The impact of a 'milking the COW' campaign in a regional hospital in Singapore.

BACKGROUND: Computerisation of various processes in hospitals and reliance on electronic devices raises the concern of contamination of these devices from the patient environment. We undertook this study to determine if an attached hand hygiene device that unlocks the screen of a computer on wheels (COW) on usage can be effective in decreasing the microbiological burden on computer keyboards. METHODS: An electronic hand sanitizer was integrated onto the COW. A prospective cohort study with a crossover design involving 2 control and 2 intervention wards was used. The study end point was the number of colony forming units found on the keyboards. Bacteria were classified into 4 main groups; pathogenic, skin flora, from the environment or those thought to be commensals in healthy individuals. We then used a mixed effects model for the statistical analysis to determine if there were any differences before and after the intervention. RESULTS: Thirty-nine keyboards were swabbed at baseline, day 7 and 14, with 234 keyboards cultured, colony forming units (CFUs) counted and organisms isolated. By mixed model analysis, the difference of mean bacteria count between intervention and control for week 1 was 32.74 (- 32.74, CI - 94.29 to 28.75, p = 0.29), for week 2 by 155.86 (- 155.86, CI - 227.45 to - 83.53, p < 0.0001), and after the 2-week period by 157.04 (- 157.04, CI - 231.53 to - 82.67, p < 0.0001). In the sub-analysis, there were significant differences of pathogenic bacteria counts for the Intervention as compared to the Control in contrast with commensal counts. CONCLUSION: A hand hygiene device attached to a COW may be effective in decreasing the microbiological burden on computer keyboards.

Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature.

Numerous studies are published on the benefits of electric hand dryers vs paper towels (PT) for drying hands after washing. Data are conflicting and lacking key variables needed to assess infection risks. We provide a rapid scoping review on hand-drying methods relative to hygiene and health risks. Controlled vocabulary terms and keywords were used to search PubMed (1946-2018) and Embase (1947-2018). Multiple researchers independently screened abstracts for relevance using predetermined criteria and created a quality assessment scoring system for relative study comparisons. Of 293 papers, 23 were included in the final analysis. Five studies did not compare multiple methods; however, 2 generally favoured electric dryers (ED); 7 preferred PT; and 9 had mixed or statistically insignificant results (among these, 3 contained scenarios favourable to ED, 4 had results supporting PT, and the remaining studies had broadly conflicting results). Results were mixed among and within studies and many lacked consistent design or statistical analysis. The breadth of data does not favour one method as being more hygienic. However, some authors extended generalizable recommendations without sufficient scientific evidence. The use of tools in quantitative microbial risk assessment is suggested to evaluate health exposure potentials and risks relative to hand-drying methods. We found no data to support any human health claims associated with hand-drying methods. Inconclusive and conflicting results represent data gaps preventing the advancement of hand-drying policy or practice recommendations.

New Contact Sensorization Smart System for IoT e-Health Applications Based on IBC IEEE 802.15.6 Communications.

This paper proposes and demonstrates the capabilities of a new sensorization system that monitors skin contact between two persons. Based on the intrabody communication standard (802.15.6), the new system allows for interbody communication, through the transmission of messages between different persons through the skin when they are touching. The system not only detects if there has been contact between two persons but, as a novelty, is also able to identify the elements that have been in contact. This sensor will be applied to analyze and monitor good follow-up of hand hygiene practice in health care, following the "World Health Organization Guidelines on Hand Hygiene in Health Care". This guide proposes specific recommendations to improve hygiene practices and reduce the transmission of pathogenic microorganisms between patients and health-care workers (HCW). The transmission of nosocomial infections due to improper hand hygiene could be reduced with the aid of a monitoring system that would prevent HCWs from violating the protocol. The cutting-edge sensor proposed in this paper is a crucial innovation for the development of this automated hand hygiene monitoring system (AHHMS).

A comparison of the accuracy of two electronic hand hygiene monitoring systems.

Interest in electronic hand hygiene monitoring systems (EHHMSs) is now widespread throughout the infection control community. We tested 2 types of EHHMS for accuracy. The type B EHHMS captured more HH events with superior accuracy. Hospitals considering an EHHMS should assess the technology's ability to accurately capture HH performance in the clinical workflow.

Optimizing Accessibility of a Hand-wash Gel to Infant's Cradle: Effect on Neonatal Conjunctivitis.

