Students' observations of hand hygiene adherence in 20 nursing home wards, during the COVID-19 pandemic.

BACKGROUND: Healthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not. METHODS: This observational study used the World Health Organization's observation tool for studying hand hygiene indication and adherence: "My five moments for hand hygiene." For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway. RESULTS: The overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them. CONCLUSIONS: Hand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers' knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.

Dangerous practices in a hemodialysis unit in Vietnam identify from mixed methods.

BACKGROUND: Non-compliance with infection control practices poses a serious risk to patients receiving chronic hemodialysis. We aimed to identify the type and frequency of non-compliance with infection control practices in a hemodialysis unit in Vietnam where a large outbreak of hepatitis C infection had occurred. METHODS: Mixed methods approach included observations and discussions of non-compliance with all 12 nurses at the Hemodialysis Unit, District-6 Hospital in Ho Chi Minh City. Observations of nursing care activities were made between September 2013 and January 2014. Compliance with hand hygiene and glove use during nursing care activities were classified according to the potential for a serious risk of transmission of infection and reported as percentages. Each nurse was expected to provide 11 nursing care activities to three patients assigned per hemodialysis sessions. Activities were to be given on an individual patient-centered care basis, that is, one patient was to receive all 11 activities by their assigned nurse. On completion of the observations all nurses were enrolled in a focus group where observed non-compliance was discussed and transcripts were examined for themes. RESULTS: Hand hygiene compliance rate was low (27%, 95%CI 25%-28%, 1633/6140) regardless of classification of seriousness of risk from this breach. Although glove use (76%, 95%CI 74-78%, 1211/1586) and other personal protective equipment use (81%, 95%CI 78%-83%, 773/959) were high gloves were observed to be reused with multiple patients during a single nursing care activity provided to consecutive patients. Nurses explained the breakdown of providing nursing care activities on an individual patient-centered basis was a response to limited supply of gloves and hand hygiene facilities and was exacerbated by nursing being co-opted by overly demanding patients to provide services without delay. CONCLUSIONS: The adaption by the nurses to provide 11 single care activities to multiple consecutive patients in the absence of changing gloves and low hand hygiene compliance was potentially the central risk factor that facilitated the hepatitis C outbreak. Patient-centered care needs to be enforced to minimize multiple nurse-patient contacts that are associated with non-compliance classified as serious risk of infection transmission. Nurse empowerment to resist unreasonable patient demands may also be pivotal to assisting their compliance with hand hygiene and single patient-centered care. An audit program to measure infection control resources and practices may facilitate enforcement of the guidelines.

Exposure of hairdressers to aromatic diamines: an interventional study confirming the protective effect of adequate glove use.

OBJECTIVES: Many hairdressers leave their profession due to health problems, including occupational hand eczema, which has been associated with skin exposure to sensitising hair dye components such as paraphenylenediamine (PPD) and paratoluenediamine (PTD). Since the use of protective gloves is advised but without the short-term effect being known, our main goal was to attribute a significant biomarker reduction to adequate glove use, in a real work situation. METHODS: 11 hairdressers were studied over 2 weeks. In the first week, they worked as usual and (re)used their gloves. Thereafter, we intervened to improve glove use during the second week. In both weeks, workplace exposure data were collected through observations, and systemic exposure was quantified by biomonitoring of PPD and PTD. The effect of improved glove use and other exposure determinants was studied through mixed models analysis. RESULTS: We showed that improved glove use significantly reduced mean PTD concentrations from 24.1 before to 4.2 µg/g creatinine after the intervention (n=11, third day postshift). In addition, mean PTD concentrations increased during the first week (14 times elevated after three consecutive shifts), but not during the second week. For PPD, no effect of improved glove use and no accumulation effect were detected. CONCLUSIONS: Our study is the first to deliver evidence for a significant reduction in systemic exposure to PTD through improved glove use. Disposable gloves should never be reused. PTD biomonitoring is shown to be a practical tool to quantify recent dermal exposure to oxidative hair dye components.

Ineffective hand washing and the contamination of carrots after using a field latrine.

