 2008. Included in the study were ten hospital departments: four surgical wards, four internal medicine departments, and two interdisciplinary intensive care units. In six participant observation trials, nursing staff were monitored for the disinfection of hands. Narrative interviews were conducted immediately after the observation with those who did not disinfect their hands in accordance with national guidelines. Observations and interviews were unannounced, taking place at different times. The collected data was analysed on subsequent categorization after summarizing the core statements (content analysis). The statistical relevance of staff compliance to the rate of used ward capacity could be proved using a multifactorial regression model (P=0.011). Workload factors (e.g. maximum ward capacity, severity of patient cases) have an impact on staff compliance with hand hygiene guidelines, even where non-compliance contradicts the personal level of professional training.
Bathke, Janaína; de Cunico, Priscila Almeida; Maziero, Eliane Cristina Sanches; Cauduro, Fernanda Leticia Frates; Sarquis, Leila Maria Mansano; de Cruz, Elaine Drehmer Almeida
Considering the importance of hands in the chain of transmission of microorganisms, this observational research investigated the material infrastructure and compliance of hand hygiene in an intensive care unit in the south of Brazil in 2010. The data was collected by direct non-participant observation and through the use of self-administered questionnaires to be completed by the 39 participants, which was analyzed with the assistance of the chi2 Test, descriptive statistics and quantitative discourse analysis. Although health professionals overestimate compliance rates, recognize the practice as relevant to the prevention of infection and refer there are no impeding factors, of the 1,277 opportunities observed, compliance was 26% and significantly lower before patient contact and the use of aseptic procedures than after patient contact: infrastructure was shown to be deficient. The results indicate risk to patient safety, and thus, the planning of corrective actions to promote hand washing is relevant.
Mani, Ameet; Shubangi, A M; Saini, Rajiv
Healthcare-associated infections are an important cause of morbidity and mortality among hospitalized patients worldwide. Transmission of health care associated pathogens generally occurs via the contaminated hands of health care workers. Hand hygiene has long been considered one of the most important infection control measures to prevent health care-associated infections. For generations, hand washing with soap and water has been considered a measure of personal hygiene. As early as 1822, a French pharmacist demonstrated that solutions containing chlorides of lime or soda could eradicate the foul odor associated with human corpses and that such solutions could be used as disinfectants and antiseptics. This paper provides a comprehensive review of data regarding hand washing and hand antisepsis in healthcare settings. In addition, it provides specific recommendations to uphold improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in healthcare settings. This article also makes recommendations and suggests the significance of hand health hygiene in infection control.
Ellison, Richard T; Barysauskas, Constance M; Rundensteiner, Elke A; Wang, Di; Barton, Bruce
Background. The use of electronic hand hygiene reminder systems has been proposed as an approach to improve hand hygiene compliance among healthcare workers, although information on efficacy is limited. We prospectively assessed whether hand hygiene activities among healthcare workers could be increased using an electronic hand hygiene monitoring and reminder system. Methods. A prospective controlled clinical trial was conducted in 2 medical intensive care units (ICUs) at an academic medical center with comparable patient populations, healthcare staff, and physical layout. Hand hygiene activity was monitored concurrently in both ICUs, and the reminder system was installed in the test ICU. The reminder system was tested during 3 administered phases including: room entry/exit chimes, display of real-time hand hygiene activity, and a combination of the 2. Results. In the test ICU, the mean number of hand hygiene events increased from 1538 per day at baseline to 1911 per day (24% increase) with the use of a combination of room entry/exit chimes, real-time displays of hand hygiene activity, and manager reports (P < .001); in addition, the ratio of hand hygiene to room entry/exit events also increased from 26.1% to 36.6% (40% increase, P < .001). The performance returned to baseline (1473 hand hygiene events per day) during the follow-up phase. There was no significant change in hand hygiene activity in the control ICU during the course of the trial. Conclusions. In an ICU setting, an electronic hand hygiene reminder system that provided real-time feedback on overall unit-wide hand hygiene performance significantly increased hand hygiene activity.
Graves, Nicholas; Page, Katie; Martin, Elizabeth; Brain, David; Hall, Lisa; Campbell, Megan; Fulop, Naomi; Jimmeison, Nerina; White, Katherine; Paterson, David; Barnett, Adrian G.
Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011–2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of $29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the Australian Capital Territory and Queensland, with ICERs of $1,030 and $8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26% chance for South Australia with an ICER of $64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand
Farhoudi, Farinaz; Hoshangi Davani, Minoo; Ghalebi, Nadiyeh; Sajadi, Golnar; Taghizadeh, Raziyeh
Objectives. As affirmed by the World Health Organization (WHO), hand hygiene is the most powerful preventive measure against healthcare-associated infections (HCAIs) and, thus, it has become one of the five key elements of patient safety program. The aim is to assess the effect of implementation of the WHO's Multimodal Hand Hygiene Improvement Strategy among healthcare workers of a tertiary teaching hospital in a developing country. Methods. Hand hygiene compliance was assessed among healthcare workers, according to five defined moments for hand hygiene of the WHO, before and after implementation of the WHO's Multimodal Hand Hygiene Improvement Strategy in fourteen wards of a tertiary teaching hospital in Shiraz, Iran. We used direct observation method and documented the results in WHO hand hygiene observation forms. Results. There was a significant change in compliance before and after implementation of WHO's Multimodal HH Improvement Strategy (29.8% and 70.98%, resp.). Conclusions. Implementing WHO hand hygiene program can significantly improve hand hygiene compliance among nurses. PMID:27999811
Landers, Timothy; Abusalem, Said; Coty, Mary-Beth; Bingham, James
Hand hygiene has been recognized as the most important means of preventing the transmission of infection, and great emphasis has been placed on ways to improve hand hygiene compliance by health care workers (HCWs). Despite increasing evidence that patients' flora and the hospital environment are the primary source of many infections, little effort has been directed toward involving patients in their own hand hygiene. Most previous work involving patients has included patients as monitors or auditors of hand hygiene practices by their HCWs. This article reviews the evidence on the benefits of including patients more directly in hand hygiene initiatives, and uses the framework of patient-centered safety initiatives to provide recommendations for the timing and implementation of patient hand hygiene protocols. It also addresses key areas for further research, practice guideline development, and implications for training of HCWs.
Tvedt, C; Bukholm, G
This study involved observation of hand-hygiene behaviour and evaluation of the effect of alcohol-based hand disinfection and handwashing with plain liquid soap on microbial flora. The study was performed in a combined medical and surgical intensive care unit. We demonstrated a crude compliance of hand hygiene of 50.4%, which was only performed adequately in 20.8% of cases. Of this group, handwashing and hand-disinfection procedures were performed properly 34.0% and 71.6% of the time, respectively. Hand samples for bacteriological examinations with the glove juice method demonstrated that whilst handwashing was sensitive to the way in which hand hygiene was performed, alcohol-based hand disinfection was less sensitive to such performance. Our study demonstrated that alcohol-based hand disinfection is a robust hand-hygiene method with many advantages in a practical setting. It is very feasible for use in hospital wards.
Klymenko, Iryna; Kampf, Günter
Aim: Every year, millions of people around the world suffer from different infectious diseases, considerable part of which are hospital-acquired infections. WHO considers hand hygiene as a priority measure aimed to reduce the level of infection. We evaluated various aspects related to the situational behavior and prioritization regarding hand hygiene measures among the healthcare workers of Ukraine. Method: Identification of system mistakes in hand hygiene was carried out first of all by direct and indirect observation of the activities of medical and pharmaceutical personnel in their everyday practice as well as during their participation in trainings on routine hand hygiene. Questionnaires also were used to estimate the level of hand hygiene compliance of participants of the study. During this period 112 training courses, 315 master-classes and presentations on proper hand hygiene were realized. The target audience included health care workers of medical centers, clinics, maternity hospitals, health care organizations and staff of pharmacies and pharmaceutical manufacturing enterprises in all regions of Ukraine. 638 respondents took part in anonymous survey on hand hygiene practice. Results: The most common mistakes were to regard hand washing and hand disinfection equally, to wash hands before doing a hand disinfection, to neglect the five moments for hand hygiene and to ignore hand hygiene before and after wearing protective gloves. Practitioners, medical attendants, pharmacy and pharmaceutical industry workers highlighted the need for practical and understandable instructions of various hand hygiene procedures, including the clarification of the possible technical mistakes. This became a ground for us to create individual master classes on hand hygiene for each cluster of healthcare workers. Conclusions: Changing hand hygiene behavior and attitude is possible by beginning to observe clinical practice and by involving healthcare workers in teaching and training
Widmer, A F
Surgical hand hygiene is standard care prior to any surgical procedure. Per-operative glove punctures are observed in almost 30% of all interventions, and a risk factor for postoperative infections. In the past, washing hands with antimicrobial soap and water (surgical scrub) was the norm, mainly with chlorhexidine or iodine. More recently, alcohol-based hand rub has been successfully introduced, showing greater effectiveness, less irritation to the hands, and requiring less time than washing hands. All products should have a remnant effect that delays microbial growth under the gloved hand. Some of the alcohol-based compounds are effective (as determined by the European Norm EN 12791) within 90 s whereas others require 3-5 min, similar to the scrub. The short procedure relies heavily on proper technique and timing, since lowering the exposure time to <90 s leads to significantly lower effectiveness of bacterial killing. Today, surgical hand hygiene should meet EN 12791 in Europe, or other standards, such as the US Food and Drug Administration tentative final monograph norm in the USA. It is best performed by using an alcohol-based hand rub, but a scrub with chlorhexidine-containing soap also meets these standards.
Szél, Borbála; Nagy, Kamilla; Milassin, Márta; Tálosi, Gyula
Contaminated hands can play pivotal role in the development and spread of healthcare-associated infections. Consequently hand hygiene practice performed with adequate technique and with adequate timing is an essential implement for patient safety. Inhibition of the practice of high level hand hygiene by the misconceptions or deficient knowledge of healthcare workers may lead to negative influence on the quality of patient care. Erroneous beliefs or "rumourous knowledge" acquired from colleagues can not only influence the attitude of healthcare workers, but can also give rise to insufficient hand hygiene compliance. Finding, interpreting and imparting the related evidence by delivering continuing education and lectures, highlighting the theoretical and practical know-how on hand hygiene could help to understand and imprint the evidence-based practice and adequate technique in the essential issue of hand hygiene. Orv. Hetil., 2017., 158(6), 212-219.
Kilpatrick, Claire; Hosie, Linda; Storr, Julie
Practising hand hygiene at the right times to prevent healthcare-associated infections is one of the most important patient care practices health professionals can undertake. However, changing behaviour to ensure staff practise appropriate hand hygiene requires a multifaceted approach. This article highlights two important aspects of the message staff need--the when and the how of hand hygiene.
Aragon, Daleen; Sole, Mary Lou; Brown, Scott
Nosocomial infections are a major health problem for hospitalized patients and their families. Since the 1800s, hand hygiene has been recognized as the single best method to prevent the spread of pathogens and nosocomial infections. Despite this fact, many healthcare workers do not adhere to hand hygiene policies. The Centers for Disease Control and Prevention issued a guideline for hand hygiene practices in 2002. Multifaceted approaches to improve hand hygiene have been shown to increase compliance among healthcare workers and subsequently reduce infections. A performance improvement project was initiated to implement this guideline and other strategies to prevent nosocomial infection. This article summarizes the performance improvement processes and the preliminary outcomes on adherence to infection prevention policies related to hand hygiene and isolation practices. Clinically and statistically significant increases were noted for hand hygiene prior to patient care and in wearing masks when indicated. Nurses and patient care technicians had the greatest increases in compliance. Increases in hand hygiene after patient contact and wearing of gown and gloves were also noted, but results were not statistically significant. Nosocomial infection rates from antibiotic-resistant organisms decreased in the first surveillance, but rates increased during the 1-year surveillance. Consumption of alcohol-based foam disinfectant doubled from baseline. Findings are consistent with other published studies. The project will continue with further reinforcement and education over the second year.
Leblebicioglu, Hakan; Koksal, Iftihar; Akan, Özay Arıkan; Özgültekin, Asu; Kendirli, Tanil; Erben, Nurettin; Yalcin, Ata Nevzat; Ulusoy, Sercan; Sirmatel, Fatma; Ozdemir, Davut; Alp, Emine; Yıldızdaş, Dinçer; Esen, Saban; Ulger, Fatma; Dilek, Ahmet; Yilmaz, Hava; Yýlmaz, Gürdal; Kaya, Selçuk; Ulusoy, Hülya; Tulunay, Melek; Oral, Mehmet; Ünal, Necmettin; Turan, Güldem; Akgün, Nur; İnan, Asuman; Ince, Erdal; Karbuz, Adem; Çiftçi, Ergin; Taşyapar, Nevin; Güneş, Melek; Ozgunes, Ilhan; Usluer, Gaye; Turhan, Ozge; Gunay, Nurgul; Gumus, Eylul; Dursun, Oguz; Arda, Bilgin; Bacakoglu, Feza; Cengiz, Mustafa; Yilmaz, Leyla; Geyik, Mehmet Faruk; Şahin, Ahmet; Erdogan, Selvi; Kılıc, Aysegul Ulu; Horoz, Ozden Ozgur
Aims: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. Design: An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. Results: We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6–93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79–0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73–0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54–0.60, p 0.0001). Conclusions: Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance.
O'Donnell, Marguerite; Harris, Tony; Horn, Terancita; Midamba, Blondelle; Primes, Vickie; Sullivan, Nancy; Shuler, Rosalyn; Zabarsky, Trina F; Deshpande, Abhishek; Sunkesula, Venkata C K; Kundrapu, Sirisha; Donskey, Curtis J
Hand hygiene by patients may prevent acquisition and dissemination of health care-associated pathogens, but limited efforts have been made to engage patients in hand hygiene interventions. In a long-term care facility, we found that residents were aware of the importance of hand hygiene, but barriers, such as inaccessible products or difficult to use products, limited compliance. A dramatic and sustained improvement in meal time hand hygiene was achieved through engagement of staff and residents.
Larson, Elaine L.; Quiros, Dave; Lin, Susan X.
Background The diffusion of national evidence-based practice guidelines and their impact on patient outcomes often go unmeasured. Methods Our objectives were to (1) evaluate implementation and compliance with clinical practices recommended in the new Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline, (2) compare rates of health care-associated infections (HAI) before and after implementation of the Guideline recommendations, and (3) examine the patterns and correlates of changes in rates of HAI. We used pre- and post-Guideline implementation site visits and surveys in the setting of 40 US hospitals—members of the National Nosocomial Infections Surveillance System—and measured HAI rates 1 year before and after publication of the CDC Guideline and used direct observation of hand hygiene compliance and Guideline implementation scores. Results All study hospitals had changed their policies and procedures and provided products in compliance with Guideline recommendations; 89.8% of 1359 staff members surveyed anonymously reported that they were familiar with the Guideline. However, in 44.2% of the hospitals (19/40), there was no evidence of a multidisciplinary program to improve compliance. Hand hygiene rates remained low (mean, 56.6%). Rates of central line-associated bloodstream infections were significantly lower in hospitals with higher rates of hand hygiene (P < .001). No impact of Guideline implementation or hand hygiene compliance on other HAI rates was identified. Other factors occurring over time could affect rates of HAI. Observed hand hygiene compliance rates were likely to overestimate rates in actual practice. The study may have been of too short duration to detect the impact of a practice guideline. Conclusion Wide dissemination of this Guideline was not sufficient to change practice. Only some hospitals had initiated multidisciplinary programs; practice change is unlikely without such multidisciplinary efforts and explicit
Szabó, Rita; Böröcz, Karolina; Nagy, Orsolya; Takács, Mária; Szomor, Katalin N
Transmission of pathogens via healthcare workers' (HCWs) hands is one of the most frequent means of spreading multi-resistant organisms and occurring healthcare-associated infections (HAIs) in hospitals. The role of contaminated hands in pathogen transmission was recognized by Hungarian physician, Ignác Semmelweis. Hand hygiene prevents cross-infections in hospitals, but numerous epidemiological and microbiology-based studies have documented low compliance of HCWs with this simple procedure. Furthermore, hand hygiene perception of HCWs plays an important role in determining hand hygiene compliance. Our aim was to describe the opinion of HCWs about their perception regarding hand hygiene practice. Our further goal was to strengthen a laboratory basis for bacterial backup control of nosocomial pathogens. A cross-sectional descriptive study was conducted between December 2010 and February 2011 in 13 participating hospitals in Hungary. HCWs know that there is correlation between contaminated hands and HAIs (83%), but neither the frequency (62%) nor the implementation (73%) of their hand hygiene performance are satisfying.We recommend that multimodal interventions - highlighted active microbiological surveillance of HCWs' hands - are the most suitable strategies to reduce the occurrence of HAIs and to determine their impact on cross-transmission of microorganisms and to overcome barriers of HCWs.
Seto, Wing Hong; Yuen, Shanny W S; Cheung, Christina W Y; Ching, Patricia T Y; Cowling, Benjamin J; Pittet, Didier
Campaign fatigue was evident in a large hospital in Hong Kong when hand hygiene compliance remained just above 50% after 4 years of aggressive and varied promotional activities. A new innovative strategy was developed that directly involved the infection control link nurses both in formulating the strategy and in implementing the various proposed programs. The new strategy was successful in increasing hand hygiene compliance to 83%.
Gould, D J; Creedon, S; Jeanes, A; Drey, N S; Chudleigh, J; Moralejo, D
The purpose of hand hygiene is to break the chain of healthcare-associated infection. In many countries hand hygiene is regularly audited as part of quality assurance based on recommendations from the World Health Organization. Direct observation is the recommended audit method but is associated with disadvantages, including potential for being observed to alter usual behaviour. The Hawthorne effect in relation to hand hygiene is analogous with productivity improvement by increasing the frequency with which hand hygiene is undertaken. Unobtrusive and/or frequent observation to accustom staff to the presence of observers is considered an acceptable way of reducing the Hawthorne effect, but few publications have discussed how to implement these techniques or examine their effectiveness. There is evidence that awareness of being watched can disrupt the usual behaviour of individuals in complex and unpredictable ways other than simple productivity effect. In the presence of auditors, health workers might defer or avoid activities that require hand hygiene, but these issues are not addressed in guidelines for practice or research studies. This oversight has implications for the validity of hand hygiene audit findings. Measuring hand hygiene product use overcomes avoidance tactics. It is cheaper and generates data continuously to assess the compliance of all clinicians without disrupting patient care. Disadvantages are the risk of overestimating uptake through spillage, wastage, or use by visitors and non-clinical staff entering patient care areas. Electronic devices may overcome the Hawthorne and avoidance effects but are costly and are not widely used outside research studies.
Mackert, Michael; Lazard, Allison; Champlin, Sara; Liang, Ming-Ching; Mabry, Amanda; Stroever, Stephanie; Guadagno, Marie; Watkins, Lynda
Two posters were designed to encourage hospital staff hand hygiene. One focused on broad benefits of hand hygiene to patients and staff, and the other highlighted hand hygiene as a long-known measure to infection control. The former was better received in terms of attention, likability, and potential to promote hand hygiene. A third-person effect, the perception of stronger impact of communication messages on others, was observed. Implications on health promotion message design were discussed.
Maskerine, Courtney; Loeb, Mark
Increased adherence to hand hygiene is widely acknowledged to be the most important way of reducing infections in health care facilities. Despite evidence of benefit, adherence to hand hygiene among health care professionals remains low. Several behavioral and organizational theories have been proposed to explain this. As a whole, the success of…
Hand hygiene remains the single most effective measure to prevent hospital acquired infection and yet poor compliance is reported repeatedly. Nurses represent the largest labour group and perform the greatest amount of direct patient care in the contemporary National Health Service. They receive their initial hand hygiene training in the pre-registration curriculum within a competence framework based on knowledge, skills and attitudes. The pre-eminent training method is one that delivers behavioural competence, making the tacit assumption that compliance will follow. In this study a mixed methods approach demonstrated that students overestimated their knowledge and skills, found it difficult to give an objective account of their performance, and reported an improbable level of compliance. The reasons why people can be self serving in their judgements may be due to information processing errors, exacerbated by the model of education and training. Flawed self assessments may present major barriers to improved performance if students view their compliance as better than it actually is. Conceptualising hand hygiene as a taxonomy of learning and introducing the cognitive strategies of reflection and self assessment would better enable students to problem solve, seek out new information, draw on past experience and gain greater and deeper understanding of the complex topic of hand hygiene behaviour.
White, Katherine M.; Starfelt, Louise C.; Jimmieson, Nerina L.; Campbell, Megan; Graves, Nicholas; Barnett, Adrian G.; Cockshaw, Wendell; Gee, Phillip; Page, Katie; Martin, Elizabeth; Brain, David; Paterson, David
Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The "5 critical moments" of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this…
A dental health care worker (DHCW) has an obligation to prevent the spread of health care associated infections. Adhering to proper hand hygiene procedures, selecting appropriate hand hygiene products and the use of gloves are all important elements of infection control. The CDC Guidelines for Hand Hygiene state that improved hand hygiene practices can reduce transmission of pathogenic microorganisms to patients and personnel in health care settings. DHCWs must also protect themselves by recognizing pitfalls such as irritants or allergies that may pose obstacles to proper hand hygiene. Occupational irritants and allergies can be caused by frequent hand washing, exposure to hand hygiene products, exposure to chemicals and shear forces associated with wearing or removing gloves. Since the primary defense against infection and transmission of pathogens is healthy, unbroken skin, DHCWs must take steps to ensure that their skin remains healthy and intact. These steps include evaluating different types of hand hygiene products, lotions and gloves for the best compatibility. If the DHCW sees a breakdown of his or her skin barrier, steps should be taken to determine the cause and remedy. Remedies can include the use of alcohol-based hand sanitizers containing emollients and moisturizers and regular use of a medical grade hand lotion. The bottom line: healthy skin protects you at work and at home. Selection and use of appropriate hand hygiene products, including moisturizers, are an essential part ofa dental office infection control program. My coworker lost the use of her thumb for several months due to complications of a staph infection. She was unable to work and found even simple tasks such as closing a button hard to do. Think of how difficult your work would be if something happened to your hands. Injury, irritation or allergies could alter your ability to work or even perform routine tasks. Our hands provide us with the ability to work in clinical dentistry. It makes
Pincock, Ted; Bernstein, Paul; Warthman, Shawn; Holst, Elizabeth
Proper performance of hand hygiene at key moments during patient care is the most important means of preventing health care-associated infections (HAIs). With increasing awareness of the cost and societal impact caused by HAIs has come the realization that hand hygiene improvement initiatives are crucial to reducing the burden of HAIs. Multimodal strategies have emerged as the best approach to improving hand hygiene compliance. These strategies use a variety of intervention components intended to address obstacles to complying with good hand hygiene practices, and to reinforce behavioral change. Although research has substantiated the effectiveness of the multimodal design, challenges remain in promoting widespread adoption and implementation of a coordinated approach. This article reviews elements of a multimodal approach to improve hand hygiene and advocates the use of a "bundled" strategy. Eight key components of this bundle are proposed as a cohesive program to enable the deployment of synergistic, coordinated efforts to promote good hand hygiene practice. A consistent, bundled methodology implemented at multiple study centers would standardize processes and allow comparison of outcomes, validation of the methodology, and benchmarking. Most important, a bundled approach can lead to sustained infection reduction.
Sasahara, Teppei; Hayashi, Shunji; Hosoda, Kouichi; Morisawa, Yuji; Hirai, Yoshikazu
Bacillus cereus is a spore-forming bacterium. B. cereus occasionally causes nosocomial infections, in which hand contamination with the spores plays an important role. Therefore, hand hygiene is the most important practice for controlling nosocomial B. cereus infections. This study aimed to determine the appropriate hand hygiene procedure for removing B. cereus spores. Thirty volunteers' hands were experimentally contaminated with B. cereus spores, after which they performed 6 different hand hygiene procedures. We compared the efficacy of the procedures in removing the spores from hands. The alcohol-based hand-rubbing procedures scarcely removed them. The soap washing procedures reduced the number of spores by more than 2 log10. Extending the washing time increased the spore-removing efficacy of the washing procedures. There was no significant difference in efficacy between the use of plain soap and antiseptic soap. Handwashing with soap is appropriate for removing B. cereus spores from hands. Alcohol-based hand-rubbing is not effective.
Lehotsky, Á; Szilágyi, L; Ferenci, T; Kovács, L; Pethes, R; Wéber, G; Haidegger, T
This study investigated the effectiveness of targeting hand hygiene technique using a new training device that provides objective, personal and quantitative feedback. One hundred and thirty-six healthcare workers in three Hungarian hospitals participated in a repetitive hand hygiene technique assessment study. Ultraviolet (UV)-labelled hand rub was used at each event, and digital images of the hands were subsequently taken under UV light. Immediate objective visual feedback was given to participants, showing missed areas on their hands. The rate of inadequate hand rubbing reduced from 50% to 15% (P < 0.001). However, maintenance of this reduced rate is likely to require continuous use of the electronic equipment.
Birnbach, D J; King, D; Vlaev, I; Rosen, L F; Harvey, P D
This study investigated the impact of a fresh scent on the rate of hand hygiene compliance (HHC) among novice healthcare providers. In all, 165 participants examined a standardized patient with one sample exposed to fresh scent (N = 79) and the other exposed to the standard environment (N = 86). Hand hygiene behaviours were tracked before patient contact using video surveillance. The standard environment group had an HHC rate of 51% whereas participants in the fresh scent group had a higher HHC rate of 80% (P < 0.001). These data demonstrate that hand hygiene behaviour may be subconsciously influenced by cues in the environment.
van den Hoogen, Agnes; Brouwer, Annemieke J; Verboon-Maciolek, Malgorzata A; Gerards, Leo J; Fleer, André; Krediet, Tannette G
Nosocomial infections are serious complications among preterm infants admitted to neonatal intensive care units (NICU). Hand hygiene is one of the most effective measures to prevent these infections. This study, performed in a tertiary level NICU, highlights the importance of a multimodal intervention program for adherence to hand hygiene. The compliance with hand hygiene among health care workers of the NICU increased significantly from 23% in the baseline assessment to 50% in the second assessment and the incidence of sepsis decreased from 13.4% to 11.3% after implementation of an intervention program.
Musuuza, Jackson S.; Barker, Anna; Ngam, Caitlyn; Vellardita, Lia; Safdar, Nasia
OBJECTIVE Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation. DESIGN Systematic review METHODS A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed. RESULTS A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure. CONCLUSIONS Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene. PMID:26861117
Zhou, Guangyu; Jiang, Tingting; Knoll, Nina; Schwarzer, Ralf
To improve regular hand hygiene in adolescents, educational messages based on medical information have not been very successful. Therefore, a theory-guided self-regulatory intervention has been designed with a particular focus on planning strategies. A randomised controlled trial with 307 adolescents, aged 12-18 years, was conducted in high schools. The control group received educational hand hygiene leaflets, whereas the experimental group received a self-regulatory treatment which required them to generate specific action plans and coping plans. Three times during one month, both groups received verbal reminder messages about planning to wash their hands properly. At one-month follow-up, hand hygiene behaviour as well as planning to practise hand hygiene were higher in the self-regulation than in the education group (p < .01). Moreover, changes in planning levels operated as a mediator between experimental conditions and changes in behavioural outcomes. Teaching self-regulatory planning strategies may constitute a superior approach than educational messages to improve regular hand hygiene practice in adolescents.
Hospital-acquired infections occur at an alarmingly high frequency, possibly affecting as many as 1 in 10 patients, resulting in a staggering morbidity and an annual mortality of many tens of thousands of patients. Appropriate hand hygiene is highly effective and represents the simplest approach that we have to preventing nosocomial infections. The Agency for Healthcare Research and Quality has targeted hand-washing compliance as a top research agenda item for patient safety. Recent research has identified inadequate hand washing and contaminated anesthesia workstation issues as likely contributors to nosocomial infections, finding aseptic practices highly variable among providers. It is vital that all healthcare providers, including anesthesia providers, appreciate the role of inadequate hand hygiene in nosocomial infection and meticulously follow the mandates of the American Association of Nurse Anesthetists and other professional healthcare organizations.
Guerre, Graziella; Aho-Glele, Ludwig-Serge; Astruc, Karine
Hand hygiene is often considered as the attribute of caregivers. However, it is the patient who is increasingly targeted by improved communication around hygiene in care notably in the framework of the "Clean Hands Mission". In this sense, the French regional centres for the fight against nosocomial infections in Burgundy has proved itself innovative on two levels by organising a photo competition in nursing homes. The aim was to show residents how to prevent care-related infections through the simple act of handwashing.
Kampf, Günter; Löffler, Harald
Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore, suggests that the skin barrier is already damaged. Two options for hand hygiene are generally available in clinical practice: (1) hand washing with some type of soap and water or (2) hand disinfection with alcohol-based hand rubs. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids. The overall compliance rate in hand hygiene is around 50%, which is far too low. In addition, healthcare workers quite often wash their hands with soap and water, when they should use an alcohol-based hand rub. This not only adds to the degree of skin irritation, but is also potentially dangerous for patients, due to the low efficacy of hand washing when compared to hand disinfection with alcohol rubs. Adhering to evidence-based hand hygiene protocols and following international guidelines on hand hygiene practices therefore, can help prevent irritant contact dermatitis among healthcare workers.
Fries, Jason; Segre, Alberto M.; Thomas, Geb; Herman, Ted; Ellingson, Katherine; Polgreen, Philip M.
Objective To explore how hand-hygiene-observer scheduling influences the number of events and unique individuals observed. Design We deployed a mobile sensor network to capture detailed movement data for 6 categories of healthcare workers (HCWs) over 2 weeks Setting: The University of Iowa Hospital and Clinic’s MICU. Methods We recorded 33721 time-stamped HCW entries to and exits from patient rooms and considered each entry or exit an opportunity for hand hygiene. Architectural drawings were used to derive 4 optimal line-of-sight placements for observers. We ran simulations for different observer movement schedules, all with a budget of 1 hour total observation time. We considered observation times of 1–15, 15–30, 30 and 60 minutes per station. We stochastically generated HCW hand-hygiene compliance based on all data and recorded the total unit compliance as it would be reported by each simulated observer. Results Considering a 60 minute total observation period, aggregate simulated observers captured at best 1.7% of the average total number of opportunities per day and at worst 0.5%. The 1–15 minute schedule captures on average 16% fewer events than the 60-minute (i.e., static) schedule, but samples 17% more unique individuals. The 1–15 minute schedule also provides the best estimator of compliance for the duration of the shift, with a mean standard deviation of 17% versus 23% for the 60-minute schedule. Conclusions Our results show that observations are sensitive to different observers’ schedules and suggest the importance of using data-driven approaches to schedule hand-hygiene audits. PMID:22669230
Kendall, Anson; Landers, Timothy; Kirk, Jane; Young, Elizabeth
Best practices for hand hygiene provide indications for performance of hand hygiene at specific points in time during patient care. For hand hygiene to prevent infections, hand hygiene resources must be readily available to health care workers whenever required. This article reviews practices and recommendations intended to facilitate hand hygiene behavior at the point of care (POC) within the health care setting. Key aspects of POC hand hygiene include the provision of alcohol-based hand rub products, integration of dispensing solutions within the patient zone, consideration of patient care workflow, and dispenser designs that optimize acceptance and usage.
Gopal Rao, G; Jeanes, A; Osman, M; Aylott, C; Green, J
Hand hygiene of healthcare workers is frequently poor despite the efforts of infection control teams to promote hand decontamination as the most important method to prevent transmission of hospital-acquired infections. In this case study, we describe how principles of societal marketing were applied to improve hand hygiene. Pre-marketing analysis of strengths, weaknesses, opportunities and threats to implementation; attention to product, price, promotion and placement; and post-marketing 'customer' surveys were the essential components of the marketing strategy and its implementation. Placement of an alcohol-based gel decontaminant (Spirigel) at the bedside of every patient was widely welcomed in the hospital, and has played a major role in improving hand hygiene of healthcare workers. In the twelve months following the implementation, the decontaminant was used at least 440,000 times. The cost of purchasing the decontaminant was approximately 5000 pounds sterling. Following the introduction of Spirigel, there was a consistent reduction in the proportion of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) in each of the quarters of 2000-2001 compared with 1999-2000. In the period 1999-2000, nearly 50% of the MRSA were hospital acquired compared with 39% in 2000-2001. Similarly, the average incidence of Clostridium difficile associated diarrhoea (CDAD) decreased in each of the quarters in 2000-2001 following the introduction of Spirigel. During this period, there was an average incidence of 9.5 cases of CDAD/1000 admissions compared with 11.5 cases of CDAD/1000 admissions in 1999-2000. This represents a 17.4% reduction in the incidence of CDAD. However, this reduction was not statistically significant (P=0.2). Our case study demonstrates that principles of societal marketing methods can be used effectively to promote and sustain hand hygiene in hospitals. Improvement in hand hygiene will lead to considerable reduction in hospital
Crews, Jonathan D; Whaley, Elaine; Syblik, Dorothy; Starke, Jeffrey
A quality improvement project was conducted to improve hand hygiene at a children's hospital. Interventions included education, performance feedback, an incentive program, and a marketing campaign. There were 9,322 observations performed over a 5-year period. Hospital-wide adherence increased from 39.9% to 97.9%. Adherence of 95% or greater was sustained for over 3 years.
Forrester, L A; Bryce, E A; Mediaa, A K
A year-long multifaceted hand-hygiene campaign entitled Clean Hands for Life targeting individual, environmental and organisational factors that influence healthcare worker (HCW) hand-hygiene behaviour was implemented in 36 acute and long-term care facilities in Vancouver Coastal Health region. The campaign involved rotation of ten novel posters, two poster contests, and distribution of multiple promotional items. A social marketing approach was used to implement and monitor the effectiveness of the campaign. Evaluation included quality assurance surveys, staff surveys (baseline, mid- and post-campaign), and focus groups. A total of 141 poster contest submissions was received, 5452 staff surveys completed and 14 focus groups conducted. Overall knowledge of the importance of hand-hygiene and intention to clean hands was high at baseline. No significant differences were observed when mid- and post-campaign scores were compared to baseline. The majority (89.5%) of HCWs reported that they preferred soap and water over alcohol hand gel. A significant increase in the self-reported use of hand-hygiene products was observed particularly among HCWs not providing direct patient care. Barriers to hand-hygiene included inappropriate placement of sinks, traffic flow issues, inadequately stocked washrooms, workload and time constraints. Organisational support was visible throughout the campaign. The results showed that social marketing is an effective approach in engaging HCWs. Hand-hygiene campaigns that focus almost exclusively on increasing awareness among HCWs may not be as successful as multifaceted campaigns or campaigns that target identified barriers to hand-hygiene.
Koçak Tufan, Zeliha; Irmak, Hasan; Bulut, Cemal; Cesur, Salih; Kınıklı, Sami; Demiröz, Ali Pekcan
The aims of this study were; to investigate the hand hygiene compliance of the health care workers (HCWs) during their routine patient care, to determine the methicillin-resistant Staphylococcus aureus (MRSA) hand colonization of the HCWs, to investigate the effect of different hand hygiene products on MRSA colonization and to evaluate the effectiveness of chromogenic agar for detecting MRSA. HCWs were investigated during their routine patient care and hand cultures were taken before and after hand wash/hygiene. Two different techniques were used to obtain the hand cultures: fingertip method (CHROMagar MRSA containing HygiSlide); and direct swab method and then inoculation to CHROMagar MRSA media. MRSA strains grown on those cultures were confirmed with conventional methods. A total of 100 HCWs (of them 61 were female; mean age: 32.7 ± 5.2 years; age range: 25-51 years) involving physicians (n= 33), nurses (n= 38) and health care assistants (n= 29), were included in the study. MRSA was detected in 39% and 11% before hand hygiene and in 13% and 6% after hand hygiene, with HygiSlide CHROMagar media and with CHROMagar in plate media, respectively. No difference were found regarding clinics, occupations, or the type of patient handling in those HCWs who were positive (n= 13) for MRSA colonization following hand hygiene, and those who were negative (n= 26). However, the type of the hand hygiene product used exhibited a statistical difference. None of the seven HCWs who used alcohol based hand rub revealed growth in the second culture while 10 of 19 (53%) HCWs who used soap and three of 13 (23%) HCWs who used chlorhexidine were still colonized with MRSA. In terms of reduction in the MRSA counts, the most effective one was the alcohol based hand rub while the soap was the least, since seven of 19 (37%) HCWs who used soap showed no reduction at all in the MRSA counts. A high ratio of hand colonization with MRSA was detected in our hospital staff (39%). It was shown that
According to the field of application, strategies for the prevention of the transfer of microbial skin flora from the hands must consider the various categories of flora: transient, resident or stemming from infected lesions on the hands (infection flora). Depending on the species and virulence of the microorganism and of the susceptibility of the infection target, transient flora may or may not be of pathogenic importance. In contrast, resident skin flora is usually regarded as pathogenic only under certain circumstances such as in surgery, especially with transplantation of foreign bodies and in highly susceptible hosts. Microorganisms stemming from infected lesions are of proven pathogenicity. In the non-surgical field, only the transient and infection flora from the hands play a role. Such lesions are an absolute contraindication for patient-care, preparation of pharmaceuticals or foodstuff. In some procedures, the transmission of transient flora can be prevented by use of the non-touch technique ("instruments instead of fingers") or by the intelligent use of protective gloves. Hands already contaminated may be rendered safe by procedures for the elimination of transients such as handwashing, hygienic handwash and hygienic hand rub (in the order of increasing efficacy). Among all useable chemicals, ethanol, isopropanol and n-propanol (in the order of increasing efficacy) are the strongest and fastest agents. Furthermore, the duration of treatment (between 30 and 60 s) significantly influences the achievable reduction of microbial release. According to the new European standards (CEN) for testing chemical disinfectants and antiseptics, products for hygienic handwash must be significantly more efficacious than unmedicated soap, on artificially contaminated hands. In contrast, products for the hygienic hand rub must not be significantly less efficacious than a reference disinfection including isopropanol 60% vol rubbed onto the hands of the same volunteers during
Batalla, A; García-Doval, I; de la Torre, C
Hand hygiene is the most important measure for the prevention of nosocomial infection. We describe the different products available for hygiene and antisepsis of the hands and the use of these products in daily practice. Hand hygiene products such as soaps and detergents are a cause of irritant dermatitis in health professionals. This irritation is one of the principal factors affecting their use in clinical practice. Alcohol-based products are better tolerated and less irritant than soap and water; irritation should not therefore be a limiting factor in the use of these products and they are to be recommended in place of soap and water. Informative and continued education programs could increase their use.
Han, Angela; Conway, Laurie J; Moore, Christine; McCreight, Liz; Ragan, Kelsey; So, Jannice; Borgundvaag, Emily; Larocque, Mike; Coleman, Brenda L; McGeer, Allison
OBJECTIVE To explore the frequency of hand hygiene opportunities (HHOs) in multiple units of an acute-care hospital. DESIGN Prospective observational study. SETTING The adult intensive care unit (ICU), medical and surgical step-down units, medical and surgical units, and the postpartum mother-baby unit (MBU) of an academic acute-care hospital during May-August 2013, May-July 2014, and June-August 2015. PARTICIPANTS Healthcare workers (HCWs). METHODS HHOs were recorded using direct observation in 1-hour intervals following Public Health Ontario guidelines. The frequency and distribution of HHOs per patient hour were determined for each unit according to time of day, indication, and profession. RESULTS In total, 3,422 HHOs were identified during 586 hours of observation. The mean numbers of HHOs per patient hour in the ICU were similar to those in the medical and surgical step-down units during the day and night, which were higher than the rates observed in medical and surgical units and the MBU. The rate of HHOs during the night significantly decreased compared with day (P92% of HHOs on medical and surgical units, compared to 67% of HHOs on the MBU. CONCLUSIONS Assessment of hand hygiene compliance using product utilization data requires knowledge of the appropriate opportunities for hand hygiene. We have provided a detailed characterization of these estimates across a wide range of inpatient settings as well as an examination of temporal variations in HHOs. Infect Control Hosp Epidemiol 2017;38:411-416.
Kampf, Günter; Kramer, Axel
from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product. PMID:15489352
Babeluk, Rita; Jutz, Sabrina; Mertlitz, Sarah; Matiasek, Johannes; Klaus, Christoph
Hand hygiene is acknowledged as the single most important measure to prevent nosocomial infections in the healthcare setting. Similarly, in non-clinical settings, hand hygiene is recognised as a key element in helping prevent the spread of infectious diseases. The aim of this study was to evaluate the efficacy of three different disinfectant hand sanitizers in reducing the burden of bacterial hand contamination in 60 healthy volunteers in a community setting, both before and after education about the correct use of hand sanitizers. The study is the first to evaluate the efficacy and ease of use of different formulations of hand rubs used by the general population. The products tested were: Sterillium (perfumed, liquid), desderman pure gel (odorless, gel) and Lavit (perfumed, spray). Sterillium and desderman are EN1500 (hygienic hand rub) certified products (available in pharmacy) and Lavit is non EN1500 certified and available in supermarkets. The two EN1500 certified products were found to be significantly superior in terms of reducing bacterial load. desderman pure gel, Sterillium and Lavit reduced the bacterial count to 6.4%, 8.2% and 28.0% respectively. After education in the correct use of each hand rub, the bacterial load was reduced even further, demonstrating the value of education in improving hand hygiene. Information about the testers' perceptions of the three sanitizers, together with their expectations of a hand sanitizer was obtained through a questionnaire. Efficacy, followed by skin compatibility were found to be the two most important attributes of a hand disinfectant in our target group.
Babeluk, Rita; Jutz, Sabrina; Mertlitz, Sarah; Matiasek, Johannes; Klaus, Christoph
Hand hygiene is acknowledged as the single most important measure to prevent nosocomial infections in the healthcare setting. Similarly, in non-clinical settings, hand hygiene is recognised as a key element in helping prevent the spread of infectious diseases. The aim of this study was to evaluate the efficacy of three different disinfectant hand sanitizers in reducing the burden of bacterial hand contamination in 60 healthy volunteers in a community setting, both before and after education about the correct use of hand sanitizers. The study is the first to evaluate the efficacy and ease of use of different formulations of hand rubs used by the general population. The products tested were: Sterillium (perfumed, liquid), desderman pure gel (odorless, gel) and Lavit (perfumed, spray). Sterillium and desderman are EN1500 (hygienic hand rub) certified products (available in pharmacy) and Lavit is non EN1500 certified and available in supermarkets. The two EN1500 certified products were found to be significantly superior in terms of reducing bacterial load. desderman pure gel, Sterillium and Lavit reduced the bacterial count to 6.4%, 8.2% and 28.0% respectively. After education in the correct use of each hand rub, the bacterial load was reduced even further, demonstrating the value of education in improving hand hygiene. Information about the testers' perceptions of the three sanitizers, together with their expectations of a hand sanitizer was obtained through a questionnaire. Efficacy, followed by skin compatibility were found to be the two most important attributes of a hand disinfectant in our target group. PMID:25379773
Eldridge, Noel E; Woods, Susan S; Bonello, Robert S; Clutter, Kay; Ellingson, LeAnn; Harris, Mary Ann; Livingston, Barbara K; Bagian, James P; Danko, Linda H; Dunn, Edward J; Parlier, Renee L; Pederson, Cheryl; Reichling, Kim J; Roselle, Gary A; Wright, Steven M
BACKGROUND The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC's emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement. OBJECTIVE To use the Six Sigma process to examine hand hygiene practices and increase compliance with the CDC hand hygiene recommendations required by JCAHO. DESIGN Six Sigma Project with pre-post design. PARTICIPANTS Physicians, nurses, and other staff working in 4 intensive care units at 3 hospitals. MEASUREMENTS Observed compliance with 10 required hand hygiene practices, mass of ABHR used per month per 100 patient-days, and staff attitudes and perceptions regarding hand hygiene reported by questionnaire. RESULTS Observed compliance increased from 47% to 80%, based on over 4,000 total observations. The mass of ABHR used per 100 patient-days in 3 intensive care units (ICUs) increased by 97%, 94%, and 70%; increases were sustained for 9 months. Self-reported compliance using the questionnaire did not change. Staff reported increased use of ABHR and increased satisfaction with hand hygiene practices and products. CONCLUSIONS The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC's evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use. PMID:16637959
Pan, Sung-Ching; Sheng, Wang-Huei; Tien, Kuei-Lien; Chien, Kuang-Tse; Chang, Shawn-Chwen
Background Hand hygiene is an important component in infection control to protect patient safety and reduce health care-associated infection. Objective Our aim was to evaluate the efficacy of different social media on the promotion of a hand hygiene (HH) program. Methods The observational study was conducted from May 5 to December 31, 2014, at a 2600-bed tertiary care hospital. A 3-minute video of an HH campaign in 8 languages was posted to YouTube. The Chinese version was promoted through three platforms: the hospital website, the hospital group email, and the Facebook site of a well-known Internet illustrator. The video traffic was analyzed via Google Analytics. HH compliance was measured in November 2013 and 2014. Results There were 5252 views of the video, mainly of the Chinese-language version (3509/5252, 66.81%). The NTUH website had 24,000 subscribers, and 151 of them viewed the video (connection rate was 151/24,000, 0.63%). There were 9967 users of the hospital email group and the connection rate was 0.91% (91/9967). The connection rate was 6.17% (807/13,080) from Facebook, significantly higher than the other 2 venues (both P<.001). HH compliance sustained from 83.7% (473/565) in 2013 to 86.7% (589/679) in 2014 (P=.13) among all HCWs. Conclusions Facebook had the highest connection rate in the HH video campaign. The use of novel social media such as Facebook should be considered for future programs that promote hand hygiene and other healthy behaviors. PMID:27227159
Srigley, J A; Furness, C D; Gardam, M
Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes.
