[Measures against surgical site infections in orthopaedic surgery]. / Prévention des infections postopératoires en orthopédie.

Orthopaedic surgery has low healthcare-associated infection incidences compared to other surgical disciplines. However, whenever they occur, these infections are associated with substantial morbidity, prolonged hospital stay, high costs, and difficulties of eradication with life-long recurrence risks. Among the many measures to prevent orthopaedic surgical site infections, only few are based on strong evidence, and there is insufficient evidence to ascertain which element is superior to any other. This highlights the need for multimodal approaches involving active post-discharge surveillance, as well as measures at every step of the care process; from the individual patient to department-wide interventions targeting all infections, and including antibiotic stewardship.

"Seconds save lives - clean your hands": the 5 May 2021 World Health Organization SAVE LIVES: Clean Your Hands campaign.

To highlight the urgent need to save lives by implementing best practices in health care delivery, the slogan for 5 May 2021, world hand hygiene day, is "Seconds save lives - clean your hands". The WHO campaign calls to action key stakeholders: health care workers, IPC practitioners, patients and families, facility managers, policy-makers, vaccinators, and the general public who can play critical roles in achieving optimal hand hygiene at the point of care, helping to strengthen society involvement.

Educating healthcare workers to optimal hand hygiene practices: addressing the need.

The education of healthcare workers is essential to improve practices and is an integral part of hand hygiene promotional strategies. According to the evidence reviewed here, healthcare worker education has a positive impact on improving hand hygiene and reducing healthcare-associated infection. Detailed practical guidance on steps for the organization of education programmes in healthcare facilities and teaching-learning strategies are provided using the World Health Organization (WHO) Guidelines for Hand Hygiene in Health Care as the basis for recommendations. Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools developed by WHO for education, monitoring and performance feedback.

African partnerships for patient safety: a vehicle for enhancing patient safety across two continents. [corrected].

African Partnerships for Patient Safety (APPS) aims to develop sustainable partnerships between hospitals in Africa and Europe to create a network of beacon hospitals for patient safety. The three core APPS objectives are focused on building strong patient safety partnerships between hospitals in Africa and Europe, implementing patient safety improvements in each partnership hospital on 12 patient safety action areas, and facilitating spread of patient safety improvements. APPS is working with six first wave hospital partnerships and will capture and report learning from implementation. A range of APPS resources will shortly be available to hospitals working on patient safety systems.

Hand hygiene in hospitals: anatomy of a revolution.

Healthcare-associated infections (HAIs) affect hundreds of millions of individuals worldwide. Performing hand hygiene is widely accepted as a key strategy of infection prevention and control (IPC) to prevent HAIs, as healthcare workers' contaminated hands are the vehicle most often implicated in the cross-transmission of pathogens in health care. Over the last 20 years, a paradigm shift has occurred in hand hygiene: the change from handwashing with soap and water to using alcohol-based hand rubs. In order to put this revolution into context and understand how such a change was able to be implemented across so many different cultures and geographic regions, it is useful to understand how the idea of hygiene in general, and hand hygiene specifically, developed. This paper aims to examine how ideas about hygiene and hand hygiene evolved from ancient to modern times, from a ubiquitous but local set of ideas to a global phenomenon. It reviews historical landmarks from the first known documented recipe for soap by the Babylon civilization to the discovery of chlorine, and significant contributions by pioneers such as Antoine Germain Labarraque, Alexander Gordon, Oliver Wendell Holmes, Ignaz Philip Semmelweis, Louis Pasteur and Joseph Lister. It recalls that handwashing with soap and water appeared in guidelines to prevent HAIs in the 1980s; describes why alcohol-based hand rub replaced this as the central tool for action within a multi-modal improvement strategy; and looks at how the World Health Organization and other committed stakeholders, governments and dedicated IPC staff are championing hand hygiene globally.

Fighting the good fight: the fallout of fake news in infection prevention and why context matters.

Although misinformation has always existed, the scope and speed at which fake news can reach even the most remote corners of the globe is a modern phenomenon. In the field of infection prevention and control (IPC), we like to believe that our dedication to the field and the process of conducting science protects us from the ravages of 'bad buzz' and fake news. This misconception leads medical professionals to underestimate the negative effects of misinformation on public health. This paper focuses on the nexus of what is happening between the field of IPC and the public. Its aim is to examine how information gets distorted and amplified between the medical community and the public, and outline some of the issues that deserve further attention. It looks at a number of case studies which show that even one badly conducted study can have a severe negative impact on public health, and that a well-conducted study can be distorted to make people believe something fallacious. In the current system of publishing and the proliferation of online journals that publish without peer review, 'bad buzz' and fake news can quickly do a good deal of damage.

'My five moments for hand hygiene': a user-centred design approach to understand, train, monitor and report hand hygiene.

Hand hygiene is a core element of patient safety for the prevention of healthcare-associated infections and the spread of antimicrobial resistance. Its promotion represents a challenge that requires a multi-modal strategy using a clear, robust and simple conceptual framework. The World Health Organization First Global Patient Safety Challenge 'Clean Care is Safer Care' has expanded educational and promotional tools developed initially for the Swiss national hand hygiene campaign for worldwide use. Development methodology involved a user-centred design approach incorporating strategies of human factors engineering, cognitive behaviour science and elements of social marketing, followed by an iterative prototype test phase within the target population. This research resulted in a concept called 'My five moments for hand hygiene'. It describes the fundamental reference points for healthcare workers (HCWs) in a time-space framework and designates the moments when hand hygiene is required to effectively interrupt microbial transmission during the care sequence. The concept applies to a wide range of patient care activities and healthcare settings. It proposes a unified vision for trainers, observers and HCWs that should facilitate education, minimize inter-individual variation and resource use, and increase adherence. 'My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices.