UNLABELLED: A study was undertaken to simulate the likely effects of a field worker with poor hygienic practices that had returned to work too soon after recovering from an infection by an enteric pathogen. The studies simulated a variety of hand-washing practices from no washing to washing with soap and water followed by an application of alcohol gel after using a field latrine. The numbers of generic Escherichia coli isolated from workers' hands declined with increasing thoroughness of hand-washing treatments with unwashed hands > water > water and soap > water, soap and alcohol gel. Where gloves were worn the counts obtained for the treatments were significantly reduced, but it was observed that unwashed hands contaminated gloves during the process of putting them on. Hand contamination following the use of a field latrine transferred contamination to carrots. These results suggest that if no gloves are worn it would be best practice to wash hands with water and soap and apply alcohol gel after using a field latrine. Wearing gloves reduced the risk of contaminating handled produce but workers should still wash their hands after using a field latrine before applying gloves. SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows that inadequate hand hygiene in the field following the use of a field latrine can transfer bacterial contamination to hand-harvested carrots. Where fresh produce crops are to be handled by workers, wearing gloves reduces the risk of contaminating produce but workers should still wash their hands after using a field latrine before applying gloves. If no gloves are worn it would be best practice to wash hands with water and soap and apply alcohol gel after using a field latrine.

Hand eczema among hairdressing apprentices in Denmark following a nationwide prospective intervention programme: 6-year follow-up.

BACKGROUND: Hand eczema is the commonest occupational skin disease in Denmark, and hairdressing is a high-risk profession. In 2008-2010, a clinically controlled, prospective intervention study aimed at reducing the development of hand eczema was conducted at hairdressing schools in Denmark. The findings showed that significantly fewer apprentices in the intervention group developed hand eczema over a period of 18 months. OBJECTIVES: To investigate the long-term effect of the intervention. METHODS: Two hundred and eighty-four participants were identified from the original dataset, and were sent a questionnaire. RESULTS: No difference was seen between the intervention and control groups. This may partly be attributable to the two groups no longer being well matched, and improved work habits in the control group. Overall, there was an improvement in work habits. Participants had a 1-year prevalence of hand eczema of 22.4%. Reactions to hair dye were reported for 24.5%, and 35.5% had left the trade; 36.4% used gloves when shampooing, and 21.3% stated that they cut hair before colouring it. CONCLUSIONS: The effect of the intervention was not visible after 6 years, but an overall improvement in work habits was noted.

Validation of a questionnaire on hand hygiene in the construction industry.

INTRODUCTION: Construction workers are at risk of developing occupational contact dermatitis. Gloves, when used properly, may protect against chemicals and coarse materials. We investigated the prevalence and determinants of contact dermatitis in a population of Dutch construction workers and aimed at validating questionnaire items on hand hygiene. METHODS: A cross-sectional study was conducted at 13 construction sites, yielding data of 177 subjects (95% response rate). A questionnaire covering questions on hand hygiene and contact dermatitis symptoms was used. Agreement between workplace observations and a number of questionnaire items was assessed by calculating Cohen's kappa. Log-binomial regression analysis was used to assess the association between contact dermatitis and various hand hygiene-related determinants. RESULTS: The 1-year prevalence of self-reported contact dermatitis in our study sample was 46.9%. Multiple regression analysis showed a positive association with difficulties with hand cleaning (prevalence ratio [PR]: 1.26, 95% confidence interval [CI]: 1.05-1.52), hand contamination at the end of the working day (PR: 2.30, 95% CI: 1.14-4.65), and intensive hand cream use (PR: 2.07, 95% CI: 1.42-3.01). Observations of hand contamination, glove use, and glove types were found to agree well with the self-reported data from the questionnaire (Cohen's kappa's 0.75, 0.97, and 0.88). CONCLUSIONS: Self-reported contact dermatitis prevalence in construction workers was high and related to hand hygiene. A strong agreement was found between workplace observations and self-reported questionnaire data.

The combined application of hand hygiene and non-sterile gloves by nurses in a tertiary hospital: a multi methods study.