Levchenko, Alexander I; Boscart, Veronique M; Fernie, Geoff R
Adequate hand hygiene is often considered as the most effective method of reducing the rates of hospital-acquired infections, which are one of the major causes of increased cost, morbidity, and mortality in healthcare. Electronic monitoring technologies provide a promising direction for achieving sustainable hand hygiene improvement by introducing the elements of automated feedback and creating the possibility to automatically collect individual hand hygiene performance data. The results of the multiphase testing of an automated hand hygiene reminding and monitoring system installed in a complex continuing care setting are presented. The study included a baseline Phase 1, with the system performing automated data collection only, a preintervention Phase 2 with hand hygiene status indicator enabled, two intervention Phases 3 and 4 with the system generating hand hygiene reminding signals and periodic performance feedback sessions provided, and a postintervention Phase 5 with only hand hygiene status indicator enabled and no feedback sessions provided. A significant increase in hand hygiene performance observed during the first intervention Phase 3 was sustained over the second intervention Phase 4, with the postintervention phase also indicating higher hand hygiene activity rates compared with the preintervention and baseline phases. The overall trends observed during the multiphase testing, the factors affecting acceptability of the automated hand hygiene monitoring system, and various strategies of technology deployment are discussed.
Kühner, M K; Raetzke, P B
Problems of patient compliance in periodontics are evident. This study explored factors which may contribute to the degree of adherence. Using the "Health Belief Model" a questionnaire was constructed and administered to 120 patients of the Department of Periodontology, University of Frankfurt Dental School. Compliance of these patients during the hygienic phase was assessed using a bleeding index. The data set for statistical evaluation comprised 96 patients. The loss was due to missing of appointments and incomplete questionnaires. There was no significant correlation between patient compliance on the one hand and sociodemographic variables (age, sex, family status), disease parameters, and the health beliefs "susceptibility," "barriers," "dentist-patient-relationship," and "experience with therapy" on the other hand. "Motivation," "seriousness," "benefits," "experience with affected organ," and tooth-loss-index were significant predictors with Spearman correlation coefficients running from 0.17 to 0.32. When the predictor variables were combined the coefficient was 0.59. This study further supports the assumption that health beliefs play a significant role in the determination of health related behavior.
Mackert, Michael; Lazard, Allison; Liang, Ming-Ching; Mabry, Amanda; Champlin, Sara; Stroever, Stephanie
Hand hygiene is the most effective way to prevent the spread of health care-associated infections, but many facilities may not have the resources or expertise to develop their own hand hygiene promotion campaign. This observational study demonstrated that a campaign developed for 1 facility could successfully contribute to behavior change at another, unrelated facility. It serves as a model and evidence that health care facilities can successfully adopt hand hygiene promotion campaigns developed and validated at other facilities.
Pickering, Amy J.; Davis, Jennifer; Blum, Annalise G.; Scalmanini, Jenna; Oyier, Beryl; Okoth, George; Breiman, Robert F.; Ram, Pavani K.
Handwashing is difficult in settings with limited resources and water access. In primary schools within urban Kibera, Kenya, we investigated the impact of providing waterless hand sanitizer on student hand hygiene behavior. Two schools received a waterless hand sanitizer intervention, two schools received a handwashing with soap intervention, and two schools received no intervention. Hand cleaning behavior after toilet use was monitored for 2 months using structured observation. Hand cleaning after toileting was 82% at sanitizer schools (N = 2,507 toileting events), 38% at soap schools (N = 3,429), and 37% at control schools (N = 2,797). Students at sanitizer schools were 23% less likely to have observed rhinorrhea than control students (P = 0.02); reductions in student-reported gastrointestinal and respiratory illness symptoms were not statistically significant. Providing waterless hand sanitizer markedly increased student hand cleaning after toilet use, whereas the soap intervention did not. Waterless hand sanitizer may be a promising option to improve student hand cleansing behavior, particularly in schools with limited water access. PMID:23836575
Polgreen, Philip M; Hlady, Christopher S; Severson, Monica A; Segre, Alberto M; Herman, Ted
Many efforts to automatically measure hand hygiene activity depend on radio-frequency identification equipment or similar technology that can be expensive to install. We have developed a method for automatically tracking the use of hand hygiene dispensers before healthcare workers enter (or after they exit) patient rooms that is easily and quickly deployed without permanent hardware.
Pokrywka, Marian; Feigel, Jody; Douglas, Barbara; Grossberger, Susan; Hensler, Amelia; Hensler, Amelia; Weber, David
Prevention strategies for Clostridium difficile infection traditionally have addressed barrier precautions, environmental disinfection, and health care worker hand hygiene. When applied as a bundle, this approach has been used widely as an evidence-based strategy to prevent hospital-acquired C. difficile infection. Expanding the bundle to include patient hand hygiene is a nurse-driven approach to prevent C. difficile transmission.
Grant, Adam M; Hofmann, David A
Diseases often spread in hospitals because health care professionals fail to wash their hands. Research suggests that to increase health and safety behaviors, it is important to highlight the personal consequences for the actor. However, because people (and health care professionals in particular) tend to be overconfident about personal immunity, the most effective messages about hand hygiene may be those that highlight its consequences for other people. In two field experiments in a hospital, we compared the effectiveness of signs about hand hygiene that emphasized personal safety ("Hand hygiene prevents you from catching diseases") or patient safety ("Hand hygiene prevents patients from catching diseases"). We assessed hand hygiene by measuring the amount of soap and hand-sanitizing gel used from dispensers (Experiment 1) and conducting covert, independent observations of health care professionals' hand-hygiene behaviors (Experiment 2). Results showed that changing a single word in messages motivated meaningful changes in behavior: The hand hygiene of health care professionals increased significantly when they were reminded of the implications for patients but not when they were reminded of the implications for themselves.
Infection prevention and control nurses (IPCNs) have an extremely wide remit in relation to the facilitation of appropriate infection prevention and control practice within healthcare environments. In order to be effective IPCNs need to be involved at all stages of healthcare service delivery and need to form close working relationships with staff at all levels and in all departments within their organisation. The provision of the necessary facilities within the clinical environment, along with the ongoing training and support of staff are essential prerequisites to changing the behaviour of staff in order to consistently deliver effective hand hygiene and other infection prevention and control practices. Auditing of practice and the investigation of incidents enable the identification of areas of practice requiring improvement, which subsequently informs the continual development of training programmes and initiatives with a view to improving patient and staff safety. IPCNs need to be able to react swiftly to the emergence of new infectious organisms and/or evidence to identify what is required in order to ensure that staff are compliant with anticipated practice to maintain the safety of the patients in their care, themselves and their colleagues.
Skin care is an important component of hand hygiene and also infection prevention education programmes relating to hand hygiene (Bissett, 2007a,b). Hand hygiene is the term commonly used to describe hand washing using plain soap or antiseptic soaps and hand rubbing using waterless antiseptic products or alcohol-based products. The importance of effective hand hygiene is well documented (Larson, 1997; Boyce et al, 2002; Horton and Parker, 2002) and can be achieved by following the six-step technique used for hand washing as illustrated by the Royal College of Nursing (2000). During hand washing, hand soaps not only remove soils, but also the natural oils that protect the skin. This can vary depending on the frequency of hand washing, the temperature of the water and the ability of the soap to be rinsed from the surface of the hands (Starobin, 2007). This article aims to examine the evidence available to enable healthcare staff to make an informed decision on the importance of following a skin care regime to reduce the risk of bacterial loading on the hands caused by damaged skin. This would consequently lead to an improvement in hand hygiene efficacy.
Soon, Jan Mei; Baines, Richard; Seaman, Phillip
Research has shown that traditional food safety training programs and strategies to promote hand hygiene increases knowledge of the subject. However, very few studies have been conducted to evaluate the impact of food safety training on food handlers' attitudes about good hand hygiene practices. The objective of this meta-analytical study was to assess the extent to which food safety training or intervention strategies increased knowledge of and attitudes about hand hygiene. A systematic review of food safety training articles was conducted. Additional studies were identified from abstracts from food safety conferences and food science education conferences. Search terms included combinations of "food safety," "food hygiene," "training," "education," "hand washing," "hand hygiene," "knowledge," "attitudes," "practices," "behavior," and "food handlers." Only before- and after-training approaches and cohort studies with training (intervention group) and without training (control group) in hand hygiene knowledge and including attitudes in food handlers were evaluated. All pooled analyses were based on a random effects model. Meta-analysis values for nine food safety training and intervention studies on hand hygiene knowledge among food handlers were significantly higher than those of the control (without training), with an effect size (Hedges' g) of 1.284 (95% confidence interval [CI] ∼ 0.830 to 1.738). Meta-analysis of five food safety training and intervention studies in which hand hygiene attitudes and self-reported practices were monitored produced a summary effect size of 0.683 (95% CI ∼ 0.523 to 0.843). Food safety training increased knowledge and improved attitudes about hand hygiene practices. Refresher training and long-term reinforcement of good food handling behaviors may also be beneficial for sustaining good hand washing practices.
Pittet, Didier; Allegranzi, Benedetta; Boyce, John
The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus-based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools.
Figueiredo, Ana Elizabeth; de Siqueira, Soraia Lemos; Poli-de-Figueiredo, Carlos Eduardo; d’Avila, Domingos O.
♦ Introduction and Objectives: Hand hygiene is essential for preventing peritoneal dialysis (PD)-related infections. The present study compared the effectiveness of two hygiene techniques in reducing the number of colony-forming units (CFUs) on the hands of patients undergoing PD. ♦ Methods: In this controlled clinical trial, 22 participants enrolled in the same PD program underwent a two-hand evaluation for microbiologic flora. Participants participated in two treatments: a) simple hand hygiene plus antiseptic hand hygiene, in which the patients washed their hands with water and glycerin soap for 1 minute and then rubbed and dried their hands with 70% ethyl alcohol gel; and b) antiseptic hand hygiene, in which the patients rubbed their hands with 70% ethyl alcohol gel until fully dry. To sample distal finger surfaces, we asked the participants to touch sheep blood agar plates directly. ♦ Results: The CFU count for both hands was significantly higher in the regular hygiene group than in the gel-only group [69.0 (16.0 - 101.0) CFU vs 9.0 (2.2 - 55.5) CFU, p < 0.010]. Growth of coagulase-negative Staphylococcus colonies was significantly higher in right-hand cultures from the regular hygiene group than in those from the gel-only group [69.5 (26.25 - 101.0) CFU vs 9.5 (1.0 - 41.7) CFU; p < 0.050]. ♦ Conclusions: Among patients undergoing PD, using 70% ethyl alcohol gel to cleanse the hands may be more effective than following the regular hygiene recommendations in reducing bacterial populations. PMID:24179108
Decker, Andrew S.; Cipriano, Gabriela C.; Tsouri, Gill
Objective. To assess and improve student adherence to hand hygiene indications using radio frequency identification (RFID) enabled hand hygiene stations and performance report cards. Design. Students volunteered to wear RFID-enabled hospital employee nametags to monitor their adherence to hand-hygiene indications. After training in World Health Organization (WHO) hand hygiene methods and indications, student were instructed to treat the classroom as a patient care area. Report cards illustrating individual performance were distributed via e-mail to students at the middle and end of each 5-day observation period. Students were eligible for individual and team prizes consisting of Starbucks gift cards in $5 increments. Assessment. A hand hygiene station with an RFID reader and dispensing sensor recorded the nametag nearest to the station at the time of use. Mean frequency of use per student was 5.41 (range: 2-10). Distance between the student’s seat and the dispenser was the only variable significantly associated with adherence. Student satisfaction with the system was assessed by a self-administered survey at the end of the study. Most students reported that the system increased their motivation to perform hand hygiene as indicated. Conclusion. The RFID-enabled hand hygiene system and benchmarking reports with performance incentives was feasible, reliable, and affordable. Future studies should record video to monitor adherence to the WHO 8-step technique. PMID:27170822
Decker, Andrew S; Cipriano, Gabriela C; Tsouri, Gill; Lavigne, Jill E
Objective. To assess and improve student adherence to hand hygiene indications using radio frequency identification (RFID) enabled hand hygiene stations and performance report cards. Design. Students volunteered to wear RFID-enabled hospital employee nametags to monitor their adherence to hand-hygiene indications. After training in World Health Organization (WHO) hand hygiene methods and indications, student were instructed to treat the classroom as a patient care area. Report cards illustrating individual performance were distributed via e-mail to students at the middle and end of each 5-day observation period. Students were eligible for individual and team prizes consisting of Starbucks gift cards in $5 increments. Assessment. A hand hygiene station with an RFID reader and dispensing sensor recorded the nametag nearest to the station at the time of use. Mean frequency of use per student was 5.41 (range: 2-10). Distance between the student's seat and the dispenser was the only variable significantly associated with adherence. Student satisfaction with the system was assessed by a self-administered survey at the end of the study. Most students reported that the system increased their motivation to perform hand hygiene as indicated. Conclusion. The RFID-enabled hand hygiene system and benchmarking reports with performance incentives was feasible, reliable, and affordable. Future studies should record video to monitor adherence to the WHO 8-step technique.
Tanaka, Ippei; Watanabe, Kiyoshi; Nakaminami, Hidemasa; Azuma, Chihiro; Noguchi, Norihisa
Recently, the procedure for surgical hand hygiene has been switching to a two-stage method and hand-rubbing method from the traditional hand-scrubbing method. Both the two-stage and hand-rubbing methods use alcohol-based hand-rubbing after hand washing. The former requires 5 min of antiseptic hand washing, and the latter 1 min of nonantiseptic hand washing. For a prolonged bactericidal effect in terms of surgical hand hygiene, chlorhexidine gluconate (CHG) has been noted due to its residual activity. However, no detailed study comparing the disinfection efficacy and prolonged effects according to different contents of CHG and the usage of alcohol-based hand-rubbing has been conducted. The glove juice method is able to evaluate disinfection efficacy and prolonged effects of the disinfectants more accurately because it can collect not only transitory bacteria but also normal inhabitants on hands. In the present study, we examined the disinfection efficacy and prolonged effects on alcohol-based hand-rubbing containing CHG by six hand-rubbing methods and three two-stage methods using the glove juice method. In both methods, 3 mL (one pump dispenser push volume) alcohol-based hand-rubbing solution containing 1% (w/v) CHG showed the highest disinfection efficacy and prolonged effects, and no significant difference was found between the hand-rubbing and two-stage methods. In the two methods of hand hygiene, the hand-rubbing method was able to save time and cost. Therefore, the data strongly suggest that the hand-rubbing method using a one pump dispenser push volume of alcohol-based hand-rubbing solution containing 1% (w/v) CHG is suitable for surgical hand hygiene.
Cruz, Jonas P; Bashtawi, Meshrif A
Hand hygiene is an important component of infection control, which is critical to ensuring patients' safety in hospitals. Nursing students are regarded as healthcare workers in training and can also be vehicles of cross-contamination within the hospital. Thus, this study aimed to identify the predictors of hand hygiene practice among Saudi nursing students. A descriptive, cross-sectional, self-reported study was conducted among 198 Saudi nursing students. Knowledge, attitude, and practice of hand hygiene were assessed using the WHO Hand Hygiene Knowledge Questionnaire for Health-Care Workers and its adopted scales. A regression analysis was performed to identify the predictors of hand hygiene practice. The respondents demonstrated moderate knowledge of hand hygiene (mean 13.20±2.80). The majority displayed a moderate attitude toward hand hygiene (52.1%), while only a few reported a poor attitude (13.1%). Approximately 68.7%, 29.8%, and 1.5% of the respondents reported moderate, good, and poor practice of hand hygiene, respectively. Having a good attitude toward hand hygiene, being male, being aware that hand hygiene is an effective intervention in preventing healthcare-associated infections (HAIs), attendance at hand hygiene trainings and seminars, and being in the lower academic level of nursing education were identified as predictors of better hand hygiene practice. The importance of ensuring a positive attitude toward hand hygiene and improving awareness of hand hygiene is emphasized, as are educational interventions. Educational interventions should be implemented to reinforce knowledge and instill a positive attitude toward hand hygiene.
Liu, Mingbin; Ou, Jianming; Zhang, Lijie; Shen, Xiaona; Hong, Rongtao; Ma, Huilai; Zhu, Bao-Ping; Fontaine, Robert E.
Abstract Previous observational studies have reported protective effects of hand-washing in reducing upper respiratory infections, little is known about the associations between hand-washing and good hygienic habits and seasonal influenza infection. We conducted a case-control study to test whether the risk of influenza transmission associated with self-reported hand-washing and unhealthy hygienic habits among residents in Fujian Province, southeastern China. Laboratory confirmed seasonal influenza cases were consecutively included in the study as case-patients (n = 100). For each case, we selected 1 control person matched for age and city of residence. Telephone interview was used to collect information on hand-washing and hygienic habits. The associations were analyzed using conditional logistic regression. Compared with the poorest hand-washing score of 0 to 3, odds ratios of influenza infection decreased progressively from 0.26 to 0.029 as hand-washing score increased from 4 to the maximum of 9 (P < 0.001). Compared with the poorest hygienic habit score of 0 to 2, odds ratios of influenza infection decreased from 0.10 to 0.015 with improving score of hygienic habits (P < 0.001). Independent protective factors against influenza infection included good hygienic habits, higher hand-washing score, providing soap or hand cleaner beside the hand-washing basin, and receiving influenza vaccine. Regular hand-washing and good hygienic habits were associated with a reduced risk of influenza infection. These findings support the general recommendation for nonpharmaceutical interventions against influenza. PMID:26986125
Neo, Jun Rong Jeffrey
Health care-associated infection is a leading cause of morbidity and mortality. Hand hygiene is widely regarded as an effective prevention strategy. Often, hand hygiene research is designed and conducted by health care practitioners who may lack formal training in research methods, particularly in the area of social science. In a research context, a construct is a concept that can be measured or observed in some way. A construct can be directly or indirectly measured. For example, height can be directly measured by centimeters, whereas depression can be indirectly measured by a scale of 20 items. Every construct needs to be operationalized by measure(s) to make it a variable. Hence, construct validity refers to the degree of fit between the construct of interest and its operational measure. However, issues with construct validity often weaken the translation from construct to measure(s). This article will (1) describe the common threats to construct validity pertaining to hand hygiene research, (2) identify practical limitations in current research design, and (3) provide recommendations to improve construct validity in future hand hygiene research. By understanding how construct validity may affect hand hygiene research design, there is great potential to improve the validity of future hand hygiene research findings.
Botene, Daisy Zanchi de Abreu; Pedro, Eva Neri Rubim
This paper is a qualitative descriptive study, which aims to analyze how the academic education concerning hand hygiene contributes to the pediatric patient safety. This research was developed in an university hospital in Southern Brazil, in the pediatric unit, during the period of August to December, 2012. Sixteen healthcare professionals participated (doctors, nurses and physical therapists). A semi-structured interview was used to gather information. Data was organized by the software QSR Nvivo and analyzed using the content analysis technique. The results allowed us to list two thematic categories:"Hand hygiene and healthcare professionals' academic education"; and "Hand hygiene and professional life". The first thematic category will be presented in this paper. It was identified that the academic education contributes in an ineffective way to the creation of a patient safety culture. According to the professionals, there are gaps during the educational process regarding hand hygiene. The topic is treated in an ineffective and not very significant way to the learning and adhesion of hand hygiene in the professional life. It is recommended that, for the internalization of the practice by future professionals, a transversal, continuous and systematical approach is adopted during the professional's training, evaluations concerning the hand hygiene are done throughout the academic life as well as healthcare professors bethink the topic.
Lucet, J-C; Rigaud, M-P; Mentre, F; Kassis, N; Deblangy, C; Andremont, A; Bouvet, E
The efficacy of alcohol-based handrubs (ABH) for hand hygiene (HH) compared with handwashing (HW) remains to be established in the clinical setting. Factors associated with severe hand contamination before HH techniques were medical ward, physician and not wearing gloves. Forty-three healthcare workers [HCW, 26 nurses (N), nine nurse assistants (NA) and eight physicians (P)] each performed six HH techniques in random order, immediately after a patient care activity: HW with non-antiseptic soap for 10 (US10) and 30 (US30) s; HW with antiseptic (polyvidone iodine- or chlorhexidine-based) soap for 10 (AS10), 30 (AS30) or 60 (AS60) s; and ABH (Sterillium, Bode Chemie, Germany). The fingertips of the dominant hand were pressed on to agar for culture before and after each HH technique. Five hundred and sixteen specimens were obtained. Log(10)-transformed bacterial count reductions after HH were 0.74, 0.51, 1.13, 1.14, 1.21 and 1.40 for US10, US30, AS10, AS30, AS60 and ABH, respectively; both AS and ABH were significantly better than US. Qualitative assessment showed that 11 of the 256 pre-HH specimens (4.3%) had pathogenic bacteria, and that two of these 11 remained positive after HH (US in both instances).
Wong, Valerie W. Y.; Cowling, Benjamin J.; Aiello, Alison E.
Community-based prevention strategies for seasonal and pandemic influenza are essential to minimize their potential threat to public health. Our aim was to evaluate the efficacy of hand hygiene interventions in reducing influenza transmission in the community and to investigate the possible modifying effects of latitude, temperature and humidity on hand hygiene efficacy. We identified 979 articles in the initial search and 10 randomized controlled trials met our inclusion criteria. The combination of hand hygiene with facemasks was found to have statistically significant efficacy against laboratory-confirmed influenza while hand hygiene alone did not. Our meta-regression model did not identify statistically significant effects of latitude, temperature or humidity on the efficacy of hand hygiene. Our findings highlight the potential importance of interventions that protect against multiple modes of influenza transmission, and the modest efficacy of hand hygiene suggests that additional measures besides hand hygiene may also be important to control influenza. PMID:24572643
Heinrich, Ellen R E; KuKanich, Kate S; Davis, Elizabeth; White, Brad J
Veterinary students can be exposed to environmental infectious agents in school that may include zoonotic pathogens. Encouraging effective hand hygiene can minimize the spread of zoonoses and promote public health and the One Health concept among veterinary students. The purpose of this study was to determine if a campaign could improve hand hygiene among veterinary students at extracurricular meetings serving meals. Nine Kansas State University College of Veterinary Medicine (KSU-CVM) extracurricular organizations participated in the study, sanitizer was provided at each meeting, and baseline hand-hygiene data were observed. A hand-hygiene opportunity was defined as any student observed to approach the buffet food line. Sanitizer use (yes/no) and gender (male/female) were recorded. Campaign interventions included a 3.5-minute educational video and a novel motivational poster. The video was presented to all first-year, second-year, and third-year veterinary students. Posters encouraging hand sanitization were displayed on doors and tables alongside sanitizers at each meeting. Observational hand-hygiene data were collected immediately after introduction of interventions and again 3 months later. Environmental sampling for presence of bacteria in and around meeting locations was also performed. Observed hand hygiene was lowest during baseline (11.0% ± 1.7), improved significantly post-intervention (48.8% ± 3.2), and remained improved at 3-month follow-up (33.5% ± 4.0). Females had higher probability of hand sanitizing (35.9% ± 2.2) than males (21.4% ± 2.4) (p<.01). Clostridium perfringens was isolated from 2/42 samples, and Salmonella spp. were isolated from 4/42 samples. A short-term public health campaign targeting veterinary students successfully improved hand hygiene before meals.
Goroncy-Bermes, P; Koburger, T; Meyer, B
Two different hand rubs were tested in order to investigate the minimum volume required for microbicidal efficacy according to the European Norm EN 1500; we also sought to determine whether there is a correlation with hand size. Eight male volunteers with big hands (mean 184 cm(2)) and eight female volunteers with significantly smaller hands (mean 148 cm(2); P<0.001) participated in our study. Application of 2 mL of both products (P) provided mean log(10) reductions significantly smaller than those of the reference disinfectant (R) (product A: P=3.34, R=4.00, P=0.001; product B: P=3.37, R=3.75, P=0.022). Higher volumes (product A: 3 and 4 mL; product B: 2.5, 3 and 4 mL) ensured that the pass criteria of the European Norm (EN) 1500 were fulfilled. For both products log(10) reductions increased with increasing product volume until a plateau was reached. For the smaller female hands, this plateau level was reached after applying 3 mL of product A and 2.5 mL of product B. The plateau level on male hands was observed after treating the hands with > or =4 mL of product A and 3 mL of product B. The increase in product volume also correlated with the decrease in the number of volunteers considering the product volume applied as insufficient. In conclusion, the applied volume for hygienic hand rub should not fall below 3 mL in order to achieve maximum benefit.
Chatfield, Sheryl L; Nolan, Rachael; Crawford, Hannah; Hallam, Jeffrey S
Objective: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices. Methods: We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene. Results: Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants. Conclusion: While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions
Wu, Yvonne Tzu-Ying; Willcox, Mark; Zhu, Hua; Stapleton, Fiona
A contaminated contact lens case can act as a reservoir for microorganisms that could potentially compromise contact lens wear and lead to sight threatening adverse events. The rate, level and profile of microbial contamination in lens cases, compliance and other risk factors associated with lens case contamination, and the challenges currently faced in this field are discussed. The rate of lens case contamination is commonly over 50%. Coagulase-negative Staphylococcus, Bacillus spp., Pseudomonas aeruginosa and Serratia marcescens are frequently recovered from lens cases. In addition, we provide suggestions regarding how to clean contact lens cases and improve lens wearers' compliance as well as future lens case design for reducing lens case contamination. This review highlights the challenges in reducing the level of microbial contamination which require an industry wide approach.
Chou, D T S; Achan, P; Ramachandran, M
The World Health Organization (WHO) launched the first Global Patient Safety Challenge in 2005 and introduced the '5 moments of hand hygiene' in 2009 in an attempt to reduce the burden of health care associated infections. Many NHS trusts in England adopted this model of hand hygiene, which prompts health care workers to clean their hands at five distinct stages of caring for the patient. Our review analyses the scientific foundation for the five moments of hand hygiene and explores the evidence, as referenced by WHO, to support these recommendations. We found no strong scientific support for this regime of hand hygiene as a means of reducing health care associated infections. Consensus-based guidelines based on weak scientific foundations should be assessed carefully to prevent shifting the clinical focus from more important issues and to direct limited resources more effectively. We recommend caution in the universal adoption of the WHO '5 moments of hand hygiene' by orthopaedic surgeons and other health care workers and emphasise the need for evidence-based principles when adopting hospital guidelines aimed at promoting excellence in clinical practice.
Jau, Bruno M.
This paper describes the Active Electromechanical Compliance (AEC) system that was developed for the Jau-JPL anthropomorphic robot. The AEC system imitates the functionality of the human muscle's secondary function, which is to control the joint's stiffness: AEC is implemented through servo controlling the joint drive train's stiffness. The control strategy, controlling compliant joints in teleoperation, is described. It enables automatic hybrid position and force control through utilizing sensory feedback from joint and compliance sensors. This compliant control strategy is adaptable for autonomous robot control as well. Active compliance enables dual arm manipulations, human-like soft grasping by the robot hand, and opens the way to many new robotics applications.
Sultana, Marufa; Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Hossain, Sarder Mahmud
Hand hygiene has achieved the reputation of being a convenient means of preventing communicable diseases. Although causal links between hand hygiene and rates of infectious disease have also been established earlier, studies focusing on hand hygiene among university-going students are not adequate in number. This study evaluated handwashing knowledge, practice, and other related factors among the selected university students in the city of Dhaka, Bangladesh. A cross-sectional study was conducted among 200 undergraduate students from four selected universities. A pretested, semistructured questionnaire, that included a checklist associated with handwashing practice, was applied to capture all relevant data. The mean (± SD) age of the participants was 20.4 (±1.8) years. The majority of the students washed their hands with water, but only 22.5% washed their hands effectively by maintaining the correct steps and frequency of handwashing with water, and soap or hand sanitizer. The mean (± SD) score of the participants’ hand hygiene practice was 50.81 (±4.79), while the total score with all perfect answers was considered as 66. Regression coefficient demonstrated that age has a negative influence on hand hygiene practice, as older students have lower scores compared to the younger ones (P<0.01). However, the unmarried students were a significant predictor for influencing the incensement of handwashing practice compared to the married ones (P<0.01). Findings of this study designate widespread insufficient hand hygiene practice in the university-going students and indicate a need for an extensive public health education program on this topic. Furthermore, availability of soap and sufficient water supply is needed within the university setting to facilitate handwashing. Therefore, supporting quantity and quality of available campus-based public health education programs along with providing health-washing equipment is suggested. PMID:26929673
Sultana, Marufa; Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Hossain, Sarder Mahmud
Hand hygiene has achieved the reputation of being a convenient means of preventing communicable diseases. Although causal links between hand hygiene and rates of infectious disease have also been established earlier, studies focusing on hand hygiene among university-going students are not adequate in number. This study evaluated handwashing knowledge, practice, and other related factors among the selected university students in the city of Dhaka, Bangladesh. A cross-sectional study was conducted among 200 undergraduate students from four selected universities. A pretested, semistructured questionnaire, that included a checklist associated with handwashing practice, was applied to capture all relevant data. The mean (± SD) age of the participants was 20.4 (±1.8) years. The majority of the students washed their hands with water, but only 22.5% washed their hands effectively by maintaining the correct steps and frequency of handwashing with water, and soap or hand sanitizer. The mean (± SD) score of the participants' hand hygiene practice was 50.81 (±4.79), while the total score with all perfect answers was considered as 66. Regression coefficient demonstrated that age has a negative influence on hand hygiene practice, as older students have lower scores compared to the younger ones (P<0.01). However, the unmarried students were a significant predictor for influencing the incensement of handwashing practice compared to the married ones (P<0.01). Findings of this study designate widespread insufficient hand hygiene practice in the university-going students and indicate a need for an extensive public health education program on this topic. Furthermore, availability of soap and sufficient water supply is needed within the university setting to facilitate handwashing. Therefore, supporting quantity and quality of available campus-based public health education programs along with providing health-washing equipment is suggested.
de Aceituno, Anna Fabiszewski; Bartz, Faith E; Hodge, Domonique Watson; Shumaker, David J; Grubb, James E; Arbogast, James W; Dávila-Aviña, Jorgé; Venegas, Fabiola; Heredia, Norma; García, Santos; Leon, Juan S
Effective hand hygiene is essential to prevent the spread of pathogens on produce farms and reduce foodborne illness. The U.S. Food and Drug Administration Food Safety Modernization Act Proposed Rule for Produce Safety recommends the use of soap and running water for hand hygiene of produce handlers. The use of alcohol-based hand sanitizer (ABHS) may be an effective alternative hygiene intervention where access to water is limited. There are no published data on the efficacy of either soap or ABHS-based interventions to reduce microbial contamination in agricultural settings. The goal of this study was to assess the ability of two soap-based (traditional or pumice) and two ABHS-based (label-use or two-step) hygiene interventions to reduce microbes (coliforms, Escherichia coli, and Enterococcus spp.) and soil (absorbance of hand rinsate at 600 nm [A600]) on farmworker hands after harvesting produce, compared with the results for a no-hand-hygiene control. With no hand hygiene, farmworker hands were soiled (median A600, 0.48) and had high concentrations of coliforms (geometric mean, 3.4 log CFU per hand) and Enterococcus spp. (geometric mean, 5.3 log CFU per hand) after 1 to 2 h of harvesting tomatoes. Differences in microbial loads in comparison to the loads in the control group varied by indicator organism and hygiene intervention (0 to 2.3 log CFU per hand). All interventions yielded lower concentrations of Enterococcus spp. and E. coli (P < 0.05), but not of coliforms, than were found in the control group. The two-step ABHS intervention led to significantly lower concentrations of coliforms and Enterococcus spp. than the pumice soap and label-use ABHS interventions (P < 0.05) and was the only intervention to yield significantly fewer samples with E. coli than were found in the control group (P < 0.05). All interventions removed soil from hands (P < 0.05), soap-based interventions more so than ABHS-based interventions (P < 0.05). ABHS-based interventions were
Portner, Joshua A; Johnson, Justine A
Antibiotic resistance is a growing problem in the hospital setting. Organisms that cause hospital-acquired infections are generally highly resistant, requiring expensive antibiotics and further hospitalization. As a result, many owners of infected pets choose euthanasia. Appropriate hospital disinfection and staff hygiene practices can prevent such infections by reducing the pathogen load in a facility in accordance with the "nosocomial prevention triad"-appropriate antibiotic usage, staff and patient hygiene, and hospital maintenance and disinfection. This review outlines the development and implementation of hospital disinfection protocols and hand hygiene practices in small animal veterinary hospitals.
Huang, Cunrui; Ma, Wenjun; Stack, Susan
The transmission of bacteria is more likely to occur from wet skin than from dry skin; therefore, the proper drying of hands after washing should be an integral part of the hand hygiene process in health care. This article systematically reviews the research on the hygienic efficacy of different hand-drying methods. A literature search was conducted in April 2011 using the electronic databases PubMed, Scopus, and Web of Science. Search terms used were hand dryer and hand drying. The search was limited to articles published in English from January 1970 through March 2011. Twelve studies were included in the review. Hand-drying effectiveness includes the speed of drying, degree of dryness, effective removal of bacteria, and prevention of cross-contamination. This review found little agreement regarding the relative effectiveness of electric air dryers. However, most studies suggest that paper towels can dry hands efficiently, remove bacteria effectively, and cause less contamination of the washroom environment. From a hygiene viewpoint, paper towels are superior to electric air dryers. Paper towels should be recommended in locations where hygiene is paramount, such as hospitals and clinics.
White, Cindy; Kolble, Robin; Carlson, Rebecca; Lipson, Natasha
Hand hygiene is a key element in preventing the transmission of cold and flu viruses. The authors conducted an experimental-control design study in 4 campus residence halls to determine whether a message campaign about hand hygiene and the availability of gel hand sanitizer could decrease cold and flu illness and school and work absenteeism. Their…
McGuckin, Maryanne; Storr, Julie; Longtin, Yves; Allegranzi, Benedetta; Pittet, Didier
Patient empowerment is a new concept in health care that has now been extended to the domain of patient safety. Within the framework of the development of the new World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care, the authors conducted a review of the literature from 1997 to 2008 to identify the evidence supporting programs aimed at encouraging patients to take an active role in their care. Patient empowerment is an integral part of the WHO hand hygiene multimodal strategy. Hand hygiene promotion strategies that have demonstrated evidence of successfully empowering patients include one or all of the following components: educational tools, motivation and reminder tools, and role modeling. What is important is that programs and models to empower patients must be developed with an inbuilt evaluation component that includes both qualitative and quantitative measures to determine not only what works but under what conditions and within which organizational context.
Eksi, F; Mehli, M; Akgun, S; Bayram, A; Balci, I; Aydin, N
In this study, the antimicrobial efficacy of hand washing (HW) and hand washing plus rubbing with an alcohol-based solution (HWR) on numbers of total and transient flora colonies on the hands of healthcare workers (HCWs) during routine patient care was assessed. Samples were collected, using a standard bag broth technique, from the hands of 154 HCWs, before and immediately after carrying out a hand hygiene procedure. The numbers of total and transient flora colonies per plate were counted and transient pathogens were identified. A significant statistical difference between ward speciality was detected with respect to the isolation rate of transient flora. Transient hand flora were recovered from 25.3% of HCWs before carrying out the hand hygiene procedure. With respect to the disappearance and prevention of regrowth of transient flora after hand hygiene, the HWR technique was significantly more effective than HW. In conclusion, a disinfectant should be added to the hand washing process to achieve optimum protection against nosocomial infections in routine hospital practice.
Hand disinfection is one of the most important part of patient safety. By adequate hand disinfection healthcare workers can prevent about 40 per cent of healthcare-associated infections and about 50 per cent of patients' MRSA contaminations in hospitals. Adherence to hand disinfection has been observed in an average of 40 per cent of patient contacts. One of the risk factors leading to poor adherence is the "doctor" status of a healthcare worker. Introduction of an alcohol-based hand rub close to the patient is one of the most significant factors for improved hand hygiene.
Léger, Chantal; Dutrech, Rachel
Since 2009, the Minister for Health has supported the World Health Organisation's "Clean Care is Safer Care" initiative. To this effect, a national Clean Hands Mission day is organised every year on 5th May. The French South West Centrefor the Coordination and Fight against Nosocomial Infections (CClin) marks the day by holding the "hydroalcoholic solution dance". An original approach to improve practices.
Conway, Laurie J.; Riley, Linda; Saiman, Lisa; Cohen, Bevin; Alper, Paul; Larson, Elaine L.
Article-at-a-Glance Background Despite substantial evidence to support the effectiveness of hand hygiene for preventing health care–associated infections, hand hygiene practice is often inadequate. Hand hygiene product dispensers that can electronically capture hand hygiene events have the potential to improve hand hygiene performance. A study on an automated group monitoring and feedback system was implemented from January 2012 through March 2013 at a 140-bed community hospital. Methods An electronic system that monitors the use of sanitizer and soap but does not identify individual health care personnel was used to calculate hand hygiene events per patient-hour for each of eight inpatient units and hand hygiene events per patient-visit for the six outpatient units. Hand hygiene was monitored but feedback was not provided during a six-month baseline period and three-month rollout period. During the rollout, focus groups were conducted to determine preferences for feedback frequency and format. During the six-month intervention period, graphical reports were e-mailed monthly to all managers and administrators, and focus groups were repeated. Results After the feedback began, hand hygiene increased on average by 0.17 events/patient-hour in inpatient units (interquartile range = 0.14, p = .008). In outpatient units, hand hygiene performance did not change significantly. A variety of challenges were encountered, including obtaining accurate census and staffing data, engendering confidence in the system, disseminating information in the reports, and using the data to drive improvement. Conclusions Feedback via an automated system was associated with improved hand hygiene performance in the short term. PMID:25252389
Salmon, S; Pittet, D; Sax, H; McLaws, M L
Hand hygiene is a core activity of patient safety for the prevention of healthcare-associated infections (HCAIs). To standardize hand hygiene practices globally the World Health Organization (WHO) released Guidelines on Hand Hygiene in Health Care and introduced the 'My five moments for hand hygiene' concept to define indications for hand hygiene rooted in an evidence-based model for transmission of micro-organisms by healthcare workers' (HCWs) hands. Central to the concept is the division of the healthcare environment into two geographical care zones, the patient zone and the healthcare zone, that requires the HCW to comply with specific hand hygiene moments. In resource-limited, overcrowded healthcare settings inadequate or no spatial separation between beds occurs frequently. These conditions challenge the HCW's ability to visualize and delineate patient zones. The 'My five moments for hand hygiene' concept has been adapted for these conditions with the aim of assisting hand hygiene educators, auditors, and HCWs to minimize ambiguity regarding shared patient zones and achieve the ultimate goal set by the WHO Guidelines--the reduction of infectious risks.
Anderson, Maureen E.C.; Weese, J. Scott
The objective of this study was to describe the perceived importance of and barriers to hand hygiene among companion animal clinic staff. An anonymous, voluntary written questionnaire was completed by 356 of approximately 578 individuals (62%) from 49/51 clinics. On a scale of 1 (not important) to 7 (very important), the percentage of respondents who rated hand hygiene as a 5 or higher was at least 82% in all clinical scenarios queried. The most frequently reported reason for not performing hand hygiene was forgetting to do so (40%, 141/353). Specific discussion of hand hygiene practices at work was recalled by 32% (114/354) of respondents. Although veterinary staff seem to recognize the importance of hand hygiene, it should be emphasized more during staff training. Other barriers including time constraints and skin irritation should also be addressed, possibly through increased access to and use of alcohol-based hand sanitizers. PMID:26933265
Anderson, Maureen E C; Weese, J Scott
The objective of this study was to describe the perceived importance of and barriers to hand hygiene among companion animal clinic staff. An anonymous, voluntary written questionnaire was completed by 356 of approximately 578 individuals (62%) from 49/51 clinics. On a scale of 1 (not important) to 7 (very important), the percentage of respondents who rated hand hygiene as a 5 or higher was at least 82% in all clinical scenarios queried. The most frequently reported reason for not performing hand hygiene was forgetting to do so (40%, 141/353). Specific discussion of hand hygiene practices at work was recalled by 32% (114/354) of respondents. Although veterinary staff seem to recognize the importance of hand hygiene, it should be emphasized more during staff training. Other barriers including time constraints and skin irritation should also be addressed, possibly through increased access to and use of alcohol-based hand sanitizers.
Škodová, Manuela; Gimeno-Benítez, Alfredo; Martínez-Redondo, Elena; Morán-Cortés, Juan Francisco; Jiménez-Romano, Ramona; Gimeno-Ortiz, Alfredo
Abstract Objective: because they are health professionals, nursing and medical students' hands during internships can function as a transmission vehicle for hospital-acquired infections. Method: a descriptive study with nursing and medical degree students on the quality of the hand hygiene technique, which was assessed via a visual test using a hydroalcoholic solution marked with fluorescence and an ultraviolet lamp. Results: 546 students were assessed, 73.8% from medicine and 26.2% from nursing. The area of the hand with a proper antiseptic distribution was the palm (92.9%); areas not properly scrubbed were the thumbs (55.1%). 24.7% was very good in both hands, 29.8% was good, 25.1% was fair, and 20.3% was poor. The worst assessed were the male, nursing and first year students. There were no significant differences in the age groups. Conclusions: hand hygiene technique is not applied efficiently. Education plays a key role in setting a good practice base in hand hygiene, theoretical knowledge, and in skill development, as well as good practice reinforcement. PMID:26444174
Background Day care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers’ compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers’ and children’s HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention. Methods/design The intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark the days their child has diarrhea and/or a cold. Multilevel logistic regression will be performed to assess the effect of the intervention on HH compliance. Multilevel poisson regression will be performed to assess the incidence of gastrointestinal and respiratory infections in children attending DCCs. Discussion This is one of the first DCC intervention studies to assess
Carter, Eileen J; Cohen, Bevin; Murray, Meghan T; Saiman, Lisa; Larson, Elaine L
Hand hygiene (HH) in pediatric long-term care settings has been found to be sub-optimal. Multidisciplinary teams at three pediatric long-term care facilities developed step-by-step workflow diagrams of commonly performed tasks highlighting HH opportunities. Diagrams were validated through observation of tasks and concurrent diagram assessment. Facility teams developed six workflow diagrams that underwent 22 validation observations. Four main themes emerged: 1) diagram specificity, 2) wording and layout, 3) timing of HH indications, and 4) environmental hygiene. The development of workflow diagrams is an opportunity to identify and address the complexity of HH in pediatric long-term care facilities.
Lupión, Carmen; López-Cortés, Luis Eduardo; Rodríguez-Baño, Jesús
Health-care associated infections are an important public health problem worldwide. The rates of health-care associated infections are indicators of the quality of health care. The infection control activities related to prevention of transmission of hospital microorganisms can be grouped in 4 mayor areas: standard precautions, specific precautions (including isolation if appropriate), environmental cleaning and disinfection, and surveillance activities (including providing infection rates and monitoring procedures). Hand hygiene and the correct use of gloves are the most important measures to prevent health-care associated infections and to avoid the dissemination of multidrug-resistant microorganisms. Continuous educational activities aimed at improving adherence to hand hygiene are needed. Periodical assessment of adherence to hand hygiene recommendations with feed-back have been shown to provide sustained improvement. Several complementary activities are being evaluated, including skin decolonization prior to certain surgeries, a package of measures in patients with central venous catheters or mechanical ventilation, and universal body hygiene with chlorhexidine. The present area of discussion concerns in which situations and in which groups would such measures be effective and efficient.
Taylor, J H; Brown, K L; Toivenen, J; Holah, J T
A finger rinse technique for counting micro-organisms on hands showed no significant difference in the level of recovered micro-organisms following hand drying using either warm air or paper towels. Contact plate results appeared to reflect the degree of dampness of hands after drying rather than the actual numbers of micro-organisms on the hands. In laboratory tests, a reduction in airborne count of Pseudomonas aeruginosa and Staphylococcus aureus of between 40 and 75% was achieved from 600 readings comparing inlets and outlets of warm air hand driers. In washroom trials, the number of airborne micro-organisms was reduced by between 30 and 75%. Air emitted from the outlet of the driers contained significantly fewer micro-organisms than air entering the driers. Drying of hands with hand driers was no more likely to generate airborne micro-organisms than drying with paper towels. Levels of micro-organisms on external surfaces of hand driers were not significantly different to those on other washroom surfaces. This work shows that warm air hand driers, of the type used in this study, are a hygienic method of drying hands and therefore appropriate for use in both the healthcare and food industry.