BACKGROUND: In our recent study in 2015, we showed a significant relationship between increased rate of clinical neonatal conjunctivitis (CNC) and performance of eye red reflex examination. Our study aim was to assess whether improved accessibility of staff to disinfectant gel (via attaching the gel bottle to infant's cradle) will increase the caring staff compliance with hand hygiene and decrease the rate of CNC. METHODS: Our intervention included attaching bottles of alcohol-based gel to newborns' cradles to ensure full availability and accessibility of hand-wash disinfectant. We included all newborn infants who were born beyond 35 weeks' gestation and stayed in the well-baby nursery. We compared 2 periods: pre-intervention period (n = 9380) versus an intervention period (n = 8087). Three variables were recorded: (1) rate of CNC: number of conjunctival swabs sampled per 1000 newborns whenever an eye discharge was noted, (2) rate of bacterial conjunctivitis: number of positive swabs per 1000 newborns and (3) percentage of positive swabs out of all sampled swabs. RESULTS: Compared with pre-intervention period, the rate of CNC dropped significantly during the intervention period: 28.6/1000 versus 21.3/1000, respectively, P < 0.01. However, the number of positive bacterial swabs per 1000 newborns (3.2 vs. 2.5) and the percentage of positive bacterial swabs of all sent samples (11.6% vs. 10.8%) were not different between the 2 periods. The majority of pathogens in swabs were Gram-negative sp. without difference between study periods (77.4% vs. 80%), respectively. Univariate analysis showed significant association between rate of CNC and longer length of stay >5 days (P < 0.001) and vaginal delivery. Logistic stepwise regression analysis showed that 4 variables were significantly and independently associated with higher rate of clinical conjunctivitis. These include birth during pre-intervention period [P = 0.018, odds ratio (OR) = 1.27, 95% confidence interval (CI): 1.04-1.54], length of stay 4-5 days (P < 0.001, OR = 2.23, CI: 1.63-3.06), length of stay >7 days (P < 0.001, OR = 6.51, CI: 4.24-10.02), vaginal delivery (P = 0.004, OR = 1.6, CI: 1.17-2.2) and male gender (P = 0.006, OR = 1.31, CI: 1.08-1.59). CONCLUSIONS: Accessibility of a disinfectant gel within each newborn's cradle raised hygiene awareness among the caring staff and contributed to the reduction of CNC rate in the newborn nursery.

Conhecimento sobre higienização das mãos na perspectiva de profissionais de enfermagem em um pronto atendimento / Knowledge of hand hygiene in the perspective of nursing professionals from an emergency service / Conocimiento acerca de la higiene de las manos desde la perspectiva de los profesionales de enfermería en un servicio de emergencia

Objetivo: Avaliar o conhecimento da equipe de enfermagem em relação à Higienização das mãos em uma unidade de pronto atendimento e, identificar o perfil sociodemográfico e laboral destes. Método: estudo transversal, descritivo, quantitativo realizado em município do Noroeste do Estado do Rio Grande do Sul, com profissionais de enfermagem atuantes em um pronto atendimento de um hospital privado. Dados coletados pelo "Teste de Conhecimento a respeito da Higienização das Mãos para profissionais da Saúde". Resultados: profissionais desconhecem tempo mínimo para que a preparação alcoólica destrua os microrganismos nas mãos. Com relação aos itens que devem ser evitados por associarem-se à possibilidade de colonização, a maioria correspondeu às expectativas ao assinalarem as respostas corretas. Conclusão: o conhecimento da equipe é satisfatório, todavia, existem lacunas a serem trabalhadas. Necessário que programas de educação permanente sejam instituídos para que essas práticas mantenham a conformidade com as diretrizes preconizadas pelo Ministério da Saúde

Objetivo: Evaluar el conocimiento del equipo de enfermería acerca de la higiene de las manos en una unidad de emergencia e identificar el perfil sociodemográfico y ocupacional de estos profesionales. Método: estudio descriptivo, transversal y cuantitativo llevado a cabo en un municipio ubicado en la región noroeste del estado de Rio Grande do Sul, con los profesionales de enfermería que trabajan en un servicio de emergencia en un hospital privado. Los datos fueron recogidos por el 'Cuestionario acerca de los conocimientos sobre la higiene de las manos destinado a los profesionales sanitarios'. Resultados: los profesionales no saben acerca del tiempo mínimo necesario para la preparación alcohólica destruir los gérmenes en las manos. En cuanto a los elementos que deben ser evitados ya que están asociados con la posibilidad de la colonización, la mayoría de los participantes estuvo a la altura de las expectativas al señalar las respuestas correctas. Conclusión: el conocimiento del equipo de enfermería es satisfactorio, sin embargo, hay lagunas que deben abordarse. Los programas de educación continua deben estar establecidos para que estas prácticas se mantengan de acuerdo con las directrices recomendadas por el Ministerio de Salud

Objective: The study's purpose has been to assess the knowledge of the nursing team regarding hand hygiene in an emergency service, and also identify the sociodemographic and occupational profile of those professionals. Methods: It is a cross-sectional, descriptive and quantitative survey performed in a municipality located in the Northwest of the Rio Grande do Sul State with nursing professionals who work in an emergency service from a private hospital. Data were collected through the "Hand Hygiene Knowledge Questionnaire for Health Care Workers". Results: Professionals are unaware of the minimum time required for elimination of hand microorganisms with use of an alcoholic solution. Concerning the items that must be avoided because of their association to the possibility of microorganism proliferation, most participants met the expectations by choosing the correct answers. Conclusion: The staff 's knowledge is satisfactory, however, there are gaps to be addressed. Continuing education programs should be established to keep these practices in accordance with the guidelines recommended by the Ministry of Health

Do WiFi-based hand hygiene dispenser systems increase hand hygiene compliance?