BACKGROUND: The application of hand hygiene (HH) and the use of non-sterile gloves (NSG) in daily care is highly intertwined. We aimed (1) to assess the combined application of HH and NSG among nurses and (2) to explore determinants that influence their ability to combine both measures in their care. METHODS: In a multi-methods study, we combined direct observations of care episodes with semi-structured interviews with nurses in two affiliated university hospitals. Topics were based on Flottorp's checklist of determinants of practice. RESULTS: In total, we observed 205 care episodes and interviewed 10 nurses. Observations revealed that the combination of NSG and HH was correctly applied in 19% of care episodes in which a single procedure was executed, and in 2% of care episodes in which multiple procedures were performed. From the interviews, we found determinants that influenced compliance, covered mainly by three out of seven of Flottorp's checklist domains. Nurses indicated that their knowledge of protocols was limited to HH and protocols were hardly ever actively consulted; visual reminders within their workplace were used as sources of information. Nurses' behavior was primarily influenced by their ability to operationalize this information and their ability to integrate both infection prevention measures into their care. The intention to apply and combine HH and NSG use was influenced by their risk assessment of cross-contamination, by the urge to self-protect and gut feeling. The feasibility to execute HH and NSG protocols is influenced by the urgency and the complexity of the care episode. CONCLUSIONS: The combined correct application with HH and NSG measures by nurses is low. Nurses are instructed in a fragmented way while in the day to day care HH and NSG use are highly intertwined. Operationalization and simplification of infection prevention protocols, in which instructions on both infection prevention measures are fused, should be considered. Strategies to improve practice should consider the power of habit and nurses urge to self-protect.

Microbiological Profiles of Disposable Gloves Used for Handling Ready-to-Eat Foods.

Hand hygiene is critical in the food service industry. Bacteria can easily be transferred between different surfaces to food during food preparation. Common hygiene practices include hand washing and usage of disposable gloves. Food handlers are often susceptible to transferring pathogenic bacteria to food, thus proper hand hygiene can limit such transmission. While gloves serve as a barrier between bare hands and food, their misuse, including reuse or lack of change, can potentially result in cross-contamination, compromising on food safety. In Singapore, strict regulations and consumer perceptions have encouraged the use of gloves in food handling. This study assessed the microbiological profile of gloves used by food handlers across fifty randomly chosen food establishments, by swabbing samples from the inner and outer surfaces of gloves. Glove samples were also subjected to a watertight test to detect significant physical damage. The results revealed that gloves with damage exhibited significantly higher mean Standard Plate Counts (SPCs), suggesting the likelihood that damaged gloves promoted the transfer of bacteria. Damaged gloves used to handle certain types of food, like noodles and rice dishes, also had significantly higher mean SPC than those used for beverages and snacks. However, gloves without visible damage showed no significant difference in mean SPC across different food types. The study highlighted that proper glove use can help in preventing bacterial transfer and consequently, maintaining food safety. Regular glove changes, particularly when damaged, are imperative. The findings underscore the importance of proper glove use in conjunction with other hand hygiene practices to uphold food hygiene and safety standards.

Effect of video camera monitoring feedback on hand hygiene compliance in neonatal intensive care unit, an interventional study.

BACKGROUND: The purpose of this study was to determine whether use of a video camera surveillance system for hand hygiene (HH) monitoring, video-based education, and feedback could improve the HH compliance in a neonatal intensive care unit (NICU). METHODS AND MATERIALS: This was an interventional before-after trial conducted in a level-III NICU between July 2019 and June 2020. HH compliance was measured using randomly selected video-camera footage in the baseline, intervention, and maintenance periods. After the baseline, an intervention consisting of feedback and education with video scenarios was implemented. The primary outcome was change in HH compliance. The compliance rates were analyzed as an interrupted time series (ITS) with a segmented regression model adjusted for autocorrelation for each study period. RESULTS: We identified a total of 8335 HH indications. There were non significant increases in the total compliance rate (9.0%, 95% CI -2% to 20%) at the time of intervention and in the compliance rate after intervention (0.26%, 95% CI -0.31% to 0.84%) per day. The hand hygiene compliance before patient contact significantly increased (19.8%, 95% CI, 4.8%-34.8%). Incorrect glove use improved non-significantly with the intervention (-3.4%, 95% CI -13.4% to 6.7%). CONCLUSION: In this study of HH monitoring using video-camera footage combined with an intervention including feedback and education, there were inconsistent improvements in HH compliance. However, these improvements were not sustained in the long term. Frequent feedback and education may be required to sustain high compliance.