Patthi, Basavaraj; Singla, Ashish; Gupta, Ritu; Prasad, Monika; Pandita, Venisha; Malhi, Ravneet; Vashishtha, Vaibhav
Introduction There has been a profound leap in developing countries in sectors of human development but it falls short of millennium development goals. Diarrhoea, respiratory infections are primary cause of child deaths around the world due to improper hygiene practice. There is lack of systematic objective analysis, follow-up and quantification of hand hygiene guidelines. So, there is an urgent requisite of a tool to assess the same. Aim To conduct a pilot test for assessing the efficacy of Graphical Assessment Technique (GAT) in objectively evaluating and comparing intervention based hand hygiene among students of National Association of Blind School (NABS) and a government school. Materials and Methods GAT was used to assess the baseline and post-intervention improvement of 80 students considered for the study. Data was analyzed using SPSS software version 20.0 and was subjected to quantitative analysis and parametric tests. Results Non-significant difference (p≥0.05) was found at baseline and immediate post-intervention on percentage mean scores of blind school students and government school student, while government school children also showed non-significant difference at one week. Significant difference (p≤0.05) was found at baseline, post-intervention one week and post-intervention one month for blind school children along with baseline and post-intervention mean percentage scores for government school children. Conclusion The primary agenda behind the study was to test a tool which can objectively evaluate, quantify and compare the follow-up of hand hygiene guidelines and aid in better hand hygiene promotion. PMID:27656553
Ford, Eric W; Boyer, Brian T; Menachemi, Nir; Huerta, Timothy R
We tested the efficacy of a simple, visual cue to increase hand washing with soap and water. Automated towel dispensers in 8 public bathrooms were set to present a towel either with or without activation by users. We set the 2 modes to operate alternately for 10 weeks. Wireless sensors were used to record entry into bathrooms. Towel and soap consumption rates were checked weekly. There were 97,351 hand-washing opportunities across all restrooms. Towel use was 22.6% higher (P=.05) and soap use was 13.3% higher (P=.003) when the dispenser presented the towel without user activation than when activation was required. Results showed that a visual cue can increase hand-washing compliance in public facilities.
Boyer, Brian T.; Menachemi, Nir; Huerta, Timothy R.
We tested the efficacy of a simple, visual cue to increase hand washing with soap and water. Automated towel dispensers in 8 public bathrooms were set to present a towel either with or without activation by users. We set the 2 modes to operate alternately for 10 weeks. Wireless sensors were used to record entry into bathrooms. Towel and soap consumption rates were checked weekly. There were 97 351 hand-washing opportunities across all restrooms. Towel use was 22.6% higher (P = .05) and soap use was 13.3% higher (P = .003) when the dispenser presented the towel without user activation than when activation was required. Results showed that a visual cue can increase hand-washing compliance in public facilities. PMID:24228670
Sunkesula, Venkata C K; Kundrapu, Sirisha; Knighton, Shanina; Cadnum, Jennifer L; Donskey, Curtis J
We conducted a non-blinded randomized trial to determine the impact of a patient hand-hygiene intervention on contamination of hospitalized patients' hands with healthcare-associated pathogens. Among patients with negative hand cultures on admission, recovery of pathogens from hands was significantly reduced in those receiving the intervention versus those receiving standard care. Infect Control Hosp Epidemiol 2016;1-3.
Joshi, Sudhir Chandra; Joshi, Rita; Sharma, Megha; Shah, Harshada; Pathak, Ashish; Tamhankar, Ashok J.; Stålsby Lundborg, Cecilia
Aim To describe self-reported practices and assess knowledge and attitudes regarding hand hygiene among healthcare workers in a rural Indian teaching hospital. Setting A rural teaching hospital and its associated medical and nursing colleges in the district of Ujjain, India. Method The study population consisted of physicians, nurses, teaching staff, clinical instructors and nursing students. Self-administered questionnaires based on the World Health Organization Guidelines on Hand Hygiene in Healthcare were used. Results Out of 489 healthcare workers, 259 participated in the study (response rate = 53%). The proportion of healthcare workers that reported to ‘always’ practice hand hygiene in the selected situations varied from 40–96% amongst categories. Reported barriers to maintaining good hand hygiene were mainly related to high workload, scarcity of resources, lack of scientific information and the perception that priority is not given to hand hygiene, either on an individual or institutional level. Previous training on the topic had a statistically significant association with self-reported practice (p = 0.001). Ninety three per cent of the respondents were willing to attend training on hand hygiene in the near future. Conclusion Self-reported knowledge and adherence varied between situations, but hand hygiene practices have the potential to improve if the identified constraints could be reduced. Future training should focus on enhancing healthcare workers’ knowledge and understanding regarding the importance of persistent practice in all situations. PMID:27711173
Background Evaluations are essential to judge the success of public health programmes. In Europe, the proportion of public health programmes that undergo evaluation remains unclear. The European Centre for Disease Prevention and Control sought to determine the frequency of evaluations amongst European national public health programmes by using national hand hygiene campaigns as an example of intervention. Methods A cohort of all national hand hygiene campaigns initiated between 2000 and 2012 was utilised for the analysis. The aim was to collect information about evaluations of hand hygiene campaigns and their frequency. The survey was sent to nominated contact points for healthcare-associated infection surveillance in European Union and European Economic Area Member States. Results Thirty-six hand hygiene campaigns in 20 countries were performed between 2000 and 2012. Of these, 50% had undergone an evaluation and 55% of those utilised the WHO hand hygiene intervention self-assessment tool. Evaluations utilised a variety of methodologies and indicators in assessing changes in hand hygiene behaviours pre and post intervention. Of the 50% of campaigns that were not evaluated, two thirds reported that both human and financial resource constraints posed significant barriers for the evaluation. Conclusion The study identified an upward trend in the number of hand hygiene campaigns implemented in Europe. It is likely that the availability of the internationally-accepted evaluation methodology developed by the WHO contributed to the evaluation of more hand hygiene campaigns in Europe. Despite this rise, hand hygiene campaigns appear to be under-evaluated. The development of simple, programme-specific, standardised guidelines, evaluation indicators and other evidence-based public health materials could help promote evaluations across all areas of public health. PMID:24507086
Deochand, Neil; Deochand, Michelle E
Various methodologies have been utilized in hand- hygiene (HH) research to measure the quality and compliance rates of hand washing. Some notable examples are direct observation, self-report, image quantification of fluorescence, microbial sampling, automated systems, and electronically assisted devices. While direct observation is considered the gold standard of HH monitoring systems, its methodological limitations (e.g., high staffing demands, participant reactivity, and undersampling) have yet to be overcome. As a result, there is renewed interest in developing technologies or methods of assessment that are cost-effective, accurate, and not intrusive. This article provides a brief review of HH monitoring systems while presenting a less resource-intensive methodology utilizing image analysis of fluorescence to assess hand washing. Results indicate that the proposed HH protocol could be used to replace human visual analysis of fluorescence, as well as provide a less resource-intensive option to assess HH under controlled conditions. Future implications and the need for additional research, such as cross-validating the results in a real-world clinical setting, are discussed.
Amirov, Chingiz M; Candon, Heather L; Jacob, Latha
This report summarizes our experiences planning and implementing the transition to a new commercial line of hand hygiene products and their dispensing systems in a large academic health care facility in Toronto, Canada. Our lessons learned are organized into a practical guide made available in 2 different formats: this article and an illustrated peer-to-peer guide (http://www.baycrest.org/wp-content/uploads/HCE-PROG-HH_HighQuality.pdf).
Kampf, Günter; Reichel, Mirja; Feil, Yvonne; Eggerstedt, Sven; Kaulfers, Paul-Michael
Background Recent data indicate that full efficacy of a hand rub preparation for hygienic hand disinfection can be achieved within 15 seconds (s). However, the efficacy test used for the European Norm (EN) 1500 samples only the fingertips. Therefore, we investigated hand coverage using sixteen different application variations. The hand rub was supplemented with a fluorescent dye, and hands were assessed under UV light by a blind test, before and after application. Fifteen non-healthcare workers were used as subjects for each application variation apart from one test which was done with a group of twenty healthcare workers. All tests apart from the reference procedure were performed using 3 mL of hand rub. The EN 1500 reference procedure, which consists of 6 specific rub-in steps performed twice with an aliquot of 3 ml each time, served as a control. In one part of this study, each of the six steps was performed from one to five times before proceeding to the next step. In another part of the study, the entire sequence of six steps was performed from one to five times. Finally, all subjects were instructed to cover both hands completely, irrespective of any specific steps ("responsible application"). Each rub-in technique was evaluated for untreated skin areas. Results The reference procedure lasted on average 75 s and resulted in 53% of subjects with at least one untreated area on the hands. Five repetitions of the rub-in steps lasted on average 37 s with 67% of subjects having incompletely treated hands. One repetition lasted on average 17 s, and all subjects had at least one untreated area. Repeating the sequence of steps lasted longer, but did not yield a better result. "Responsible application" was quite fast, lasting 25 s among non-healthcare worker subjects and 28 s among healthcare workers. It was also effective, with 53% and 55% of hands being incompletely treated. New techniques were as fast and effective as "responsible application". Large untreated areas
Kutafina, Ekaterina; Laukamp, David; Bettermann, Ralf; Schroeder, Ulrik; Jonas, Stephan M
In this paper, we propose a novel approach to eLearning that makes use of smart wearable sensors. Traditional eLearning supports the remote and mobile learning of mostly theoretical knowledge. Here we discuss the possibilities of eLearning to support the training of manual skills. We employ forearm armbands with inertial measurement units and surface electromyography sensors to detect and analyse the user's hand motions and evaluate their performance. Hand hygiene is chosen as the example activity, as it is a highly standardized manual task that is often not properly executed. The World Health Organization guidelines on hand hygiene are taken as a model of the optimal hygiene procedure, due to their algorithmic structure. Gesture recognition procedures based on artificial neural networks and hidden Markov modeling were developed, achieving recognition rates of 98 . 30 % ( ± 1 . 26 % ) for individual gestures. Our approach is shown to be promising for further research and application in the mobile eLearning of manual skills.
Kutafina, Ekaterina; Laukamp, David; Bettermann, Ralf; Schroeder, Ulrik; Jonas, Stephan M.
In this paper, we propose a novel approach to eLearning that makes use of smart wearable sensors. Traditional eLearning supports the remote and mobile learning of mostly theoretical knowledge. Here we discuss the possibilities of eLearning to support the training of manual skills. We employ forearm armbands with inertial measurement units and surface electromyography sensors to detect and analyse the user’s hand motions and evaluate their performance. Hand hygiene is chosen as the example activity, as it is a highly standardized manual task that is often not properly executed. The World Health Organization guidelines on hand hygiene are taken as a model of the optimal hygiene procedure, due to their algorithmic structure. Gesture recognition procedures based on artificial neural networks and hidden Markov modeling were developed, achieving recognition rates of 98.30% (±1.26%) for individual gestures. Our approach is shown to be promising for further research and application in the mobile eLearning of manual skills. PMID:27527167
Peltzer, Karl; Pengpid, Supa
The aim of this study was to investigate oral and hand hygiene behaviour and risk factors among 13 to 15 year-old in-school adolescents in four Southeast Asian countries. Data were collected by self-reported questionnaire from nationally representative samples (total 13,824) of school children aged 13 to 15 years in India, Indonesia, Myanmar and Thailand. Results indicate that overall, 22.4% of school children reported sub-optimal oral hygiene (
Pickering, A.; Boehm, A.; Davis, J.
Millions of people die from diarrheal and respiratory diseases every year due to lack of proper sanitation, hygiene, and access to clean water. The act of handwashing with soap has been found to effectively reduce both diarrheal and respiratory illness, however, handwashing at critical times (i.e. after using the toilet, before preparing food) remains infrequent around the world. This research investigates the potential for alcohol- based hand sanitizer (ABHS) to be an effective and appropriate hand hygiene option in developing countries. A study was conducted to assess the microbiological effectiveness of ABHS, as compared to handwashing with soap and water, in field conditions in Dar es Salaam, Tanzania. A total of 205 participants, including mothers, nurses, students, and teachers, were introduced to ABHS, given a standardized amount (2ml) of product, and instructed on how to use the product correctly. Hand samples were obtained using the hand rinse method before and after the use of ABHS from 152 participants. The other 53 participants were hand sampled before and after handwashing with a non-antimicrobial liquid soap and clean water (prior to using ABHS). Visual inspections of the hands were performed before hand sampling to record the level of dirt on the hands. All hand samples were processed and analyzed by membrane filtration for concentrations of two microbial indicators, enterococci and E. coli. User perceptions of the product and willingness to pay are also documented. The results of this study provide valuable insight on the prospective of promoting ABHS in developing countries and water scarce areas.
Birnbach, David J; Rosen, Lisa F; Fitzpatrick, Maureen; Arheart, Kristopher L; Munoz-Price, L Silvia
Patients in an intensive care unit (ICU) are frequently immunocompromised and might be highly susceptible to infection. Visitors to an ICU who do not adequately clean their hands could carry pathogenic organisms, resulting in risk to a vulnerable patient population. This observational study identifies pathogens carried on the hands of visitors into an ICU and investigates the effect of hand hygiene. Two observers, one stationed outside and one inside the ICU, evaluated whether visitors performed hand hygiene at any of the wall-mounted alcohol-based hand sanitizer dispensers prior to reaching a patient's room. Upon reaching a patient's room, the dominant hand of all of the participants was cultured. Of the 55 participating visitors, 35 did not disinfect their hands. Among the cultures of those who failed to perform hand hygiene, eight cultures grew Gram-negative rods and one grew methicillin-resistant Staphylococcus aureus. Of the cultures of the 20 individuals who performed hand hygiene, 14 (70%) had no growth on the cultures, and the remaining six (30%) showed only the usual skin flora. The visitors who do not perform hand hygiene might carry pathogens that pose a risk to ICU patients.
Wewalka, G; Rotter, M; Koller, W; Stanek, G
The efficacy of 14 procedures for the hygienic disinfection of hands mostly with commerical preparations was tested by a new experimental model developed at the Institute of Hygiene of the university Vienna (1,3). The disinfectant power was clearly dependent on the duration of treatment as well as on the kind of alcohol used in the preparation (n-Propanol better than iso-Propanol better than Ethanol). After one minute the efficacy of all preparations containing one of the three alcohols as active agent was well comparable to that of the standard procedure which according to our proposal (5) uses iso-Propanol 60% (ml/ml) for 1 minute. For preparations with n-Propanol as the main active agent (Satinazid and Sterillium) this was true even after treatment for a period as short as 0.5 min. In our opinion disinfecting detergents are out of place for hygienic disinfection of hands. One preparation representing this group (Versuchspräparat A) was far less effective than the standard procedure.
Liu, Mingbin; Ou, Jianming; Zhang, Lijie; Shen, Xiaona; Hong, Rongtao; Ma, Huilai; Zhu, Bao-Ping; Fontaine, Robert E
Previous observational studies have reported protective effects of hand-washing in reducing upper respiratory infections, little is known about the associations between hand-washing and good hygienic habits and seasonal influenza infection. We conducted a case-control study to test whether the risk of influenza transmission associated with self-reported hand-washing and unhealthy hygienic habits among residents in Fujian Province, southeastern China.Laboratory confirmed seasonal influenza cases were consecutively included in the study as case-patients (n = 100). For each case, we selected 1 control person matched for age and city of residence. Telephone interview was used to collect information on hand-washing and hygienic habits. The associations were analyzed using conditional logistic regression. Compared with the poorest hand-washing score of 0 to 3, odds ratios of influenza infection decreased progressively from 0.26 to 0.029 as hand-washing score increased from 4 to the maximum of 9 (P < 0.001). Compared with the poorest hygienic habit score of 0 to 2, odds ratios of influenza infection decreased from 0.10 to 0.015 with improving score of hygienic habits (P < 0.001). Independent protective factors against influenza infection included good hygienic habits, higher hand-washing score, providing soap or hand cleaner beside the hand-washing basin, and receiving influenza vaccine. Regular hand-washing and good hygienic habits were associated with a reduced risk of influenza infection. These findings support the general recommendation for nonpharmaceutical interventions against influenza.
Schaffner, Donald W; Bowman, James P; English, Donald J; Fischler, George E; Fuls, Janice L; Krowka, John F; Kruszewski, Francis H
There are conflicting reports on whether antibacterial hand hygiene products are more effective than nonantibacterial products in reducing bacteria on hands and preventing disease. This research used new laboratory data, together with simulation techniques, to compare the ability of nonantibacterial and antibacterial products to reduce shigellosis risk. One hundred sixtythree subjects were used to compare five different hand treatments: two nonantibacterial products and three antibacterial products, i.e., 0.46% triclosan, 4% chlorhexidine gluconate, or 62% ethyl alcohol. Hands were inoculated with 5.5 to 6 log CFU Shigella; the simulated food handlers then washed their hands with one of the five products before handling melon balls. Each simulation scenario represented an event in which 100 people would be exposed to Shigella from melon balls that had been handled by food workers with Shigella on their hands. Analysis of experimental data showed that the two nonantibacterial treatments produced about a 2-log reduction on hands. The three antibacterial treatments showed log reductions greater than 3 but less than 4 on hands. All three antibacterial treatments resulted in statistically significantly lower concentration on the melon balls relative to the nonantibacterial treatments. A simulation that assumed 1 million Shigella bacteria on the hands and the use of a nonantibacterial treatment predicted that 50 to 60 cases of shigellosis would result (of 100 exposed). Each of the antibacterial treatments was predicted to result in an appreciable number of simulations for which the number of illness cases would be 0, with the most common number of illness cases being 5 (of 100 exposed). These effects maintained statistical significance from 10(6) Shigella per hand down to as low as 100 Shigella per hand, with some evidence to support lower levels. This quantitative microbial risk assessment shows that antibacterial hand treatments can significantly reduce Shigella risk.
Noritomi, Danilo Teixeira; Chierego, Marialuisa; Byl, Bauduin; Menestrina, Nicola; Carollo, Tiziana; Struelens, Marc; Vincent, Jean-Louis
The performance of hand disinfection by staff in a 31-bed department of intensive care was monitored. During 32 hours of observation, 727 opportunities for hand disinfection were observed, and the compliance rate was 27.9%. The level of work experience was not correlated with hand disinfection compliance rates.
Radhakrishna, Kedar; Waghmare, Abijeet; Ekstrand, Maria; Raj, Tony; Selvam, Sumithra; Sreerama, Sai Madhukar; Sampath, Sriram
The aim of this study is to increase hand sanitizer usage among healthcare workers by developing and implementing a low-cost intervention using RFID and wireless mesh networks to provide real-time alarms for increasing hand hygiene compliance during opportune moments in an open layout Intensive Care Unit (ICU). A wireless, RFID based system was developed and implemented in the ICU. The ICU beds were divded into an intervention arm (n = 10) and a control arm (n = 14). Passive RFID tags were issued to the doctors, nurses and support staff of the ICU. Long range RFID readers were positioned strategically. Sensors were placed beneath the hand sanitizers to record sanitizer usage. The system would alert the HCWs by flashing a light if an opportune moment for hand sanitization was detected. A significant increase in hand sanitizer use was noted in the intervention arm. Usage was highest during the early part of the workday and decreased as the day progressed. Hand wash events per person hour was highest among the ancilliary staff followed by the doctors and nurses. Real-time feedback has potential to increase hand hygiene compliance among HCWs. The system demonstrates the possibility of automating compliance monitoring in an ICU with an open layout.
Edmonds, Sarah L; McCormack, Robert R; Zhou, Sifang Steve; Macinga, David R; Fricker, Christopher M
Pathogenic strains of Escherichia coli and human norovirus are the main etiologic agents of foodborne illness resulting from inadequate hand hygiene practices by food service workers. This study was conducted to evaluate the antibacterial and antiviral efficacy of various hand hygiene product regimens under different soil conditions representative of those in food service settings and assess the impact of product formulation on this efficacy. On hands contaminated with chicken broth containing E. coli, representing a moderate soil load, a regimen combining an antimicrobial hand washing product with a 70% ethanol advanced formula (EtOH AF) gel achieved a 5.22-log reduction, whereas a nonantimicrobial hand washing product alone achieved a 3.10log reduction. When hands were heavily soiled from handling ground beef containing E. coli, a wash-sanitize regimen with a 0.5% chloroxylenol antimicrobial hand washing product and the 70% EtOH AF gel achieved a 4.60-log reduction, whereas a wash-sanitize regimen with a 62% EtOH foam achieved a 4.11-log reduction. Sanitizing with the 70% EtOH AF gel alone was more effective than hand washing with a nonantimicrobial product for reducing murine norovirus (MNV), a surrogate for human norovirus, with 2.60- and 1.79-log reductions, respectively. When combined with hand washing, the 70% EtOH AF gel produced a 3.19-log reduction against MNV. A regimen using the SaniTwice protocol with the 70% EtOH AF gel produced a 4.04-log reduction against MNV. These data suggest that although the process of hand washing helped to remove pathogens from the hands, use of a wash-sanitize regimen was even more effective for reducing organisms. Use of a high-efficacy sanitizer as part of a wash-sanitize regimen further increased the efficacy of the regimen. The use of a well-formulated alcohol-based hand rub as part of a wash-sanitize regimen should be considered as a means to reduce risk of infection transmission in food service facilities.
Wearn, Andy; Bhoopatkar, Harsh; Nakatsuji, Miriam
Hand hygiene is a critical element of patient care, which needs to be learned and reinforced to become an autonomous behavior. Previous studies have explored aspects of hand hygiene behavior in the clinical workplace, but not in controlled learning environments with health professional students. Development of good hand hygiene behavior requires a multi-faceted approach, including education, reinforcement, feedback and audit. Our study aimed to identify the effect of unannounced hand hygiene reminder signs on the use of antimicrobial hand gel in a clinical skills center. Year 2 MBChB students received practical learning regarding hand hygiene in their clinical skills sessions. Baseline hand gel use was measured using before and after weighing of the bottles. An A5 sign was created to remind the students to hand cleanse and was used as an unannounced intervention. In semester 2 (2012), the student groups were randomly allocated as intervention (signs) or control (no signs). Hand gel use at all sessions was measured. Data were compared between groups and over time. In total, 237 students attended the skills sessions twice during the study. Hand gel use was not significantly different between the two study arms. Overall use was low, typically 1-2 hand gel pumps per student per session. In addition, hand gel use fell over time. A visual reminder to cleanse hands did not appear to have any effect on behavior. These findings may have implications for their value in a clinical setting. Low overall use of hand gel may be context-dependent. Students are in a simulated environment and examine 'healthy' peers or actors. There may have been inconsistent tutor role-modeling or problems with the educational approach to the skill. Analysis at the level of the group, and not the individual, may have also limited our study.
Girard, R; Bousquet, E; Carré, E; Bert, C; Coyault, C; Coudrais, S; Regard, A; Garcia, E Laprugne; Valdeyron, M L; Pergay, V
Tests were performed under working practice conditions to measure the tolerance and acceptability of commercially available hand rubs with proven efficacy. The products were compared with those in current use at the Hospices Civils de Lyon for surgical hand disinfection (Sterillium) and hygienic hand disinfection (Purell) to obtain information for public sector purchases. The 12 test products were Alcogel H, Assanis Pro, Clinogel, Dermalcool, Manugel Plus, Manugel Plus NPC, Manurub Liquid, Manurub Gel, Purell 85, Spitacid, Spitagel and Sterillium Gel. They were tested from mid-November to mid-April over four periods of three weeks, separated by two-week intervals during which the customary product was re-introduced. Participation of hospital wards and theatres was voluntary. Skin dryness and irritation were scored before and after each test period. Acceptability and ease of use were assessed by means of a questionnaire. Among the eight surgical hand rubs, only Manurub Liquid, Manurub Gel and Manugel Plus NPC did not cause significantly more dryness and irritation than Sterillium. For the 10 hygienic hand rubs, differences were noted depending upon the test period. Overall, Assanis Pro, Clinogel, Purell 85 and Sterillium Gel did not cause significantly more dryness and irritation than Purell. However, over the (colder) first three test periods, Assanis Pro and Sterillium Gel caused more irritation and Purell 85 caused more dryness than Purell. Responses to the questionnaires on acceptability indicated that users preferred their customary hand rubs (Sterillium and Purell). As these field tests involving many participants did not identify any superior products, previous purchase orders were renewed.
Molina-Cabrillana, J; Dorta-Hung, M E; Otero Sanz, L; Henández Vera, J R; Martín-Rodríguez, M M; García de Carlos, P
In order to increase safety culture about hand hygiene by means of messages and reminders about its importance in preventing nosocomial infections, we developed a new set of materials in the Complejo Hospitalario Universitario Insular Materno-Infantil of Las Palmas, Gran Canaria, constitued by two centres with 450 beds each and acredited for medical internal residents training. We hired a well-known caricaturist, who adapted the messages to the local way of speaking, by using characters that used to appear in his artwork in the local newspaper. Also, we continued to work with other graphic design professionals. We monitored adherence and consumption of products for hand rubbing. We noted an increase in both indicators in the following months after the implementation of this strategy. Moreover, we revised the infrastructures for hand hygiene, and were able to demonstrate improvements in most of the patient care areas. The material was well accepted by professionals, patients and visitors. No other interventions were made, so we think improvements can be attributable to this strategy in our setting.
Arthur, Antony; Vaughan, Natalie; Wharrad, Heather; Windle, Richard
Hand hygiene adherence needs to be increased and sustained in order to prevent and reduce healthcare associated infections. We implemented an educational intervention and observed the adherence of healthcare workers, patients and visitors over 24 hour periods at four observation points. For healthcare workers a total of 2,294 opportunities were observed and for patients and visitors, a total of 597 opportunities were observed. Healthcare worker adherence increased following the introduction of the educational intervention, with 53.0% (282/532) adherence at baseline (observation point 1), and was sustained varying between 67.7% and 70.8% in the post-intervention points (p=0.0007). The greatest increase in adherence was observed between baseline and the observation point 2. Adherence varied according to type of opportunity (p<0.0001) with the lowest level of adherence observed after contact with patient surroundings, however there was no obvious trend across the observation points. There was an interaction between point of study and ward (p=0.0001). For patients and visitors, adherence did differ according to the point of study (p=0.0074) with adherence prior to the intervention being 49.1% and then ranging from 43.5–61.8%. We suggest that future educational interventions should be implemented as this study implies that there is potential for increased and sustained adherence to hand hygiene protocols.
Aso, Mayumi; Kato, Kyoichi; Yasuda, Mitsuyoshi; Takahashi, Toshiyuki; Say, Syogo; Fujimura, Kazumasa; Kuroki, Kazunori; Nakazawa, Yasuo
A hand hygiene behavior questionnaire and environmental survey were conducted regarding the mobile X-ray system used in the emergency room. As a result, among a total of 22 radiological technologists at this hospital who replied to the questionnaire, 18 wore disposable gloves when performing X-ray imaging using the mobile system. Among those 18, 11 were found to touch computed radiology (CR) consoles and HIS/RIS terminals while still wearing the gloves, thus creating the potential for spreading pathogens to other medical equipment and systems. According to the results of an environmental survey of the emergency imaging preparation room, the highest levels of bacteria were detected on CR consoles and HIS/RIS terminals. A possible reason for this is that these locations are not wiped down and cleaned as a part of routine cleaning and disinfection protocols, thus demonstrating the importance of cleaning and disinfection. Hand hygiene by medical personnel and appropriate cleaning and disinfecting of the working environment are important for preventing the spread of nosocomial infections. Radiological technologists are also required to take effective measures against infections in consideration of the high frequency of contact with both infected patients and patients susceptible to infections.
Snelling, AM; Saville, T; Stevens, D; Beggs, CB
Aims: To compare an ultra-rapid hand dryer against warm air dryers, with regard to: (A) bacterial transfer after drying and (B) the impact on bacterial numbers of rubbing hands during dryer use. Methods and Results: The Airblade™ dryer (Dyson Ltd) uses two air ‘knives’ to strip water from still hands, whereas conventional dryers use warm air to evaporate moisture whilst hands are rubbed together. These approaches were compared using 14 volunteers; the Airblade™ and two types of warm air dryer. In study (A), hands were contaminated by handling meat and then washed in a standardized manner. After dryer use, fingers were pressed onto foil and transfer of residual bacteria enumerated. Transfers of 0–107 CFU per five fingers were observed. For a drying time of 10 s, the Airblade™ led to significantly less bacterial transfer than the other dryers (P<0·05; range 0·0003–0·0015). When the latter were used for 30–35 s, the trend was for the Airblade to still perform better, but differences were not significant (P>0·05, range 0·1317–0·4099). In study (B), drying was performed ± hand rubbing. Contact plates enumerated bacteria transferred from palms, fingers and fingertips before and after drying. When keeping hands still, there was no statistical difference between dryers, and reduction in the numbers released was almost as high as with paper towels. Rubbing when using the warm air dryers inhibited an overall reduction in bacterial numbers on the skin (P < 0·05). Conclusions: Effective hand drying is important for reducing transfer of commensals or remaining contaminants to surfaces. Rubbing hands during warm air drying can counteract the reduction in bacterial numbers accrued during handwashing. Significance and Impact of the Study: The Airblade™ was superior to the warm air dryers for reducing bacterial transfer. Its short, 10 s drying time should encourage greater compliance with hand drying and thus help reduce the spread of infectious agents
Mestre, Gabriel; Berbel, Cristina; Tortajada, Purificación; Alarcia, Margarita; Coca, Roser; Gallemi, Gema; Garcia, Irene; Fernández, Mari Mar; Aguilar, Mari Carmen; Martínez, José Antonio; Rodríguez-Baño, Jesús
Background Only multifaceted hospital wide interventions have been successful in achieving sustained improvements in hand hygiene (HH) compliance. Methodology/Principal Findings Pre-post intervention study of HH performance at baseline (October 2007– December 2009) and during intervention, which included two phases. Phase 1 (2010) included multimodal WHO approach. Phase 2 (2011) added Continuous Quality Improvement (CQI) tools and was based on: a) Increase of alcohol hand rub (AHR) solution placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency of audits (three days every three weeks: “3/3 strategy”); c) Implementation of a standardized register form of HH corrective actions; d) Statistical Process Control (SPC) as time series analysis methodology through appropriate control charts. During the intervention period we performed 819 scheduled direct observation audits which provided data from 11,714 HH opportunities. The most remarkable findings were: a) significant improvements in HH compliance with respect to baseline (25% mean increase); b) sustained high level (82%) of HH compliance during intervention; c) significant increase in AHRs consumption over time; c) significant decrease in the rate of healthcare-acquired MRSA; d) small but significant improvements in HH compliance when comparing phase 2 to phase 1 [79.5% (95% CI: 78.2–80.7) vs 84.6% (95% CI:83.8–85.4), p<0.05]; e) successful use of control charts to identify significant negative and positive deviations (special causes) related to the HH compliance process over time (“positive”: 90.1% as highest HH compliance coinciding with the “World hygiene day”; and “negative”:73.7% as lowest HH compliance coinciding with a statutory lay-off proceeding). Conclusions/Significance CQI tools may be a key addition to WHO strategy to maintain a good HH performance over time. In addition, SPC has shown to be a powerful methodology to detect special causes in HH performance (positive
Pickering, Amy J.; Boehm, Alexandria B.; Mwanjali, Mathew; Davis, Jennifer
Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci (P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed. PMID:20134005
Arbogast, James W.; Moore-Schiltz, Laura; Jarvis, William R.; Harpster-Hagen, Amanda; Hughes, Jillian; Parker, Albert
Objective: The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. Methods: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. Results: Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (P < 0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. Conclusion: Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction. PMID:27281645
Kramer, A; Jünger, M; Kampf, G
Hygienic hand disinfection must be carried out after all patient-care activities associated with contamination risks, as well as when moving from contaminated to clean body sites, after contact with environmental surfaces in the immediate vicinity of patients, after glove removal and before aseptic procedures. Preparatory handwashing (for about 10 seconds) to mechanically remove soil and bacterial spores should be performed at least 10 minutes before surgical hand disinfection. This allows time for the normalization of increased skin hydration, a prerequisite for effective hand disinfection. Depending on the manufacturer's instructions, application times of 1.5, 3 or 5 minutes can be observed. The regular use of skin care and skin protection products can help to prevent toxic skin irritation. For skin antisepsis the recommended exposure times are > or =15 seconds before subcutaneous injections, > or =1 minute before puncture of joints and body cavities as well as preoperatively, and > or =10 minutes on skin areas rich in sebaceous glands. For all 3 indications, alcohol-based formulations are the agents of choice.
Pickering, Amy J.; Blum, Annalise G.; Breiman, Robert F.; Ram, Pavani K.; Davis, Jennifer
Background In-person structured observation is considered the best approach for measuring hand hygiene behavior, yet is expensive, time consuming, and may alter behavior. Video surveillance could be a useful tool for objectively monitoring hand hygiene behavior if validated against current methods. Methods Student hand cleaning behavior was monitored with video surveillance and in-person structured observation, both simultaneously and separately, at four primary schools in urban Kenya over a study period of 8 weeks. Findings Video surveillance and in-person observation captured similar rates of hand cleaning (absolute difference <5%, p = 0.74). Video surveillance documented higher hand cleaning rates (71%) when at least one other person was present at the hand cleaning station, compared to when a student was alone (48%; rate ratio = 1.14 [95% CI 1.01–1.28]). Students increased hand cleaning rates during simultaneous video and in-person monitoring as compared to single-method monitoring, suggesting reactivity to each method of monitoring. This trend was documented at schools receiving a handwashing with soap intervention, but not at schools receiving a sanitizer intervention. Conclusion Video surveillance of hand hygiene behavior yields results comparable to in-person observation among schools in a resource-constrained setting. Video surveillance also has certain advantages over in-person observation, including rapid data processing and the capability to capture new behavioral insights. Peer influence can significantly improve student hand cleaning behavior and, when possible, should be exploited in the design and implementation of school hand hygiene programs. PMID:24676389
Alfahan, Ali; Alhabib, Samia; Abdulmajeed, Imad; Rahman, Saeed; Bamuhair, Samira
Background Hand hygiene is one of the essential means to prevent the spread of infections. The aim of this study was to assess the knowledge, attitudes, and practice (KAP) of hand hygiene in primary care settings. Methods A cross-sectional study using a self-reported questionnaire was conducted in primary care settings located in Riyadh, Kingdom of Saudi Arabia, under the service of King Abdulaziz Medical City (KAMC). The Institutional Review Board of KAMC Research Centre approved the study. Data were analyzed using IBM SPSS software. Results A total of 237 participants were included in the analysis. Participants who received hand hygiene training within the last 3 years (2012–2014) scored higher on a knowledge scale. Generally, there was an overall positive attitude from participants toward hand hygiene practice. In total, 87.54% acknowledged that they routinely used alcohol-based hand rub, 87.4% had sufficiently decontaminated hands even under high work pressure, and 78.6% addressed that this practice was not affected by less compliant colleagues. Conclusion Practicing hand hygiene was suggested to be influenced by variables related to the environmental context, social pressure, and individual attitudes toward hand hygiene. We believe that addressing beliefs, attitudes, capacity, and supportive infrastructures to sustain hand-hygiene routine behaviors are important components of an implementation strategy in enhancing health care workers’ KAP of hand hygiene. PMID:27609728
Allwood, Paul B; Jenkins, Timothy; Paulus, Colleen; Johnson, Lars; Hedberg, Craig W
Inadequate hand washing by food workers is an important contributing factor to foodborne disease outbreaks in retail food establishments (RFEs). We conducted a survey of RFEs to investigate the effect of hand washing training, availability of hand washing facilities, and the ability of the person in charge (PIC) to describe hand washing according to the Minnesota Food Code (food code) on workers' ability to demonstrate food code-compliant hand washing. Only 52% of the PICs could describe the hand washing procedure outlined in the food code, and only 48% of workers could demonstrate code-compliant hand washing. The most common problems observed were failure to wash for 20 s and failure to use a fingernail brush. There was a strong positive association between the PIC being a certified food manager and being able to describe the food code hand washing procedure (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.2 to 13.7), and there was an even stronger association between the PIC being able to describe hand washing and workers being able to demonstrate code-compliant hand washing (OR, 15; 95% CI, 6 to 37). Significant associations were detected among correct hand washing demonstration, physical infrastructure for hand washing, and the hand washing training methods used by the establishment. However, the principal determinant of successful hand washing demonstration was the PIC's ability to describe proper hand washing procedure. These results suggest that improving hand washing practices among food workers will require interventions that address PIC knowledge of hand washing requirement and procedure and the development and implementation of effective hand washing training methods.
Kampf, Günter; Löffler, Harald
The WHO regards hand hygiene as an essential tool for the prevention of noso-comial infections. The hygienic hand disinfection has a superior antimicrobial efficacy compared to hand washing and should be performed as the treatment of choice before and after a variety of activities at the point of patient care. Washing hands should be preferred when the hands are visibly soiled. Skin irritation is quite common among healthcare workers and is mainly caused by water, soap and long lasting occlusion. Compliance with hand disinfection in clinical practice is often low. Measures to improve compliance include training, provision of hand rubs where they are needed, and the responsibility of doctors to set a good example. Improved compliance in hand hygiene and targeted use of alcohol-based hand rubs can reduce the nosocomial infection rate by up to 40 %. The benefit of hand disinfection is therefore much larger than possible risks.
Cohen, Bevin; Murray, Meghan; Jia, Haomiao; Jackson, Olivia; Saiman, Lisa; Neu, Natalie; Hutcheon, Gordon; Larson, Elaine
Background Studies in adult long-term care facilities (LTCFs) have shown a correlation between hand hygiene (HH) and viral outbreak reduction, but no such studies have been conducted in pediatric LTCFs where the epidemiology of viral pathogens is different. Methods We compared electronically monitored facility-wide HH frequency in the weeks immediately prior to outbreaks of acute respiratory or gastrointestinal infections versus control weeks in a 137-bed pediatric LTCF from October 2012-August 2015. Control weeks were the 8-14 day (control 1) and 15-21 day (control 2) periods prior to the onset of each outbreak. Results There was no difference in HH frequency in the weeks leading up to the outbreaks versus control weeks (odds ratio [OR], 1.0; 95% confidence interval CI, 1.00-1.001 using control 1 and OR, 1.0; 95% CI, 1.00-1.001 using control 2). Conclusions Our findings differed from those in adult LTFCs, possibly because of the greater contact between residents and staff in the pediatric setting, increased susceptibility to viral pathogens because of immunologic immaturity, or differences in the types of pathogens prevalent in each setting. Although HH may be important for limiting the number of residents infected during outbreaks, we found no association between HH frequency and subsequent outbreak onset. PMID:27566873
Scott, Beth; Curtis, Val; Rabie, Tamer; Garbrah-Aidoo, Nana
Each year more than 2 million children die from diarrhoeal diseases; the same number again die from acute respiratory infections. The simple hygiene behaviour of washing hands with soap represents an effective way of preventing the transmission of many of these infections. However, rates of handwashing across the globe are low, presenting a challenge for health promotion programmes. Behaviour change is not easy, and past efforts based upon health education have met with limited success. New approaches are needed. We propose that much can be learnt from the world of consumer marketing. Rather than base communications programmes for behaviour change on increasing knowledge, marketers aim to respond to the inner desires and motivations of their target audiences. This study used consumer research to investigate the factors motivating handwashing with soap in order to inform a national communications campaign for Ghana. It revealed that the strongest motivators for handwashing with soap were related to nurturance, social acceptance and disgust of faeces and latrines, especially their smell. Protection from disease is mentioned as a driving force, but was not a key motivator of handwashing behaviour. The ways in which these findings have been translated into a handwash promotion campaign are discussed.
Mori, Kohji; Hayashi, Yukinao; Akiba, Tetsuya; Noguchi, Yayoi; Yoshida, Yasuko; Kai, Akemi; Yamada, Sumio; Sakai, Sachi; Hara, Motonobu
As a preventive action plan against gastroenteritis caused by the Norovirus (NV), we studied hand hygiene effects using with three hand rubbing products, four wet wipe products, and two functional water types using Feline Calicivirus as a Norovirus surrogate. After treatment using antiseptic hand rubbing products containing chlorhexidine, quaternary ammonium, and povidone-iodine, high inactivation detected by TCID50 was observed compared to products containing povidone-iodine, although no difference was seen in viral removal measured by the amount of viral genome copies in real-time-PCR. Among wet wipes soaked in chlorhexidine, quaternary ammonium, benzoic acid and PHMB, two groups showed viral inactivation and removal. Two products were more effective for functional water, viral decrease was seen in rinsing in running electrolyzed acid water and handwashing by soap. Results underscore the importance of selection in hand washing metheds (alternative soap and also) in preventing viral gastroenteritis.
Kim, Eun Joo; Pai, Andrew J; Kang, Nam-E; Kim, Woo Kyoung; Kim, Young Soon; Moon, Hyun-Kyung; Ha, Ae Wha
The hand hygiene behavior of 400 middle school students (grades 1-3) in Seoul and Gyeonggi-Do was studied to determine how stages of change were affected by food safety education, focusing on hand hygiene and general food safety. Subjects were 51.3% male and 44.3% of study subjects were first graders of middle school. Approximately 40% of subjects were at the stage of action, 42.7% were at the stage of contemplation, and 16.4% were at pre-contemplation. The most important factor that influenced proper hand washing was self efficacy (P < 0.001). Proper hand washing was also correlated significantly with positive belief (P < 0.01) and stages of change (P < 0.01). After food safety education by high-school mentors, middle-school students who were in the stages of pre-contemplation (11.1%) and contemplation (88.9%) showed significant progression toward the action stage (P < 0.001). Proper hand washing (P < 0.01) and food safety knowledge (P < 0.05) were also significantly increased after educational intervention.
Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase.
Horn, Kim; Otter, Jonathan A
We report a statistically significant reduction in Clostridium difficile infection (from 1.38 to 0.90 cases per 1,000 patient days), vancomycin-resistant enterococci (from 0.21 to 0.01 cases per 1,000 patient days), and extended-spectrum β-lactamase-producing gram-negative bacteria (from 0.16 to 0.01 cases per 1,000 patient days) associated with the introduction of hydrogen peroxide vapor for terminal decontamination of patient rooms and improvements in hand hygiene compliance.
Edmonds, Sarah L; Mann, James; McCormack, Robert R; Macinga, David R; Fricker, Christopher M; Arbogast, James W; Dolan, Michael J
The risk of inadequate hand hygiene in food handling settings is exacerbated when water is limited or unavailable, thereby making washing with soap and water difficult. The SaniTwice method involves application of excess alcohol-based hand sanitizer (ABHS), hand "washing" for 15 s, and thorough cleaning with paper towels while hands are still wet, followed by a standard application of ABHS. This study investigated the effectiveness of the SaniTwice methodology as an alternative to hand washing for cleaning and removal of microorganisms. On hands moderately soiled with beef broth containing Escherichia coli (ATCC 11229), washing with a nonantimicrobial hand washing product achieved a 2.86 (±0.64)-log reduction in microbial contamination compared with the baseline, whereas the SaniTwice method with 62 % ethanol (EtOH) gel, 62 % EtOH foam, and 70 % EtOH advanced formula gel achieved reductions of 2.64 ± 0.89, 3.64 ± 0.57, and 4.61 ± 0.33 log units, respectively. When hands were heavily soiled from handling raw hamburger containing E. coli, washing with nonantimicrobial hand washing product and antimicrobial hand washing product achieved reductions of 2.65 ± 0.33 and 2.69 ± 0.32 log units, respectively, whereas SaniTwice with 62 % EtOH foam, 70 % EtOH gel, and 70 % EtOH advanced formula gel achieved reductions of 2.87 ± 0.42, 2.99 ± 0.51, and 3.92 ± 0.65 log units, respectively. These results clearly demonstrate that the in vivo antibacterial efficacy of the SaniTwice regimen with various ABHS is equivalent to or exceeds that of the standard hand washing approach as specified in the U.S. Food and Drug Administration Food Code. Implementation of the SaniTwice regimen in food handling settings with limited water availability should significantly reduce the risk of foodborne infections resulting from inadequate hand hygiene.
DuBois, Cathy L.Z.; Grey, Scott F.; Kingsbury, Diana M.; Shakya, Sunita; Scofield, Jennifer; Slenkovich, Ken
Objective: To determine the effectiveness of an office-based multimodal hand hygiene improvement intervention in reducing self-reported communicable infections and work-related absence. Methods: A randomized cluster trial including an electronic training video, hand sanitizer, and educational posters (n = 131, intervention; n = 193, control). Primary outcomes include (1) self-reported acute respiratory infections (ARIs)/influenza-like illness (ILI) and/or gastrointestinal (GI) infections during the prior 30 days; and (2) related lost work days. Incidence rate ratios calculated using generalized linear mixed models with a Poisson distribution, adjusted for confounders and random cluster effects. Results: A 31% relative reduction in self-reported combined ARI-ILI/GI infections (incidence rate ratio: 0.69; 95% confidence interval, 0.49 to 0.98). A 21% nonsignificant relative reduction in lost work days. Conclusions: An office-based multimodal hand hygiene improvement intervention demonstrated a substantive reduction in self-reported combined ARI-ILI/GI infections. PMID:25719534
Graham, Philip L
This article describes strategies to prevent 2 important healthcare associated infections in the neonatal intensive care unit: central line-associated bloodstream infections and catheter-associated urinary tract infections. Hand hygiene is discussed as the cornerstone for prevention of all healthcare associated infections. Specific recommendations for education and training of health care personnel who insert and maintain central venous catheters and urinary tract catheters are made and best practices for insertion and maintenance of these catheters are discussed. Throughout this article, the emphasis is on prevention of these high morbidity and mortality healthcare associated infections.