Innovative methods to ensure better compliance in hand hygiene are urgently needed. The aim of this study was to determine if WiFi-based hand hygiene dispenser-driven self-assessment systems (Wireless Fidelity, WiFi-dispenser) can support the work of infection control teams. Our results suggest that the continuous monitoring of dispenser usage can be a valuable addition to infection prevention and control programs, when used in a bundle in combination with conventional hand hygiene training.

Adesão à higienização das mãos: um olhar sobre a edificação do treinamento no processo de cuidar / Adhesion to hand hygiene: a look at the construction of training in the caring process

Construir estratégias com os profissionais da enfermagem para a adesão da higienização das mãos (HM) edificando uma prática de prevenção de infecções, envolvendo, conhecimento, incorporação de mudanças e interesse no cumprimento das normas, foi o que motivou o desenvolvimento desse estudo, que teve como objetivos: 1 ­ Identificar situações apontadas pelos enfermeiros (as) que possam não ser facilitadoras da adesão a HM; 2 ­ Rastrear nestas situações que ações e comportamentos são inibidores ou não da HM; 3 ­ Propor revisão das estratégias utilizadas pela CCIH para adesão a HM a partir dos resultados produzidos. Método descritivo observacional, intervencionista com abordagem qualitativa, desenvolvido em Hospital Universitário do Estado do Rio de Janeiro, em enfermarias de clínicas médicas e cirúrgicas. O material obtido foi dividido em duas etapas: 1- Treinamentos programados sobre higienização das mãos, intervenções quando identificadas oportunidades para HM não realizadas e atividade experimental em que o profissional executa e interpreta a experiência que revela a sujidade invisível das mãos. 2- Produção de dados onde 31 enfermeiros (as) responderam sobre as implicações da distância da pia ou a falta delas. O tema central adesão à higienização das mãos apresentou maior evidência verbal: dever (27), ter (30), ser (43), lavar as mãos (34), higienizar as mãos (25). Verificados dados relativos a esquecimento da retirada de adornos quando realizada a HM. Os resultados demonstram que a percepção sobre os treinamentos são satisfatórias, mas atestam a falta de tempo, recursos humanos insuficientes e infraestrutura necessária para a prática da HM. Neste processo destacamos alguns pressupostos ou hipóteses a ser investigados se o olhar for outro que deveria envolver corpos, cuidados e ambiente: continuamos arriscando a pratica, nossos clientes e a nós mesmos a contribuir com as infecções hospitalares, por que não aderimos a HM como numa ação e um processo correto como é preconizado

To construct strategies with nursing professionals for the adhesion of hand hygiene (HM), building a practice of infection prevention, involving knowledge, incorporation of changes and interest in compliance with standards, was the reason for the development of this study. as objectives: 1 - Identify situations pointed out by nurses who may not be facilitators of adherence to HM; 2 - To trace in these situations that actions and behaviors are inhibitive or not of HM; 3 - To propose a review of the strategies used by CCIH to join HM from the results produced. Observational descriptive method, interventionist with qualitative approach, developed in University Hospital of the State of Rio de Janeiro, in medical and surgical clinic wards. The material obtained was divided into two stages: 1- Programmed training on hand hygiene, interventions when opportunities for unrealized HM were identified and experimental activity in which the professional performs and interprets the experience that reveals the invisible dirt of the hands. 2- Data production where 31 nurses answered about the implications of distance from the sink or lack of them. The central theme of adherence to hand hygiene presented greater verbal evidence: duty (27), to have (30), to be (43), to wash hands (34), to sanitize hands (25). Verified data on forgetfulness of the removal of adornments when performed to HM. The results show that the perception about the training is satisfactory, but it shows the lack of time, insufficient human resources and the necessary infrastructure for the practice of HM. In this process we highlight some assumptions or hypotheses to be investigated if the gaze is another one that should involve bodies, care and environment: we continue to risk practicing, our clients and ourselves to contribute to hospital infections, why we do not adhere to HM as in a action and a correct process as advocated

The Hygiene Games.