Characterization of Cleaning and Disinfection Product Use, Glove Use, and Skin Disorders by Healthcare Occupations in a Midwestern Healthcare Facility.

Healthcare facility staff use a wide variety of cleaning and disinfecting products during their daily operations, many of which are associated with respiratory or skin irritation or sensitization with repeated exposure. The objective of this study was to characterize the prevalence of cleaning and disinfection product use, glove use during cleaning and disinfection, and skin/allergy symptoms by occupation and identify the factors influencing glove use among the healthcare facility staff. A questionnaire was administered to the current employees at a midwestern Veterans Affairs healthcare facility that elicited information on cleaning and disinfection product use, glove use during cleaning and disinfection, skin/allergy symptoms, and other demographic characteristics, which were summarized by occupation. The central supply/environmental service workers (2% of the total survey population), nurses (26%,), nurse assistants (3%), and laboratory technicians (5%) had the highest prevalence of using cleaning or disinfecting products, specifically quaternary ammonium compounds, bleach, and alcohol. Glove use while using products was common in both patient care and non-patient care occupations. The factors associated with glove use included using bleach or quaternary ammonium compounds and using cleaning products 2-3 or 4-5 days per week. A high frequency of glove use (≥75%) was reported by workers in most occupations when using quaternary ammonium compounds or bleach. The use of alcohol, bleach, and quaternary ammonium compounds was associated with skin disorders (p < 0.05). These research findings indicate that although the workers from most occupations report a high frequency of glove use when using cleaning and disinfection products, there is room for improvement, especially among administrative, maintenance, and nursing workers. These groups may represent populations which could benefit from the implementation of workplace interventions and further training regarding the use of personal protective equipment and the potential health hazards of exposure to cleaning and disinfecting chemicals.

Perceptions of Glove Use During Vaccination: A Cross-Sectional Study.

PURPOSE: To better understand clinic attendees' perceptions of nonsterile glove (NSG) use during vaccination and their concern for the environment. DESIGN: This was a cross-sectional, self-administered, in-person survey. METHODS: A nonrandom volunteer sample of vaccination clinic attendees (n = 789) completed a survey assessing their perception of NSG use during influenza vaccination administration and their concern for the environment. FINDINGS: Nearly all respondents equated NSG use with increased safety and professionalism. More than half of respondents reported feeling concerned about environmental waste associated with NSG use. CONCLUSIONS: NSG are not indicated for routine vaccination. Adherence to evidence-based practices on NSG use during vaccination can substantially reduce associated medical waste. Nurses can lead by example by only using NSG when indicated.

Transfer rates of pathogenic bacteria during pork processing.

We examined the rates of pathogenic bacterial cross-contamination from gloves to meat and from meat to gloves during pork processing under meat-handling scenarios in transfer rate experiments of inoculated pathogens. The inoculated pork contained ~5-6 Log10 CFU/g pathogenic bacteria like Escherichia coli (E. coli), Staphylococcus aureus (S. aureus), Listeria monocytogenes (L. monocytogenes), and Salmonella enterica subsp. enterica (Sal. enteritidis). On cotton gloves, after cutting the pork, the cutting board, knife, and cotton gloves showed 3.07-3.50, 3.29-3.92 and 4.48-4.86 Log10 CFU/g bacteria. However, when using polyethylene gloves, fewer bacteria (3.12-3.75, 3.20-3.33, and 3.07-3.97 Log10 CFU/g, respectively) were transferred. When four pathogens (6 Log10 CFU/g) were inoculated onto the gloves, polyethylene gloves showed a lower transition rate (cutting board 2.47-3.40, knife 2.01-3.98, and polyethylene glove 2.40-2.98 Log10 CFU/g) than cotton gloves. For cotton gloves, these values were 3.46-3.96, 3.37-4.06, and 3.55-4.00 Log10 CFU/g, respectively. Use of cotton gloves, polyethylene gloves, knives and cutting boards for up to 10 hours in a meat butchering environment has not exceeded HACCP regulations. However, after 10 h of use, 3.09, 3.27, and 2.94 Log10 CFU/g of plate count bacteria were detected on the cotton gloves, cutting board, and knives but polyethylene gloves showed no bacterial count. Our results reveal the transfer efficiency of pathogenic bacteria and that gloved hands may act as a transfer route of pathogenic bacteria between meat and hands. The best hand hygiene was achieved when wearing polyethylene gloves. Thus, use of polyethylene rather than cotton gloves reduces cross-contamination during meat processing.