Background Some national hospital hygiene societies in Europe such as the French society for hospital hygiene (SFHH) have positive lists of disinfectants. Few hand disinfectants with a rather low concentration of ethanol are listed by one society as effective for hygienic hand disinfection with 3 mL in 30 s including a virucidal activity in 30 s or 60 s, but published data allow having doubts. We have therefore evaluated the efficacy of three commonly used hand disinfectants according to EN 1500 and EN 14476. Methods Products 1 (Aniosgel 85 NPC) and 2 (Aniosrub 85 NPC) were based on 70% ethanol, product 3 (ClinoGel derma+) on 60% ethanol and 15% isopropanol (all w/w). They were tested in 3 laboratories according to EN 1500. Three mL were applied for 30 s and compared to the reference treatment of 2 × 3 mL applications of isopropanol 60% (v/v), on hands artificially contaminated with Escherichia coli. Each laboratory used a cross-over design against the reference alcohol with 15 or 20 volunteers. The virucidal activity of the products was evaluated (EN 14476) in one laboratory against adenovirus and poliovirus in different concentrations (80%, 90%, 97%), with different organic loads (none; clean conditions; phosphate-buffered saline) for up to 3 min. Results Product 1 revealed a mean log10-reduction of 3.87 ± 0.79 (laboratory 1) and 4.38 ± 0.87 (laboratory 2) which was significantly lower compared to the reference procedure (4.62 ± 0.89 and 5.00 ± 0.87). In laboratory 3 product 1 was inferior to the reference disinfection (4.06 ± 0.86 versus 4.99 ± 0.90). Product 2 revealed similar results. Product 3 fulfilled the requirements in one laboratory but failed in the two other. None of the three products was able to reduce viral infectivity of both adenovirus and poliovirus by 4 log10 steps in 3 min according to EN 14476. Conclusions Efficacy data mentioned in a positive list published by a society for hospital hygiene should still be regarded with caution
Zapka, C; Leff, J; Henley, J; Tittl, J; De Nardo, E; Butler, M; Griggs, R; Fierer, N; Edmonds-Wilson, S
Hands play a critical role in the transmission of microbiota on one's own body, between individuals, and on environmental surfaces. Effectively measuring the composition of the hand microbiome is important to hand hygiene science, which has implications for human health. Hand hygiene products are evaluated using standard culture-based methods, but standard test methods for culture-independent microbiome characterization are lacking. We sampled the hands of 50 participants using swab-based and glove-based methods prior to and following four hand hygiene treatments (using a nonantimicrobial hand wash, alcohol-based hand sanitizer [ABHS], a 70% ethanol solution, or tap water). We compared results among culture plate counts, 16S rRNA gene sequencing of DNA extracted directly from hands, and sequencing of DNA extracted from culture plates. Glove-based sampling yielded higher numbers of unique operational taxonomic units (OTUs) but had less diversity in bacterial community composition than swab-based sampling. We detected treatment-induced changes in diversity only by using swab-based samples (P < 0.001); we were unable to detect changes with glove-based samples. Bacterial cell counts significantly decreased with use of the ABHS (P < 0.05) and ethanol control (P < 0.05). Skin hydration at baseline correlated with bacterial abundances, bacterial community composition, pH, and redness across subjects. The importance of the method choice was substantial. These findings are important to ensure improvement of hand hygiene industry methods and for future hand microbiome studies. On the basis of our results and previously published studies, we propose recommendations for best practices in hand microbiome research.IMPORTANCE The hand microbiome is a critical area of research for diverse fields, such as public health and forensics. The suitability of culture-independent methods for assessing effects of hygiene products on microbiota has not been demonstrated. This is the first
Schindler, C; Grossmann, M; Dobrev, D; Francke, K; Ravens, U; Kirch, W
Assessment of drug-induced venodilation by the dorsal hand vein compliance method requires stable constriction of the vein. This study was designed to investigate intra- and intersubject reproducibility of the venous preconstriction technique in response to phenylephrine and prostaglandin F2 alpha and to determine the influence of basal vein size. Twelve healthy male nonsmokers participated in a prospective cross-over study. Inter- and intrasubject variability was tested in response to phenylephrine and PGF2 alpha on different study days in the same hand vein. The dose of the respective constrictor causing approximately 80% constriction of the vein (ED80) was determined and infused for another 100 minutes. Actual vein size was measured every 5 minutes. Coefficient of variation and regression analyses were performed to analyze influence of vessel size on ED80 of the respective constrictor. Adjusted constriction levels were stable and well reproducible in all subjects. The intersubject coefficient of variation of ED80 ranged from 0.9% to 6.7% for phenylephrine and from 0.9% to 6.9% for PGF2 alpha. Whereas responses to phenylephrine were independent of basal vein diameter, there was a positive correlation between ED80 of PGF2 alpha and basal vein size. Thus, the hand vein compliance method is a suitable method to study dilatory responses in phenylephrine- or PGF2 alpha-constricted veins with considerable interindividual but small intraindividual variability. However, in such studies, phenylephrine appears to be a more reliable tool than PGF2 alpha.
Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America.
Boyce, John M; Pittet, Didier
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Mendez, Diana; Webb, Rebecca; Berger, Lee; Speare, Rick
Hygiene protocols for handling amphibians in the field and in laboratories have been proposed to decrease the transmission of chytridiomycosis caused by infection with the amphibian chytrid fungus Batrachochytrium dendrobatidis, which is responsible for global amphibian declines. However, these protocols are mainly based on theoretical principles. The aim of this study was to develop an evidence-based approach to amphibian handling hygiene protocols by testing the survival of B. dendrobatidis on human hands and various gloves. Bare or gloved human fingers were exposed to cultured zoospores and zoosporangia of B. dendrobatidis. Survival of B. dendrobatidis on hands and gloves was tested for up to 10 min post-exposure by inoculation onto tryptone/gelatin hydrolysate/lactose (TGhL) agar plates. The effects of repeated hand washings with water and with 70% ethanol and of washing gloves with water were also tested. Bare human skin demonstrated a fungicidal effect on B. dendrobatidis by 2 min and killed 100% of cells by 6 min, but this killing effect was reduced by repeated washing with water and ethanol. Nitrile gloves killed all B. dendrobatidis on contact, but washing in water decreased this effect. Latex and polyethylene gloves had no killing effect, and B. dendrobatidis survived for over 6 min. The killing effect of vinyl gloves varied with brands and batches. These results support the use of an unused pair of gloves for each new amphibian handled in either the field or the laboratory, and if this is not possible, bare hands are a preferable, although imperfect, alternative to continual use of the same pair of gloves.
Jamil, M. F. A.; Jalani, J.; Ahmad, A.
Safety is a vital issue in Human-Robot Interaction (HRI). In order to guarantee safety in HRI, a model reference impedance control can be a very useful approach introducing a compliant control. In particular, this paper establishes a fuzzy logic compliance control (i.e. active compliance control) to reduce impact and forces during physical interaction between humans/objects and robots. Exploiting a virtual mass-spring-damper system allows us to determine a desired compliant level by understanding the behavior of the model reference impedance control. The performance of fuzzy logic compliant control is tested in simulation for a robotic hand known as the RED Hand. The results show that the fuzzy logic is a feasible control approach, particularly to control position and to provide compliant control. In addition, the fuzzy logic control allows us to simplify the controller design process (i.e. avoid complex computation) when dealing with nonlinearities and uncertainties.
Lee, Hui Key; Abdul Halim, Hishamuddin; Thong, Kwai Lin; Chai, Lay Ching
Institutional foodborne illness outbreaks continue to hit the headlines in the country, indicating the failure of food handlers to adhere to safe practices during food preparation. Thus, this study aimed to compare the knowledge, attitude, and self-reported practices (KAP) of food safety assessment and microbiological assessment of food handlers’ hands as an indicator of hygiene practices in food premises. This study involved 85 food handlers working in a university located in Kuala Lumpur, Malaysia. The food safety KAP among food handlers (n = 67) was assessed using a questionnaire; while the hand swabs (n = 85) were tested for the total aerobic count, coliforms, and Escherichia coli, Staphylococcus aureus, Salmonella, Vibrio cholerae and Vibrio parahaemolyticus. The food handlers had moderate levels of food safety knowledge (61.7%) with good attitude (51.9/60) and self-reported practices (53.2/60). It is noteworthy that the good self-reported practices were not reflected in the microbiological assessment of food handlers’ hands, in which 65% of the food handlers examined had a total aerobic count ≥20 CFU/cm2 and Salmonella was detected on 48% of the food handlers’ hands. In conclusion, the suggestion of this study was that the food handlers had adequate food safety knowledge, but perceived knowledge failed to be translated into practices at work.
Leff, J.; Henley, J.; Tittl, J.; De Nardo, E.; Butler, M.; Griggs, R.; Fierer, N.
ABSTRACT Hands play a critical role in the transmission of microbiota on one’s own body, between individuals, and on environmental surfaces. Effectively measuring the composition of the hand microbiome is important to hand hygiene science, which has implications for human health. Hand hygiene products are evaluated using standard culture-based methods, but standard test methods for culture-independent microbiome characterization are lacking. We sampled the hands of 50 participants using swab-based and glove-based methods prior to and following four hand hygiene treatments (using a nonantimicrobial hand wash, alcohol-based hand sanitizer [ABHS], a 70% ethanol solution, or tap water). We compared results among culture plate counts, 16S rRNA gene sequencing of DNA extracted directly from hands, and sequencing of DNA extracted from culture plates. Glove-based sampling yielded higher numbers of unique operational taxonomic units (OTUs) but had less diversity in bacterial community composition than swab-based sampling. We detected treatment-induced changes in diversity only by using swab-based samples (P < 0.001); we were unable to detect changes with glove-based samples. Bacterial cell counts significantly decreased with use of the ABHS (P < 0.05) and ethanol control (P < 0.05). Skin hydration at baseline correlated with bacterial abundances, bacterial community composition, pH, and redness across subjects. The importance of the method choice was substantial. These findings are important to ensure improvement of hand hygiene industry methods and for future hand microbiome studies. On the basis of our results and previously published studies, we propose recommendations for best practices in hand microbiome research. PMID:28351915
Azor-Martinez, Ernestina; Cobos-Carrascosa, Elena; Seijas-Vazquez, Maria Luisa; Fernández-Sánchez, Carmen; Strizzi, Jenna M.; Torres-Alegre, Pilar; Santisteban-Martínez, Joaquin; Gimenez-Sanchez, Francisco
Background: We assessed the effectiveness of a handwashing program using hand sanitizer to prevent school absenteeism due to upper respiratory infections (URIs). Methods: This was a randomized, controlled, and open study on a sample of 1341 children 4-12 years old, attending 5 state schools in Almería (Spain), with an 8-month follow-up. The…
Davis, Jennifer; Pickering, Amy J; Rogers, Kirsten; Mamuya, Simon; Boehm, Alexandria B
Safe water storage and hand hygiene have been shown to reduce fecal contamination and improve health in experimental settings; however, triggering and sustaining such behaviors is challenging. This study investigates the extent to which personalized information about Escherichia coli contamination of stored water and hands influenced knowledge, reported behaviors, and subsequent contamination levels among 334 households with less than 5-year-old children in peri-urban Dar es Salaam, Tanzania. One-quarter of the study participants received information about strategies to reduce risk of water- and sanitation-related illness. Respondents in another three study cohorts received this same information, along with their household's water and/or hand-rinse test results. Findings from this study suggest that additional work is needed to elucidate the conditions under which such testing represents a cost-effective strategy to motivate improved household water management and hand hygiene.
Kramer, A; Bernig, T; Kampf, G
very important, as user acceptability has an impact on compliance. Sterillium is the only hand disinfectant containing mecetronium etilsulphate which has been shown to have an emolliant effect. Future research should focus on user acceptability in order to improve compliance.
Schiffers, Hank; Zaatreh, Sarah; Mittelmeier, Wolfram; Bader, Rainer
Introduction: Work in hospitals is supported by contributions of life sciences industry representatives (IR) in various ways of fields. Close contact between them, caretakers and patients is unavoidable, even in situations where hygiene is critical. The present study investigates whether IR display comparable levels of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) contamination after being exposed to a shared environment for a minimum of 4 hours. Material and methods: An anonymous survey to sample a group of healthcare professionals for traces of fingertip contamination was performed. We used dip slides (S. aureus and MRSA) to evaluate 311 healthcare professionals at the medical exhibition MEDICA. After applying exclusion criteria 298 participants remained valid, they consisted of 208 industry representatives, 49 nurses and 41 physicians. Results: IR where engaged in hospitals, operating rooms and outpatient clinics (82%, 41.8%, 51.9% respectively). 65.9% of IR (vs. 48.8% physicians and 40.8% nurses) carried a microbiological burden ≥104 CFU (colony forming units). Neither S. aureus (≥104 CFU) in IR (40.9%) did show statistical differences in contamination patterns in comparison to physicians (43.9%, p=0.346) and nurses (36.7%, p=0.878) nor did MRSA (physicians p=0.579, nurses p=0.908). We were unable to differentiate transient from pre-existing permanent colonization. Conclusion: Exposure to the same environment may result in similar hand contamination patterns of IR when compared caregivers. This supports the concern that industry representatives can cause cross infection between hospitals and hygiene sensitive areas like operation room, intensive care unit and central sterilization units particularly. Further study is required to clarify whether pre-existing bacterial colonization is an influencing factor and how industry is taking care of this to create a safe working environment for their employees, the customers and
Malherbe, Hélène; Nugier, Angélique; Clément, Juliette; Lamboy, Béatrice
Infectious diseases remain a major cause of death among young people throughout the world. This paper reviews the current knowledge of empirically validated and promising interventions aimed at preventing infectious diseases among children caused by poor hand hygiene in schools. The study used a standard protocol to identify and review the literature and to classify the selected interventions. Approximately ten interventions were found to have a beneficial effect by promoting hand washing and hand hygiene in schools. The study also found that most of the interventions were implemented at elementary school. However, some interventions were also implemented at kindergarten or in child care centers, while others were aimed at university students. Most of the interventions were implemented by teachers, peers and/or external professionals. The study found that hand hygiene is effective regardless of the type of cleaning product used (i.e. antibacterial or plain soap, alcohol-based or alcohol-free hand sanitizer). This study aims to contribute to the understanding of empirically validated and promising interventions and to promote reflection on professional practice in France.
Traub-Dargatz, Josie L.; Weese, J. Scott; Rousseau, Joyce D.; Dunowska, Magdalena; Morley, Paul S.; Dargatz, David A.
Abstract Reduction factors (RFs) for bacterial counts on examiners’ hands were compared when performing a standardized equine physical examination, followed by the use of one of 3 hand-hygiene protocols (washing with soap, ethanol gel application, and chlorohexidine-ethanol application). The mean RFs were 1.29 log10 and 1.44 log10 at 2 study sites for the alcohol-gel (62% ethyl alcohol active ingredient) protocols and 1.47 log10 and 1.94 log10 at 2 study sites for the chlorhexidine-alcohol (61% ethyl alcohol plus 1% chlorhexidine active ingredients) protocols, respectively. The RFs were significantly different (P < 0.0001) between the hand-washing group and the other 2 treatment groups (the alcohol-gel and the chlorhexidine-alcohol lotion). The use of alcohol-based gels or chlorhexidine-alcohol hand hygiene protocols must still be proven effective in equine practice settings, but in this study, these protocols were equivalent or superior to hand washing for reduction in bacterial load on the hands of people after they perform routine physical examinations. PMID:16898109
Traub-Dargatz, Josie L; Weese, J Scott; Rousseau, Joyce D; Dunowska, Magdalena; Morley, Paul S; Dargatz, David A
Reduction factors (RFs) for bacterial counts on examiners' hands were compared when performing a standardized equine physical examination, followed by the use of one of 3 hand-hygiene protocols (washing with soap, ethanol gel application, and chlorohexidine-ethanol application). The mean RFs were 1.29 log10 and 1.44 log10 at 2 study sites for the alcohol-gel (62% ethyl alcohol active ingredient) protocols and 1.47 log10 and 1.94 log10 at 2 study sites for the chlorhexidine-alcohol (61% ethyl alcohol plus 1% chlorhexidine active ingredients) protocols, respectively. The RFs were significantly different (P < 0.0001) between the hand-washing group and the other 2 treatment groups (the alcohol-gel and the chlorhexidine-alcohol lotion). The use of alcohol-based gels or chlorhexidine-alcohol hand hygiene protocols must still be proven effective in equine practice settings, but in this study, these protocols were equivalent or superior to hand washing for reduction in bacterial load on the hands of people after they perform routine physical examinations.
Cheng, V C C; Chen, J H K; Poon, R W S; Lee, W M; So, S Y C; Wong, S C Y; Chau, P H; Yip, C C Y; Wong, S S Y; Chan, J F W; Hung, I F N; Ho, P L; Yuen, K Y
An increasing endemicity of multiple-drug-resistant Acinetobacter baumannii (MRAB) ST457 was noted in Hong Kong. The epidemiology, risk factors, and infection control measures to prevent nosocomial transmission of this epidemic clone were analyzed. A total of 5,058 patients cultured positive with A. baumannii between 1 January 2004 and 30 June 2014 were included, of which 297 (5.9 %) had bacteremia. The first case of MRAB bacteremia emerged in 2009, with an incidence that increased from 0.27 (one case) in 2009 to 1.86 (14 cases) per 100,000 patient-days in 2013 (p < 0.001). With the implementation of strict contact precautions and directly observed hand hygiene in conscious patients immediately before receiving meals and medications in July 2013, the incidence of MRAB bacteremia reduced from its peak to 0.77 (one case) per 100,000 patient-days in the first 6 months of 2014 (p < 0.001). Patients from long-term care facilities for the elderly [odds ratio (OR) 18.6, confidence interval (CI) 2.1-162.4, p = 0.008] and history of carbapenem (OR 7.0, CI 1.7-28.0, p = 0.006) and beta-lactam/beta-lactamase use (OR 5.6, CI 1.1-28.7, p = 0.038) 90 days prior to admission were independent risk factors for MRAB bacteremia by logistic regression when compared with carbapenem-susceptible A. baumannii bacteremia.
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Ottawa Public Health in partnership with health staff from the municipality of KEEA (Komenda, Edina, Eguafo, Abrem) in Ghana engaged in a city-to-city partnership to adapt, implement, and evaluate an evidence-based hand hygiene public health initiative in elementary schools in Ghana. All 4 participating schools gained the necessary resources to carry out proper hand hygiene practice, and hand hygiene practice improved. Furthermore, pupils were more likely to wash hands after using the toilets and teachers were better equipped to be good role models. Providing resources to schools was key to the success of the implementation. This partnership gave health and education workers in Ghana the tools, knowledge, and confidence to implement a simple, evidence-based, hand hygiene program. One other remarkable outcome is that school children were the initiators of a behavior change in their community.
Greene, Leslie E.; Freeman, Matthew C.; Akoko, Daniel; Saboori, Shadi; Moe, Christine; Rheingans, Richard
Handwashing with soap effectively reduces exposure to diarrhea-causing pathogens. Interventions to improve hygiene and sanitation conditions in schools within low-income countries have gained increased attention; however, their impact on schoolchildren's exposure to fecal pathogens has not been established. Our trial examined whether a school-based water, sanitation, and hygiene intervention reduced Escherichia coli contamination on pupils' hands in western Kenya. A hygiene promotion and water treatment intervention did not reduce risk of E. coli presence (relative risk [RR] = 0.92, 95% confidence interval [CI] = 0.54–1.56); the addition of new latrines to intervention schools significantly increased risk among girls (RR = 2.63, 95% CI = 1.29–5.34), with a non-significant increase among boys (RR = 1.36, 95% CI = 0.74–2.49). Efforts to increase usage of school latrines by constructing new facilities may pose a risk to children in the absence of sufficient hygiene behavior change, daily provision of soap and water, and anal cleansing materials. PMID:22802437
Bennett, Sarah D; Otieno, Ronald; Ayers, Tracy L; Odhiambo, Aloyce; Faith, Sitnah H; Quick, Robert
Many health care facilities (HCF) in developing countries lack access to reliable hand washing stations and safe drinking water. To address this problem, we installed portable, low-cost hand washing stations (HWS) and drinking water stations (DWS), and trained healthcare workers (HCW) on hand hygiene, safe drinking water, and patient education techniques at 200 rural HCFs lacking a reliable water supply in western Kenya. We performed a survey at baseline and a follow-up evaluation at 15 months to assess the impact of the intervention at a random sample of 40 HCFs and 391 households nearest to these HCFs. From baseline to follow-up, there was a statistically significant increase in the percentage of dispensaries with access to HWSs with soap (42% vs. 77%, p<0.01) and access to safe drinking water (6% vs. 55%, p<0.01). Female heads of household in the HCF catchment area exhibited statistically significant increases from baseline to follow-up in the ability to state target times for hand washing (10% vs. 35%, p<0.01), perform all four hand washing steps correctly (32% vs. 43%, p = 0.01), and report treatment of stored drinking water using any method (73% vs. 92%, p<0.01); the percentage of households with detectable free residual chlorine in stored drinking water did not change (6%, vs. 8%, p = 0.14). The installation of low-cost, low-maintenance, locally-available, portable hand washing and drinking water stations in rural HCFs without access to 24-hour piped water helped assure that health workers had a place to wash their hands and provide safe drinking water. This HCF intervention may have also contributed to the improvement of hand hygiene and reported safe drinking water behaviors among households nearest to HCFs.
Otieno, Ronald; Odhiambo, Aloyce; Faith, Sitnah H.
Many health care facilities (HCF) in developing countries lack access to reliable hand washing stations and safe drinking water. To address this problem, we installed portable, low-cost hand washing stations (HWS) and drinking water stations (DWS), and trained healthcare workers (HCW) on hand hygiene, safe drinking water, and patient education techniques at 200 rural HCFs lacking a reliable water supply in western Kenya. We performed a survey at baseline and a follow-up evaluation at 15 months to assess the impact of the intervention at a random sample of 40 HCFs and 391 households nearest to these HCFs. From baseline to follow-up, there was a statistically significant increase in the percentage of dispensaries with access to HWSs with soap (42% vs. 77%, p<0.01) and access to safe drinking water (6% vs. 55%, p<0.01). Female heads of household in the HCF catchment area exhibited statistically significant increases from baseline to follow-up in the ability to state target times for hand washing (10% vs. 35%, p<0.01), perform all four hand washing steps correctly (32% vs. 43%, p = 0.01), and report treatment of stored drinking water using any method (73% vs. 92%, p<0.01); the percentage of households with detectable free residual chlorine in stored drinking water did not change (6%, vs. 8%, p = 0.14). The installation of low-cost, low-maintenance, locally-available, portable hand washing and drinking water stations in rural HCFs without access to 24-hour piped water helped assure that health workers had a place to wash their hands and provide safe drinking water. This HCF intervention may have also contributed to the improvement of hand hygiene and reported safe drinking water behaviors among households nearest to HCFs. PMID:25961293
Girou, E; Oppein, F
The baseline compliance with handwashing in a French university hospital was as low as the compliance rates reported in other countries, i.e., less than 50%. By introducing the use of hand-rubbing with an alcoholic solution, as a substitution method for both handwashing with soap and handwashing with an antiseptic agent, we significantly improved hand-cleansing compliance. Despite these encouraging results, mainly due to the accessibility of these non-aqueous products, three major obstacles remain before a wide acceptance by healthcare workers: distrust in terms of efficacy, distrust in terms of skin tolerance and lack of knowledge on hand-cleansing indications.
Background Good hand hygiene compliance is essential to prevent nosocomial infections in healthcare settings. Direct observation of hand hygiene compliance is the gold standard but is time consuming. An electronic dispenser with built-in wireless recording equipment allows continuous monitoring of its usage. The purpose of this study was to monitor the use of alcohol-based hand rub dispensers with a built-in electronic counter in a neonatal intensive care unit (NICU) setting and to determine compliance with hand hygiene protocols by direct observation. Methods A one-year observational study was conducted at a 27 bed level III NICU at a university hospital. All healthcare workers employed at the NICU participated in the study. The use of bedside dispensers was continuously monitored and compliance with hand hygiene was determined by random direct observations. Results A total of 258,436 hand disinfection events were recorded; i.e. a median (interquartile range) of 697 (559–840) per day. The median (interquartile range) number of hand disinfection events performed per healthcare worker during the day, evening, and night shifts was 13.5 (10.8 - 16.7), 19.8 (16.3 - 24.1), and 16.6 (14.2 - 19.3), respectively. In 65.8% of the 1,168 observations of patient contacts requiring hand hygiene, healthcare workers fully complied with the protocol. Conclusions We conclude that the electronic devices provide useful information on frequency, time, and location of its use, and also reveal trends in hand disinfection events over time. Direct observations offer essential data on compliance with the hand hygiene protocol. In future research, data generated by the electronic devices can be supplementary used to evaluate the effectiveness of hand hygiene promotion campaigns. PMID:23043639
Ilboudo, A J; Savadogo, A; Barro, N; Ouedraogo, M; Traore, A S
This present study was conducted to assess the hygienic quality of meals served in three cafeterias at the national university in Ouagadougou and the compliance of kitchen staff with good hygiene practices. Microbiological analyses assessed the hygienic quality of the raw meat and of meat-based meals. The results showed poor hygiene practices by food handlers along the food chain. These observations were confirmed by the identification of salmonella, coliform and staphylococcal bacteria in raw meat and cooked meals. Overall, 60% of the raw meat samples were unsatisfactory for aerobic mesophilic flora and 6.6% for salmonella. For the cooked meat meals, on the other hand, 45% of the samples were satisfactory for aerobic mesophilic flora, 100% for salmonella, 93.3% for fecal thermotolerant coliforms and 96.6% for staphylococci. These results showed poor hygiene in the handling of raw meat, but a clear improvement in hygienic quality after cooking. Raising the awareness of cafeteria staff about compliance with hygiene rules appears primordial. Moreover improvement of the food environment, the kitchen equipment, and organization as well as the introduction of a cleaning-disinfection programme would make it possible to provide more hygienic meals in these institutional facilities.
Willmott, Micky; Nicholson, Alexandra; Busse, Heide; MacArthur, Georgina J; Brookes, Sara; Campbell, Rona
Objective To undertake a systematic review and meta-analysis to establish the effectiveness of handwashing in reducing absence and/or the spread of respiratory tract (RT) and/or gastrointestinal (GI) infection among school-aged children and/or staff in educational settings. Design Randomised-controlled trials (RCTs). Setting Schools and other settings with a formal educational component in any country. Patients Children aged 3–11 years, and/or staff working with them. Intervention Interventions with a hand hygiene component. Main outcome measures Incidence of RT or GI infections or symptoms related to such infections; absenteeism; laboratory results of RT and/or GI infections. Results Eighteen cluster RCTs were identified; 13 school-based, 5 in child day care facilities or preschools. Studies were heterogeneous and had significant quality issues including small numbers of clusters and participants and inadequate randomisation. Individual study results suggest interventions may reduce children's absence, RT infection incidence and symptoms, and laboratory confirmed influenza-like illness. Evidence of impact on GI infection or symptoms was equivocal. Conclusions Studies are generally not well executed or reported. Despite updating existing systematic reviews and identifying new studies, evidence of the effect of hand hygiene interventions on infection incidence in educational settings is mostly equivocal but they may decrease RT infection among children. These results update and add to knowledge about this crucial public health issue in key settings with a vulnerable population. More robust, well reported cluster RCTs which learn from existing studies, are required. PMID:26471110
Hand hygiene has always been an important element of perioperative practice and is a topic that has gained even more importance in recent years for healthcare workers. In the mid 19th century Semmelweis first noted the link between hospital acquired diseases and hand hygiene (Semmelweis 1847, NATN 2000). More recently, it has been established that continuous effective hand hygiene can significantly decrease the transmission of microorganisms, thus reducing cross infection rates of many hospital acquired infections (Pratt et al 2007).
... wind Avoid washing hands with hot water Limit hand washing as much as possible while maintaining good hygiene Try to keep the air in your home humid Use mild soaps or non-soap cleansers Use ... on your hands regularly, especially if you live in a dry ...
Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza Province, Kenya, 2008.
Sreenivasan, N; Gotestrand, S A; Ombeki, S; Oluoch, G; Fischer, T K; Quick, R
Many clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention's impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.
... of any kind, either expressed or implied. The responsibility for the interpretation and use of the material ... a patient when approaching him/ her. WHY? To protect the patient against harmful germs carried on your ...
Pellegrino, Robert; Crandall, Philip G; Seo, Han-Seok
Lack of hand washing is a leading cause of food borne illnesses. To successfully increase hand hygiene compliance, interventions must have continual engagement with employees. This study used a real-time prospective memory (PM) scenario to measure the effectiveness of a control and sensory reminders of disgust to influence hand washing behavior and performance. First, a model of hand washing performance was built by having six participants' hands contaminated with GermGlo (a florescent micro-particle) and then washed their hands using predetermined protocols while monitored by an electronic hand hygiene verification (HHV) system. Next, eighty Hispanic/Latino participants, in a between-group experimental design, performed a PM experiment while one of four reminders were present (hand washing poster, disgusting image, disgusting sound, and disgusting odor) as the HHV recorded their hand washing performance. Visual cues, typical of hand washing campaigns, were not as effective at increasing hand hygiene compliance as disgust-induced sensory cues. Furthermore, olfactory disgust showed a significantly higher probability that individuals would engage in hand washing behaviors than all other conditions. This study provides new insight into the effectiveness of different senses and emotion to reduce the intention-behavior gap associated with modifying behaviors, and broadens current PM research to a real-time application.
Pellegrino, Robert; Crandall, Philip G.; Seo, Han-Seok
Lack of hand washing is a leading cause of food borne illnesses. To successfully increase hand hygiene compliance, interventions must have continual engagement with employees. This study used a real-time prospective memory (PM) scenario to measure the effectiveness of a control and sensory reminders of disgust to influence hand washing behavior and performance. First, a model of hand washing performance was built by having six participants’ hands contaminated with GermGlo (a florescent micro-particle) and then washed their hands using predetermined protocols while monitored by an electronic hand hygiene verification (HHV) system. Next, eighty Hispanic/Latino participants, in a between-group experimental design, performed a PM experiment while one of four reminders were present (hand washing poster, disgusting image, disgusting sound, and disgusting odor) as the HHV recorded their hand washing performance. Visual cues, typical of hand washing campaigns, were not as effective at increasing hand hygiene compliance as disgust-induced sensory cues. Furthermore, olfactory disgust showed a significantly higher probability that individuals would engage in hand washing behaviors than all other conditions. This study provides new insight into the effectiveness of different senses and emotion to reduce the intention-behavior gap associated with modifying behaviors, and broadens current PM research to a real-time application. PMID:26732033
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Sansoni, Julita; Mariani, Paola; De Caro, Walter; Sorrentino, Milena; Marucci, Anna Rita; Giammarco, Enrichetta; Di Foggia, Fernanda; Cristofaro, Domenico; van de Mortel, Thea
The main objective of the study is assessing knowledge, opinions and compliance with the procedures of health professionals (physician, nurses, medical and nursing students) about Hand Hygiene (HH). There is a number of research which indicates that physicians respect less than nurses Hand Hygiene, there are a smaller number which investigates the differences in the attitude of the aforementioned subjects during their studies. A questionnaire was administered to a sample of 756 participants (252 doctors, 268 nurses, 117 nursing students and 119 students of medicine) at a large University Hospital in Rome, to determine their knowledge, compliance and procedures with Hand Hygiene. Knowledge of medical students is lower than that of nursing students, as well as they have lower values in adherence to practice. In both HH Beliefs Scale (HBS) and HH Practices Inventory (HHPI) questionnaires, nursing students have higher scores than nurses, doctors and medical students. The questions on the use of alcohol-based cleaners have been those where there was the lowest number of correct responses, across all professions. Physicians compared to nurses have a lower adherence to Hand Hygiene. Future research should clarify what the differences are in the construction of the study on the practice of washing hands, what are the barriers to health professionals and best methods for teaching habits, namely the effectiveness of hand washing. Professionals should be more involved in the fight against Healthcare-associated infections.
Kampf, G; Muscatiello, M
Alcohol-based hand rubs have been used for hygienic hand disinfection in hospitals for decades. In order to achieve good compliance with hand hygiene practices in the healthcare setting, dermal tolerance of a hand rub product is crucial. Sterillium, which is used in many European countries for hygienic hand disinfection, is based on iso-propanol, n-propanol and mecetronium etilsulphate. The potential for dermal irritation and sensitization of commercially available propanol-based hand rubs containing emollients has not been studied systematically. We therefore studied the dermal tolerance of Sterillium in a repetitive occlusive patch test on 55 subjects. Sterillium was applied to one site on the back under an occlusive patch during an induction phase (total of nine applications over a three-week period) and two weeks later to a virgin site on the back during a challenge phase (one application). Twenty-four hours after removal of the patches (induction phase and challenge phase), and in addition, after 48 and 72 h (challenge phase), the sites were graded for skin reactions using a standardized scoring scale. In the induction phase, two of the 55 subjects had a barely perceptible minimal erythema at one of nine time points. The remaining 53 subjects had no skin reaction at any time. In the challenge phase, all 55 subjects had no skin reaction at all. The absence of significant reactions with respect to severity and frequency demonstrates the favourable dermal tolerance of the hand rub product. The lack of irritation or sensitization potential could enhance compliance with hand hygiene among healthcare workers.
Mayor, Antoinette C.
The Chemical Management Team is responsible for ensuring compliance with the OSHA Laboratory Standard. The program at Lewis Research Center (LeRC) evolved over many years to include training, developing Standard Operating Procedures (SOPS) for each laboratory process, coordinating with other safety and health organizations and teams at the Center, and issuing an SOP binder. The Chemical Hygiene Policy was first established for the Center. The Chemical Hygiene Plan was established and reviewed by technical, laboratory and management for viability and applicability to the Center. A risk assessment was conducted for each laboratory. The laboratories were prioritized by order of risk, higher risk taking priority. A Chemical Management Team staff member interviewed the lead researcher for each laboratory process to gather the information needed to develop the SOP for the process. A binder containing the Chemical Hygiene Plan, the SOP, a map of the laboratory identifying the personal protective equipment and best egress, and glove guides, as well as other guides for safety and health. Each laboratory process has been captured in the form of an SOP. The chemicals used in the procedure have been identified and the information is used to reduce the number of chemicals in the lab. The Chemical Hygiene Plan binder is used as a training tool for new employees. LeRC is in compliance with the OSHA Standard. The program was designed to comply with the OSHA standard. In the process, we have been able to assess the usage of chemicals in the laboratories, as well as reduce or relocate the chemicals being stored in the laboratory. Our researchers are trained on the hazards of the materials they work with and have a better understanding of the hazards of the process and what is needed to prevent any incident. From the SOP process, we have been able to reduce our chemical inventory, determine and implement better hygiene procedures and equipment in the laboratories, and provide
Kaptsov, V A
There are presented the main ethical and deontological problems encountered in practice and research activities of the hygienist in transport. There is shown the importance of strict compliance with hygienic standards, disregard for the principle of "technical attainability", the necessity of continuous training, improvement of skills of sanitary-educational activity and readiness to solve emerging ethical issues in connection with the development of scientific and technical progress.
Cure, Laila; Van Enk, Richard; Tiong, Ewing
Compliance with hand hygiene practices is directly affected by the accessibility and availability of cleaning agents. Nevertheless, the decision of where to locate these dispensers is often not explicitly or fully addressed in the literature. In this paper, we study the problem of selecting the locations to install alcohol-based hand sanitizer dispensers throughout a hospital unit as an indirect approach to maximize compliance with hand hygiene practices. We investigate the relevant criteria in selecting dispenser locations that promote hand hygiene compliance, propose metrics for the evaluation of various location configurations, and formulate a dispenser location optimization model that systematically incorporates such criteria. A complete methodology to collect data and obtain the model parameters is described. We illustrate the proposed approach using data from a general care unit at a collaborating hospital. A cost analysis was performed to study the trade-offs between usability and cost. The proposed methodology can help in evaluating the current location configuration, determining the need for change, and establishing the best possible configuration. It can be adapted to incorporate alternative metrics, tailored to different institutions and updated as needed with new internal policies or safety regulation.
Oliveira, Eloíde André; Garcia, Telma Ribeiro; de Sá, Lenilde Duarte
Descriptive survey aimed at identifying which aspects of body hygiene are valued by a nursing staff both in regard to personal body hygiene and to patients body hygiene. This survey has been conducted inside eight public health institutions, and the sample consisted of 126 nursing professionals, corresponding to 12.8% of a total of 986 people of the nursing personnel in such institutions. When considering personal body hygiene, the number of nail and hair care related quotes was higher than the number of answers concerning basic aspects such as hands hygiene, and this fact has called our attention. In patients body hygiene, a shower was the highest regarded aspect by the nursing staff; oral hygiene by registered nurses and nursing aids; and nail care by registered nurses and nursing technicians.
Herruzo, R; Vizcaino, M J; Herruzo, I
The use of alcohol-based hand rubs serves to reduce hospital-acquired infections. Many products of this type are now on offer and it is essential to know how to rank their efficacy. A sequence of tests is proposed here to compare any given new alcohol-based solution against the reference solution (60% 2-isopropyl-alcohol) with 30 s of contact time: (i) in vitro (with pig skin as carrier) testing of >30 species of microorganism; (ii) in vitro assessment of residual efficacy (after 30 min of drying); (iii) in vivo study of transient microbiota (modification of the EN 1500 standard procedure) using four ATCC strains; (iv) in vivo study of resident hand microbiota. After performing the in vitro evaluation of seven alcohol-based hand rubs, the two most efficacious (chlorhexidine-quac-alcohol and mecetronium- alcohol) were chosen and studied, comparatively with the reference solution (60% isopropyl alcohol), in vitro (for chemical sustainability on the skin) and in vivo (against transient and resident microbiota). Chlorhexidine-quac-alcohol proved to be significantly superior to mecetronium-alcohol or the reference solution in all tests, except against resident microbiota for which the improvement was not statistically significant.
Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study
Fuller, Christopher; Savage, Joan; Cookson, Barry; Hayward, Andrew; Cooper, Ben; Duckworth, Georgia; Michie, Susan; Murray, Miranda; Jeanes, Annette; Roberts, J; Teare, Louise; Charlett, Andre
Objective To evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement. Design Prospective, ecological, interrupted time series study from 1 July 2004 to 30 June 2008. Setting 187 acute trusts in England and Wales. Intervention Installation of bedside alcohol hand rub, materials promoting hand hygiene and institutional engagement, regular hand hygiene audits, rolled out nationally from 1 December 2004. Main outcome measures Quarterly (that is, every three months) rates for each trust of hospital procurement of alcohol hand rub and liquid soap; Staphylococcus aureus bacteraemia (meticillin resistant (MRSA) and meticillin sensitive (MSSA)) and Clostridium difficile infection for each trust. Associations between procurement and infection rates assessed by mixed effect Poisson regression model (which also accounted for effect of bed occupancy, hospital type, and timing of other national interventions targeting these infections). Results Combined procurement of soap and alcohol hand rub tripled from 21.8 to 59.8 mL per patient bed day; procurement rose in association with each phase of the campaign. Rates fell for MRSA bacteraemia (1.88 to 0.91 cases per 10 000 bed days) and C difficile infection (16.75 to 9.49 cases). MSSA bacteraemia rates did not fall. Increased procurement of soap was independently associated with reduced C difficile infection throughout the study (adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993, 95% confidence interval 0.990 to 0.996; P<0.0001). Increased procurement of alcohol hand rub was independently associated with reduced MRSA bacteraemia, but only in the last four quarters of the study (0.990, 0.985 to 0.995; P<0.0001). Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia (0.86, 0.75 to 0.98; P=0
Fung, Isaac C-H; Cairncross, Sandy
We reviewed evidence of hand-washing compliance in community settings during the 2003 SARS outbreak. Literature was searched through PubMed, Cochrane Library, Wan Fang database and Google. English and Chinese papers were reviewed. Studies containing data on hand-washing, self-reported or directly observed, in community settings were selected. Case-control studies and studies in healthcare settings were excluded. Fourteen studies were reviewed. Self-reported hand-washing compliance increased in the first phase of the SARS outbreak and maintained a high level 22 months after the outbreak. The decline of hand-washing in Hong Kong after SARS was relatively slow. A significant gender difference in hand-washing compliance (female > male) was found in eight studies. The importance of family support and 'significant female others' in hand hygiene promotion are noted. The impact of education is uncertain. Perceived susceptibility to and severity of SARS, and perceived efficacy of hand-washing in preventing SARS, also predicted self-reported hand-washing compliance.
Wells, Emma; Mitro, Brittany; Desmarais, Anne Marie; Scheinman, Pamela; Lantagne, Daniele
To prevent disease transmission, 0.05% chlorine solution is commonly recommended for handwashing in Ebola Treatment Units. In the 2014 West Africa outbreak this recommendation was widely extended to community settings, although many organizations recommend soap and hand sanitizer over chlorine. To evaluate skin irritation caused by frequent handwashing that may increase transmission risk in Ebola-affected communities, we conducted a randomized trial with 91 subjects who washed their hands 10 times a day for 28 days. Subjects used soap and water, sanitizer, or one of four chlorine solutions used by Ebola responders (calcium hypochlorite (HTH), sodium dichloroisocyanurate (NaDCC), and generated or pH-stabilized sodium hypochlorite (NaOCl)). Outcomes were self-reported hand feel, irritation as measured by the Hand Eczema Score Index (HECSI) (range 0–360), signs of transmission risk (e.g., cracking), and dermatitis diagnosis. All groups experienced statistically significant increases in HECSI score. Subjects using sanitizer had the smallest increases, followed by higher pH chlorine solutions (HTH and stabilized NaOCl), and soap and water. The greatest increases were among neutral pH chlorine solutions (NaDCC and generated NaOCl). Signs of irritation related to higher transmission risk were observed most frequently in subjects using soap and least frequently by those using sanitizer or HTH. Despite these irritation increases, all methods represented minor changes in HECSI score. Average HECSI score was only 9.10 at endline (range 1–33) and 4% (4/91) of subjects were diagnosed with dermatitis, one each in four groups. Each handwashing method has benefits and drawbacks: soap is widely available and inexpensive, but requires water and does not inactivate the virus; sanitizer is easy-to use and effective but expensive and unacceptable to many communities, and chlorine is easy-to-use but difficult to produce properly and distribute. Overall, we recommend Ebola responders
Peruzzi, W T; Smith, B
Bronchial hygiene therapy is useful and effective in the presence of careful patient evaluation, clear definition of therapeutic goals, and application of appropriate modalities. This article defines the variable bronchial hygiene modalities and discusses their indications, contraindications, and applications. Prophylactic and therapeutic bronchial hygiene modalities, diagnostic methods associated with bronchial hygiene therapy, inhaled antibiotic therapy, and therapist driven protocols are also addressed.
Mutters, Nico T.; Hägele, Ulrike; Hagenfeld, Daniel; Hellwig, Elmar; Frank, Uwe
Aim: Compliance with infection control practices is the key to quality care and excellence in dentistry. Infection control remains one of the most cost-beneficial interventions available. However, implementing control procedures requires full compliance of the whole dental team. The aim of our study was to measure the compliance in daily clinical practice. Methods: The compliance with infection control practices in dentistry by dental health care personnel (DHCP) in a German university dental clinic was observed during clinical work. In addition, a survey was conducted to assess the individual knowledge about infection control procedures. Contamination of the workplace during invasive dental procedures was tested, as well. Results: A total of 58 invasive dental treatments implying close contacts between HCWs and patients were scrutinized. All HCWs (100%) wore gloves during dental work, but in some cases (female dentists: 14.3%; dental assistants: 28.6%) gloves were neither changed nor hands were disinfected between different activities or patient contacts (female dentists: 68.6%; male dentists: 60.9%; dental assistants: 93%). Only 31.4% of female and 39.1% of male dentists carried out adequate hygienic hand disinfection after removing gloves. Male dentists wore significantly more often (100%) protective eyewear compared to 77.1% of female dentists (p<0.05). In addition, most of female dentists (62.9%) and dental assistants (80.7%) wore jewelry during dental procedures. Conclusion: Despite the knowledge of distinct hygiene procedures only a small percentage of dental staff performs hygiene practices according to recommended guidelines. Strict audit is clearly needed in the dental setting to ensure compliance with infection control guidelines to prevent transmission of pathogens. Our results provide insights for the development of a targeted education and training strategy to enhance compliance of dental staff especially of dental assistants with infection control
Finogenov, A. M.; Azhayev, A. N.; Kaliberdin, G. V.
The biomedical maintenance of astronauts is discussed in terms of personal hygiene. Principal characteristics and general requirements are described which must be followed in perfecting a system of hygienic practices and in devising means to maintain personal hygiene, flight clothing, underwear, bedding, and medical-domestic equipment for manned space flights of varying durations. Factors discussed include: disposable clothing, thermal protection, oral hygiene, cleansing of the skin, and grooming of the hair.
Barbut, Frédéric; Maury, Eric; Goldwirt, Laurianne; Boëlle, Piérre-Yves; Neyme, Denis; Aman, Rubina; Rossi, Beatrice; Offenstadt, Georges
The aims of this study were to compare the antibacterial efficacy of handrubbing with an alcoholic rinse (AHRR) and two different alcoholic gels (AHRG) in reducing hand contamination under practical use conditions. We wanted to assess the acceptability of the three products and to determine the effect of each product on overall hand hygiene compliance. A prospective alternating time-series clinical trial was performed in a medical intensive care unit. The study was divided into three six-week periods (P1, P2, P3). Handrubbing was achieved with Sterillium rinse (AHRR) during P1, sterillium gel(AHRG-1) during P2 and Manugel Plus (AHRG-2) during P3. Pre- and post-rubbing hand contaminations were assessed immediately after a direct contact with a patient, using the glove juice technique. Health care workers (HCWs) evaluated the acceptability of the products through a self-administered anonymous questionnaire. Compliance of HCWs with hand hygiene was assessed during the three periods. We studied 242 handrubbing opportunities. The mean reduction factor (expressed as the Log(10) CFU/mL) of the AHRR, AHRG-1 and AHRG-2 were 1.28+/-0.95, 1.29+/-0.84 and 0.51+/-0.73, respectively (p<0.001). Assessment of the three products by HCWs indicated that AHRR and AHRG-1 were significantly better accepted than AHRG-2. The overall compliance of HCWs to hand hygiene was better when gel was available. Under practical use conditions, AHRG-1 and AHRR were more effective than AHRG-2, although all were claimed to pass the European standard EN1500. In vivo trials are essential to compare the antimicrobial efficacy of products for handrubbing.