Addressing the correlation of hospital acquired infections and insufficient hand hygiene, we propose a supportive system to enhance the individual hygiene habits of health care workers. By applying gamification to incentivize health care professionals while maintaining a high standard of privacy and usability, the system focuses on technical simplicity by using concepts like bring your own device in a scaleable proof of concept implementation.

A Review of Electronic Hand Hygiene Monitoring: Considerations for Hospital Management in Data Collection, Healthcare Worker Supervision, and Patient Perception.

Healthcare-associated infections (HAIs) in U.S. acute care hospitals lead to a burden of $96-$147 billion annually on the U.S. health system and affect 1 in 20 hospital patients (Marchetti & Rossiter, 2013). Hospital managers are charged with reducing and eliminating HAIs to cut costs and improve patient outcomes. Healthcare worker (HCW) hand hygiene (HH) practice is the most effective means of preventing the spread of HAIs, but compliance is at or below 50% (McGuckin, Waterman, & Govednik, 2009). For managers to increase the frequency of HCW HH occurrences and improve the quality of HH performance, companies have introduced electronic technologies to assist managers in training, supervising, and gathering data in the patient care setting. Although these technologies offer valuable feedback regarding compliance, little is known in terms of capabilities in the clinical setting. Less is known about HCW or patient attitudes if the system allows feedback to be shared. Early-adopting managers have begun to examine their experiences with HH technologies and publish their findings. We review peer-reviewed research on infection prevention that focused on the capabilities of these electronic systems, as well as the related research on HCW and patient interactions with electronic HH systems. Research suggests that these systems are capable of collecting data, but the results are mixed regarding their impact on HH compliance, reducing HAIs, or both and their costs. Research also indicates that HCWs and patients may not regard the technology as positively as industry or healthcare managers may have intended. When considering the adoption of electronic HH monitoring systems, hospital administrators should proceed with caution.

Effect of hand sanitizer location on hand hygiene compliance.

BACKGROUND: Hand hygiene is the most important intervention to prevent infection in hospitals. Health care workers should clean their hands at least before and after contact with patients. Hand sanitizer dispensers are important to support hand hygiene because they can be made available throughout hospital units. The aim of this study was to determine whether the usability of sanitizer dispensers correlates with compliance of staff in using the sanitizer in a hospital. This study took place in a Midwest, 404-bed, private, nonprofit community hospital with 15 inpatient care units in addition to several ambulatory units. METHODS: The usability and standardization of sanitizers in 12 participating inpatient units were evaluated. The hospital measured compliance of staff with hand hygiene as part of their quality improvement program. Data from 2010-2012 were analyzed to measure the relationship between compliance and usability using mixed-effects logistic regression models. RESULTS: The total usability score (P = .0046), visibility (P = .003), and accessibility of the sanitizer on entrance to the patient room (P = .00055) were statistically associated with higher observed compliance rates. Standardization alone showed no significant impact on observed compliance (P = .37). CONCLUSION: Hand hygiene compliance can be influenced by visibility and accessibility of dispensers. The sanitizer location should be part of multifaceted interventions to improve hand hygiene.

Hand dryer noise in public restrooms exceeds 80 dBA at 10 ft (3 m).

High airflow hand dryers are found in many public restrooms today. These dryers offer quick and clean hand drying, and are seen as being an environment-friendly alternative to paper towels. However, many new hand dryers are loud, exposing individuals using the facilities as well as those employees who clean the facilities to potentially dangerous noise. Prolonged exposure to high levels of occupational noise can cause damage to hair cells in the cochlea, resulting in varying degrees of noise-induced hearing loss. This study examined the intensity (in dBA) of the noise produced by the air dryers in campus restrooms. Hand dryer peak and average noise was measured with a sound level meter at 2.5 ft, 5 ft, and 10 ft from the dryer. Noise measurements did not decrease as predicted by the inverse-square law, probably because of the reverberative surfaces found in the restrooms. The small sample of hand dryers tested was mostly found to be producing more noise than the manufacturer claimed they would; indeed, none of the dryers would be safe for an 8-h workday exposure. While hand dryers do reduce paper trash, they pose as a different sort of hazard to our environment and population.

Contact precautions and hand hygiene in veterinary clinics.

Hand hygiene, contact precautions, and other basic infection control measures are crucial in veterinary clinics, because these facilities can be community mixing pots of animals and people with a wide range of health and disease-carrier states. Veterinary staff must be knowledgeable and well trained regarding when and how to apply situation-appropriate contact precautions and to properly perform hand hygiene. The limited information on the use of contact precautions and hand hygiene practices among veterinary staff suggests that compliance is low. Improving the infection control culture in clinics and in veterinary medicine is critical to achieving better compliance with these practices.

Use of hygiene protocols to control the spread of viruses in a hotel.

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).