The global hand-sanitizing relay: promoting hand hygiene through innovation.

On the 10th anniversary of the 'Clean Care is Safer Care' programme, the World Health Organization (WHO) Collaborating Centre on Patient Safety launched the 'Global Hand Sanitizing Relay 2015' (HSRelay). This hospital-wide activity promotes the WHO handrubbing technique to improve hand hygiene (HH) compliance. More than 15,000 healthcare workers (HCWs) from 133 hospitals in 43 countries participated. Between May and September 2015, 14 hospitals submitted pre- and post-event HH compliance data; 57% (8/14) reported a significant increase while others showed minimal or no improvement (average absolute change 9.4%). The HSRelay demonstrated that HCWs were interested in novel strategies to improve HH compliance.

Role of parents in the promotion of hand hygiene in the paediatric setting: a systematic literature review.

BACKGROUND: When a child is hospitalized, parents have to share their role to protect the child with the hospital, and establish a partnership with healthcare workers to deliver safe care to the child, including undertaking good hand hygiene practices. AIM: To review the scientific evidence about the participation of parents in the promotion of hand hygiene in paediatric settings. METHODS: A systematic search of MEDLINE, EMBASE and SciELO databases was undertaken using the following terms: ('hand hygiene'[MeSH] OR 'hand hygiene' OR 'hand disinfection'[MeSH] OR hand disinf* OR hand wash* OR handwash* OR hand antisep*) AND (parent OR caregiver OR mother OR father OR family OR families OR relatives). The Integrated Quality Criteria for Review of Multiple Study Designs tool was used for quality assessment. FINDINGS: The literature search yielded 1645 articles, and 11 studies met the inclusion criteria for the final analysis. Most studies were observational, and were based on questionnaires or interviews. Most parents had little knowledge about the indications to perform hand hygiene, but recognized hand hygiene as a relevant tool for the prevention of healthcare-associated infections. Their willingness to remind healthcare workers about a failed opportunity to perform hand hygiene was variable and, overall, rather low. Parents felt more comfortable about reminding healthcare workers about hand hygiene if they had previously been invited to do so. CONCLUSIONS: Literature on the subject is scarce. The promotion of hand hygiene by parents should be further explored by research as a potential intervention for enhancing patient safety in paediatric settings.

The 'My five moments for hand hygiene' concept for the overcrowded setting in resource-limited healthcare systems.

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.

Organization of infection control in European hospitals.

BACKGROUND: The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) survey was initiated to investigate the status of healthcare-associated infection (HCAI) prevention across Europe. AIM: This paper presents the methodology of the quantitative PROHIBIT survey and outlines the findings on infection control (IC) structure and organization including management's support at the hospital level. METHODS: Hospitals in 34 countries were invited to participate between September 2011 and March 2012. Respondents included IC personnel and hospital management. FINDINGS: Data from 309 hospitals in 24 countries were analysed. Hospitals had a median (interquartile range) of four IC nurses (2-6) and one IC doctor (0-2) per 1000 beds. Almost all hospitals (96%) had defined IC objectives, which mainly addressed hand hygiene (87%), healthcare-associated infection reduction (84%), and antibiotic stewardship (66%). Senior management provided leadership walk rounds in about half of hospitals, most often in Eastern and Northern Europe, 65% and 64%, respectively. In the majority of hospitals (71%), sanctions were not employed for repeated violations of IC practices. Use of sanctions varied significantly by region (P < 0.001), but not by countries' healthcare expenditure. CONCLUSION: There is great variance in IC staffing and policies across Europe. Some areas of practice, such as hand hygiene, seem to receive considerably more attention than others that are equally important, such as antibiotic stewardship. Programmes in IC suffer from deficiencies in human resources and local policies, ubiquitous factors that negatively impact on IC effectiveness. Strengthening of IC policies in European hospitals should be a public health priority.

Environmental controls in operating theatres.

Surgical-site infection is the leading complication of surgery. Normal skin flora of patients or healthcare workers causes more than half all infections following clean surgery, but the importance of airborne bacteria in this setting remains controversial. Modern operating theatres have conventional plenum ventilation with filtered air where particles >/=5 microm are removed. For orthopaedic and other implant surgery, laminar-flow systems are used with high-efficiency particulate air (HEPA) filters where particles >/=0.3 microm are removed. The use of ultra-clean air has been shown to reduce infection rates significantly in orthopaedic implant surgery. Few countries have set bacterial threshold limits for conventionally ventilated operating rooms, although most recommend 20 air changes per hour to obtain 50-150 colony forming units/m(3) of air. There are no standardized methods for bacterial air sampling or its frequency. With the use of HEPA filters in operating theatre ventilation, there is a tendency to apply cleanroom technology standards used in industry for hospitals. These are based on measuring the presence of particles of varying sizes and numbers, and are better suited than bacterial sampling. Environmental bacterial sampling in operating theatres should be limited to investigation of epidemics, validation of protocols, or changes made in materials which could influence the microbial content.