Renner, Jason M.
Discusses how designing a hand washing-friendly environment can help to reduce the spread of germs in school restrooms. Use of electronic faucets, surface risk management, traffic flow, and user- friendly hand washing systems that are convenient and maximally hygienic are examined. (GR)
The present publication discusses the following hypotheses: 1) With a continual increase in the state of scientific knowledge and the hygienic risk factors (infectious diseases, multi-resistant pathogens, age structure of the population with increasing risk of infection, etc.) a hygiene behaviour with increasing deficits develops. 2) Essential hygiene behaviour is blocked by irrational psychological defensive strategies: (a) hygiene biases (childhood illnesses as stabilisers for health development; hygiene as a health risk; overrating chemical-physical environmental risks as e.g. triggers for causing illness), (b) one's own personal risk balance: objective risks are minimised in the likelihood of their occurrence. 3) Hygiene education: the development of a prophylaxis-oriented lifestyle lies (a) in the model behaviour of parents, (b) in conveying the reasons for sensible behaviour, (c) in continually checking behaviour and (d) in appropriate sanctioning when deficits are perceived. 4) Conveying hygiene knowledge is an essential but inadequate prerequisite for corresponding hygiene behaviour. Motivators for hygiene behaviour are the following: (a) parental model behaviour and development of personal responsibility, (b) establishing simple, short, understandable and--for specific risk areas--specific rules of behaviour, (c) conveying hygiene information in the language of the target group, (d) integrating hygiene behaviour in a preventive lifestyle which must be inspired by the quality of life and well-being occurring and being experienced.
Brisbin, Steven G.
This breakout session is a traditional conference instrument used by the NASA industrial hygiene personnel as a method to convene personnel across the Agency with common interests. This particular session focused on two key topics, training systems and automation of industrial hygiene data. During the FY 98 NASA Occupational Health Benchmarking study, the training system under development by the U.S. Environmental Protection Agency (EPA) was deemed to represent a "best business practice." The EPA has invested extensively in the development of computer based training covering a broad range of safety, health and environmental topics. Currently, five compact disks have been developed covering the topics listed: Safety, Health and Environmental Management Training for Field Inspection Activities; EPA Basic Radiation Training Safety Course; The OSHA 600 Collateral Duty Safety and Health Course; and Key program topics in environmental compliance, health and safety. Mr. Chris Johnson presented an overview of the EPA compact disk-based training system and answered questions on its deployment and use across the EPA. This training system has also recently been broadly distributed across other Federal Agencies. The EPA training system is considered "public domain" and, as such, is available to NASA at no cost in its current form. Copies of the five CD set of training programs were distributed to each NASA Center represented in the breakout session. Mr. Brisbin requested that each NASA Center review the training materials and determine whether there is interest in using the materials as it is or requesting that EPA tailor the training modules to suit NASA's training program needs. The Safety, Health and Medical Services organization at Ames Research Center has completed automation of several key program areas. Mr. Patrick Hogan, Safety Program Manager for Ames Research Center, presented a demonstration of the automated systems, which are described by the following: (1) Safety
Gopal Rao, G; Jeanes, A; Russell, H; Wilson, D; Atere-Roberts, E; O'Sullivan, D; Donaldson, N
In this prospective cluster randomized controlled trial we evaluated the impact of short-term provision of enhanced infection control support on infection control practice in nursing homes in South London. Twelve nursing homes were recruited, six each in intervention (300 residents) and control (265 residents) groups. Baseline observations of hand hygiene facilities, environmental cleanliness and safe disposal of clinical waste showed poor compliance in both groups. Post-intervention observations showed improvement in both groups. There was no statistical difference between the two groups in the compliance for hand hygiene facilities (P=0.69); environmental cleanliness (P=0.43) and safe disposal of clinical waste (P=0.96). In both groups, greatest improvement was in compliance with safe disposal of clinical waste and the least improvement was in hand hygiene facilities. Since infection control practice improved in intervention and control groups, we could not demonstrate that provision of short-term, enhanced, infection control support in nursing homes had a significant impact in infection control practice.
Gagné, D; Bédard, G; Maziade, P J
The role of patients and their relatives as unidentified transient meticillin-resistant Staphylococcus aureus (MRSA) carriers and sources of dissemination in healthcare institutions has not been systematically addressed. Patients' and their relatives' hands may represent a substantial and 'unaccounted for' mode of transmission. This study aimed to verify this hypothesis in our 250-bed community hospital. The trial consisted of a systematic waterless washing and gel rinse disinfection of all patients' and visiting relatives' hands for a period of one year, along with retrospective comparison of the nosocomial infection rates. Under the supervision of infection control personnel, a team of four full-time and four part-time attendants was trained to meet all patients and visiting relatives and encourage them to clean their hands with an alcohol gel rinse twice a day on every weekday. Rates of MRSA infections per thousand admissions, cost-benefit analysis and staff hand hygiene compliance were audited throughout. From the comparative year, the rate of MRSA nosocomial infections per thousand admissions decreased by 51%. Assuming that the incidence of MRSA was maintained from comparative to study year, the intervention may have prevented 51 cases of MRSA infection and resulted in substantial savings. While focusing extensively on staff behaviour to prevent MRSA transmission, we may have overlooked hand hygiene practices by patients and their relatives as a potential mode of transmission. Systematic hand hygiene of patients and relatives appears to be an inexpensive and highly effective preventive measure against MRSA nosocomial transmission.
da Cunha, Gilmara Holanda; de Araujo, Thelma Leite; Lima, Francisca Elisângela Teixeira; Cavalcante, Tahissa Frota; Galvão, Marli Teresinha Gimeniz
The objective of this study was to analyze the scientific production on health interventions related to hygiene for adults with HIV/AIDS. An integrative literature review was performed using six databases in June 2013. The descriptors AIDS and Hygiene were used, in Portuguese, English or Spanish. A total of 682 articles were found and 16 were selected. Personal hygiene practices were identified, such as hand washing, showers, tooth brushing and quitting smoking. Food hygiene practices involved washing food and kitchen utensils, using treated water, conserving and cooking food. Environmental hygiene took into account raising domestic animals, control of disease vectors, household cleanliness, waste disposal and basic sanitation. In conclusion, these specific hygiene interventions can be applied to the general population and, especially, to people with HIV/AIDS, due to immunosuppression.
From the data he had collected, Ignaz Phillip Semmelweis drew the right conclusions and began using disinfectants for handwashing. And this at a time when it was not at all known that infections were caused by bacteria. While ridiculed by colleagues, the results achieved impressively attested to just how correct were his views: there was a demonstrable reduction in mortality rates among puerperae from some 20% to 3%, which was very low for that time. In the course of the 20th century “Surveillance” was introduced, entailing systematic recording, analysis and interpretation of nosocomial infection data, in several countries throughout the world. This helps identify infection problems and take appropriate preventive measures. But the ongoing trend of emergent infectious diseases and the development of antibiotic-resistant bacteria continue to pose new challenges for us: the microorganisms appear to be always one step ahead of us. During the 20th century the prevailing belief was that hand disinfection was the easiest, least expensive and most effective preventive measure to prevent the spread of microorganisms. In the 21st century compliance is the main focus of attention. We must devise novel motivational systems, tailored to the present day setting, to inculcate a sense of responsibility and ensure observance of hand hygiene regimens. Here, the infection control nurse plays a pivotal role. PMID:20200682
Abd Elaziz, K M; Bakr, I M
Most nosocomial infections are thought to be transmitted by the hands of health care workers. The aim of this work was to assess the knowledge, attitude and practice of hand washing among health care workers (HCW) in Ain-Shams University hospitals and to investigate the presence of the necessary facilities and supplies required for hand washing (HW) in ten wards. A cross-sectional descriptive and observational study was conducted for six months from June till November 2006. Observation of the HCW for hand washing practice was done at any opportunity of contact with the patients in the different wards by members of the infection control team. Knowledge & attitude of HCW towards hand hygiene was done through self-administered questionnaire to HCW in 10 different departments. The total opportunities observed were 2189 opportunities. Doctors showed a significantly higher compliance (37.5%) than other groups of HCW (P = 0.000), however only 11.6% of the opportunities observed for doctors were done appropriately. The most common type of HW practiced among HCW was the routine HW (64.2%) and the least was the antiseptic HW (3.9%). Having a short contact time and improper drying (23.2%) were the most common errors that lead to inappropriate HW. Most of the wards had available sinks (80%) but none of them had available paper towels. The mean knowledge score was higher in nurses compared to doctors (42.6 +/- 1.7 versus 39.1 +/- 10.5). Most of the nurses (97.3%) believe that administrative orders and continuous observation can improve hand washing practices. Implementation of multifaceted interventional behavioral hand hygiene program with continuous monitoring and performance feedback, increasing the supplies necessary for HW and institutional support are important for improving the compliance of hand hygiene guidelines.
Luciak-Donsberger, C; Krizanová, M
This article reports on the development of the dental hygiene profession in Slovakia from a global perspective. The aim is to inform about current developments and to examine, how access to qualified dental hygiene care might be improved and how professional challenges might be met. For an international study on dental hygiene, secondary source data were obtained from members of the House of Delegates of the International Federation of Dental Hygienists (IFDH) or by fax and e-mail from experts involved in the national professional and educational organization of dental hygiene in non-IFDH member countries, such as Slovakia. Responses were followed-up by interviews, e-mail correspondence, visits to international universities, and a review of supporting studies and reference literature. Results show that the introduction of dental hygiene in Slovakia in 1992 was inspired by the delivery of preventive care in Switzerland. Initiating local dentists and dental hygienists strive to attain a high educational level, equitable to that of countries in which dental hygiene has an established tradition of high quality care. Low access to qualified dental hygiene care may be a result of insufficient funding for preventive services, social and cultural lack of awareness of the benefits of preventive care, and of limitations inherent in the legal constraints preventing unsupervised dental hygiene practice. These may be a result of gender politics affecting a female-dominated profession and of a perception that dental hygiene is auxiliary to dental care. International comparison show that of all Eastern European countries, the dental hygiene profession appears most advanced in Slovakia. This is expressed in high evidence-based academic goals, in extensive work with international consultants from the Netherlands and Switzerland, in annual congresses of high professional quality, and in the establishment of a profession, which has not been introduced in all Western EU countries.
Describes steps schools can take to provide cleaner and safer washrooms. Emphasizes hand-washing to battle germs and asserts that creating a comfortable and user-friendly washroom is a critical and often overlooked aspect for encouraging better hygiene habits. (EV)
Guilhermetti, M; Marques Wiirzler, L A; Castanheira Facio, B; da Silva Furlan, M; Campo Meschial, W; Bronharo Tognim, M C; Botelho Garcia, L; Luiz Cardoso, C
In recent years, several commercial alcohol-based hand gels have appeared on the market to improve the hand-cleansing compliance of healthcare workers. Although the antimicrobial efficacy of these products has been reported in different countries, few studies have investigated this subject in Brazil. In this study, we assessed the antimicrobial efficacy of 12 alcohol-based hand gels produced in Brazil, containing 70% w/w or v/v ethyl alcohol as the active ingredient, according to the European Standard EN 1500 (EN 1500). The following alcohol gels were tested: Hand Gel, Voga Gel, Solumax Solugel, Doctor Clean, Rio Gel, Clear Gel, Sevengel, Hand CHC, Gel Bac, WBL-50 Gel, Sanigel and Soft Care Gel. In addition, 70% w/w ethyl alcohol and three alcohol-based hand rubs (Sterillium, Sterillium Gel, and Spitaderm), commonly used in Europe and effective according to EN 1500, were also tested. All the products tested, except for two, were approved by the EN 1500 test protocol with a 60s application. The results confirmed the antimicrobial efficacy of the majority of the alcohol gels produced in Brazil for hand hygiene of healthcare workers.
Askarian, M; Khalooee, A; Emroodi, N N
Complying with infection control standards is essential to prevent nosocomial infections. We aimed to determine health workers' hygiene practices and compliance with recommended instructions for personal hygiene among staff in all 30 hospitals affiliated to Shiraz University of Medical Sciences. The results showed that physicians and nurses were less compliant with personal hygiene practices than cleaners. Availability of protective measures was better in teaching hospitals than nonteaching hospitals as were vaccination rates among staff (hepatitis B and tetanus/diphtheria) with physicians scoring highest. Measures are needed to improve health workers' compliance.
Takahashi, Ikuko; Turale, Sue
Internationally, it has been found that regular and timely hand washing is part of hand-hygiene practices that can reduce rates of infection in health-care facilities, but research has shown that there is a low level of compliance with hand washing in hospitals worldwide, including Japan. The number of aged-care facilities is growing throughout the world as our populations age, but hand-washing compliance appears even lower in such settings where there are vulnerable and frail elderly persons. This study used a correlational, cross-sectional design to clarify, for the first time, individual and facility factors related to the hand-washing behaviors of care staff at Japanese aged-care facilities. In 56 facilities (31 special nursing homes and 25 health-service facilities) in Yamaguchi Prefecture, data were gathered through survey questionnaires from care staff and facility managers. A total of 1323 (79.6%) questionnaires were returned and 1016 (61.1%) were analyzed. Using logistical regression analysis, two individual factors were investigated ("willingness to practice standard precautions" and "attendance at seminars") and two facility factors were investigated ("implementation of hand-washing evaluation" and "hand-washing environment"). These factors were found to promote hand washing, but no single factor was particularly related to its promotion in aged-care settings. If the health of elderly residents is to be better protected and infection rates lowered, especially in an era of increasing pandemics and epidemics, the compliance rate of health-care workers needs to be increased. We conclude that diverse approaches to both individual and facility factors are necessary to improve compliance with hand washing.
Skin hygiene, particularly of the hands, is a primary mechanism for reducing contact and fecal-oral transmission of infectious agents. Widespread use of antimicrobial products has prompted concern about emergence of resistance to antiseptics and damage to the skin barrier associated with frequent washing. This article reviews evidence for the relationship between skin hygiene and infection, the effects of washing on skin integrity, and recommendations for skin care practices. PMID:11294712
Czerwinski, B S
Adult feminine hygiene practices are the focus of this exploratory descriptive study. In a sample of 193 women, the typical respondent lived in the Southeast and was a single student who was 23 years of age, and White. Body cleansing, feminine hygiene, and menses management practices were examined. It was found that handwashing varied according to bodily involvement or specific feminine hygiene practices. Assorted menses management products were used for menses management and were used when the woman was not menstruating. The results of this study suggest that it might be possible for health care providers to teach women safe and economical health care practices, such as not douching and handwashing before and after use of menses management products to prevent infections.
Kramer, A; Hübner, N; Below, H; Heidecke, C-D; Assadian, O
At present, no universal agreement on detailed practice for surgical hand preparation exists. In order to fill this gap, in 2002 a Franco-German recommendation for surgical hand preparation was published as a first step towards a generally accepted European recommendation. Based on an assessment of the actual literature, a protocol for surgical hand preparation is discussed with the aim to recommend evidence-based standard procedures including prerequisites, washing and disinfection phase, and its practical implementation. In contrast to hygienic hand disinfection, for surgical hand preparation compliance is not an issue, since it mostly is regarded as a ceremony which is carried out without exception. Nevertheless, the following factors influence acceptance and efficacy: skin tolerance, ease of use, duration of procedure, and recommended time), potential for impaired efficacy due to incorrect performance of the procedure, possibility of systemic risks and irritating potential by applied preparations, religious restrictions, ecological aspects, costs and safety. Here, we report our experience with the introduction of a new hand preparation regime in all surgical disciplines in our university hospital based on the above factors. The following statements were evaluated: 1) The immediate efficacy of an alcohol-based hand disinfectant is impaired by a preceding hand wash for up to 10 minutes. Therefore hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling. 2) A shortened application time (1.5 minutes) is equal to 3 min in terms of efficacy. 3) Hands should be air dried before gloves are put on, otherwise the perforation rate of gloves will increase. 4) The efficacy of alcohol-based disinfectants is significantly higher when hands are allowed to dry for 1 minute after the washing phase and before the disinfection phase. To clarify the above questions before the establishment of the modified
National Commission on Accrediting, Washington, DC.
The Council on Dental Education cooperates with the American Dental Hygienists' Association in developing educational requirements for schools of dental hygiene. To be eligible for accreditation, schools must operate on a non-profit basis. A school applying for accreditation completes a previsitation questionnaire concerning its program. The…
Peter Jennings, technical director for ACO Building Drainage, which specialises in the development of corrosion-resistant drainage systems and building products, looks at the key issues to consider when specifying and installing pipework and drainage for hygiene-critical environments such as hospitals and other healthcare facilities.
This plan was written to administer and monitor safety measures and chemical hygiene principles in the TAC Uranium Mill Tailing Remedial Action Project sample preparation facility in Albuquerque, New Mexico. It applies to toxic and/or hazardous materials to radioactive materials.
Jager, E; Heudorf, U
Considering the physiological contamination of skin and mucous membranes in the ear, nose, and throat region by facultative pathogen microorganisms, as well as the increase in multidrug resistant organisms (MDRO), it is mandatory that hygienic procedures be observed in ENT institutions, in order to prevent transmission of bacteria and infections in patients. General guidelines for hygiene in otorhinolaryngology are presented based on the recommendations published by the German Commission on Hospital Hygiene and Infection Prevention (KRINKO). These encompass hand hygiene, surface disinfection, and reprocessing of medical devices. The correct reprocessing of the various components of ENT treatment units (including endoscopes, water bearing systems) is reported. Although law requires and KRINKO recommends that manufacturers of medical devices publish instructions for reprocessing their products, these reprocessing recommendations are often insufficient. Manufacturers should thus be called upon to improve their recommendations. In this paper, the requirements for handling of ENT treatment units are compared with the observations made by the Public Health Department in 7 ENT clinics and 32 ENT practices in Frankfurt/Main, Germany, in 2014.
Bedell, Susanna E; Graboys, Thomas B
Examination of the hands has the potential to transform the encounter between physician and patient. Taking the hands conveys a sense of warmth and connectedness and is a means to communicate the physician's mindfulness. The hands can focus the examination on the individual patient as a complete human being, and not merely a disease or a collection of symptoms. The hands provide readily accessible information that may not be available through other evaluations, and they offer clues to a patient's physical and mental health. Commonplace observations, such as those revealed in the hands, can unravel medical mysteries and provide profound clinical insights.
Bowen, Denise M
Dental hygiene is defined as the science and practice of the recognition, treatment and prevention of oral diseases. The history of dental hygiene research is considered in the context of the development of the discipline and an emerging infrastructure. Research-related events supporting the growth and maturation of the profession are considered from the early years to the most recent. The benefits of preventive oral health services provided by dental hygienists have been supported by research, and the practice of dental hygiene has expanded as a result of research findings since its inception 100 years ago. Dental hygienists' engagement in research, however, did not begin until the 1960s as research associates or administrators, primarily with dental researchers as primary investigators. The Journal of Dental Hygiene (JDH) has provided information for dental hygiene practice since 1927, and has been the primary venue for dissemination of dental hygiene research since 1945. Graduate education in dental hygiene at the master's degree level and the work of early dental hygiene researchers led to the first conference on dental hygiene research in 1982. Over 30 years later, dental hygiene has established a meta-paradigm and defined conceptual models, built an initial infrastructure to support research endeavors and contributed much to the development of dental hygiene as a unique discipline. A doctoral degree in the discipline, continued theory-based research, initiatives to foster collaborations between dental hygiene and other researchers and enhanced capabilities to attract funding to support large scale studies are goals that must be attained through the efforts of future researchers to address the needs for additional development in the discipline of dental hygiene. Dental hygiene research supports the growing discipline and its value to society.
Owing to the embarrassing anal itch caused by threadworm infection, some sufferers feel they cannot even mention the problem to their doctor. Community nurses, often regarded as a more approachable source of support, will also be able to prescribe medication if they have prescribing status. With an adequate understanding of the complaint, they can offer a choice of treatment options, mechanical removal or drugs, necessarily backed by the appropriate personal and environmental hygiene measures. The starting point for relevant hygiene is cheerful good practice in hand washing at home and school, which is also key to preventing the spread of many other more serious infections. Implementation is of basic importance and should form part of any of the current initiatives from Sure Start to Healthy Schools.
Ataee, Ramezan Ali; Ataee, Mohammad Hosein; Mehrabi Tavana, Ali; Salesi, Mahmud
The aim of this review is to show the historical aspects of hands washing for healthy life and explains how can reduce the transmission of community-acquired infectious agents by healthcare workers and patients. This review article is prepared based on available database. The key words used were hands washing, risk assessment, hands hygiene, bacterial flora, contamination, infection, nosocomial, tap water, sanitizer, bacterial resistance, hands bacterial flora, washing methods, antiseptics, healthcare workers, healthcare personnel, from PubMed, ScienceDirect, Embase, Scopus, Web of Sciences, and Google Scholar. Data were descriptively analyzed. The insistence on hand washing has a history of 1400 years. The research results indicate that the bacteria released from the female washed hands in wet and dry condition was lower than from the male's hands with a significance level (3 CFU vs. 8 CFU; confidence interval 95%, P ≤ 0.001). The valuable results of the study indicated that released amount of bacterial flora from wet hands is more than 10 times in compared to dry hands. In addition, established monitoring systems for washing hands before and after patient's manipulation as well as after toilet were dominant indices to prevent the transfer of infectious agents to the patients. Increasing awareness and belief of the healthcare workers have shown an important role by about 30% reduction in the transfection. Hand washing could reduce the episodes of transmission of infectious agents in both community and healthcare settings. However, hand washing is an important key factor to prevent transmission of infectious agents to patients. There is no standard method for measuring compliance. Thus, permanent monitoring of hand washing to reduce the transmission of infections is crucial. Finally, the personnel must believe that hand washing is an inevitable approach to infection control. PMID:28382192
Prescriptive standards for the work environment affect the professional practice of industrial hygiene. Among the advantages are: legal requirements reinforce professional recommendations; penalties encourage abatement of hazards; compliance should ensure a safe and healthful environment; recordkeeping requirements will provide a basis for future action. Among the disadvantages are: rigid evaluation procedures, reporting format, etc., discourage professional judgment and development of new methods; professional reports become legal documents; single standards do not focus on the total environment.
Bonetti, Debbie; Hampson, Victoria; Queen, Kerry; Kirk, Donna; Clarkson, Jan; Young, Linda
Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care.
This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford`s compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute.
Gorter, A C; Sandiford, P; Pauw, J; Morales, P; Pérez, R M; Alberts, H
Poor hygiene practices are among the risk factors for the transmission of childhood diarrhea, a leading cause of morbidity and mortality in Nicaragua. Findings are reported from a prospective follow-up study in rural Nicaragua of the effect of a number of hygiene practices upon diarrheal disease in children under age 2 years old. 172 families, of whom half had experienced a higher than expected rate of diarrhea in their children and the other half a lower rate, participated. Hygiene behavior was observed over 2 mornings and diarrhea incidence was recorded with a calendar over the course of 5 months. Of 46 good practices studied, 39 were associated with a lower risk of diarrhea, 5 were unrelated, and a higher risk was observed for 2. The washing of hands, domestic cleanliness, and the use of a diaper/underclothes by the child had the strongest protective effect against diarrhea. Mothers with more than 3 years of primary school education and in a comparatively better economic position, including having a radio, exhibited comparatively better general hygiene behavior. Education had a slightly stronger effect when a radio was present. However, individual hygiene behavior seems to be highly variable compared to the consistent behavior of the overall community. Appropriate indicators of hygiene behavior were domestic cleanliness and the use of a diaper or underclothes by the child.
This manual contains information concerning the policies and procedures of the Southern Illinois University-Carbondale Dental Hygiene Clinic. The manual is presented in a question/answer format for the information and convenience of dental hygiene students in the program, and is intended to answer their questions concerning clinical policies and…
... Guide Journal of Hand Surgery (JHS) Home Anatomy Hand Therapy Email to a friend * required fields From * ... ensure a healthy style of work. Find a Hand Therapist Search for a hand therapist in your ...
Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan
Introduction Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. Methods We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. Results There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Conclusion Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing. PMID:26587098
Ejemot-Nwadiaro, Regina I; Ehiri, John E; Arikpo, Dachi; Meremikwu, Martin M; Critchley, Julia A
syndrome (AIDS) (148 participants). Hand washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevents around one-third of diarrhoea episodes in high income countries (rate ratio 0.70; 95% CI 0.58 to 0.85; nine trials, 4664 participants, high quality evidence), and may prevent a similar proportion in LMICs but only two trials from urban Egypt and Kenya have evaluated this (rate ratio 0.66, 95% CI 0.43 to 0.99; two trials, 45,380 participants, low quality evidence). Only three trials reported measures of behaviour change and the methods of data collection were susceptible to bias. In one trial from the USA hand washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; three trials, 1845 participants, low quality evidence). Hand washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (rate ratio 0.72, 95% CI 0.62 to 0.83; eight trials, 14,726 participants, moderate quality evidence). However, six of these eight trials were from Asian settings, with only single trials from South America and sub-Saharan Africa. In six trials, soap was provided free alongside hand washing education, and the overall average effect size was larger than in the two trials which did not provide soap (soap provided: rate ratio 0.66, 95% CI 0.56 to 0.78; six trials, 11,422 participants; education only: rate ratio: 0.84, 95% CI 0.67 to 1.05; two trials, 3304 participants). There was increased hand washing at major prompts (before eating/cooking, after visiting the toilet or cleaning the baby's bottom), and increased compliance to hand hygiene procedure (behavioural outcome) in the intervention groups than the control in community trials (data not pooled: three trials, 3490 participants, high quality evidence). Hand washing promotion for the one trial conducted in a hospital among high
... Water Fluoridation Leadership Policy & Recommendations Fast Facts Healthy Water Sites Healthy Water Home Drinking Water Healthy Swimming / ... Recommend on Facebook Tweet Share Compartir Information on Water-related Hygiene Handwashing It is estimated that washing ...
Kampf, G; Kramer, A; Rotter, M; Widmer, A
For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.
Prejean, Stephen E.; Booher, Cletis R.
A personal hygiene system is currently under development for Space Station application that will provide capabilities equivalent to those found on earth. This paper addresses the study approach for specifying both primary and contingency personal hygiene systems and provisions for specified growth. Topics covered are system definition and subsystem descriptions. Subsystem interfaces are explored to determine which concurrent NASA study efforts must be monitored during future design phases to stay up-to-date on critical Space Station parameters. A design concept for a three (3) compartment personal hygiene facility is included as a baseline for planned test and verification activities.
Bergler, R; Borneff, M
The subject of the study is a systematizing analysis of present research concerned with the barriers which prevent scientific findings about hygiene from being carried out and which hamper the obvious adoption of hygienically and psycho-hygienically relevant prophylactic measures. A general interpretive model with explanatory value for health- and hygiene-related behavior is being developed. Future studies will particularly have to clarify what significance and what interpretative relevance do the diverse influencing factors have for a particular person in a particular position and situation and how in the course of one's biography even something like lifestyles of hygienic behavior develop and change. For the necessity of improvement as regards the hygienic status in various realms of life the knowledge about existing barriers is a basic essential. The following quantities and constructs pass into the theoretic interpretive model which should also provide the basis for further evolvement of theories as well as the starting point for specific research hypotheses but not least for the development of specific research and evaluation designs: Standard of information, informational behavior and quality of information. The individual risk assessment: A function of the subjective importance and probability that benefit and cost factors of prophylactic behavior will occur. Additional influencing factors essential to the development of a desirable health- and hygiene-related behavior are: Objective shortcomings with regard to prophylaxis: deficits of the hygienic research including the deficits concerning the development of feasible and universally applicable disinfection methods. Hazards connected to prophylaxis: Objective risks with regard to prophylaxis (disinfection methods which may cause allergies, which involve problems with the compatibility of materials and so forth) and psychological risks (impaired relations between physician and patient due to the wearing of a
Ramos, Mary M.; Blea, Mary; Trujillo, Rebecca; Greenberg, Cynthia
Hand washing and hand antisepsis are proven infection control measures in the school setting, yet barriers such as lack of soap, paper towels, and hand sanitizer can hinder compliance. This pilot study measured the prevalence of hand cleaning supplies in public schools. Ten school districts (93 schools) participated in school nurse inspections. In…
Gebel, J; Teichert-Barthel, U; Hornbach-Beckers, S; Vogt, A; Kehr, B; Littmann, M; Kupfernagel, F; Ilschner, C; Simon, A; Exner, M
Basic hygiene measures aim at promoting and maintaining good health. The necessary routines are most effectively learned and adopted during childhood. These key findings form the basis for the educational programme "Hygiene Tips for Kids" which was initiated at the Department of Hygiene and Public Health at Bonn University under the auspices of WHO Europe in 2003. The programme addresses children, teachers and parents and offers a range of materials and activities tailored to the specific needs of the target groups based on expert advice. The objective is to exert a long-lasting, positive influence on the performance of hygiene routines. Campaigns are usually directed at pre-school, kindergarten and primary school settings, with the public health service personnel playing a crucial role in coordinating and implementing the various activities. Evaluation of a campaign in the federal state of Mecklenburg-Vorpommern has proven a positive effect on hand washing routines in pre-school as well as in the domestic setting. Moreover, Hygiene Tips for Kids has a sustained positive effect on the cooperation and communication between public health authorities and teachers, children and their parents. Teachers implement their own ideas within a framework of standardised information to suit their local needs. A long-term goal would be the obligatory integration of a sensible health education programme in the syllabus of pre-school, kindergarten and primary schools.
Ulnar nerve palsy - claw hand; Ulnar nerve dysfunction - claw hand; Ulnar claw ... Someone can be born with claw hand (congenital), or they can develop it because of certain disorders, such as nerve injury.
Avshits, I V; Shirinskiĭ, V A
During a comprehensive study, the investigators have made a hygienic assessment of an academic process and the actual nutrition of military school pupils, revealed the specific features of functioning of the body's major systems in adolescents at a closed primary military education establishment, studied the body's adaptive reactions to a combination of factors during study, and hygienically evaluated the pupils' health. Their health has been shown to improve at a closed education establishment according to the basic parameters of the body's functional status and nonspecific resistance, physical development. Specific recommendations are proposed to correct daily diets for pupils of primary military education establishments in order to bring the actual nutrition of cadets in compliance with the standard physiological requirements for this group of pupils.
Amer, Hatem; Carlsen, Brian T; Dusso, Jennifer L; Edwards, Brooks S; Moran, Steven L
The first successful hand transplant was performed in 1998, opening up a new possibility for patients who have suffered mutilating hand injuries. Since then, more than 60 such procedures have been performed throughout the world. This article describes the evolution of hand transplantation, outcomes of patients listed in the International Registry of Hand and Composite Tissue Transplantation, and ethical issues involved in hand transplantation. It also describes the hand transplantation program at Mayo Clinic, which was established in 2010.
Issa, Mohamad; McHenry, Michael; Issa, Abdul Aziz; Blackwood, R Alexander
Diarrheal illness, frequently associated with fecal-oral transmission, is one of the leading causes of death worldwide. It is commonly preventable through the implementation of safe water practices. This experiment concerns how to best implement safe water practices in a quasi-permanent refugee camp setting with limited ability for structural changes. Specifically, we explore how health promotion activities that help identify target groups for hygiene interventions can play a role in disease prevention. An anonymous survey was conducted at the United Nations Relief and Works Agency Health Clinic in the Kulandia refugee camp to assess the safe water and personal hygiene practices. Demographic and social characteristics, accessible water and personal hygiene characteristics, and gastrointestinal (GI) burden for individuals and their households were assessed. A total of 96 individuals were enrolled; 62 females and 34 males. Approximately 58% of the sample had soap available and washed hands before and after eating and when preparing food. Piped water was the main source of drinking water (62%), while 31% of our sample utilized tanker-trucks. 93% of participants had access to toilet facilities, with 86% of these facilities being private households. 55% practice extra water hygiene measures on their household drinking water source. 51.3% considered vendor cleanliness when they were buying food. 51% had received formal health education. 68.8% had been taught by their parents, but only 55.2% were teaching their children and 15.6% had consistent access to a health professional for hygiene inquiries. Individual variables and hygiene practices associated with lower rates of diarrheal illnesses included having water piped into the home, proper hand washing, adequate soap availability, proper consideration of vendor cleanliness, higher income, levels of education, health hygiene education, and having access to healthcare professions to discuss hygiene related matters. This is
Issa, Mohamad; McHenry, Michael; Issa, Abdul Aziz
Diarrheal illness, frequently associated with fecal-oral transmission, is one of the leading causes of death worldwide. It is commonly preventable through the implementation of safe water practices. This experiment concerns how to best implement safe water practices in a quasi-permanent refugee camp setting with limited ability for structural changes. Specifically, we explore how health promotion activities that help identify target groups for hygiene interventions can play a role in disease prevention. An anonymous survey was conducted at the United Nations Relief and Works Agency Health Clinic in the Kulandia refugee camp to assess the safe water and personal hygiene practices. Demographic and social characteristics, accessible water and personal hygiene characteristics, and gastrointestinal (GI) burden for individuals and their households were assessed. A total of 96 individuals were enrolled; 62 females and 34 males. Approximately 58% of the sample had soap available and washed hands before and after eating and when preparing food. Piped water was the main source of drinking water (62%), while 31% of our sample utilized tanker-trucks. 93% of participants had access to toilet facilities, with 86% of these facilities being private households. 55% practice extra water hygiene measures on their household drinking water source. 51.3% considered vendor cleanliness when they were buying food. 51% had received formal health education. 68.8% had been taught by their parents, but only 55.2% were teaching their children and 15.6% had consistent access to a health professional for hygiene inquiries. Individual variables and hygiene practices associated with lower rates of diarrheal illnesses included having water piped into the home, proper hand washing, adequate soap availability, proper consideration of vendor cleanliness, higher income, levels of education, health hygiene education, and having access to healthcare professions to discuss hygiene related matters. This is
Kerley, J.; Eklund, W.; Burkhardt, R.; Rossoni, P.
The object of the investigation was to solve mechanical problems using cable-in-bending and cable-in-torsion. These problems included robotic contacts, targets, and controls using cable compliance. Studies continued in the use of cable compliance for the handicapped and the elderly. These included work stations, walkers, prosthetic knee joints, elbow joints, and wrist joints. More than half of these objects were met, and models were made and studies completed on most of the others. It was concluded that the many different and versatile solutions obtained only opened the door to many future challenges.
Bifulco, Maurizio; Capunzo, Mario; Marasco, Magda; Pisanti, Simona
The link between hygiene and the concept of transmission of infective diseases was established earlier than the birth of microbiology, thanks to the studies of two neglected physicians of maternity clinic, Ignác Fülöp Semmelweis and Oliver Holmes, in the mid-1800s. Surprisingly, centuries earlier, a medieval women physician, Trotula de Ruggiero, introduced for the first time the notion of diseases’ prevention, highlighting the importance of the association of personal hygiene, balanced nutrition and physical activity for better health. Moreover, she was particularly concerned of hands hygiene for the midwives during child birth, to preserve the good health of both the mother and the baby. She practiced inside the medieval Medical School of Salerno, whose main text, the “Regimen Sanitatis Salerni” has an entire part dedicated to hygiene, providing hygienic precepts that anticipate the concepts derived from the revolutionary discoveries in medical science only centuries later.
Prokopenko, L V; Kravchenko, O K; Kur'erov, N N
The authors compared approaches to vibration safety regulations, presented by new Russian Federal governmental standards, international standards and rules from one hand, and by Russian Federal Sanitary Regulation documents from the other hand. Main directions to improve hygienic regulation of occupational vibration in new technical regulation system are determined.
Monney, Isaac; Agyei, Dominic; Owusu, Wellington
With the booming street food industry in the developing world there is an urgent need to ensure food vendors adhere to hygienic practices to protect public health. This study assessed the adherence to food hygiene practices by food vendors in educational institutions in Konongo, Ghana. Structured questionnaires, extensive observation and interviews were used for the study involving 60 food vendors from 20 basic schools. Attributable to the influence of school authorities and the level of in-training of food vendors, the study points out that food vendors in educational institutions generally adhered to good food hygiene practices, namely, regular medical examination (93%), protection of food from flies and dust (55%); proper serving of food (100%); good hand hygiene (63%); and the use of personal protective clothing (52%). The training of food vendors on food hygiene, instead of the level of education had a significant association (p < 0.05) with crucial food hygiene practices such as medical examination, hand hygiene and protection of food from flies and dust. Further, regulatory bodies legally mandated to efficiently monitor the activities of food vendors lacked the adequate capacity to do so. The study proposes that efforts should be geared towards developing training programmes for food vendors as well as capacity building of the stakeholders.
Sisty-LePeau, N; Nielsen-Thompson, N
Original manuscripts published in the Journal of the American Dental Hygienists' Association (JADHA), (now JDH) from 1927-1970 provide a historical perspective on dental hygiene's professional development. While many of the problems facing hygiene today are not new, there is evidence of progress in addressing them. The problems considered are: (1) hygiene's unique occupational role, (2) independent practice, (3) baccalaureate education, and (4) responsibility for licensure and practice. Support is provided regarding hygiene's unique contribution to society's oral health needs. Further, the article documents progress toward assuming professional responsibility as expressed in hygiene's relationship with dentistry, and in the expansion of hygiene's educational base and research efforts.
Wójcik, O P; Holt, J; Kjerulf, A; Müller, L; Ethelberg, S; Mølbak, K
Incidence of various diseases can increase following a flood. We aimed to identify professionals in Copenhagen who became ill after contact with 2 July 2011 floodwater/sediment and determine risks and protective factors associated with illness. We conducted a cohort study of employees engaged in post-flood management activities. Participants completed a questionnaire collecting information about demographics, floodwater/sediment exposure, compliance with standard precautions, and symptoms of illness. Overall, 257 professionals participated, with 56 (22%) cases. Risk of illness was associated with not washing hands after floodwater/sediment contact [relative risk (RR) 2∙45], exposure to floodwater at work and home (RR 2∙35), smoking (RR 1∙92), direct contact with floodwater (RR 1∙86), and eating/drinking when in contact with floodwater (RR 1∙77). Professionals need to follow standard precautions when in contact with floodwater/sediment, especially proper hand hygiene after personal protective equipment use and before eating/drinking and smoking.
Tran, D; Phongsavan, P; Bauman, A E; Havea, D; Galea, G
This study presents findings on health-related hygiene behaviours of 9,013 adolescents from Vanuatu, Tonga and Pohnpei in the Federal States of Micronesia as part of the Health Behaviour of Pacific Youth Life surveys. We examined the prevalence of and relationship between tooth brushing, hand washing before eating, hand washing after toileting and a range of psychosocial factors such as sociodemographic charac-teristics, health behaviour and school affiliation. The results showed that patterns of prevalence and relationships were consistent for all countries, with weaker associations observed in Pohnpei. In general, adolescents reported moderate levels of optimal hygiene practice. Girls reported significantly more frequent optimal hygiene practice than boys. Logistic regression analysis confirmed that frequent hygiene behaviours were significantly associated with gender, parental occupations and high levels of school affiliation. These findings suggest the need to consider psycho-social and economic factors when examining potential influences on hygiene behaviour to ensure effective interventions.
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National Indian Child Abuse and Neglect Resource Center, Tulsa, OK.
The second in a series on parenting education for American Indians, the booklet offers information on health and hygiene for the mother-to-be and the newborn baby. Chapters include care during pregnancy, mother's weight, mother's health, feeding newborns, washing the baby, baby's early diet, and baby's health care. (ERB)
Developed by educators from the Emily Griffith Opportunity School with input from employees--both workplace literacy students and nonstudents--this guide contains activities for teaching health and hygiene on the job. Flowing from a perspective of respecting cultural diversity and guided by a common thread of good work practices, the activities…
New York State Education Dept., Albany. Office of the Professions.
A reference guide to laws, rules, and regulations that govern dentistry and dental hygiene practice in New York State is presented. In addition to identifying licensing requirements/procedures for dentists and dental hygienists, general provisions of Title VIII of the Education Law are covered, along with state management, professional misconduct,…
New York State Education Dept., Albany. Office of the Professions.
This handbook, developed as a reference guide, contains the texts of laws, rules, and regulations of the New York State Education Department governing dentistry and dental hygiene practice in the state. It also describes licensure requirements and includes complete application forms and instructions for obtaining a license and first registration…
New York State Education Dept., Albany. Office of the Professions.
The handbook contains laws, rules, and regulations of the New York State Education Department that govern dentistry and dental hygiene practice in the state. It describes licensure requirements and includes complete application forms and instructions for obtaining license and first registration as a dentist and dental hygienist. Applicants are…
This learning activity package on oral hygiene is one of a series of 12 titles developed for use in health occupations education programs. Materials in the package include objectives, a list of materials needed, a list of definitions, information sheets, reviews (self evaluations) of portions of the content, and answers to reviews. These topics…
Capolongo, S; Buffoli, M; Oppio, A; Rizzitiello, S
This paper proposes an innovative and transparent methodology to support the "ASL Milano" (Local Health Agency) in the hygiene and health evaluation of construction projects, in order to highlight their positive and negative performance beyond the requirements imposed by the current laws and regulations regarding buildings' hygiene performance, which are too old and therefore unsuitable to ascertain the real quality of indoor environments. The compliance with laws or regulations, mostly out of date, and the assessment of performance involving only a part of the current emerging needs and problems, in fact, should be considered as a necessary, although not a sufficient step, to ensure high quality indoors. Consequently, it is necessary to identify and test an assessment tool which could provide an effective and flexible support for the development of hygiene and health statements regarding projects at building scale (new construction, conversion of the existing, rehabilitation, extension, change of use, etc). The assessment tool suggested by this paper is tailored for the metropolitan area of the city of Milan, but its evaluation framework could be developed and applied to other contexts.
Curtis, Val; Biran, Adam; Deverell, Katie; Hughes, Clarissa; Bellamy, Kate; Drasar, Bo
Much infectious intestinal disease (IID) arises in the home environment. If programmes to prevent infection are to be effective it is essential to both identify the particular practices that risk disease transmission, and to understand the reasons for these practices. An in-depth, multidisciplinary study of carer and child hygiene in the domestic environment in the Wirral, UK, employed structured observation, surface swabbing for polio vaccine virus and enteric marker organisms, semi-structured interviews, projective interviews and focus group discussions. Observations revealed that child carers washed hands with soap after changing a dirty nappy on 42% of occasions, and that one in five toilet users did not wash hands with soap afterwards. Microbiological samples were taken from household surfaces at sites thought likely to be involved in the transfer of faecal material. 15% of bathroom samples showed contamination with polio vaccine virus. Nappy changing took place mainly in living rooms. Contact with living room surfaces and objects during nappy changing was frequent and evidence of faecal contamination was found in 12% of living room samples. Evidence of faecal contamination was also found in kitchens, again on surfaces thought likely to be involved in the transmission of faeces (taps and soap dispensers). Key factors motivating hygiene were the desire to give a good impression to others, protection of the child and aesthetics. In this setting, the particular risk practices to be addressed included washing hands with soap after stool and nappy contact and preventing the transfer of pathogenic organisms to the kitchen. The occasion of the birth of a child may be a privileged moment for the promotion of safer home hygiene practices. Using polio vaccine virus as an indicator of faecal contamination produces results that could be used in large-scale studies of household disease transmission. A better understanding of the household transmission of the agents of IID
Small, Willard S.
The early history of educational hygiene was largely the history of "school hygiene." The name was accurately indicative of character--the hygiene of the school as an environment rather than as a "community of children" learning under the leadership of teachers to know and live health. Environment bulked large; the education of individuals for…
... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Personal hygiene. 551.6 Section 551.6... Grooming § 551.6 Personal hygiene. The Warden shall make available to an inmate those articles necessary for maintaining personal hygiene....
... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Personal hygiene. 551.6 Section 551.6... Grooming § 551.6 Personal hygiene. The Warden shall make available to an inmate those articles necessary for maintaining personal hygiene....
... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Personal hygiene. 551.6 Section 551.6... Grooming § 551.6 Personal hygiene. The Warden shall make available to an inmate those articles necessary for maintaining personal hygiene....
... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Personal hygiene. 551.6 Section 551.6... Grooming § 551.6 Personal hygiene. The Warden shall make available to an inmate those articles necessary for maintaining personal hygiene....
... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Personal hygiene. 551.6 Section 551.6... Grooming § 551.6 Personal hygiene. The Warden shall make available to an inmate those articles necessary for maintaining personal hygiene....
Cameron, Cheryl A.; Beemsterboer, Phyllis L.; Johnson, Lynn A.; Mislevy, Robert J.; Steinberg, Linda S.; Breyer, F. Jay
As part of the development of a scoring algorithm for a simulation-based dental hygiene initial licensure examination, this effort conducted a task analysis of the dental hygiene domain. Broad classes of behaviors that distinguish along the dental hygiene expert-novice continuum were identified and applied to the design of nine paper-based cases…
Poor oral health for all older adults can result in higher risk for heart disease, stroke, diabetes, and oral cancer. Findings from this study indicated older veterans needed to improve their oral hygiene habits but barriers to oral hygiene performance prevented them from receiving and performing oral hygiene measures.
Hand osteoarthritis (OA) is a common chronic disorder causing pain and limitation of mobility of affected joints. The prevalence of hand OA increases with age and more often affects females. Clinical signs obviously do not correlate with radiographic findings - symptomatic hand OA affects approximately 26 % of adult subjects, but radiographic changes can be found in up to two thirds of females and half of males older than 55 years.Disease course differ among individual patients. Hand OA is a heterogeneous disease. Nodal hand OA is the most common subtype affecting interphalangeal joints, thumb base OA affects first carpometacarpal joint. Erosive OA represents a specific subtype of hand OA, which is associated with joint inflammation, more pain, functional limitation and erosive findings on radiographs.Treatment of OA is limited. Analgesics and nonsteroidal anti-inflammatory drugs are the only agents reducing symptoms. New insights into the pathogenesis of disease should contribute to the development of novel effective treatment of hand OA.
In Swaziland, access to safe water supply and sanitation has improved significantly and was expected to result in improved health and, in particular, reduced infant mortality rates. On the contrary, mortality rates in the under 5 years age group are high and have doubled from 60 in 1996, to 120 deaths per 1000 in 2006. The main objective of the study was to assess whether the water projects permit, and are accompanied by, changes in hygienic behaviour to prevent transmission of diseases. The study area was Phonjwane, located in the dry Lowveld of Swaziland, where water projects play a significant role in meeting domestic water demands. Hygienic behaviour and sanitation facilities were analysed and compared before and after project. The results of the study show that domestic water supply projects have significantly reduced distances travelled and time taken to collect water, and that increased quantities of water are collected and used. While the majority of respondents (95.6%) used the domestic water project source, the quantities allowed per household (125 l which translates to an average of 20.8 l per person) were insufficient and therefore were supplemented with harvested rainwater (57.8%), water from a polluted river (17.8%), and water from a dam (2.2%). Increased water quantities have permitted more baths and washing of clothes and hands, but significant proportions of the population still skip hygienic practices such as keeping water for washing hands inside or near toilet facilities (40%) and washing hands (20%). The study concludes that the water supply project has permitted and improved hygienic practices but not sufficiently. The health benefits of safe domestic water supplies are hampered by insufficient quantities of water availed through the projects, possible contamination of the water in the house, poor hygienic behaviours and lack of appropriate sanitation measures by some households. There is a need to provide sufficient quantities of safe water
Ashkenazi, Malka; Yaish, Yaniv; Yitzhak, Moran; Sarnat, Haim; Rakocz, Meir
To investigate the extent to which a relationship may exist between nurses' own oral hygiene and their commitment and capability of following instructions for tooth brushing with conventional and triple-headed toothbrushes, to cerebral palsy (CP) children. The study included 43 individuals with CP and their 44 nurses. A structured questionnaire was designed to assess I. Demographic characteristics of the nurses II. Nurses' knowledge and maintenance of their own oral-hygiene and that of their CP patients. Nurses' ability to follow instruction for tooth-brushing was evaluated and scored using the TB-PS-I/Ashkenazi index following the first brushing, as well as on a recall visit one month later. More nurses (72.7%) reported routine tooth-brushing in the morning than in the evening (40.9%). Most nurses (73%) reported not flossing their teeth at all, and more than half reported visiting their dentist only when they suffer pain. A positive correlation was found between the nurses' knowledge of preventive oral measures and their compliance with their own oral hygiene and with that of their CP patients. Similarly, a positive correlation was found between nurses' receiving previous instruction for correct oral hygiene and their maintenance of their patients' oral hygiene. Institutions for CP patients should disseminate information on oral hygiene to staff, as a means of increasing their maintenance of their patients' oral health.
Olesov, E E; Shaĭmieva, N I; Kononenko, V I; Bersanov, R U; Monakova, N E
Periodontal status and oral hygiene indexes were studied in 125 young employee of Kurchatov Institute. Oral hygiene values dynamic was assessed after professional oral hygiene in persons with unsatisfactory oral hygiene at baseline examination. When compared with the same values in the absence of professional oral hygiene procedures the results allowed calculating cost-effectiveness rate for biannual professional oral hygiene.
Compliance assurance monitoring is intended to provide a reasonable assurance of compliance with applicable requirements under the Clean Air Act for large emission units that rely on pollution control device equipment to achieve compliance.
Robots are limited only by the dexterity of the hand. Dr. Salisbury, in conjunction with Stanford, Caltech and Jet Propulsion Laboratory, developed the Salisbury Hand which has three, three-jointed human-like fingers. The tips are covered with a resilient, high friction material for gripping. The robot hand can manipulate objects by finger motion, and adapts to different aims. Advanced software allows the hand to interpret information from fingertip sensors. Further development is expected. A company has been formed to reproduce the device; copies have been delivered to several laboratories.
Haxall, Katharine; Conway, Laurie; Kelly, Nicole; Stare, Dianne; Tropiano, Christina; Gilman, Allan; Seward, Samuel L.; Larson, Elaine
Background While several studies have documented the importance of hand washing in the university setting, the added role of environmental hygiene remains poorly understood. The purpose of this study was to characterize the personal and environmental hygiene habits of college students, define the determinants of hygiene in this population, and assess the relationship between reported hygiene behaviors, environmental contamination, and health status. Methods 501 undergraduate students completed a previously validated survey assessing baseline demographics, hygiene habits, determinants of hygiene, and health status. Sixty survey respondents had microbiological samples taken from eight standardized surfaces in their dormitory environment. Bacterial contamination was assessed using standard quantitative bacterial culture techniques. Additional culturing for coagulase-positive Staphylococcus and coliforms was performed using selective agar. Results While the vast majority of study participants (n = 461, 92%) believed that hand washing was important for infection prevention, there was a large amount of variation in reported personal hygiene practices. More women than men reported consistent hand washing before preparing food (p = .002) and after using the toilet (p = .001). Environmental hygiene showed similar variability although 73.3% (n = 367) of subjects reported dormitory cleaning at least once per month. Contamination of certain surfaces was common, with at least one third of all bookshelves, desks, refrigerator handles, toilet handles, and bathroom door handles positive for >10 CFU of bacteria per 4 cm2 area. Coagulase-positive Staphylococcus was detected in three participants' rooms (5%) and coliforms were present in six students' rooms (10%). Surface contamination with any bacteria did not vary by frequency of cleaning or frequency of illness (p>.05). Conclusions Our results suggest that surface contamination, while prevalent, is unrelated to
The traveler attended the International Workshop on Robot Hands at the Palace Hotel in Dubrovnik, Yugoslavia. The traveler presented a lecture on An integrated sensor system for the ORNL mobile robot.'' The traveler obtained important information on current R D efforts in multi-fingered robot hands and object recognition using touch sensing.
Oosthuysen, Jeanné; Potgieter, Elsa; Fossey, Annabel
Many publications are available on the topic of compliance with infection prevention and control in oral health-care facilities all over the world. The approaches of developing and developed countries show wide variation, but the principles of infection prevention and control are the same globally. This study is a systematic review and global perspective of the available literature on infection prevention and control in oral health-care facilities. Nine focus areas on compliance with infection-control measures were investigated: knowledge of infectious occupational hazards; personal hygiene and care of hands; correct application of personal protective equipment; use of environmental barriers and disposable items; sterilisation (recirculation) of instruments and handpieces; disinfection (surfaces) and housekeeping; management of waste disposal; quality control of dental unit waterlines, biofilms and water; and some special considerations. Various international studies from developed countries have reported highly scientific evidence-based information. In developed countries, the resources for infection prevention and control are freely available, which is not the case in developing countries. The studies in developing countries also indicate serious shortcomings with regard to infection prevention and control knowledge and education in oral health-care facilities. This review highlights the fact that availability of resources will always be a challenge, but more so in developing countries. This presents unique challenges and the opportunity for innovative thinking to promote infection prevention and control.
Tomasevic, Igor; Kuzmanović, Jelena; Anđelković, Aleksandra; Saračević, Miroslava; Stojanović, Marija M; Djekic, Ilija
A total of 48,246 microbiological test results were collected from 130 meat processing plants and 220 meat retail facilities over a seven year period: 41 months before and 43 months after HACCP implementation. Our results confirm a strong positive effect of mandatory HACCP implementation on process hygiene indicators in meat establishments. Significant reductions were observed in the number of hygiene indicator organisms on all types of surfaces examined and types of meat establishments investigated. The improvement of process hygiene was articulated as aerobic colony count reduction of at least 1.0 log10 CFU/cm(2) for food contact surfaces and over 2 log10 CFU/cm(2) for cooling facilities (refrigerators, freezers and other meat cooling devices). Meat handlers' hands hygiene was least positively affected. The period after mandatory HACCP implementation was also marked by a steady decline of positive Enterobacteriaceae and Staphylococcus samples. Process hygiene advances for meat processing plants and meat retail facilities were similar.
... En Español Making a Change – Your Personal Plan Hot Topics Am I in a Healthy Relationship? Who ... hands clean: Use warm water (not cold or hot). Use whatever soap you like. Antibacterial soaps are ...
Agarwal, Uma Shankar; Besarwal, Raj Kumar; Gupta, Rahul; Agarwal, Puneet; Napalia, Sheetal
Hand eczema is often a chronic, multifactorial disease. It is usually related to occupational or routine household activities. Exact etiology of the disease is difficult to determine. It may become severe enough and disabling to many of patients in course of time. An estimated 2-10% of population is likely to develop hand eczema at some point of time during life. It appears to be the most common occupational skin disease, comprising 9-35% of all occupational diseases and up to 80% or more of all occupational contact dermatitis. So, it becomes important to find the exact etiology and classification of the disease and to use the appropriate preventive and treatment measures. Despite its importance in the dermatological practice, very few Indian studies have been done till date to investigate the epidemiological trends, etiology, and treatment options for hand eczema. In this review, we tried to find the etiology, epidemiology, and available treatment modalities for chronic hand eczema patients. PMID:24891648
Pickering, Amy J; Davis, Jennifer; Boehm, Alexandria B
Handwashing education and promotion are well established as effective strategies to reduce diarrhea and respiratory illness in countries around the world. However, access to reliable water supplies has been identified as an important barrier to regular handwashing in low-income countries. Alcohol-based hand sanitizer (ABHS) is an effective hand hygiene method that does not require water, but its use is not currently recommended when hands are visibly soiled. This study evaluated the efficacy of ABHS on volunteers' hands artificially contaminated with Escherichia coli in the presence of dirt (soil from Tanzania) and cooking oil. ABHS reduced levels of E. coli by a mean of 2.33 log colony forming units (CFU) per clean hand, 2.32 log CFU per dirt-covered hand, and 2.13 log CFU per oil-coated hand. No significant difference in efficacy was detected between hands that were clean versus dirty or oily. ABHS may be an appropriate hand hygiene method for hands that are moderately soiled, and an attractive option for field settings in which access to water and soap is limited.
Latyshevskaia, N I; Strekalova, A S
In article necessity of development of new directions of researches--nanoecology (ecology of nanoindustry) and nanohygiene (hygiene of nanotechnologies and nanomaterials) is proved. On the basis of the spent review key ecological and hygienic problems of nanoindustrial development are systematized and also debatable questions are allocated. The conclusion is drawn on necessity of an intensification of studying of ecological and hygienic aspects of nanotechnologies and nanomaterials.
Fadner, Dawn E.
The American Industrial Hygiene Association (AIHA) is a society of professionals dedicated to the health and safety of workers and community. With more than 10,000 members, the AIHA is the largest international association serving occupational and environmental health professionals practicing industrial hygiene in private industry, academia, government, labor, and independent organizations. In 1973, AIHA developed a National Industrial Hygiene Laboratory Accreditation Program. The purposes of this program are shown.
Summarising, it can be stated that the disposal of carcases primarily represents a problem of epidemic hygiene but it also concerns fodder and food hygiene as well as the hygiene of waste water and air purity. Factories under the obligation to satisfy the sanitary demands mentioned and ensure low-cost operation at the same time, are occasionally confronted with great difficulties. In view of the present upward trend of the energy costs, these problems will not become less.
Reading once more the Gospels, we found a discussion between Jesus and the Pharisee about the hand washing, this golden rule of medicine, and then, with the help of Thomas Mann, we began a search for other notes on hygiene in the Bible. For the return from Egypt to the Promised Land, Moses established several rules for his people, some of them disguised as religious principles, concerning elimination of excreta, healthy and poisonous foods, isolation in case of contagious diseases (leprosy, gonorrhea), decontamination of clothes and houses, and many others that now seem to us ahead his time.
League for Innovation in the Community Coll., Los Angeles, CA.
A survey was conducted by the League for Innovation in the Community College and Johnson County Community College to determine the state of the dental hygiene profession. The study sought the opinions of all dental hygiene program administrators in the United States and Canada regarding the principal concerns facing dental hygiene education and…
Taylor, Jane A; Hayes, Melanie J; Wallace, Linda
While placements in external locations are being increasingly used in dental education globally, few studies have explored the student learning experience at such placements. The purpose of this study was to investigate student experiences while on external placement in a baccalaureate dental hygiene program. A self-reporting questionnaire was distributed to final-year dental hygiene students (n=77) at the University of Newcastle, Australia, in 2010. The questionnaire included questions regarding the type of placement, experiences offered, supervision, resources available, and lasting impressions. Responding students were generally positive about their external placement experience and indicated that the majority of facilities provided them with the opportunity to provide direct patient care and perform clinical tasks typical of a practicing hygienist. However, there was a statistically significant difference in their opinions about discipline-focused and community placements. Students indicated that their external placement experience provided opportunities to learn more about time and patient management, including hands-on experience with specific clinical tasks. Ongoing evaluations are necessary to ensure that external placements meet both student needs and intended learning outcomes within dental hygiene programs.
Borchgrevink, Carl P; Cha, JaeMin; Kim, SeungHyun
Many people do not wash their hands when the behavior in which they engage would warrant it. Most research of hand washing practices to date has taken place in high-traffic environments such as airports and public attraction venues. These studies have established a persistent shortcoming and a gender difference in hand washing compliance. Using field observations of 3,749 people in a college town environment, the research described in this article replicates and extends earlier work while identifying potential environmental and demographic predictors of hand washing compliance. Additionally, the authors' research suggests that proper hand washing practices, as recommended by the Centers for Disease Control and Prevention, are not being practiced. Finally, the authors' research raises a question as to the accuracy of earlier measurements of "proper" hand washing practices, suggesting that compliance rates are inflated. The results can help increase hand washing rates for the general public and thus decrease the risk of transmitting disease.
Cook, Heather A.; Cimiotti, Jeannie P.; Della-Latta, Phyllis; Saiman, Lisa; Larson, Elaine L.
Background The Centers for Disease Control and Prevention recommends the use of an alcohol-based handrub for health care worker hand hygiene. The purpose of this study was to examine effects of hand hygiene product and skin condition on the antimicrobial resistance patterns of colonizing hand flora among nurses. Methods Colonizing hand flora of 119 nurses working in 2 neonatal intensive care units was compared during a 22-month crossover study using alcohol handrub or antiseptic soap. Results Altogether, 1442 isolates from 834 hand cultures (mean, 7 cultures/nurse) were obtained. In 3 of 9 regression analyses modeling for resistant staphylococcal flora, the use of antiseptic soap was a significant predictor of resistance, and nurses with damaged skin were 2.79 times more likely to carry Staphylococcus warneri isolates resistant to gentamicin. Conclusion Hand hygiene product and skin condition may influence resistance patterns of hand flora of care providers. PMID:17482994
Hathaway, S C
Meat hygiene consists of three major activities: post-mortem inspection; monitoring and surveillance for chemical hazards; and maintenance of good hygienic practice throughout all stages between slaughter and consumption of meat. Risk analysis is an applied science of increasing importance to these activities in the following areas: facilitating the distribution of pre-harvest, harvest and post-harvest inspection resources, proportional to the likelihood of public health and animal health hazards; establishing internationally-harmonized standards and specifications which are consistent and science-based; and improving the safety and wholesomeness of meat and meat products in local and international trade. Risk analysis, in one form or another, is well developed with respect to establishing standards and specifications for chemical hazards; methods for risk analysis of post-mortem meat inspection programmes are beginning to emerge. However, risk analysis of microbiological hazards in meat and meat products presents particular difficulties. All areas of application currently suffer from a lack of international agreement on risk assessment and risk management methodology.
Dafydd, Hywel; Lin, Chih-Hung
Brachial plexus disruption, major traumatic amputations, and Volkmann's contracture are all devastating injuries that present difficult reconstructive challenges. Advances in our understanding of nerve injury, regeneration, and refinement of microsurgical techniques have given rise to a number of therapeutic avenues over the last 4 decades. Hand reanimation aims to provide strength, stability, and mobility to a sensate hand. How this is achieved depends on a thorough understanding of the underlying pathophysiology, which in turn dictates what surgical modalities are suitable. Common to all reanimation procedures is the need to ensure full passive range of motion of the target joints prior to definitive surgery. Hand therapy is essential to prevent deleterious sequelae of injury, and to maximize rehabilitation following surgical reconstruction. Options for reanimation include nerve repair, nerve grafting, nerve transfer, tendon transfer, and free functioning muscle transfer.
Schiele, Philippe; Le Nen, Dominique
Superficial and deep hand infections are frequent in general medical practice. Clinical examination is a crucial step for an adapted provided care. Most of the time, surgery is the only way to heal infections. However, in some cases (like bites), empiric antibiotherapy is first indicated to limit infection. Staphyloccocus aureus as well as Group Beta Streptococcus are the most frequently pathogenes associated with hand infections. Methicillin resistant S. Aureus must always be considered in the diagnoses. Whatever treatment is provided, clinical assessement must be repeated within two days. An early adaquated treatment prevent functional complications and in some cases death of the patients.
The industrial hygiene of heavy metals consists of recognition, evaluation, and control of exposures in the occupational environment. Several of these metals have been in use since ancient times. Reports of health effects and poisonings from overexposures also have a long history. This report discusses the industrial hygiene of the heavy metals, lead, cadmium, mercury, and manganese.
... Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE REGULATORY... Employee hygiene. (a) Cleanliness. All persons working in contact with product, food-contact surfaces, and product-packaging materials must adhere to hygienic practices while on duty to prevent adulteration...
... Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE REGULATORY... Employee hygiene. (a) Cleanliness. All persons working in contact with product, food-contact surfaces, and product-packaging materials must adhere to hygienic practices while on duty to prevent adulteration...
... Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE REGULATORY... Employee hygiene. (a) Cleanliness. All persons working in contact with product, food-contact surfaces, and product-packaging materials must adhere to hygienic practices while on duty to prevent adulteration...
Honey bees have been bred to express high levels of varroa sensitive hygiene (VSH), which is the removal of mite-infested pupae from capped worker brood. This hygienic behavior is a complex interaction of bees and brood in which brood cells sometimes are inspected, and then brood is either removed (...
Freĭman, E S
Railway radiation hygiene is a modern trend of research. The main problems in this sphere are as follows: hygienic assessment of utilization of railway sources in railway objects; safe transportation of radioactive agents; prevention of accidents in railway transport; radiobiological examinations of workers, etc.
Smith, Lowell W.
The purpose of this study, which was carried out during the 1972-73 school year at three parochial schools in the Houston area, was to determine the effectiveness of the Toothkeeper Program, a multimedia program of oral hygiene training carefully developed and packaged to establish effective long-term dental hygiene practice. The study population…
The objective of this Chemical Hygiene and Safety Plan (CHSP) is to provide specific guidance to all LBL employees and contractors who use hazardous chemicals. This Plan, when implemented, fulfills the requirements of both the Federal OSHA Laboratory Standard (29 CFR 1910.1450) for laboratory workers, and the Federal OSHA Hazard Communication Standard (29 CFR 1910.1200) for non-laboratory operations (e.g., shops). It sets forth safety procedures and describes how LBL employees are informed about the potential chemical hazards in their work areas so they can avoid harmful exposures and safeguard their health. Generally, communication of this Plan will occur through training and the Plan will serve as a the framework and reference guide for that training.
Infection is spread in hospital mainly by hands, making hand decontamination the most important means of preventing dissemination. There is some evidence to suggest that when access to hand-decontaminating agents is poor or the agents available are disliked, hands are washed too seldom, increasing risks of cross-infection. However, little attention has been paid to the use of towels and factors which promote their use, although it is known that damp hands transfer bacteria more readily than dry ones and that hands which become sore through poor drying have higher bacterial counts, contributing to the risk of cross-infection. This paper reports the results of the Nursing Times Hand Drying survey designed to assess nurses' access to hand decontamination agents and towels. The results suggest that the 112 nurses who participated were aware of the need for attention to hand hygiene but that access to both hand-decontaminating agents and paper towels was variable. Forty-one per cent complained of a shortage of soap and although nearly all used paper towels, these were in many cases of poor quality. Such towels were perceived as damaging to hands, leaving them feeling damp and sore. Good-quality, soft, paper towels were much appreciated by respondents in this sample. It is concluded that the quality of paper towels contributes to good infection control practice.
Tousman, Stuart; Arnold, Dani; Helland, Wealtha; Roth, Ruth; Heshelman, Nannatte; Castaneda, Oralia; Fischer, Emily; O'Neil, Kristen; Bileto, Stephanie
The purpose of this project was to determine if a multiple-week learner-centered hand washing program could improve hand hygiene behaviors of 2nd-graders in a northern Illinois public school system. Volunteers from the Rockford Hand Washing Coalition went into 19 different classrooms for 4 consecutive weeks and taught a learner-centered program.…
The article Next Generation Compliance by Cynthia Giles, Assistant Administrator for OECA was published in The Environmental Forum, Sept-Oct 2013 explains EPA's strategy on using new technologies to improve compliance with environmental laws.
Bishop, Michele R.; Kenzer, Amy L.; Coffman, Christine M.; Tarbox, Courtney M.; Tarbox, Jonathan; Lanagan, Taira M.
Routine toothbrushing is an essential part of good oral hygiene. This study investigated the use of stimulus fading without escape extinction to increase compliance with toothbrushing with three children with autism spectrum disorder (ASD). A 30-step stimulus fading hierarchy was implemented; gradually increasing the proximity of the toothbrush to…
, whereby ample contact time must be allowed for the disinfecting agent. Coarse contamination of the transducer should be removed with disposable tissue. Above all, dried blood spots should be avoided. Intraoperatively used transducers (= critical medical products), which, for instance, come in contact with abdominal organs, are subject to applicable rules and regulation for cleaning and disinfection. Before each use, an adequately long sterile cover must be placed over the transducer and connecting cable. When the examination is completed, the cover is removed and discarded, and the transducer cleaned and disinfected. The applicability of a reusable medical product implies that each manufacturer is obligated to provide care instruction, including formulated instructions for cleaning and disinfection. This entails that each manufacturer of sonographic equipment must make available a detailed summary of the appropriate disinfectants suitable for the respective transducers. Customarily, recommendations for care and cleaning of the transducers can be found in the manual that comes with the sonographic unit. In the absence of such a manual, a written request should be sent to the manufacturer of the sonographic equipment. Sonographic equipment manufacturers and disinfectant producers prefer disinfecting agents for instruments that are based on glutaraldehyde, aldehydes and quaternary agents, mostly for reason of material compatibility rather than their anti-infective effectiveness. Most recommended disinfectants are not tested for antiviral properties, but this is obligatory when applied to transducers that enter a body cavity potentially harboring a virus load - regardless whether the work is done with protective cover . Further information about the topic "medical products" can be found in the guidelines for hospital hygiene and infection prevention published by the Robert Koch Institute (Section: Required Hygienic Standards for Medical Products ), the website of the Robert
Schneider, J A; Dude, A; Dinaker, M; Kumar, V; Laumann, E O; Holloway-Beth, A; Oruganti, G; Saluja, G S; Chundi, V; Yeldandi, V; Mayer, K H
The relationships between hygiene, sexual behaviour and HIV infection are poorly understood. We examine these relationships in Indian truck drivers, a group at high risk for HIV infection. Truck drivers (n = 189) were recruited into an integrated HIV and hygiene Information Motivation (IM) programme. Sociodemographic characteristics, sexual and hygiene behaviour and HIV prevalence were determined. Multivariate logistic regression and linear generalized estimating equation models were utilized. At baseline, 2.1% of drivers were HIV infected and 34% who reported having contact with female sex workers (FSWs) had contact within the previous six months. Those who washed their hands postdefecation were less likely to report genital symptoms (OR 0.02; P = 0.01) and have sex with an FSW (OR [odds ratio] 0.21; P = 0.05). After an IM intervention, there were no changes in sexual risk-taking behaviour (coefficient -0.15 to -0.02; P = 0.13-0.75); however, hygiene behaviour improved from baseline (coefficient 0.09-0.31; P < 0.01 to P = 0.03). Personal hygiene habits, like handwashing, seem to be a modifiable behaviour after a modest intervention, whereas HIV risk-taking behaviour was not. The association between hygiene and HIV risk-taking suggests the need for further evaluation of the relationship and that of other hygiene practices in high-risk men in India.
Kerwat, Klaus; Wulf, Hinnerk
There is a plethora of laws, regulations, guidelines and recommendations relating to infection control and hygiene. Major issues are the prevention of nosocomial infections, staff protection and environmental protection. Of the highest relevance are the infection control law [Infektionsschutzgesetz (IfSG)], the hygiene regulations of the German federal states [Hygieneverordnungen der Bundesländer], the German technical rules for biological materials [Technische Regel Biologische Arbeitsstoffe 250 (TRBA 250)] - biological materials in health-care and welfare work [Biologische Arbeitsstoffe im Gesundheitswesen und in der Wohlfahrtspflege], the guidelines for hospital hygiene and prevention of infection of the commission for hospital hygiene and prevention of infection of the Robert-Koch Institute [Richtlinie für Krankenhaushygiene und Infektionsprävention von der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut], the recommendations of the commission on anti-infectives, resistance and therapy of the Robert-Koch Institute [Empfehlungen der Kommission Antiinfektiva, Resistenz und Therapie (ART) beim Robert Koch-Institut]. Of subordinate importance are, e.g., the recommendations of the German Society for Anesthesiology and Intensive Medicine (DGAI). It is practically impossible for an anesthesiologist working in a hospital to have knowledge of all laws, regulations, guidelines and recommendations. And this is also not reasonable. Thus it is necessary to distinguish the relevant from the irrelevant. Checklists can be useful here. The most important and effective individual action in hospital hygiene is and remains hand hygiene as is propagated in the action "clean hands", irrespective of all laws, regulations, guidelines and recommendations.
Hills, Laura Sachs
Can you tell your medical practice staff how you want them to look? Where in your office they can eat? Can they chew gum at work? Can they wear red nail polish or a charm bracelet? In the pages that follow, the author suggests not only that you can establish rules for employee dress and hygiene, but why you should. This article suggests several good ways to structure staff rules for wearing uniforms and street clothing. It also covers possible rules for wearing practice nametags, cosmetics, jewelry, hair styles, neatness, stowing of personal possessions, personal hygiene, drinking, eating, smoking, and gum chewing. Finally, this article offers practical suggestions for establishing your practice's dress and hygiene "first aid" kit as well as guidance for making your practice's dress and hygiene codes non-discriminatory.
Skin health is essential for well being in older people. Personal hygiene is fundamental to skin health, but a lack of evidence exists about effective practices. An evidence base, disseminated through nursing education and patient health promotion, must be developed.
... Health & Hygiene for Young Children Page Content Article Body As you might guess, the number-one dental problem among preschoolers is tooth decay . One out of 10 two- year-olds already have one or more cavities ...
Hobbs, Betty C.; Colbourne, M. J.; Mayner, P. E.
The incidence of gastroenteritis on a passenger ship is reviewed and discussed in relation to the agents of infection from stool specimens, the bacteriological condition of food samples, and the practice of galley hygiene. PMID:1208291
Journal of Dental Education, 1985
The American Association of Dental Schools curriculum guidelines for clinical dental hygiene include definitions, notes on the interrelationship of courses, an overview of course objectives, and suggested primary educational goals, prerequisites, core content, specific objectives, sequencing, faculty, and facilities. (MSE)
The legend about Parmentier is quite reductive when it limits his activity to the promotion of potato. This military pharmacist intended mainly to make science serve human being, whatever could be his various activities. Actor of the foundation of food chemistry, reorganizer of military pharmacy, he has always been highly concerned with hygiene and public health. He then studied the quality of water, particularly in the case of river Seine, or the purity of air, especially in hospitals. The affair of Dunkerque exhumations or that of cesspools, or the utilisation of human excrements in agriculture were parts of the occurrences for which he had the opportunity to find a scientific approach allowing to solve the difficult questions that were asked to him, for the best benefit of public health. The exhaustive study he published in "Bulletin de pharmacie" for the conservation of meat shows that he did not ignore anything about freezing of food in order to preserve it. It is necessary not to forget the important role he played, as soon as he were informed of Jenner's discovery, for the diffusion of vaccination in France. It is simply astounding to observe how modern were the questions he solved and how intense was his spirit of dedication to the public good, when exerting his functions in "Comité de Salubrité de la Seine" or "Conseil de Santé des Armées", as well as outside these prestigious institutions.
Kaptsov, V A
A unique Institute of Railway Hygiene was created 70 years ago in Russia, one of the major railway countries in the world. Since then the Institute's staffers have carried out huge work on improvement of railway workers' health, prevention of their exposure to noise, unfavorable microclimate, vibration and other occupational hazards. Significant contribution into the world occupational hygiene was made by such Institute's professionals as S.F. Kazansky, P.I. Nikitin, A.M. Volkov and others.
Cobban, Sandra J; Edgington, Eunice M; Clovis, Joanne B
Dental hygiene, as an emerging profession, needs to increase the number of intervention studies that identify improvements in oral health outcomes for clients. Historically, dental hygiene studies have typically been atheoretical, but the use of theoretical frameworks to guide these studies will increase their meaningfulness. Rogers' theory of diffusion of innovations has been used to study research utilization across many disciplines, and may offer insights to the study of research use in dental hygiene. Research use is an important component of evidence-based practice (EBP), and diffusion of research knowledge is an important process in implementing EBP. The purpose of this paper is to use diffusion of innovations theory to examine knowledge movement in dental hygiene, specifically through the example of the preventive practice of oral cancer screening by dental hygienists, considered as an innovation. Diffusion is considered to be the process by which an innovation moves through communication channels over time among a social network. We suggest diffusion theory holds promise for the study of knowledge movement in dental hygiene, but there are limitations including access to and understanding research studies as innovations. Nevertheless, using a theoretical framework such as Rogers' diffusion of innovations will strengthen the quality of intervention research in dental hygiene, and subsequently, health outcomes for clients.
Prokhorov, Kimberlee S.; Feldman, Brienne; Walker, Stephanie; Bruce, Rebekah
Hygiene is something that is usually taken for granted by those of us on the Earth. The ability to perform hygiene satisfactorily during long duration space flight is crucial for the crew's ability to function. Besides preserving the basic health of the crew, crew members have expressed that the ability to clean up on-orbit is vital for mental health. Providing this functionality involves more than supplying hygiene items such as soap and toothpaste. On the International Space Station (ISS), the details on where and how to perform hygiene were left to the crew discretion for the first seventeen increments. Without clear guidance, the methods implemented on-orbit have resulted in some unintended consequences to the ISS environment. This paper will outline the issues encountered regarding hygiene activities on-board the ISS, and the lessons that have been learned in addressing those issues. Additionally, the paper will address the resolutions that have been put into place to protect the ISS environment while providing the crew sufficient means to perform hygiene.
Curtis, V.; Kanki, B.; Cousens, S.; Diallo, I.; Kpozehouen, A.; Sangaré, M.; Nikiema, M.
OBJECTIVES: To determine whether a large, 3-year hygiene promotion programme in Bobo-Dioulasso, Burkina Faso, was effective in changing behaviours associated with the spread of diarrhoeal diseases. The programme was tailored to local customs, targeted specific types of behaviour, built on existing motivation for hygiene, and used locally appropriate channels of communication. METHODS: Two population surveys recorded the coverage of the programme among target audiences (mothers of children aged 0-35 months). Four surveys were carried out: three prior to the programme and one in 1998 (after the programme had been running for 3 years), using structured observation of hygiene behaviours in the participants' homes to document changes in target behaviours. FINDINGS: After the programme had run for 3 years, three-quarters of the mothers targeted had had contact with programme activities. Half could cite the two main messages of the programme correctly. Although the safe disposal of children's stools changed little between 1995 and 1998 (80% pre-intervention, 84% post-intervention), hand-washing with soap after cleaning a child's bottom rose from 13% to 31%. The proportion of mothers who washed their hands with soap after using the latrine increased from 1% to 17%. CONCLUSION: Hygiene promotion programmes can change behaviour and are more likely to be effective if they are built on local research and use locally appropriate channels of communication repeatedly and for an extended time. PMID:11436473
Maillet, J Peggy; Millar, A Michele; Burke, Jillian M; Maillet, Michelle A; Maillet, Wayne A; Neish, Nancy R
The chair-side work posture of dental hygienists has long been a concern because of health-related problems potentially caused or exacerbated by poor posture. The purpose of this study was to investigate if using magnification loupes improved dental hygiene students' posture during provision of treatment. The treatment chosen was hand-scaling, and the effect of the timing of introduction of the loupes to students was also examined. Thirty-five novice dental hygiene students took part in the study. Each student was assessed providing dental hygiene care with and without loupes, thus controlling for innate differences in natural posture. Students were randomized into two groups. Group one used loupes in the first session and did not use them for the second session. Group two reversed this sequence. At the end of each session, all students were videotaped while performing scaling procedures. Their posture was assessed using an adapted version of Branson et al.'s Posture Assessment Instrument (PAI). Four raters assessed students at three time periods for nine posture components on the PAI. A paired t-test compared scores with and without loupes for each student. Scores showed a significant improvement in posture when using loupes (p<0.0001), and these improvements were significantly more pronounced for students starting loupes immediately on entering the program compared with students who delayed until the second session (p<0.1). These results suggest a significant postural benefit is realized by requiring students to master the use of magnification loupes as early as possible within the curriculum.
That the use of modern technology against the laws of Nature must fail, has been clearly demonstrated again some years ago when sewage sludge postpasteurization was rashly introduced. Although many attempts were made to improve this procedure, it had to be abandoned because of unavoidable massive regrowth of pathogens which invaded the germ-free postpasteurized sludge. In contrast of postpasteurization, long-term large-scale tests with the pasteurization of fresh sludge (prepasteurization) have demonstrated that this procedure where methane digestion with its pathogen displacing effect constitutes the final stage, is basically able to function. With respect to the Swiss Sewage Sludge Decree which came into force in May 1981, and which imposes sludge hygienization for most applications throughout the year, various thermal prepasteurization methods have been offered on the market ready for application to meet the legally prescribed requirements. However, some of them still need selective improvements in order to ensure the desired hygienisation effect permanently. For some time now, attention has been focussed on a novel biological 2-stage procedure based on partial aerobic thermophilic fermentation followed by anaerobic sludge digestion which in addition to good hygienisation promises improved sludge thickening, reduced digestion time, more favourable energy consumption and added process stability etc. Although it has already been offered on the market, this interesting process is being thouroughly tested and optimized in parallel pilot tests plant at the WWTP Altenrhein. Finally, reference is made to further sludge treatment processes such as sludge drying and sludge composting which mostly comprise efficent sludge hygienisation although they may not entirely prevent pathogenic regrowth. Moreover, some unconventional and less popular processes such as liquid sludge irradiation and chemical methods are also mentioned.
Engeswick, Lynnette Marie
This study was conducted to discover the extent dental hygiene educators in 25 entry-level dental hygiene programs from the Upper Midwest demonstrate Emotional Resilience, Flexibility and Openness, Perceptual Acuity, and Personal Autonomy as they relate to their level of education and multicultural experiences. An additional purpose was to examine…
Grimason, Anthony Martin; Masangwi, Salule Joseph; Morse, Tracy Dawn; Jabu, George Christopher; Beattie, Tara Kate; Taulo, Steven Elias; Lungu, Kingsley
A study was undertaken to determine the efficacy of hygiene practices in 2 primary schools in Malawi. The study determined: (1) presence of Escherichia coli on the hands of 126 primary school pupils, (2) knowledge, awareness and hygiene practices amongst pupils and teachers and (3) the school environment through observation. Pupil appreciation of hygiene issues was reasonable; however, the high percentage presence of E. coli on hands (71%) and the evidence of large-scale open defaecation in school grounds revealed that apparent knowledge was not put into practice. The standard of facilities for sanitation and hygiene did not significantly impact on the level of knowledge or percentage of school children's hands harbouring faecal bacteria. Evidence from pupils and teachers indicated a poor understanding of principles of disease transmission. Latrines and hand-washing facilities constructed were not child friendly. This study identifies a multidisciplinary approach to improve sanitation and hygiene practices within schools.
Bloomfield, Sally F
Contrary to expectation, the risks of infection are growing rather than declining, even in everyday life. After all, who is able to make a distinction between cleanliness and hygiene? This situation is further compounded by the growing number of persons who are susceptible to infections. If one wants to combat infectious diseases in an economically feasible and consistent manner, public support must be sought. In turn, the public have a right to be informed in a proper and responsible manner. The difference between "dirt" and "contamination" must be highlighted once again.To create a forum for everyday hygiene, an international expert working group was set up (http://www.ifh-homehygiene.org). The hallmark of this group is its holistic view of hygiene in the family setting, something that is not true in the case of most public health sectors. Based on the latest study results, the International Forum for Hygiene (IFH) has coined a new motto "Selective Hygiene", and evaluates the causes of infection so as to be able to react in an appropriate manner. The aim cannot be routine, daily repetitive decontamination of all potentially dangerous microbes that are found in a normal household, but rather selective reaction to important transmission processes, i.e. hands and foodstuffs, kitchen, bathroom and toilet. The motto can be summarized as follows: "Do the right thing at the right time". This, however, calls for an understanding of the risks and of effective procedures for microbial reduction. Depending on the respective circumstances, hands can be washed with running water or by using a hand disinfectant. Even experts must learn that hygiene in the home must be evaluated differently from that of the hospital setting. The comparatively lower risk is offset by markedly less awareness of the risks involved. These risks can be significantly increased by any members of the household who are ill. Hence in some cases it is advisable to use disinfectants in the home too - even
Meckstroth, R L
A large percentage of the residents in long-term care facilities are unable to achieve an acceptable level of oral hygiene due to mental and physical incapacities and must thus rely on nursing staff for daily oral care. Significant morbidity is associated with chronic inadequate oral hygiene. In addition, a lack of self-esteem related to poor dental status has been observed in some nursing home patients, leading to withdrawal from social interaction and personal isolation. The Collis Curve toothbrush removed more plaque than the straight bristle toothbrush. The curved bristle toothbrush was well received by the residents and well accepted by the nursing staff. A clinically significant number of staff reported that the curved bristle toothbrush made their job easier. Monitoring of the nurses' aides' brushing techniques during the study caused them to provide more effective oral hygiene than prior to the study. The importance of proper oral hygiene must be monitored and supported by nursing supervisors, regardless of the type of brush, used to achieve acceptable levels of oral hygiene.
Lumens, M E; Ulenbelt, P; Géron, H M; Herber, R F
The impact of hygienic behaviour on the uptake of chromium has been studied in two small chromium plating factories. The correlation between the environmental monitoring measure (Cr-A) and the biological monitoring measure (Cr-U) varied between the two factories. In one factory (I) the correlation between Cr-U and Cr-A was 0.68 (P < 0.001), while in the other factory (II) it was negative (r = -0.64, P = 0.03). However, in both populations a significant impact of hygienic behaviour on the variance in Cr-U levels could be detected. In factory I, explained variance could be enhanced to R2 = 0.94 (P < 0.001) when considering expressions of hygienic behaviour. In factory II, a strong relation proved to exist between Cr-U and dermal uptake. For the various questions referring to skin problems and possible dermal uptake, the correlation with Cr-U is up to 0.70 (P = 0.03). When comparing the results for the two factories, it is shown that in addition to individual differences in hygienic behaviour, general hygienic conditions also have an impact on uptake of chromium. In factory II, where many efforts were made to prevent exposure to chromium, Cr-U was significantly lower than in factory I (P < 0.001).
Kamat, Maithili; Malkani, Ram
The use of disposable diapers has offered improved health care benefits. Urine and fecal matter leakage from the cloth nappies and the hand-to-mouth behavior in infants leads to many illnesses with a feco-oral mode of transmission. Also, the tender skin of the infant is more prone to nappy rash. The modern age disposable diapers, when compared to cloth nappy, have displayed a superior ability in containment of urine and feces, thereby reducing contamination and transmission of infection. Also disposable diapers contain Super Absorbent Material (SAM) that successfully reduces the incidence of nappy rash.
Background People living with HIV/AIDS have substantially greater need for water, sanitation, and hygiene. Encouraging hygiene education for People Living with HIV/AIDS in home based care services and additional support for the provision of water, sanitation, and hygiene services is recommended. Methods A cross-sectional study was carried during 2009 to assess water, sanitation status and hygiene practices and associated factors among People Living with HIV/AIDS in home based care services in Gondar city of Ethiopia. A systematic random sampling was used to select study subjects from 900 Home Based Care clients of People Living HIV/AIDS in Gondar city. Data was collected from 296 People Living with HIV/AIDS from two NGO’s in the city. For in-depth interview, four different categories were participated. Logistic regression and thematic framework analysis were performed for quantitative and qualitative part respectively. Results Two hundred ninety four subjects (72.8% (214) females and 27.2% (80) males) were studied. The mean age was 35.8 ± 8.7 years. In the study, 42.9% (126) of the households have unimproved water status, 67% (197) of the households have unimproved sanitation status, and 51.7% (152) of the households have poor hygienic practice. Diarrhoea with water status; educational status and latrine availability with sanitation status; and hand washing device availability and economical reasons for the affordability of soap with hygienic practice were significantly associated. Economical reasons and hygiene education were factors that affect water, sanitation, and hygienic practice. Stigma and discrimination were minimized as a factor in the study area. Conclusions There is high burden of water, sanitation and hygiene in people living HIV/AIDS in home based care services. Encouraging hygiene education for people living HIVAIDS in home based care services and additional support for the provision of water, sanitation, and hygiene services is recommended
Saito, A; Sato, Y; Nakamura, A; Nozawa, H; Haneta, M; Matsumoto, S; Cathcart, G
This paper reports the development of an international dental hygiene educational programme between Japan and Canada, and the evaluation of its outcomes. In 2004, a unique collaborative programme with Canadian dental hygiene schools was introduced as part of a 3-year dental hygiene curriculum. This international programme mainly consists of three parts: a spring (full Japanese faculty and student exchange to Canada), fall (select Japanese faculty and student exchange to Canada for focused professional development) and summer (select Canadian student exchange to Japan) component. The spring component provides an opportunity for all Japanese students to visit the Canadian dental hygiene schools at the end of their second year. Students and faculty members share information about their programmes and culture through instructional presentations, chair-side hands-on clinical simulations, and table clinic presentations. For the fall component, selected Japanese students and faculty re-visit the Canadian school for more extensive learning and exchange with Canadian students. Workshops are held for faculty on educational and research topics. For the summer component, selected second year Canadian students visit Japan. The Japanese students' basic knowledge of Canada and Canadian dental hygiene showed statistically significant improvement (P < 0.001) as assessed by pre- and post-tests. Other programme evaluations including faculty and students' surveys have so far identified positive outcomes in learning and research. The programme has offered opportunities for faculty professional development and joint research projects. In conclusion, the findings reported here demonstrate that incorporation of the international collaborative programme can be a significant addition to dental hygiene education.
In Italy, the year 1946 was characterized, on one hand, by the growing concern for the lack of public structures and, on the other, by the hopes placed in the research sector, namely the apparently inexhaustible properties of penicillin and antibiotics. Consistently, Igiene e Sanità Pubblica reflected the general mood of the hygienists, swinging between the strong protests against a far too slow political system incapable of spurring scientific research, and the constant engagement aimed at enhancing the future role of public health. Besides facing many institutional problems, such as claiming an official recognition for their profession, hygienists also managed to make Italians understand the real value of a discipline conceived for the community service.
Virji, M Abbas; Woskie, Susan R; Pepper, Lewis D
A 2005 regulatory review of the lead in construction standard by the Occupational Safety and Health Administration (OSHA) noted that alternative pathways of exposure can be as significant as inhalation exposure and that noncompliance with the standard pertaining to hygiene facilities and practices was the second most commonly violated section of the standard. Noncompliance with provisions of the standard and unhealthy work and hygiene practices likely increase the likelihood of take-home lead via contaminated clothing, automobiles, and skin, thus contributing to elevated blood lead levels (BLL) among construction workers and their family members. We performed a cross-sectional study of bridge painters working for small contractors in Massachusetts to investigate causes of persistent elevated BLLs and to assess lead exposures. Thirteen work sites were evaluated for a 2-week period during which surface and skin wipe samples were collected and qualitative information was obtained on personal hygiene practices, decontamination and hand wash facilities, and respiratory protection programs. Results showed lead contamination on workers' skin, respirators, personal automobiles, and the decontamination unit, indicating a significant potential for take-home lead exposure. Overall, the geometric mean (GM) skin lead levels ranged from 373 microg on workers' faces at end of shift to 814 microg on hands at break time. The overall GM lead level inside respirators was 143 microg before work and 286 microg after work. Lead contamination was also present inside workers' personal vehicles as well as on surfaces inside the clean side of the decontamination unit. Review of the respiratory protection programs, work site decontamination and hand wash facilities, and personal hygiene practices indicated that these factors had significant impact on skin and surface contamination levels and identified significant opportunities for improving work site facilities and personal practices
Uzunova, S; Iordanova, I; Baĭnova, A; Tachev, A; Ivanov, T
The purpose of the study is to establish hygienic properties of the new preparations for intensive washing and their effect on the skin of man. Examinations are performed on 5 new washing preparations from firm "Verila": "Linda" (from the producer and from the trade network from the country--Ruse, Blagoevgrad, Stara Zagora, Pleven, Cherven Bryag, Plovdiv and Dobrich), recipe No 1, 2, 3 and 4. Sanitary and chemical examinations are carried out: organoleptic indices, nonionogenic surface active substances, total content of surface active substances, content of carbamide, sodium carbonate, ammonium nitrate, formaldehyde and free alkali. Investigations are made on 125 volunteers for skin irritative and allergenic effect, with epicutaneous test before and after 30-day washing--respectively with 0.5% and 2% and with 5% and 20% of the washing preparations. The results point out the absence of ammonium nitrate and formaldehyde and compliance with the content of the composition of the declared expenditure norms (except of "Linda" from the trade network of the country). There are no reactions of skin irritation and allergy in neither of the subjects with all washing preparations. Recommendations are given to the producer for observing the technological discipline and requirements to the packings.
North Seattle Community Coll., WA.
The goal of the Chemical Hygiene Plan (CHP), created by North Seattle Community College, is to provide an environment that protects and promotes health and safety and complies with health and safety laws. The CHP focuses especially on the laboratory workplace (biology and chemistry), as many hazardous materials can be found there. Employee…
Tanner, Floyd R.; And Others
Text, illustrations, and exercises are utilized in this set of five learning modules to instruct dental patients and the general public in the fundamental principles of dental hygiene. The first module, "Identify the Responsibilities for Your Oral Health" by Floyd R. Tanner, discusses the respective roles of the dentist and the patient…
Broĭtman, V I
Workers engaged in reclamation construction are exposed to dust and chemical agents, appearing in the air during the work. Vibration, noise, meteorologic conditions overmatch the normal parameters. Immunologic status is changed, transitory disablement incidence is high, occupational diseases occur. Hygienic measures for this population are recommended and put into practice.
New York State Education Dept., Albany. Office of the Professions.
The laws, rules and regulations of the New York State Education Department governing dentistry and dental hygiene practice in the state are presented. In addition, the requirements and procedures for obtaining licensure and first registration as a dentist and dental hygienist in New York are discussed. The following chapters are provided: (1)…
Kreps, Alice Roelofs; Dreith, Rita Vallero
One of twenty course guides in the Community Living Skills Guide for the College for Living series, this document provides guidelines and workbook activities for the course, Looking Good: Hygiene. The series of courses for developmentally disabled adults is intended to supplement residential programs and to aid in orienting institutionalized…
Boyd, Linda D.; Fun, Kay; Madden, Theresa E.
Two hours of tobacco instructions were incorporated into the baccalaureate dental hygiene curricula in a university in the Northwestern United States. Prior to graduation, all senior students were invited to complete anonymously a questionnaire surveying attitudes and clinical skills in providing tobacco services to their clinic patients. Twenty…
American Dental Hygienists' Association, Chicago, IL.
A prospectus providing a rational basis for decision and action in the field of dental hygiene is presented, noting that all occupations are obliged to assess their value to society and take whatever actions are indicated to fulfill their social contract. A philosophical and conceptual foundation for change is examined. Three chapters focus on the…
This instructor's packet accompanies the learning activity package (LAP) on oral hygiene. Contents included in the packet are a time sheet, suggested uses for the LAP, an instruction sheet, final LAP reviews, a final LAP review answer key, suggested activities, additional resources (student handouts), student performance checklists for both…
Devries, T J; Aarnoudse, M G; Barkema, H W; Leslie, K E; von Keyserlingk, M A G
Poor dairy cow hygiene has been consistently associated with elevated somatic cell count (SCC) and the risk of subclinical mastitis. The objective of this study was to determine the associations between dairy cow standing and lying behavior, barn hygiene, cow hygiene, and the risk of experiencing elevated SCC. Lactating Holstein dairy cows (n=69; 86 ± 51 DIM; parity: 2.0 ± 1.2; means ± SD), kept in 1 of 2 groups, were monitored over a 4-mo period. Each group contained 61 ± 1 (mean ± SD) cows over the study period; complete data were obtained from 37 and 32 animals within each respective group. Cows were housed in a sand-bedded, freestall barn with 2 symmetrical pens, each with a free cow traffic automatic milking system. To vary barn hygiene, in 4 consecutive 28-d periods, alley manure scrapers in each of the 2 pens were randomly assigned to frequencies of operation of 3, 6, 12, and 24 times per day. During the last 7 d of each period, cow hygiene (upper leg/flank, lower legs, and udder; scale of 1 = very clean to 4 = very dirty) and stall hygiene (number of 0.15×0.15-m squares contaminated with manure in a 1.20×1.65-m grid) were recorded. Standing and lying behavior of the cows were collected during those days using data loggers. Individual-cow SCC was recorded at the beginning and end of each 28-d period. Elevated SCC was used as an indicator of subclinical mastitis; incidence of elevated SCC was defined as having a SCC >200,000 cells/mL at the end of each 28-d period, when SCC was <100,000 cells/mL at the beginning of the period. Less frequent scraping of the barn alleys was associated with cows having poorer hygiene. Poor udder hygiene was associated with poor stall hygiene. Longer lying duration was associated with poor hygiene of the upper legs/flank and udder. Greater premilking standing duration was associated with poor udder hygiene and decreased frequency of lying bouts was associated with poor hygiene of the lower legs. Higher milk yield was
Brown, Franklin C; Buboltz, Walter C; Soper, Barlow
College students are known for their variable sleep schedules. Such schedules, along with other common student practices (e.g., alcohol and caffeine consumption), are associated with poor sleep hygiene. Researchers have demonstrated in clinical populations that improving sleep hygiene knowledge and practices is an effective treatment for insomnia. However, researchers who have examined relationships between sleep hygiene and practices in nonclinical samples and overall sleep quality have produced inconsistent findings, perhaps because of questionable measures. In this study, the authors used psychometrically sound instruments to examine these variables and to counter the shortcomings in previous investigations. Their findings suggest that knowledge of sleep hygiene is related to sleep practices, which, in turn, is related to overall sleep quality. The data from their regression modeling indicated that variable sleep schedules, going to bed thirsty, environmental noise, and worrying while falling asleep contribute to poor sleep quality.
Sifuentes, Laura Y; Koenig, David W; Phillips, Ronnie L; Reynolds, Kelly A; Gerba, Charles P
The goals of this study were to observe the spread of viruses in a hotel setting and to assess the effectiveness of a hygiene intervention in reducing their spread. Selected fomites in one hotel room were inoculated with bacteriophage ϕx-174, and fomites in a conference center within the same hotel were inoculated using bacteriophage MS2. Cleaning of the contaminated room resulted in the spread of viruses to other rooms by the housekeeping staff. Furthermore, viruses were transferred by hotel guests to the conference center and a communal kitchen area. Additionally, conference attendees transferred viruses from the conference center to their hotel rooms and a communal kitchen area. This study demonstrated how viruses can be spread throughout a hotel setting by both housekeepers and guests. A hygiene intervention, which included providing hand hygiene products and facial tissues to the guests and disinfecting solutions with disposable wipes to the housekeeping staff, was successful in reducing the spread of viruses between the hotel guest rooms and conference center. The hygiene intervention resulted in significantly reduced transfer of the ϕx-174 between the contaminated hotel room and other hotel rooms, communal areas, and the conference center (p = 0.02).
Purpose. This review was done to explore the impact of water treatment, hygiene, and sanitary interventions on improving child health outcomes such as absenteeism, infections, knowledge, attitudes, and practices and adoption of point-of-use water treatment. Methods. A literature search was conducted using the databases PubMed and Google scholar for studies published between 2009 and 2012 and focusing on the effects of access to safe water, hand washing facilities, and hygiene education among school-age children. Studies included were those that documented the provision of water and sanitation in schools for children less than 18 years of age, interventions which assessed WASH practices, and English-language, full-text peer reviewed papers. Results. Fifteen studies were included in the final analysis. 73% (n = 11) of the studies were conducted in developing countries and were rural based (53%, n = 8). The child's age, gender, grade level, socioeconomic index, access to hygiene and sanitary facilities, and prior knowledge of hygiene practices were significantly associated with the outcomes. Nutrition practices which are key factors associated with the outcomes were rarely assessed. Conclusion. Further research is required to assess the long-term impact of such interventions in different settings. PMID:24454415
Jordan D'Ambrisi, Kathleen M.
Dental hygiene education has evolved over the years from dental hygiene professions who provide patient education on oral health care to assuming the responsibility for the assimilation of knowledge that requires judgment, decision making and critical thinking skills. Given that the dental hygiene professions has moved toward evidence-based,…
Al Toufailia, Hasan; Alves, Denise A; Bento, José M S; Marchini, Luis C; Ratnieks, Francis L W
Social insects have many defence mechanisms against pests and pathogens. One of these is hygienic behaviour, which has been studied in detail in the honey bee, Apis mellifera Hygienic honey bee workers remove dead and diseased larvae and pupae from sealed brood cells, thereby reducing disease transfer within the colony. Stingless bees, Meliponini, also rear broods in sealed cells. We investigated hygienic behaviour in three species of Brazilian stingless bees (Melipona scutellaris, Scaptotrigona depilis, Tetragonisca angustula) in response to freeze-killed brood. All three species had high mean levels of freeze-killed brood removal after 48 h ∼99% in M. scutellaris, 80% in S. depilis and 62% in T. angustula (N=8 colonies per species; three trials per colony). These levels are greater than in unselected honey bee populations, ∼46%. In S. depilis there was also considerable intercolony variation, ranging from 27% to 100% removal after 2 days. Interestingly, in the S. depilis colony with the slowest removal of freeze-killed brood, 15% of the adult bees emerging from their cells had shrivelled wings indicating a disease or disorder, which is as yet unidentified. Although the gross symptoms resembled the effects of deformed wing virus in the honey bee, this virus was not detected in the samples. When brood comb from the diseased colony was introduced to the other S. depilis colonies, there was a significant negative correlation between freeze-killed brood removal and the emergence of deformed worker bees (P=0.001), and a positive correlation with the cleaning out of brood cells (P=0.0008). This shows that the more hygienic colonies were detecting and removing unhealthy brood prior to adult emergence. Our results indicate that hygienic behaviour may play an important role in colony health in stingless bees. The low levels of disease normally seen in stingless bees may be because they have effective mechanisms of disease management, not because they lack diseases.
Alves, Denise A.; Bento, José M. S.; Marchini, Luis C.; Ratnieks, Francis L. W.
ABSTRACT Social insects have many defence mechanisms against pests and pathogens. One of these is hygienic behaviour, which has been studied in detail in the honey bee, Apis mellifera. Hygienic honey bee workers remove dead and diseased larvae and pupae from sealed brood cells, thereby reducing disease transfer within the colony. Stingless bees, Meliponini, also rear broods in sealed cells. We investigated hygienic behaviour in three species of Brazilian stingless bees (Melipona scutellaris, Scaptotrigona depilis, Tetragonisca angustula) in response to freeze-killed brood. All three species had high mean levels of freeze-killed brood removal after 48 h ∼99% in M. scutellaris, 80% in S. depilis and 62% in T. angustula (N=8 colonies per species; three trials per colony). These levels are greater than in unselected honey bee populations, ∼46%. In S. depilis there was also considerable intercolony variation, ranging from 27% to 100% removal after 2 days. Interestingly, in the S. depilis colony with the slowest removal of freeze-killed brood, 15% of the adult bees emerging from their cells had shrivelled wings indicating a disease or disorder, which is as yet unidentified. Although the gross symptoms resembled the effects of deformed wing virus in the honey bee, this virus was not detected in the samples. When brood comb from the diseased colony was introduced to the other S. depilis colonies, there was a significant negative correlation between freeze-killed brood removal and the emergence of deformed worker bees (P=0.001), and a positive correlation with the cleaning out of brood cells (P=0.0008). This shows that the more hygienic colonies were detecting and removing unhealthy brood prior to adult emergence. Our results indicate that hygienic behaviour may play an important role in colony health in stingless bees. The low levels of disease normally seen in stingless bees may be because they have effective mechanisms of disease management, not because they lack
Bloomfield, SF; Stanwell-Smith, R; Crevel, RWR; Pickup, J
Summary The ‘hygiene hypothesis’ as originally formulated by Strachan, proposes that a cause of the recent rapid rise in atopic disorders could be a lower incidence of infection in early childhood, transmitted by unhygienic contact with older siblings. Use of the term ‘hygiene hypothesis’ has led to several interpretations, some of which are not supported by a broader survey of the evidence. The increase in allergic disorders does not correlate with the decrease in infection with pathogenic organisms, nor can it be explained by changes in domestic hygiene. A consensus is beginning to develop round the view that more fundamental changes in lifestyle have led to decreased exposure to certain microbial or other species, such as helminths, that are important for the development of immunoregulatory mechanisms. Although this review concludes that the relationship of the hypothesis to hygiene practice is not proven, it lends strong support to initiatives seeking to improve hygiene practice. It would however be helpful if the hypothesis were renamed, e.g. as the ‘microbial exposure’ hypothesis, or ‘microbial deprivation’ hypothesis, as proposed for instance by Bjorksten. Avoiding the term ‘hygiene’ would help focus attention on determining the true impact of microbes on atopic diseases, while minimizing risks of discouraging good hygiene practice. PMID:16630145
The Guide is intended to assist Department of Energy personnel by providing information on the NEPA process, the processes of other environmental statutes that bear on the NEPA process, the timing relationships between the NEPA process and these other processes, as well as timing relationships between the NEPA process and the development process for policies, programs, and projects. This information should be helpful not only in formulating environmental compliance plans but also in achieving compliance with NEPA and various other environmental statutes. The Guide is divided into three parts with related appendices: Part I provides guidance for developing environmental compliance plans for DOE actions; Part II is devoted to NEPA with detailed flowcharts depicting the compliance procedures required by CEQ regulations and Department of Energy NEPA Guidelines; and Part III contains a series of flowcharts for other Federal environmental requirements that may apply to DOE projects.
Gramacho, Kátia Peres; Gonçalves, Lionel Segui; Stort, Antônio Carlos; Noronha, Adriana Backx
Hygienic behavior is a desirable trait in honey bees (Apis mellifera L.), as hygienic bees quickly remove diseased brood, interrupting the infectious cycle. Hygienic lines of honey bees appear to be more sensitive to the odors of dead and diseased honey bee brood, and Africanized honey bees are generally more hygienic than are European honey bees. We compared the number of sensilla placodea, antennal sensory structures involved in the perception of odor, in 10 bees from each of six hygienic and four non-hygienic colonies of Africanized honey bees. The sensilla placodea of three of the terminal segments (flagellomeres) of the right antenna of each bee were counted with a scanning electron microscope. There were no significant differences in the mean numbers of sensilla placodea between the hygienic and non-hygienic bees, though the variance was higher in the hygienic group. Flagellomere 4 had significantly more sensilla placodea than flagellomeres 6 and 8. However, there was no significant difference between the other two flagellomeres. As hygienic bees are capable of identifying dead, injured, or infested brood inside a capped brood cell, sensilla placodea probably have an important role in enabling worker bees to sense sick brood. However, we did not find greater numbers of this sensory structure in the antennae of hygienic, compared to non-hygienic Africanized honey bees.
Lutsky, Kevin; Kim, Nayoung; Medina, Juana; Maltenfort, Mitchell; Beredjiklian, Pedro K
The goals of this study were to (1) assess how frequently patients present for evaluation of common hand disorders in relation to hand dominance and (2) evaluate the effect of hand dominance on function in patients with these conditions. The authors hypothesized that (1) the majority of patients who seek evaluation would have a condition that affects the dominant hand, and (2) disability scores would be worse if the dominant hand is involved. They retrospectively reviewed the records of consecutive patients who presented for treatment to their institution with unilateral symptoms of 5 common disorders of the hand: carpal tunnel syndrome (CTS), de Quervain's tenosynovitis (DEQ), lateral epicondylitis (LE), hand osteoarthritis (OA), and trigger finger (TF). The authors assessed the effect of diagnosis and hand dominance on Disabilities of the Arm, Shoulder and Hand (DASH) scores. The study group comprised 1029 patients (379 men and 650 women) with a mean age of 59.5 years. Ninety percent were right-hand dominant. The dominant and nondominant hands were affected with relatively equal frequency for CTS, DEQ, OA, and TF (range, 45%-53%). Patients with LE had a significantly higher incidence of dominant hand involvement. Men had lower DASH scores than women by an average of 7.9 points, and DASH scores were significantly but slightly higher for the overall group (3.2 points) when the dominant side was affected. Men with LE and women with TF and OA had significantly higher DASH scores when their dominant extremity was affected. Common hand disorders such as CTS, DEQ, OA, and TF affect the dominant and nondominant hands in roughly equivalent proportions, whereas LE is more common on the dominant side. Dominant hand involvement results in significantly worse DASH scores, although the magnitude of this is relatively small. Women have significantly higher DASH scores than men for the conditions evaluated. [Orthopedics. 2016; 39(3):e444-e448.].
Kramer, Axel; Below, Harald; Bieber, Nora; Kampf, Guenter; Toma, Cyril D; Huebner, Nils-Olaf; Assadian, Ojan
Background Despite the increasing promotion of alcohol-based hand rubs and the worldwide use of ethanol-based hand rubs in hospitals only few studies have specifically addressed the issue of ethanol absorption when repeatedly applied to human skin. The aim of this study was to assess if ethanol absorption occurs during hygienic and surgical hand disinfection using three different alcohol-based hand-rubs, and to quantify absorption levels in humans. Methods Twelve volunteers applied three hand-rubs containing 95% (hand-rub A), 85% (hand-rub B) and 55% ethanol (hand-rub C; all w/w). For hygienic hand disinfection, 4 mL were applied 20 times for 30 s, with 1 minute break between applications. For surgical hand disinfection, 20 mL of each hand rub was applied to hands and arms up to the level of the elbow 10 times for 3 minutes, with a break of 5 minutes between applications. Blood concentrations of ethanol and acetaldehyde were determined immediately prior and up to 90 minutes after application using head space gas chromatography. Results The median of absorbed ethanol after hygienic hand disinfection was 1365 mg (A), 630 mg (B), and 358 mg (C). The proportion of absorbed ethanol was 2.3% (A), 1.1% (B), and 0.9% (C). After surgical hand disinfection, the median of absorbed ethanol was 1067 mg (A), 1542 mg (B), and 477 mg (C). The proportion of absorbed ethanol was 0.7% (A), 1.1% (B), and 0.5% (C). The highest median acetaldehyde concentration after 20 hygienic hand disinfections was 0.57 mg/L (hand-rub C, after 30 min), after 10 surgical hand disinfections 3.99 mg/L (hand-rub A, after 20 minutes). Conclusion The overall dermal and pulmonary absorption of ethanol was below toxic levels in humans and allows the conclusion that the use of the evaluated ethanol-based hand-rubs is safe. PMID:17927841
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Chapped hands can be sore and painful. Chapped hands may be soothed by the use of moisturizing lotions and the avoidance of excess exposure to water. If hands become badly chapped, hydrocortisone creams (available over the ...
... Arthritis Thumb Sprains Trigger Finger Tumors Wrist Fracture Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin ... A-Z Videos Infographics Symptom Picker Anatomy About Hand Surgery What is a Hand Surgeon? What is ...
... this page: //medlineplus.gov/ency/presentations/100142.htm Hand splint - series—Indications To use the sharing features ... out of 4 Overview To begin making a hand dressing, place the injured hand around a cloth ...
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Detry, Jean G; Sindic, Marianne; Deroanne, Claude
Hygiene is a permanent concern for food industries since they must commercialize high quality products in order to comply with the legislation and the expectations of the consumers. The hygienic state of a surface is thus a critical parameter with respect to the performances of the production process and to the final quality of the product. For this reason, cleaning and disinfection are essential. However, the efficiency of the cleaning process will not only depend on the optimization of the process by itself and on the equipment design but also on the characteristics of the soiled surface i.e. mainly its roughness, surface chemical composition, and surface energy. The relation between these parameters and the cleanability are presented here, mainly for food applications. Some examples of existing easy-to-clean and self-cleaning surfaces based on the modification of these surface parameters are also presented.
Batista, Leonardo M; Portela de Oliveira, Millena Teles; Magalhaes, Wilrama B; Bastos, Poliana Lima
Parkinson's disease is a chronic progressive neurodegenerative disorder with a multifactorial etiology. The symptoms are characterized by motor disorders - tremor, rigidity, bradykinesia and postural instability, which hinder oral hygiene. Oral and dental health in Parkinson's disease has been under-documented and findings are conflicting. Moreover, a number of dentists have limited experience regarding the management of these patients. This article reviews literature published within the last fifteen years, to better understand the impact of this disease in oral health. A literature search (MEDLINE and PUBMED), using keywords Parkinson Disease and Oral Hygiene, yielded 27 articles, from which 20 were selected. All of the articles were published in English in the last 15 years.
Skin problems due to the use of absorbent hygiene products, such as diapers, incontinence pads, and feminine sanitary articles, are mostly due to climate or chafing discomfort. If these conditions are allowed to prevail, these may develop into an irritant contact dermatitis and eventually superficial skin infections. Skin humidity and aging skin are among the most significant predisposing and aggravating factors for dermatitis development. Improved product design features are believed to explain the decline in observed diaper dermatitis among infants. Where adult incontinence-related skin problems are concerned, it is very important to apply a holistic perspective to understand the influences due to the individual's incontinence level and skin condition, as well as the hygiene and skin care measures provided. Individuals with frail, sensitive skin or with skin diseases may preferably have to use high-quality products, equipped with superabsorbent polymers and water vapor-permeable back sheets, to minimize the risk of skin complications.
Kampf, G; Rudolf, M; Labadie, J-C; Barrett, S P
excellent acceptance by healthcare workers it may significantly improve compliance for hand hygiene and thereby help to reduce the incidence of nosocomial infection.
Hellwig, E; Lussi, A
Acidic or EDTA-containing oral hygiene products and acidic medicines have the potential to soften dental hard tissues. The low pH of oral care products increases the chemical stability of some fluoride compounds, favors the incorporation of fluoride ions in the lattice of hydroxyapatite and the precipitation of calcium fluoride on the tooth surface. This layer has some protective effect against an erosive attack. However, when the pH is too low or when no fluoride is present these protecting effects are replaced by direct softening of the tooth surface. Xerostomia or oral dryness can occur as a consequence of medication such as tranquilizers, anti-histamines, anti-emetics and anti-parkinsonian medicaments or of salivary gland dysfunction e.g. due to radiotherapy of the oral cavity and the head and neck region. Above all, these patients should be aware of the potential demineralization effects of oral hygiene products with low pH and high titratable acids. Acetyl salicylic acid taken regularly in the form of multiple chewable tablets or in the form of headache powder as well chewing hydrochloric acids tablets for treatment of stomach disorders can cause erosion. There is most probably no direct association between asthmatic drugs and erosion on the population level. Consumers, patients and health professionals should be aware of the potential of tooth damage not only by oral hygiene products and salivary substitutes but also by chewable and effervescent tablets. Additionally, it can be assumed that patients suffering from xerostomia should be aware of the potential effects of oral hygiene products with low pH and high titratable acids.
Johnson, P M
Occupational regulation of health personnel is important to professional associations and their members, the public that relies on their services and the regulatory agencies responsible for their conduct. There is increasing interest in ensuring that dental hygiene regulation fosters the continuing evolution of the profession and its contribution to oral health. The keynote address for the 2007 Regulatory Forum on Dental Hygiene, this paper discusses the rationale for and issues pertaining to occupational regulation, outlines the evolvement of dental hygiene and identifies regulatory options for the profession. Professional regulation exists to ensure public safety, health and welfare. However, negative political-economic side effects coupled with environmental pressures have resulted in increased scrutiny for health professionals. One such profession is dental hygiene. Its evolution has been dramatic, in particular over the past few decades, as illustrated by its rapidly increasing numbers and broader distribution globally, gradual shift to the baccalaureate as the entry-level educational requirement and increase in postgraduate programs and expanding scope of practice and increased professional autonomy. Regulatory changes have been more gradual. Regulation is mandatory for the vast majority of dental hygienists. Of the options available, the practice act - the most rigorous type, is predominant. Globally, regulation tends to be administered directly by the government (n = 9 countries) more so than indirectly through a dental board (n = 4) or self-regulation (n = 3). Whether regulated directly or indirectly, dental hygienists increasingly are seeking a greater role in shaping their professional future. Self-regulation, its responsibilities, misperceptions and challenges, is examined as an option.
Bhardwaj, Praveen; Sabapathy, S. Raja
Cerebral palsy is the musculoskeletal manifestation of a nonprogressive central nervous system lesion that usually occurs due to a perinatal insult to the brain. Though the cerebral insult is static the musculoskeletal pathology is progressive. Some patients with cerebral palsy whose hands are affected can be made better by surgery. The surgical procedures as such are not very technically demanding but the assessment, decision-making, and selecting the procedures for the given patient make this field challenging. When done well, the results are rewarding not only in terms of improvement in hand function but also in appearance and personal hygiene, which leads to better self-image and permits better acceptance in the society. This article focuses on the clinical examination, patient selection, and decision-making while managing these patients. PMID:22022045
Qorbani, Mostafa; Kelishadi, Roya; Djalalinia, Shirin; Motlagh, Mohammad Esmaeil; Kasaeian, Amir; Ardalan, Gelayol; Shafiee, Gita; Safari, Omid; Heshmat, Ramin; Baradaran Mahdavi, Sadegh
Background: This study aimed to assess the pattern of hygienic behaviors of Iranian children and adolescents at national and sub-national levels according to the socioeconomic status (SES) of their living region. Methods: Data were obtained from the fourth national school-based surveillance survey entitled, "CASPIANIV study" (2011-2012). It was conducted among 14,880 students, aged 6-18 years, who were selected by multistage random cluster sampling from 30 provinces in Iran. We used the World Health Organization Global School-based Student Health Survey (WHO- GSHS) questionnaire. Data were analyzed at national and subnational levels according to the SES of the living region. Results: Overall, 13,486 students (49.2% girls) with the mean (SD) age of 12.50 (3.36) years participated in this study (participation rate: 90.6%). At the national level, 67.21% of the participants had daily tooth brushing, the frequencies for always washing hands after using the toilet, washing hands before eating, and washing hands with soap in school were 85.61%, 56.53%, and 50.32%, respectively. The frequency of daily tooth brushing had no significant difference according to the SES of the living region. In all of the categories of washing hands, the West region (second high SES rank) had the highest frequency of hygienic behaviors (p<0.001). Conclusion: In general, the reported hygienic behaviors were at an acceptable level; however, a large comprehensive health-promoting plan should be considered for all children and adolescents at the national and subnational levels taking into account the disparities according to their SES. PMID:28210596
Person, Bobbie; Schilling, Katharine; Owuor, Mercy; Ogange, Lorraine; Quick, Rob
Background Recommended disease prevention behaviors of hand washing, hygienic hand drying, and covering one’s mouth and nose in a hygienic manner when coughing and sneezing appear to be simple behaviors but continue to be a challenge to successfully promote and sustain worldwide. We conducted a qualitative inquiry to better understand current hand drying behaviors associated with activities of daily living, and mouth and nose covering practices, among Kenyans. Methods and Findings We conducted 7 focus group discussions; 30 in-depth interviews; 10 structured household observations; and 75 structured observations in public venues in the urban area of Kisumu; rural communities surrounding Kisumu; and a peri-urban area outside Nairobi, Kenya. Using a grounded theory approach, we transcribed and coded the narrative data followed by thematic analysis of the emergent themes. Hand drying, specifically on a clean towel, was not a common practice among our participants. Most women dried their hands on their waist cloth, called a leso, or their clothes whether they were cooking, eating or cleaning the nose of a young child. If men dried their hands, they used their trousers or a handkerchief. Children rarely dried their hands; they usually just wiped them on their clothes, shook them, or left them wet as they continued with their activities. Many people sneezed into their hands and wiped them on their clothes. Men and women used a handkerchief fairly often when they had a runny nose, cold, or the flu. Most people coughed into the air or their hand. Conclusions Drying hands on dirty clothes, rags and lesos can compromise the benefits of handwashing. Coughing and sneezing in to an open hand can contribute to spread of disease as well. Understanding these practices can inform health promotion activities and campaigns for the prevention and control of diarrheal disease and influenza. PMID:24069302
Ramos, Mary M; Blea, Mary; Trujillo, Rebecca; Greenberg, Cynthia
Hand washing and hand antisepsis are proven infection control measures in the school setting, yet barriers such as lack of soap, paper towels, and hand sanitizer can hinder compliance. This pilot study measured the prevalence of hand cleaning supplies in public schools. Ten school districts (93 schools) participated in school nurse inspections. In November 2008, 90 schools (97%) reported their inspection results. Among 697 total bathrooms, 88.8% had soap and 91.7% had paper towels or hand dryers. Hand sanitizer was reported in 1.2% of bathrooms and 15.2% of cafeterias. No difference was observed between boys' and girls' bathrooms, or primary and secondary schools, in the prevalence of soap or paper towels/hand dryers. Hand washing supplies were generally available in public school bathrooms. Alcohol-based hand sanitizer in school bathrooms was reported occasionally and should be discouraged. Hand sanitizer in a supervised setting, the school cafeteria, was not often reported and should be promoted.
Chittleborough, Catherine R.; Nicholson, Alexandra L.; Basker, Elaine; Bell, Sarah; Campbell, Rona
This paper explores factors that may influence hand washing behaviour among pupils and staff in primary schools. A qualitative process evaluation within a cluster randomised controlled trial included pupil focus groups (n=16, ages 6 to 11, semi-structured interviews (n=16 teachers) and observations of hand washing facilities (n=57). Pupils and staff in intervention and control schools demonstrated a similar level of understanding of how, when and why they should wash their hands. Lack of time, poor adult modelling of regular hand washing and unattractive facilities were seen as important barriers to regular hand washing. Reminders and explanations for the importance of hand hygiene were thought to have a positive impact. Influencing individual choices about hand washing through education and information may be necessary, but not sufficient, for initiating and maintaining good hand washing practices. Structural factors, including having time to wash hands using accessible, clean facilities, and being encouraged through the existence of hand washing opportunities in the daily routine and hand washing being viewed as the social norm, will also influence hand washing behaviour. The effectiveness of educational interventions at improving hand hygiene in primary schools may be improved by changing priorities of staff and increasing accessibility to quality facilities. PMID:22623617
Chittleborough, Catherine R; Nicholson, Alexandra L; Basker, Elaine; Bell, Sarah; Campbell, Rona
This article explores factors that may influence hand washing behaviour among pupils and staff in primary schools. A qualitative process evaluation within a cluster randomized controlled trial included pupil focus groups (n = 16, aged 6-11 years), semi-structured interviews (n = 16 teachers) and observations of hand washing facilities (n = 57). Pupils and staff in intervention and control schools demonstrated a similar level of understanding of how, when and why they should wash their hands. Lack of time, poor adult modelling of regular hand washing and unattractive facilities were seen as important barriers to regular hand washing. Reminders and explanations for the importance of hand hygiene were thought to have a positive impact. Influencing individual choices about hand washing through education and information may be necessary, but not sufficient, for initiating and maintaining good hand washing practices. Structural factors, including having time to wash hands using accessible, clean facilities, and being encouraged through the existence of hand washing opportunities in the daily routine and hand washing being viewed as the social norm, will also influence hand washing behaviour. The effectiveness of educational interventions at improving hand hygiene in primary schools may be improved by changing priorities of staff and increasing accessibility to quality facilities.
This paper is a digest of environmental issues and requirements most often encountered by clients navigating environmental law and regulations promulgated by Congress, US EPA, the Georgia General Assembly, Georgia Environmental Protection Division, and local authorities. The environmental compliance landscape in Georgia, as elsewhere, is changing with the introduction of active `private attorneys general` via federal citizen suit provisions. Also, this trend is complicated by an increasing awareness and obligation to manage corporate environmental compliance by auditing programs. While both EPA and the State of Georgia encourage self-critical analysis, there are currently no legal protections for such analysis other than audits developed under attorney-client privilege or attorney work product. The introduction of risk assessment principles in Georgia`s Hazardous Site Response Act and corrective action under Georgia`s Underground Storage Tank regulation is another interesting and challenging trend that pushes environmental compliance further beyond the ken of the ordinary man.
Resistance of peripheral or "small" airways is only a small part of the total pulmonary resistance (Raw). Even considerable obstruction in these airways will have little effect on total resistance. Conversely this will lead to inequality in the time constants of units in parallel, and dynamic lung compliance (C dyn) shall fall as respiratory frequence increases. C dyn is measured from simultaneous recordings of transpulmonary pressure (esophageal balloon) and volume obtained from a volume displacement plethysmograph. If Raw and static compliance are found to be normal, the frequency dependance of compliance will result from peripheral airway obstruction only. Early stages of chronic airway obstruction can be established by this method. However this appear not suitable for wide-scale studies.
Convertino, Victor A.; Doerr, Donald F.; Flores, Jose F.; Hoffler, G. Wyckliffe; Buchanan, Paul
The relationship between the leg compliance and factors related to the size of leg muscle and to physical fitness was investigated in ten healthy subjects. Vascular compliance of the leg, as determined by a mercury strain gauge, was found to be not significantly correlated with any variables associated with physical fitness per se (e.g., peak O2 uptake, calf strength, age, body weight, or body composition. On the other hand, leg compliance correlated with the calf cross-sectional area (CSA) and the calculated calf volume, with the CSA of calf muscle being the most dominant contributing factor (while fat and bone were poor predicators). It is suggested that leg compliance can be lowered by increasing calf muscle mass, thus providing structural support to limit the expansion of leg veins.
Rindel, A K; Kronborg, D; Jensen, S T
Sick leave among the children in 24 day nurseries in Copenhagen was registered during a period of one year. The physical, environmental and hygienic conditions of the institutions were assessed by means of interviews and inspection, supplemented by information from the local authorities. Sick leave constitutes 7.5% of the days during which the institutions were open and the average number of sick days per child varied from 14.6 to 24.4. Comparisons with similar investigations are inclusive on account of variations in the methods of registration and age distributions. It was characteristic of the institutions investigated that these included a number of old institutions in flats, many in streets with considerable traffic and where the conditions of ventilation and space do not conform with present-day standards. In some of the institutions, the hygiene is unsatisfactory, particularly where ventilation, outdoor activities and hand-washing are concerned. A statistically significant connection was found between amount of traffic at the institution, the hygiene and playroom area per child, on one hand, and absence due to sickness, on the other, as assessed by a statistical model for sick leave for child in a given institution. In order to prevent sickness, it is concluded that efforts to improve hygiene and space are desirable and, similarly, further research concerning the effects of atmospheric pollution is relevant.
Eberlin, Kyle R; Ring, David
Postoperative infections are uncommon after hand surgery. Infection can delay recovery and contribute to scarring and stiffness. Measures intended to reduce the risk of infection after hand surgery include hand washing, skin preparation, sterile technique, and prophylactic antibiotics. The role of prophylactic antibiotics for small, clean, elective hand surgery procedures lasting less than 2 hours is debated.
... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF TRANSPORTATION... seeks a waiver of compliance for five freight cars from 49 CFR 215.303, which requires stenciling on restricted freight cars; and 49 CFR 231.1(a)3(i), which requires that `` he hand brake shall be so...
Al-Khatib, Issam A; Abusara, Lara W; Odeh, Yazan M; Sbeih, Sbeih A; Massoud, May A
Regular and proper hand washing is a low-cost and effective intervention to prevent the spread of infectious diseases. The authors' study aimed to assess the socioeconomic and demographic characteristics associated with attitudes and practices of hand washing before eating in the West Bank and Gaza Strip. It also assessed parents' participation in the personal hygiene of their children. Results revealed that almost all participants believed that it is always necessary to wash one's hands before eating. Females had higher rates than males for washing hands before eating as well as for helping with child hygiene. Not surprisingly, a positive relationship existed between educational level and attitudes and practice of washing hands before eating. The authors recommend that governments, ministries, and different nongovernmental organizations have an active role in developing and implementing programs in order to improve the health of their communities. Such programs should be conducted in all localities and at all levels including homes, schools, and public domains.
Addy, M; Griffiths, G; Dummer, P; Kingdom, A; Shaw, W C
Numerous factors may affect the distribution of plaque and gingivitis in any individuals mouth. Of considerable importance must be the oral hygiene habits of each person, which will be influenced by compliance and dexterity with tooth cleaning methods. The pattern of gingivitis seen at a young age may, with time, reflect the eventual distribution of attachment loss. This in part, could explain the considerable variation in chronic periodontal disease seen between individuals and at different sites within the same mouth. This study reports the baseline data for the distribution of plaque and gingivitis in 1105, 11-12-year-old children in South Wales. The children were selected by disproportionate stratified random sampling and examined by a multidisciplinary group with the long-term aim of evaluating the importance of malocclusion to dental health and psychosocial variables. Toothbrushing frequency had a very low but significant correlation with the distribution of plaque and gingivitis, accounting therefore for only a small % of the variance in the group. For the total group and right-handed toothbrushers, buccal plaque and gingivitis was significantly increased on right contralateral teeth. No specific pattern for plaque and gingivitis distribution by side was seen for 100 left-handed toothbrushers. Plaque and gingivitis also showed significant differences dependent upon arch, tooth number, and surface. The population is being followed at 4-year intervals to monitor the pattern of periodontal disease with time and correlate changes with these baseline findings.
Raponi, Matteo; Damiani, Gianfranco; Vincenti, Sara; Wachocka, Malgorzata; Boninti, Federica; Bruno, Stefania; Quaranta, Gianluigi; Moscato, Umberto; Boccia, Stefania; Ficarra, Maria Giovanna; Specchia, Maria Lucia; Posteraro, Brunella; Berloco, Filippo; Celani, Fabrizio; Ricciardi, Walter; Laurenti, Patrizia
The purpose of this research is to identify and formalize the Hospital Hygiene Service activities and products, evaluating them in a cost accounting management view. The ultimate aim, is to evaluate the financial adverse events prevention impact, in an Hospital Hygiene Service management. A three step methodology based on affinity grouping activities, was employed. This methodology led us to identify 4 action areas, with 23 related productive processes, and 86 available safety packages. Owing to this new methodology, we was able to implement a systematic evaluation of the furnished services.
Turabelidze, George; Lin, Mei; Wolkoff, Barbara; Dodson, Douglas; Gladbach, Stephen; Zhu, Bao-Ping
Methicillin-resistant Staphylococcus aureus (MRSA) infections outside the healthcare setting are an increasing concern. We conducted a case-control study to investigate an MRSA outbreak during 2002-2003 in a Missouri prison and focused on hygiene factors. Information on sociodemographic characteristics, medical history, and hygiene practices of study participants was collected by interview and medical record review. Logistic regression was used to evaluate MRSA infection in relation to hygiene factors individually and as a composite hygiene score; potential confounding factors were controlled. Selected MRSA isolates were analyzed by pulsed-field gel electrophoresis (PFGE). MRSA infection was significantly associated with a low composite hygiene score. Transmission among prison inmates appeared to be responsible for this outbreak. PFGE analysis showed that isolates were indistinguishable and associated with community-onset MRSA infections in other US prisons. Improving hygiene practices and environmental conditions may help prevent and interrupt future MRSA outbreaks in prison settings.
Chibbaro, M J; Colyer, C
Healthcare organizations have created corporate compliance programs in an effort to adhere to Federal government recommendations, minimize the risk of wrongful behavior, and possibly reduce fines that may result from a government investigation. Compliance programs may have undetected weaknesses. Corporate compliance officers, executives, and board members need to be certain that their organization's program has sufficient infrastructure, oversight, and resources; effective education and training; an effective mechanism (hotline) to receive reports of compliance problems; and ongoing auditing and monitoring capabilities.
Lehotsky, Ákos; Szilágyi, László; Demeter-Iclănzan, Annamária; Haidegger, Tamás; Wéber, György
The aim of this study was to objectively assess the hand hygiene performance of medical students. Hand rubbing technique was evaluated by employing innovative UV-light-based imaging technology, identifying patterns and trends in missed areas after applying WHO's six-step protocol. This specially designed hand hygiene education and assessment program targeted 1,344 medical students at two distant sites in Central Europe. Students were introduced to a short video, presenting the basics of hand hygiene, and then received further demonstration from professional trainers, focusing on the correct execution of WHO's six-step technique. To verify the acquired skill, participants rubbed their hands with UV-marked alcohol-based solution. Digital images of the hands were recorded under UV light, followed by computer evaluation and assessment. Immediate objective visual feedback was given to the participants showing missed areas on their hands. The statistical analysis of missed spots was based on retrospective expert-driven manual evaluation. Significant difference in rubbing quality was found between female and male participants [35.3% (CI 95%: 33-38%) versus 29.0% (CI 95%: 27-31%), p < 0.001], dominant and non-dominant hands [43.4% (CI 95%: 39-48%) versus 34.9% (CI 95%: 32-38%), p = 0.002], and various zones of the hands' dorsal side. Based on the participants' feedback and the evaluation of the infection control specialists, it can be stated that the identification of typically missed patterns and the instant visual feedback have a vital role in improving the hand hygiene technique of prospective medical staff.
Kimbrell, W. David
Compliance regulations for the Asbestos Hazard Emergency Response Act (AHERA) are so complex that each school district must name an asbestos coordinator. Discusses requirements for the October 12, 1988, and July 9, 1989, deadlines and how to meet these requirements. (MLF)
Davis, Kevin R.
Compliance officers investigate, report on, and oversee the correction of behaviors that fail to comply with the law. At colleges they monitor a vast array of regulatory requirements in areas as diverse as health care, scientific research, immigration, labor law, and environmental safety. Until recently the strongest argument in favor of a…
This section of the 1994 Hanford Site Environmental Report summarizes the roles of the principal agencies, organizations, and public in environmental compliance and cleanup of the Hanford Site. Regulatory oversight, the Federal Facility Agreement and Consent Order, the role of Indian tribes, public participation, and CERCLA Natural Resource Damage Assessment Trustee Activities are all discussed.
Samutin, N M; Vaisman, Y I; Rudakova, L V; Kalinina, E V; Glushankova, I S; Batrakova, G M
The object of investigations was soda industry waste. Slimes are formed at slimes storage which occupy considerable areas and are considered to be the source of permanent impact on the hydrosphere objects. Slimes storage placement within settlement boundaries and water protection zone of large watercourses leads to the deterioration of sanitary, hygienic and environmental situation and to the rising of risks to health of communities. Waste processing with getting new materials on the base of soda industry waste with wide application is seems to be one of the way for problem solving. It is essential to take into account sanitary and hygienic characteristics of slimes within justifying possible directions of its use. Thus, researches concerning assessment of physical, chemical and toxicological waste characteristics are considered to be actual. The aim of researches is to examine physical, chemical and toxicological characteristics of soda production slimes for justifying directions of its use including delivery of new materials respondent to the all regulatory sanitary and hygienic requirements. Experimental investigations of assessment physical, chemical and toxicological characteristics of slimes were carried out according to standard methods. Within assessment of toxicological slimes characteristics the following test-objects were used: Ceriodaphnia affinis, Paramecium caudatum. As a result of investigations watered slime samples were determined to be referred to the 4th hazard level (low-hazard) waste; samples with preliminary mechanical dehydration are referred to the 5th hazard level (practically nonhazardous) waste for environment. These are correspond to the 3rd and 4th hazard level according to sanitary regulations, respectively.
Buchtiyrov, I V; Denisov, E I; Eryomin, A L
The rising flow of information affects the health and affords ground for strengthening measures of hygienists. There is considered the place of information hygiene in preventive medicine. There are discussed physical and hygienic aspects of measurement and evaluation of information, there are considered some of their negative consequences. International and local regulations and guidance documents in this area are presented. In the light of the strategy of innovative development of Russia there are considered hygienic aspects of innovation and the improvement of hygienic standards.
Miller, B R; Harvey, C E
A telephone questionnaire survey of owners of 51 dogs was conducted. All 51 dogs had had periodontal treatment at VHUP six months or more previously. At that time, they had received a tooth brush, dentifrice, instructions and a demonstrations of brushing. The owners were asked to brush the dogs' teeth once daily. At the time of survey, 53% of the clients were still brushing several times a week and 38% were no longer brushing at all.
Grebniak, N P
Optimization of the preparation of school-children for the working activity may be presented as a model consisting of 4 blocks. Socially significant functions are system-forming factors of this model, i.e. the functions of an organism with which successful implementation of the major types of activities is associated. System approach to the management of schoolchildren's activities based on the dynamic control of socially significant functions and on selective influence on external and internal factors with the help of prophylactic and corrective activities make it possible to maintain its hygienic optimization.
Subhaktha, P K J P; Prasad, P V V; Narayana, A
Every Society, in its unending process of evolution, devises its own methods of survival in ethical, medical and emotional aspects. The urge for good and healthy living, the desire for longevity of life are not only inherent but also largely evident in all the societies right from the time of its primitivity. Jews are a wonder community. Though negligible in numbers, they managed to win 17.5% of noble prizes announced so far. Besides, almost all the major inventions in the world are by Jews. This despite the years of persecution and trials the community was subjected to in the history. The pages of the human history are smeared with the blood patches of the Jews in the hands of oppressors for several centuries. Apart from the fact that theirs is the community chosen specially by God, the intellectual prowess and tenacity of the Jewish community basically stems from the discipline and dietary code they received from their leader Moses in wilderness. Jewish nation was conceived in the vision of their patriarch Abraham but in fact, born on the night they left as slaves from Egypt for good under the dynamic leadership of Moses. Mosaic code for all aspects of life has made Jews or Israelites what they are today. A modest effort is being made in this article to trace their community's health and hygiene social behavioral precepts as given by Moses.
Fuller, James A; Eisenberg, Joseph N S
Herd immunity arises when a communicable disease is less able to propagate because a substantial portion of the population is immune. Nonimmunizing interventions, such as insecticide-treated bednets and deworming drugs, have shown similar herd-protective effects. Less is known about the herd protection from drinking water, sanitation, and hand hygiene (WASH) interventions. We first constructed a transmission model to illustrate mechanisms through which different WASH interventions may provide herd protection. We then conducted an extensive review of the literature to assess the validity of the model results and identify current gaps in research. The model suggests that herd protection accounts for a substantial portion of the total protection provided by WASH interventions. However, both the literature and the model suggest that sanitation interventions in particular are the most likely to provide herd protection, since they reduce environmental contamination. Many studies fail to account for these indirect effects and thus underestimate the total impact an intervention may have. Although cluster-randomized trials of WASH interventions have reported the total or overall efficacy of WASH interventions, they have not quantified the role of herd protection. Just as it does in immunization policy, understanding the role of herd protection from WASH interventions can help inform coverage targets and strategies that indirectly protect those that are unable to be reached by WASH campaigns. Toward this end, studies are needed to confirm the differential role that herd protection plays across the WASH interventions suggested by our transmission model.
Aunger, Robert; Greenland, Katie; Ploubidis, George; Schmidt, Wolf; Oxford, John; Curtis, Valerie
A substantial proportion of the total infectious disease burden world-wide is due to person-to-person spread of pathogens within households. A questionnaire-based survey on the determinants of hand-washing with soap and cleaning of household surfaces was conducted in at least 1000 households in each of twelve countries across the world (N = 12,239). A structural equation model of hygiene behaviour and its consequences derived from theory was then estimated on this dataset for both behaviours, using a maximum likelihood procedure. The analysis showed that the frequency of handwashing with soap is significantly related to how automatically it is performed, and whether or not someone is busy, or tired. Surface cleaning was strongly linked to possessing a cleaning routine, the perception that one is living in a dirty environment and that others are doing the behaviour, whether one has a strong sense of contamination, as well as a felt need to keep one's surroundings tidy. Being concerned with good manners is also linked to the performance of both behaviours. This study is the first to identify the role of manners, orderliness and routine on hygiene behaviours globally. Such findings should prove helpful in designing programs to improve domestic hygiene practices.
Aunger, Robert; Greenland, Katie; Ploubidis, George; Schmidt, Wolf; Oxford, John; Curtis, Valerie
A substantial proportion of the total infectious disease burden world-wide is due to person-to-person spread of pathogens within households. A questionnaire-based survey on the determinants of hand-washing with soap and cleaning of household surfaces was conducted in at least 1000 households in each of twelve countries across the world (N = 12,239). A structural equation model of hygiene behaviour and its consequences derived from theory was then estimated on this dataset for both behaviours, using a maximum likelihood procedure. The analysis showed that the frequency of handwashing with soap is significantly related to how automatically it is performed, and whether or not someone is busy, or tired. Surface cleaning was strongly linked to possessing a cleaning routine, the perception that one is living in a dirty environment and that others are doing the behaviour, whether one has a strong sense of contamination, as well as a felt need to keep one’s surroundings tidy. Being concerned with good manners is also linked to the performance of both behaviours. This study is the first to identify the role of manners, orderliness and routine on hygiene behaviours globally. Such findings should prove helpful in designing programs to improve domestic hygiene practices. PMID:27541259
Takanashi, Kumiko; Chonan, Yuko; Quyen, Dao To; Khan, Nguyen Cong; Poudel, Krishna C.
A cross-sectional study was conducted to investigate the potential factors of food-hygiene practices of mothers on the prevalence of diarrhoea among their children. Mothers who had children aged 6 months–5 years were recruited in a hamlet in Viet Nam. The food-hygiene practices included hand-washing, method of washing utensils, separation of utensils for raw and cooked food, and the location where foods were prepared for cooking. A face-to-face interview was conducted, and data on 206 mothers were analyzed. The risk of diarrhoea was significantly higher among children whose mothers prepared food for cooking somewhere other than the table (typically on the ground) compared to children whose mothers prepared food on the table (adjusted odds ratio=2.85, 95% confidence interval 1.11–7.28). The results indicate that food-hygiene practices of mothers, such as avoiding preparing food for cooking on the ground, has a potential impact in preventing diarrhoea among children in Viet Nam. PMID:19902795
Veterinary services and veterinary education and training must keep pace with the constantly changing patterns of agriculture and food processing. Changes in methods of animal production are associated with many problems of food processing and food quality. Veterinary supervision of the animal feed industry and of meat and distribution is essential. Quality testing of meat, milk, and eggs requires the introduction of suitable routine sampling systems, laboratory procedures, and complex evaluation procedures. Food hygiene problems have changed in recent years not only as a result of new methods of animal production, but also because of changes in food processing technology and in the presentation of food to the consumer, increased environmental pollution, increased international trade, and increased tourist travel. Food hygienists must adopt an active and progressive policy and change the scope of food control from a purely negative measure into a positive force working towards improved food quality and the avoidance of losses during production. A modern food hygiene programme should cover all stages of production, processing, and distribution of food and also other ingredients, additives and the water used for production and processing. Veterinarians should also be involved in the registration and licensing of enterprises and this should take into account the premises, the procedures to be used, new techniques in animal husbandry, machines and equipment, etc. In order to facilitate the microbiological analysis of foodstuffs, new mechanized or automated laboratory methods are required, and consideration must be given to adequate sampling techniques. PMID:310716
Smagulov, N K; Mukhametzhanov, A M
The article gives the hygienic characteristics of the daily diet of soldiers doing call-up military service. The object of study--military servicemen aged 18-22 years doing call-up military service. The material of the study data was obtained from a continuous cross-sectional study of dietary intake among military personnel. Investigation pointed out that consumption of nutrients and energy value of the surveyed military personnel was broadly in accordance with recommended physiological requirements for nutrients and energy for this age group. However; despite the adequacy of energy supply, showed signs of imbalance on the nutrients of rations provided in the military establishment. Structure of consumption of products is not in full compliance with the existing recommendations of the Kazakh academy of Nutrition.
... this page: //medlineplus.gov/ency/patientinstructions/000552.htm Hand fracture - aftercare To use the sharing features on ... need to be repaired with surgery. Types of Hand Fractures Your fracture may be in one of ...
... for a living, you are always using your hands. When there is something wrong with them, you ... not be able to do your regular activities. Hand problems include Carpal tunnel syndrome - compression of a ...
Hand and Finger Exercises Place your palm flat on a table. Raise and lower your fingers one ... times for ____ seconds. Pick up objects with your hand. Start out with larger objects. Repeat ____ times for ____ ...
... Submit Button Past Emails CDC Features Wash Your Hands Language: English Español (Spanish) Recommend on Facebook Tweet ... facilities and hospitals . When should you wash your hands? You can help yourself and others stay healthy ...
... Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring ... Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring ...
... Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring ... Hand Safety Fireworks Safety Lawnmower Safety Snowblower safety Pumpkin Carving Gardening Safety Turkey Carving Removing a Ring ...
Tcheng, Ping; Elliot, Joe
Special grip-strength meter designed for accurate, reproducible measurement of hand rehabilitation. Four strain gauges connected in Wheatstone bridge to measure deflection caused by gripping hand. Compressive force exerted by hand transmitted to measuring beams. Beams therefore deflected or strained, and mechanical strain sensed by strain gauges and converted into electrical signal. After amplification and conditioning, signal displayed on LED as measure of gripping strength of hand.
McNeil, Alice; Koppel, Carl
Critical care nurses assume vital roles in maintaining patient care quality. There are distinct facets to the process including standard setting, regulatory compliance, and completion of reports associated with these endeavors. Typically, multiple niche software applications are required and user interfaces are varied and complex. Although there are distinct quality indicators that must be tracked as well as a list of serious or sentinel events that must be documented and reported, nurses may not know the precise steps to ensure that information is properly documented and actually reaches the proper authorities for further investigation and follow-up actions. Technology advances have permitted the evolution of a singular software platform, capable of monitoring quality indicators and managing all facets of reporting associated with regulatory compliance.
Burgemeestre, Brigitte; Hulstijn, Joris; Tan, Yao-Hua
A Normative Multi-Agent System consists of autonomous agents who must comply with social norms. Different kinds of norms make different assumptions about the cognitive architecture of the agents. For example, a principle-based norm assumes that agents can reflect upon the consequences of their actions; a rule-based formulation only assumes that agents can avoid violations. In this paper we present several cognitive agent architectures for self-monitoring and compliance. We show how different assumptions about the cognitive architecture lead to different information needs when assessing compliance. The approach is validated with a case study of horizontal monitoring, an approach to corporate tax auditing recently introduced by the Dutch Customs and Tax Authority.
X-ray - hand ... A hand x-ray is taken in a hospital radiology department or your health care provider's office by an ... technician. You will be asked to place your hand on the x-ray table, and keep it ...
Kanji, Zul; Sunell, Susanne; Boschma, Geertje; Imai, Pauline; Craig, Bonnie J
There is little published literature about the outcomes of dental hygiene baccalaureate degree education, particularly in Canada. Since there are various dental hygiene entry-to-practice educational models in Canada, exploring baccalaureate dental hygiene education is becoming an increasingly important subject. The purpose of this study was to explore the personal outcomes and dental hygiene practice outcomes of dental hygiene degree-completion education in Canada from the perspectives of diploma dental hygienists who have continued their education to the bachelor's degree level. This study employed a qualitative phenomenological design, using a maximum variation purposeful sampling strategy. Data generation occurred with sixteen dental hygienists across Canada through individual semistructured interviews. Interviews were audiorecorded, transcribed verbatim, and coded for data analysis, involving pattern recognition and thematic development. Themes that emerged included changes in self-perception, values, and knowledge base. Changes in self-perception were reflected in a reported increase in self-confidence and perceived credibility. Changes in values included a greater appreciation for lifelong learning. Advancements in knowledge strengthened the development of specific abilities that ultimately influenced participants' dental hygiene practice. These abilities included an increased ability to think critically, to make evidence-based decisions, and to provide more comprehensive care. Participants also commented on having more career opportunities available to them outside of the private clinical practice setting. These results reveal important insights into the impact of earning a dental hygiene baccalaureate degree on oneself and one's dental hygiene practice.
Ley, Eugene; And Others
Administrative decisions about the future of dental hygiene programs are often based on inadequate information about employment trends and about the importance of the dental hygienist in dental practices. Studies indicate that demand for dental hygiene services will remain high in the 1980s. (Author/MLW)
Prodanchuk, N G; Mudryĭ, I V
The paper touches upon the topical aspects of the hygiene and toxicology of fertilizers and their state sanitary-and-epidemiological examination at the present stage. It also considers guidelines for the toxicological-and-hygienic evaluation when state trials are carried out.
Markin, A V; Terekhova, T V; Liubimova, S V
The pupils from Rostov-on-Don were interviewed by a questionnaire on medical helminthology. They were found to poor knowledge in this sphere. They do not observe elementary personal hygienic rules. The ways of improving the hygienic education of pupils.
Markin, A V
Evidence is provided for the value and priority of sanitary and hygienic measures and hygienic education of the population in the prevention of enterobiasis. It is emphasized that preventive work can be successful only when the parents, tutors of preschool institutions and teachers of schools are obligatorily attracted to it.
Pegram, Anne; Bloomfield, Jacqueline; Jones, Anne
The maintenance of personal hygiene is essential for a patient's health and well-being. Nurses play a key role in ensuring that the individual hygiene needs of patients are met. In this article the process of bed-bathing a patient is described.
Lane Community Coll., Eugene, OR.
This self-paced student training module on hygiene safety is one of a number of modules developed for Pre-apprenticeship Phase 1 Training. Purpose of the module is to familiarize students with the different types of airborne contaminants--including noise--which may be health hazards and with the proper hygienic measures for dealing with them. The…
Vaughan, Dina Agnone; DeBiase, Christina B.; Gibson-Howell, Joan C.
A survey investigated the extent of use of case-based learning in 141 dental hygiene programs. A majority of responding schools use the approach, most frequently in clinical dental hygiene, community dental health, and dental science courses. Proportion of instructional time was greatest in the content areas of special needs, ethics, medical…
Holt, Marianne; Lucas, John A.
In an effort to evaluate the effectiveness of its dental hygiene program, William Rainey Harper College (WRHC), in Illinois, conducted a follow-up study of program graduates from 1994. Surveys were mailed to all 30 1994 dental hygiene associate degree graduates, receiving responses from 77% (n=23). Study findings included the following: (1) all…
Paarmann, Carlene S.; And Others
The establishment of the baccalaureate degree as the minimum entry level for dental hygiene practice centers around three main concerns: changes in health care delivery, awarding of a degree commensurate with students' educational background, and the credibility of dental hygiene as a profession. A curriculum model is discussed. (MLW)
Data from numerous experiments and hardware inventories were scanned for Skylab personal hygiene use. A computer program was formulated for predicting the degree of man's involvement with personal hygiene needs. A tabulation was kept for such events as water intake, frequency of urination and defecation, accidents or events requiring clean-up, methods of clean-up, microbiological environment and shower water contamination.
... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Health and hygiene of personnel. 590.560 Section 590.560 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF..., Processing, and Facility Requirements § 590.560 Health and hygiene of personnel. (a) Personnel...
... 9 Animals and Animal Products 2 2011-01-01 2011-01-01 false Health and hygiene of personnel. 590.560 Section 590.560 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF..., Processing, and Facility Requirements § 590.560 Health and hygiene of personnel. (a) Personnel...
... 7 Agriculture 3 2011-01-01 2011-01-01 false Health and hygiene of personnel. 56.77 Section 56.77 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... EGGS Grading of Shell Eggs Facility Requirements § 56.77 Health and hygiene of personnel. (a) No...
... 7 Agriculture 3 2010-01-01 2010-01-01 false Health and hygiene of personnel. 56.77 Section 56.77 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... EGGS Grading of Shell Eggs Facility Requirements § 56.77 Health and hygiene of personnel. (a) No...
... 7 Agriculture 3 2013-01-01 2013-01-01 false Health and hygiene of personnel. 56.77 Section 56.77 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Standards... EGGS Grading of Shell Eggs Facility Requirements § 56.77 Health and hygiene of personnel. (a) No...
Bowers, Denise E.
The historiography of the Rhodes State College Dental Hygiene Program (Program) presents a historical journey of health care, as it relates to oral health, in the United States, in Ohio, and in Lima. This study bridges the gap between the history of higher education and the history of an academic program, dental hygiene. Prior to this study, there…
Shih, Yeng-Hung; Chang, Chien-Huey Sophie
This study investigated the effects of a program that taught oral hygiene skills to students with visual impairments using group instruction and individual coaching. The results showed that the program enhanced the oral hygiene skills of the three participants significantly, and its effectiveness lasted for at least two months after the…
Karst, Nancy S.
Thirty-three two-year dental hygiene programs throughout the United States were surveyed to identify the radiographic imaging system most often used and the accompanying rationale for that decision. A literature review identified the three radiographic imaging systems most frequently used and indicated that all dental hygiene programs had the…
Not too long ago, physicians took 'compliance' or 'adherence' to mean the strict obedience of patients and parents - doing what the physician said, suggesting that the success or failure of the treatment lay entirely in the hands of the patient. But it is preferable to improve compliance rather than enforce it. As there is no single solution that will ensure compliance, several steps should be taken: (i) 'exploration' includes open questions, and allows admission of non-compliance, e.g. in terms of failure to take drugs, or smoking; (ii) 'education' means explaining pathomechanisms, and reducing corticophobia; (iii) 'tailoring' is reached by focussing therapeutic options on individual requirements, and simplifying treatment regimens; (iv) 'contracting' involves negotiating a realistic therapeutic regimen on an individual basis; (v) 'reminders' are practical tips, which may help to overcome reluctance, e.g. by placing drugs in the toothbrush glass, and on the breakfast table, or in the sports bag; (vi) 'follow-up' ensures long-term compliance, with regular visits to the physician, and self-management programmes. In conclusion, non-compliance of patients and parents is a challenging problem in daily practice. Including the aspects of the abovementioned factors can help build up a relation of trust and partnership, which is the prerequisite of any therapeutic success. However, this is an ongoing process, which has to be continuously reviewed.
The investigation was intended to analyse the attitude towards hygiene and cleanliness in the Federal Republic of Germany, France, and Spain. On the basis of a theoretical explanatory model and empirically gained qualitative raw data a standardized questionnaire was prepared; in a number of questions comparability with a study carried out in the Federal Republic of Germany in 1968 was ensured. In all countries the population was subjected to representative random tests (Federal Republic of Germany n = 1016; France n = 517; Spain n = 514). The paper presents a review of the hypothesis that quality and intensity of the cleanliness increases with (1) the extent of personal sensitivity to hygiene in the private, professional and public sphere, (2) with increasing physical sensibility, (3) the increase in our knowledge of hygiene and health, (4) with the increase in the personal behavioral standards for measures concerned with prevention, hygiene of the body, household, underwear and environment, (5) with the increasing weight given to hygiene and toilet during the process of development, and (6) with the extent of regular control of education in cleanliness based on established rules of behavior. The spheres of behavior investigated and mentioned below confirmed the validity of the hypothesis for (1) household hygiene (spring-cleaning, window cleaning, cleaning of the home: dusting, vacuum-cleaning, cleaning of the floor), (2) hygiene of the body (frequency of taking a shower, bathing, toothbrushing, intimate hygiene), (3) hygiene of the laundry (frequency of changing underclothes such as panties/underpants, brassieres, nightgowns/pyjamas, stockings/socks, linen, pillows, dish and kitchen towels). The following general findings were established: (1) In the Federal Republic of Germany the attitude towards hygiene and cleanliness has improved over the last 20 years. (2) The level of hygiene and cleanliness in France and Spain is significantly higher than in the FRG. (3
Morton, Jennifer L.; Schultz, Alyce A.
Elementary school-age children are particularly vulnerable to infections. While handwashing is the best method of preventing infections, many elementary schools are housed in buildings that have barriers to effective hand hygiene. The purpose of this study was to determine the effectiveness of an alcohol gel as an adjunct to handwashing in…
Corrigan, Robert D. (Inventor); Hauer, Robert L. (Inventor)
A hand hold utilizes joining mechanisms which comprises two different mounting brackets that are permanently fastened to a supporting structure. A slide plate is disposed at one end of the hand rail or hand hold which mates with one of the mounting brackets. A securing member is disposed at the opposite end of the hand rail/hand hold which connects with the other mounting bracket by means of a locking device. The slide plate has a central tapered tongue with two matching slots disposed on each side thereof.
Di Luca, M; Knörlein, B; Ernst, M O; Harders, M
Spring compliance is perceived by combining the sensed force exerted by the spring with the displacement caused by the action (sensed through vision and proprioception). We investigated the effect of delay of visual and force information with respect to proprioception to understand how visual-haptic perception of compliance is achieved. First, we confirm an earlier result that force delay increases perceived compliance. Furthermore, we find that perceived compliance decreases with a delay in the visual information. These effects of delay on perceived compliance would not be present if the perceptual system would utilize all force-displacement information available during the interaction. Both delays generate a bias in compliance which is opposite in the loading and unloading phases of the interaction. To explain these findings, we propose that information during the loading phase of the spring displacement is weighted more than information obtained during unloading. We confirm this hypothesis by showing that sensitivity to compliance during loading movements is much higher than during unloading movements. Moreover, we show that visual and proprioceptive information about the hand position are used for compliance perception depending on the sensitivity to compliance. Finally, by analyzing participants' movements we show that these two factors (loading/unloading and reliability) account for the change in perceived compliance due to visual and force delays.
Strohbehn, Catherine; Sneed, Jeannie; Paez, Paola; Meyer, Janell
Transmission of viruses, bacteria, and parasites to food by way of improperly washed hands is a major contributing factor in the spread of foodborne illnesses. Field observers have assessed compliance with hand washing regulations, yet few studies have included consideration of frequency and methods used by sectors of the food service industry or have included benchmarks for hand washing. Five 3-h observation periods of employee (n = 80) hand washing behaviors during menu production, service, and cleaning were conducted in 16 food service operations for a total of 240 h of direct observation. Four operations from each of four sectors of the retail food service industry participated in the study: assisted living for the elderly, childcare, restaurants, and schools. A validated observation form, based on 2005 Food Code guidelines, was used by two trained researchers. Researchers noted when hands should have been washed, when hands were washed, and how hands were washed. Overall compliance with Food Code recommendations for frequency during production, service, and cleaning phases ranged from 5% in restaurants to 33% in assisted living facilities. Procedural compliance rates also were low. Proposed benchmarks for the number of times hand washing should occur by each employee for each sector of food service during each phase of operation are seven times per hour for assisted living, nine times per hour for childcare, 29 times per hour for restaurants, and 11 times per hour for schools. These benchmarks are high, especially for restaurant employees. Implementation would mean lost productivity and potential for dermatitis; thus, active managerial control over work assignments is needed. These benchmarks can be used for training and to guide employee hand washing behaviors.
Ontario Dept. of Education, Toronto.
GRADES OR AGES: Grades 1-6. SUBJECT MATTER: Physical education and hygiene. ORGANIZATION AND PHYSICAL APPEARANCE: The guide is in French. It is divided into two main sections, one for physical education, and one for hygiene. Each section contains several straight-text chapters with illustrations interspersed. The guide is offset printed and…
Kampf, G; Muscatiello, M; Häntschel, D; Rudolf, M
We studied the dermal tolerance (repetitive occlusive patch test; ROPT) and the skin hydrating properties of a new ethanol-based gel [85% (w/w)], Sterillium Gel. For the ROPT, 53 participants were studied. Gel was applied to one site on the back under an occlusive patch during an induction phase (nine applications over three weeks) and two weeks later to a virgin site on the back during a challenge phase (one application). Twenty-four hours after the removal of the patches (induction phase and challenge phase), then 48 and 72 h later (challenge phase) sites were graded for skin reactions using a standardized scale. In the induction phase none of the 53 participants had a skin reaction. In the challenge phase one participant had a barely perceptible skin reaction, and one had mild erythema at one time point. To evaluate skin hydrating properties of the gel, treated skin of 21 participants was compared to untreated skin. The gel was applied twice a day to the forearm for 14 days. Control corneometer values were taken before application of the gel (mean: 32.7 +/- 5.0) and after one (36.3 +/- 4.4) and two weeks (36.1 +/- 5.4). Relative skin hydration on treated skin in comparison with an untreated control field was significantly higher after one week by 6.85% (P = 0.0031; paired t -test for dependent samples) and after two weeks by 4.47% (P = 0.0153). Sterillium Gel did not demonstrate a clinically relevant potential for dermal irritation or sensitization, and significantly increased skin hydration after repetitive use, and so could enhance compliance with hand hygiene among healthcare workers.
Elizarov, B B; Sin'kov, A V
Subway train drivers work in specific conditions of underground surroundings, face psychoemotional stress due to high intensity of signals analyzed in short time for the decision, prominent responsibility for passengers' lives. The work is also associated with significant levels of noise, minor artificial illumination, air pollution with dust and unfavorable microclimate. By the end of working shift the drivers demonstrate marked changes in blood pressure, prolonged oculomotor reactions, depressed visual function. Morbidity with transitory disablement is high among the drivers, presenting especially cardiovascular and gastrointestinal diseases. Unfavorable changes of ageing process are seen in the drivers over 35, in age group of 40-49 years (with length of service at least 20 years). The complex investigations helped to elaborate hygienic norms for new subway cars, to base rational schedule ot work and rest for the drivers.
McNulty, Cliodna A M; Lecky, Donna M; Farrell, David; Kostkova, Patty; Adriaenssens, Niels; Koprivová Herotová, Tereza; Holt, Jette; Touboul, Pia; Merakou, Kyriakoula; Koncan, Raffaella; Olczak-Pienkowska, Anna; Avô, António Brito; Campos, José
Antibiotic resistance is an increasing community problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed. e-Bug is a European project involving 18 European countries, partly funded by The Directorate-General for Health and Consumers (DG SANCO) of the European Commission. It aims to develop and disseminate across Europe a junior and senior school teaching pack and web site (hosting the lesson plans and complementary games) that teach young people about prudent antibiotic use, microbes, transmission of infection, hygiene and vaccines. The aim of e-Bug is to increase young people's understanding, through enjoyable activities, of why it is so important to use antibiotics correctly in order to control antibiotic resistance, and to have good hand and respiratory hygiene to help reduce the spread of infection. Within the senior school pack the sexual transmission of infections has also been included, as the peak age of chlamydial infection is in 16-24 year olds. Teachers, young people and the consortium of 18 countries were closely involved with agreeing learning outcomes and developing the resource activities. Young people helped create the characters and microbe artwork. The resources have been translated, adapted for and disseminated to schools across 10 countries in Europe, and endorsed by the relevant government departments of health and education. The web site has been accessed from >200 countries. The resources will be translated into all European Union languages, and have been used to promote European Antibiotic Awareness Day and better hand and respiratory hygiene during the influenza pandemic in 2009.
Silva, Danilo Augusto Lopes da; Dias, Mariane Rezende; Cossi, Marcus Vinícius Coutinho; Castilho, Natália Parma Augusto de; Camargo, Anderson Carlos; Nero, Lúis Augusto
The quality and safety of meat products can be estimated by assessing their contamination by hygiene indicator microorganisms and some foodborne pathogens, with Listeria monocytogenes as a major concern. To identify the main sources of microbiological contamination in the processing environment of three butcher shops, surface samples were obtained from the hands of employees, tables, knives, inside butcher displays, grinders, and meat tenderizers (24 samples per point). All samples were subjected to enumeration of hygiene indicator microorganisms and detection of L. monocytogenes, and the obtained isolates were characterized by their serogroups and virulence genes. The results demonstrated the absence of relevant differences in the levels of microbiological contamination among butcher shops; samples with counts higher than reference values indicated inefficiency in adopted hygiene procedures. A total of 87 samples were positive for Listeria spp. (60.4%): 22 from tables, 20 from grinders, 16 from knives, 13 from hands, 9 from meat tenderizers, and 7 from butcher shop displays. Thirty-one samples (21.5%) were positive for L. monocytogenes, indicating the presence of the pathogen in meat processing environments. Seventy-four L. monocytogenes isolates were identified, with 52 from serogroups 1/2c or 3c and 22 from serogroups 4b, 4d, 4a, or 4c. All 74 isolates were positive for hlyA, iap, plcA, actA, and internalins (inlA, inlB, inlC, and inlJ). The establishment of appropriate procedures to reduce microbial counts and control the spread of L. monocytogenes in the final steps of the meat production chain is of utmost importance, with obvious effects on the quality and safety of meat products for human consumption.
Wu, Shuangsheng; Ma, Chunna; Yang, Zuyao; Yang, Peng; Chu, Yanhui; Zhang, Haiyan; Li, Hongjun; Hua, Weiyu; Tang, Yaqing; Li, Chao; Wang, Quanyi
The objective of this study was to identify possible hygiene behaviors associated with the incidence of ILI among adults in Beijing. In January 2011, we conducted a multi-stage sampling, cross-sectional survey of adults living in Beijing using self-administered anonymous questionnaires. The main outcome variable was self-reported ILI within the past year. Multivariate logistic regression was used to identify factors associated with self-reported ILI. A total of 13003 participants completed the questionnaires. 6068 (46.7%) of all participants reported ILI during the past year. After adjusting for demographic characteristics, the variables significantly associated with a lower likelihood of reporting ILI were regular physical exercise (OR 0.80; 95% CI 0.74-0.87), optimal hand hygiene (OR 0.87; 95% CI 0.80-0.94), face mask use when going to hospitals (OR 0.87; 95% CI 0.80-0.95), and not sharing of towels and handkerchiefs (OR 0.68; 95% CI 0.63-0.73). These results highlight that personal hygiene behaviors were potential preventive factors against the incidence of ILI among adults in Beijing, and future interventions to improve personal hygiene behaviors are needed in Beijing.
Song, Jae W.; Haas, Ann; Chung, Kevin C.
During the nineteenth century, with the emergence of public health as a goal to improve hygiene and conditions of the poor, statistics established itself as a distinct scientific field important for critically interpreting studies of public health concerns. During the twentieth century, statistics began to evolve mathematically and methodologically with hypothesis testing and experimental design. Today, the design of medical experiments centers around clinical trials and observational studies, and with the use of statistics, the collected data are summarized, weighed, and presented to direct both physicians and the public towards Evidence-Based Medicine. Having a basic understanding of statistics is mandatory in evaluating the validity of published literature and applying it to patient care. In this review, we aim to apply a practical approach in discussing basic statistical tests by providing a guide to choosing the correct statistical test along with examples relevant to hand surgery research. PMID:19969193
Brosseau, Lisa; Fredrickson, Ann
To ensure that industrial hygiene professionals continue to be prepared for current and future trends, it is important to regularly assess the value of their education. Described here are the results of discussions with employers and a mailed survey of graduates. Comparisons are made with past mailed surveys of both groups. Two sets of discussions were held in late 2005 with employers of industrial hygienists and other health and safety professionals. Twenty-eight participants were asked to discuss current and future needs for professionals in their organization and economic sector, their expectations for knowledge and skills when hiring professionals, methods for finding and hiring, and the importance of ABET accreditation. At the same time, a survey was mailed to 71 industrial hygiene students graduating in the last 15 years. Respondents were asked to rank the value of and their proficiency in 42 competencies. Questions also assessed employment experience, certification, the importance of ABET accreditation, and demographic characteristics. There was a lot of agreement between the two stakeholder groups (employers and graduates) about the most important skill and knowledge areas. Most employers identified communicating effectively and exposure assessment among the most important skills, with designing and initiating research as among the least. Hazard recognition, exposure measurement principles, and personal protective equipment were the most highly ranked knowledge areas. Employers discussed the need for good "business skills" such as teamwork, communication, and project management, and the importance of problem-solving skills. Graduates reported that skills in the areas of recognition, evaluation, and control were most valuable in their first jobs and generally reported high levels of proficiency in these skill areas. There was a similar dichotomy in opinions about accreditation within each stakeholder group. The reputation of the academic program was
Beebe, Catherine R R; Gurenlian, JoAnn R; Rogo, Ellen J
A growing body of literature suggests that today's learners have changed and education must change as well since Millennial generation students expect technology to be used in their coursework. This study sought to determine what educational technology is being used in U.S. dental hygiene programs, what student and faculty perceptions are of the effectiveness of technology, and what barriers exist to implementing educational technology. A stratified random sample of 120 entry-level dental hygiene programs nationwide were invited to participate in a survey. Fourteen programs participated, yielding a pool of 415 potential individual participants; out of those, eighty-four student and thirty-eight faculty respondents were included in the analysis, a total of 122. Results were analyzed using descriptive statistics and a Mann-Whitney U test (p<0.05). Faculty and student respondents agreed on the effectiveness of educational technology in all areas except clickers and wikis. The faculty members tended to rate the effectiveness of educational technology higher than did the students. The greatest perceived barrier to implementing technology was technical difficulties. This study suggests that support services should be available to faculty and students to ensure successful implementation of technology. Dental hygiene educators have adopted many types of educational technology, but more data are needed to determine best practices.
Bicchi, Antonio; Gabiccini, Marco; Santello, Marco
We report on recent work in modelling the process of grasping and active touch by natural and artificial hands. Starting from observations made in human hands about the correlation of degrees of freedom in patterns of more frequent use (postural synergies), we consider the implications of a geometrical model accounting for such data, which is applicable to the pre-grasping phase occurring when shaping the hand before actual contact with the grasped object. To extend applicability of the synergy model to study force distribution in the actual grasp, we introduce a modified model including the mechanical compliance of the hand's musculotendinous system. Numerical results obtained by this model indicate that the same principal synergies observed from pre-grasp postural data are also fundamental in achieving proper grasp force distribution. To illustrate the concept of synergies in the dual domain of haptic sensing, we provide a review of models of how the complexity and heterogeneity of sensory information from touch can be harnessed in simplified, tractable abstractions. These abstractions are amenable to fast processing to enable quick reflexes as well as elaboration of high-level percepts. Applications of the synergy model to the design and control of artificial hands and tactile sensors are illustrated. PMID:21969697
Bicchi, Antonio; Gabiccini, Marco; Santello, Marco
We report on recent work in modelling the process of grasping and active touch by natural and artificial hands. Starting from observations made in human hands about the correlation of degrees of freedom in patterns of more frequent use (postural synergies), we consider the implications of a geometrical model accounting for such data, which is applicable to the pre-grasping phase occurring when shaping the hand before actual contact with the grasped object. To extend applicability of the synergy model to study force distribution in the actual grasp, we introduce a modified model including the mechanical compliance of the hand's musculotendinous system. Numerical results obtained by this model indicate that the same principal synergies observed from pre-grasp postural data are also fundamental in achieving proper grasp force distribution. To illustrate the concept of synergies in the dual domain of haptic sensing, we provide a review of models of how the complexity and heterogeneity of sensory information from touch can be harnessed in simplified, tractable abstractions. These abstractions are amenable to fast processing to enable quick reflexes as well as elaboration of high-level percepts. Applications of the synergy model to the design and control of artificial hands and tactile sensors are illustrated.
Achieving patient compliance in taking prescribed medications is a formidable challenge for all clinicians. As PAs, we have daily opportunities to communicate with patients and improve their compliance. An office-based compliance program, combining patient education and behavior-modification components, can be beneficial in this regard. Strategies for improving compliance include giving clear, concise, and logical instructions in familiar language, adapting drug regimens to daily routines, eliciting patient participation through self-monitoring, and providing educational materials that promote overall good health in connection with medical treatment.
... 42 Public Health 3 2012-10-01 2012-10-01 false Compliance plan. 425.300 Section 425.300 Public... Protections § 425.300 Compliance plan. (a) The ACO must have a compliance plan that includes at least the...) An ACO's compliance plan must be in compliance with and be updated periodically to reflect changes...
... 42 Public Health 3 2013-10-01 2013-10-01 false Compliance plan. 425.300 Section 425.300 Public... Protections § 425.300 Compliance plan. (a) The ACO must have a compliance plan that includes at least the...) An ACO's compliance plan must be in compliance with and be updated periodically to reflect changes...
There is no single personality trait, psychological condition, socioeconomic factor or stage of disease that can reliably be used to predict drug compliance. Missing doses of protease inhibitors can lead to drug resistance, so complying with a treatment regimen is critical. One major issue is the timing of medication; some drugs need to be taken with foods, some without, and many complex treatment regimens specify rigid times at which the drugs should be taken. Patients are encouraged to keep a written record of their care, and are more likely to comply if they know the reasons why it is necessary and are prepared to expect some physical discomfort.
Panikkath, Deepa; Mojumder, Deb; Nugent, Kenneth
A 77-year-old woman presented with the complaint of observing her left hand moving without her knowledge while watching television. Her left hand stroked her face and hair as if somebody was controlling it. These movements lasted only half an hour but on recovery, she had left hemiparesis. Alien hand syndrome as the presentation of cardioembolic stroke is extremely rare but can be terrifying to patients. PMID:24982566
Hand and Power Tools U.S. Department of Labor Occupational Safety and Health Administration OSHA 3080 1998 (Revised) Report Documentation Page Report...Date 00001998 Report Type N/A Dates Covered (from... to) - Title and Subtitle Hand and Power Tools Contract Number Grant Number Program...basic safety procedures and safeguards associated with hand and portable power tools . Material in this booklet is based on the standards of the
Venkataraman, Subramanian T. (Editor); Iberall, Thea (Editor)
Recent studies of human hand function and their implications for the design of robot hands are discussed in reviews and reports. Topics addressed include human grasp choice and robotic grasp analysis, opposition space and human prehension, coordination in normal and prosthetic reaching, and intelligent exploration by the human hand. Consideration is given to a task-oriented dextrous manipulation architecture, the control architecture for the Belgrade/USC hand, the analysis of multifingered grasping and manipulation, and tactile sensing for shape interpretation. Diagrams, graphs, and photographs are provided.
Prüss-Ustün, Annette; Bartram, Jamie; Clasen, Thomas; Colford, John M; Cumming, Oliver; Curtis, Valerie; Bonjour, Sophie; Dangour, Alan D; De France, Jennifer; Fewtrell, Lorna; Freeman, Matthew C; Gordon, Bruce; Hunter, Paul R; Johnston, Richard B; Mathers, Colin; Mäusezahl, Daniel; Medlicott, Kate; Neira, Maria; Stocks, Meredith; Wolf, Jennyfer; Cairncross, Sandy
Objective To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. Methods For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. Results In 2012, 502 000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280 000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297 000 deaths. In total, 842 000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361 000 deaths could be prevented, representing 5.5% of deaths in that age group. Conclusions This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene. PMID:24779548
... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Partial compliance not deemed compliance. 12.70 Section 12.70 Judicial Administration DEPARTMENT OF JUSTICE REGISTRATION OF CERTAIN PERSONS HAVING KNOWLEDGE OF FOREIGN ESPIONAGE, COUNTERESPIONAGE, OR SABOTAGE MATTERS UNDER THE ACT OF AUGUST...
... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Partial compliance not deemed compliance. 12.70 Section 12.70 Judicial Administration DEPARTMENT OF JUSTICE REGISTRATION OF CERTAIN PERSONS HAVING KNOWLEDGE OF FOREIGN ESPIONAGE, COUNTERESPIONAGE, OR SABOTAGE MATTERS UNDER THE ACT OF AUGUST...
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Partial compliance not deemed compliance. 12.70 Section 12.70 Judicial Administration DEPARTMENT OF JUSTICE REGISTRATION OF CERTAIN PERSONS HAVING KNOWLEDGE OF FOREIGN ESPIONAGE, COUNTERESPIONAGE, OR SABOTAGE MATTERS UNDER THE ACT OF AUGUST...
... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Partial compliance not deemed compliance. 12.70 Section 12.70 Judicial Administration DEPARTMENT OF JUSTICE REGISTRATION OF CERTAIN PERSONS HAVING KNOWLEDGE OF FOREIGN ESPIONAGE, COUNTERESPIONAGE, OR SABOTAGE MATTERS UNDER THE ACT OF AUGUST...
... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Partial compliance not deemed compliance. 12.70 Section 12.70 Judicial Administration DEPARTMENT OF JUSTICE REGISTRATION OF CERTAIN PERSONS HAVING KNOWLEDGE OF FOREIGN ESPIONAGE, COUNTERESPIONAGE, OR SABOTAGE MATTERS UNDER THE ACT OF AUGUST...
Putnam, David F.; Jolly, Clifford D.; Colombo, Gerald V.; Price, Don
A multifiltration hygiene water reclamation process that utilizes adsorption and particulate filtration techniques is described and evaluated. The applicability of the process is tested using a simulation of a 4-man subsystem operation for 240 days. It is proposed the process has a 10 year life, weighs 236 kg, and uses 88 kg of expendable filters and adsorption beds to process 8424 kg of water. The data reveal that the multifiltration is an efficient nonphase change technique for hygiene water recovery and that the chemical and microbiological purity of the product water is within the standards specified for the Space Station hygiene water.
Centanni, N; Monroe, M; White, L; Larson, R
The service sector within the biopharmaceutical industry has experienced phenomenal growth over the past decade. In the highly regulated Good Laboratory Practices environment, the need for timely, high-quality service, accurate results, and on-time deliverables becomes paramount for the success and profitability of biopharmaceutical companies. The quality assurance process is a vital component of this drug product-development cycle and ensures compliance to the highest domestic and international regulatory standards. Quality-assurance professionals historically have held the role of independent auditors of the processes, who certify that results meet current standards of practice. Covance, a contract research organization that includes Good Laboratory Practices laboratories, reorganized and expanded the functional responsibilities of its quality assurance team in 1997. Auditors and quality assurance professionals have assumed roles beyond traditional compliance auditing and are forging new leadership and mentoring roles as process-improvement specialists. The results have been tangible, measurable benefits for clients and the Covance organization. This article provides an overview of this cultural change and the processes put in place to improve efficiency, productivity, and customer and employee satisfaction.
Visalachy, Sowndarya; Kopula, Sridharan Sathyamoorthy; Sekar, Uma
Introduction Maximal contact between the patients and Health Care Workers (HCWs) happens in the Intensive Care Units (ICU). Control of nosocomial infections requires compliance with hand hygiene and contamination free surfaces. Aim To determine the colonization of potential pathogens in the hands of HCWs and frequent contacted environmental surfaces. Materials and Methods A cross sectional study was conducted between September 2012 and May 2013 at Sri Ramachandra Medical College and Hospital. A total of 327 samples were collected using Glove juice technique from hands and swabs from frequently contacted surfaces. A sum of 157 samples were collected by glove juice technique from the hands of HCWs which included Consultants (20), Internees (3), Residents (10), Staff nurse (102) and support staff (22). A total of 170 samples were collected through swabbing which included frequently touched surfaces of apron and dress (140 which included 10 consultants, 3 internees, 9 Residents, 101 Staff nurse and 17 support staff), 9 door handle, 4 key board, 12 tap handles and 5 monitors. The samples were inoculated into Blood agar, Chocolate agar and Mac-Conkey agar plates and incubated at 370C aerobically. The plates showing growth were further processed to identify the organisms by Gram staining and biochemical reactions. Antibiotic susceptibility testing was done for the isolates by Kirby-baur disc diffusion method as per CLSI guidelines. Results Out of the 157 hand sampling done by glove juice method 67(42.7%) of them showed growth and 90(57.3%) showed no growth. The potential pathogens grown were 13 (8.3%), consisting of Methicillin Sensitive Staphylococcus aureus (MSSA) 6(3.8%), Methicillin Resistant Staphylococcus aureus (MRSA) 2(1.3%), Pseudomonas spp 4(2.6%) and Acenitobacter spp 1 (0.6%). The MRSA was seen in Consultant 1(5%; n=20) and Staff nurse 1(0.9%; n= 102). Among the 140 sampling from the dress of HCWs growth was observed in 69(49.3%) and growth was absent in 71
Ashur, H; Mushayov, R
Almost every year just before Passover there is increased exposure to hand trauma in matzah bakeries. In the past 5 years we treated 11 cases of hand trauma incurred during matzah baking. The typical injuries were amputations at different levels, crush injuries and burns. We present a case seen last Passover and suggest preventive methods to eliminate these accidents in the future.
Hastings, D. E.; Welsh, R. P.
Deformities in the rheumatoid hand will vary according to whether the joints or the tendons are involved. Frequently both will be involved and several different deformities will be present in the same hand. However, a logical approach to examination and treatment, as outlined in this article, will simplify decision making and ensure prompt, appropriate treatment. PMID:21304805
Efficiency in the 1980's, quality in the 1990's, compliance in the 2010's - private sector management techniques and mechanisms find their way to public services. This paper facilitates the understanding of how compliance management controls can improve operations and prevent or detect failure or wrong doing. The last few years' empirical research…
This article explores the difficulties patients encounter in complying with prescribed drug regimens, and describes some of the compliance aids which are commonly available. A sensitive understanding of patients' individual difficulties by health care staff is an essential precursor to successful compliance behaviour.
AA, Lambrechts; IS, Human; JH, Doughari; JFR, Lues
Background and Objectives: Hands of ready-to-eat food service employees have been shown to be vectors in the spread of foodborne disease, mainly because of poor personal hygiene and accounting for approximately 97% of food borne illnesses in food service establishments and homes. Our objective was to evaluate the efficacy of hand washing practices and sanitation before commencing work among food handlers in the convenient food industry in Gauteng, South Africa. Methods: A total of 230 samples were collected, involving 100% of the food handlers, in 8 selected convenient food outlets with their main focus on preparing ready-to-eat foods. The workers’ cleaned and disinfected dominant hands were sampled for Total Plate Count (TPC), Staphylococcus aureus and Escherichia coli. Bacteria were isolated and counted using standard methods. Results: The highest bacterial count from the hand samples was 7.4 x 103 cfu.cm-2 and the lowest showed no detectable growth. Although hands with a count of 0 cfu.cm-2 were found in all of the plants, the results indicated that all the plants exceeded the legal limit for food surfaces or hands of < 100 cfu.cm-2 when the average bacterial counts on hands were compared. Sixty percent of the TPC analysed exceeded the legal limit and only 18% of the food handlers had no bacteria detectable on their hands. One sample tested positive for E. coli and S. aureus could not be detected on the hands of any of the food handlers. Conclusion: The study revealed that hand hygiene is unsatisfactory and may have serious implications for public health due to contamination of food from food handlers’ hands. This therefore underlined the importance of further training to improve food handlers’ knowledge of good hand washing practices. PMID:25097511