Use of non-sterile gloves in the ward environment: an evaluation of healthcare workers' perception of risk and decision making.

BACKGROUND: Studies have found that inappropriate use of non-sterile gloves (NSG) can affect hand hygiene compliance; the main risks are missing opportunities for hand hygiene and gloves being a vector for microbial transmission. AIM: The aims of this study were to explore the accuracy of healthcare worker (HCW) risk assessment and decision making regarding the use of NSG. METHODS: The study was conducted in two acute NHS Trusts and a community social enterprise. A cross-sectional survey was carried out, followed by qualitative semi-structured interviews. FINDINGS: There were highly significant differences at the 95% probability level between staff groups, unqualified staff being significantly more likely than qualified staff to report NSG use when not indicated (P < 0.0001). The primary motivating factor for staff to wear NSG was for personal protection; the secondary factor being the protection of patients. Staff were also motivated by a desire to create an image of professionalism. Respondents were more likely to follow the lead of seniors in their own profession. DISCUSSION: The results suggest a necessity for change interventions aimed at unqualified staff such as healthcare assistants (HCAs). It would be beneficial to review the indications for glove use and amend organisational policies accordingly. Leaders in each professional staff group would be required to influence practice across organisations, taking into account motivating factors, and in association with multi-modal interventions to improve practice.

Hand hygiene before donning nonsterile gloves: Healthcareworkers' beliefs and practices.

BACKGROUND: Understanding the perceptions and beliefs of health care workers (HCWs) regarding glove use and associated hand hygiene (HH) may be informative and ultimately improve practice. Research in this area is limited. This study examined the practices and beliefs of HCWs surrounding the use of nonsterile gloves and HH before gloving. METHODS: The study was conducted at 3 large academic US hospitals using a parallel convergent mixed-method design. To estimate compliance rates, the gloving and HH practices of HCWs were observed at entry to patient rooms for 6 months. Interviews were conducted with 25 providers, nurses, and nursing assistants to investigate their beliefs and perceptions of these practices. RESULTS: Observed HH compliance rates before gloving were 42%, yet in the interviews most HCWs reported 100% compliance. Observed compliance with gloving before entering contact precaution rooms was 78%, although all HCWs reported always gloving for standard and contact precautions. Most HCWs described using gloves more often than necessary. HCWs generally use gloves for their own safety and sanitize hands before gloving for patient safety. Numerous barriers to compliance with HH before gloving were discussed, including beliefs that gloves provide enough protection. CONCLUSIONS: HH and glove use are highly intertwined in clinical practice and should be considered jointly in infection prevention improvement efforts.

Exploring inappropriate certified nursing assistant glove use in long-term care.

BACKGROUND: Certified Nursing Assistants (CNAs) frequently wear gloves when they care for patients in standard precautions. If CNAs use gloves inappropriately, they may spread pathogens to patients and the environment, potentially leading to health care-associated infections (HAIs). METHODS: Using a descriptive structured observational design, we examined the degree of inappropriate health care personnel glove use in a random sample of 74 CNAs performing toileting and perineal care at 1 long-term care facility. RESULTS: During the 74 patient care events, CNAs wore gloves for 80.2% (1,774/2,213) of the touch points, failing to change gloves at 66.4% (225/339) of glove change points. CNAs changed gloves a median of 2.0 times per patient care event. A median of 1.0 change occurred at a change point. CNAs failed to change their gloves at a glove change point a median of 2.5 times per patient care event. Most (61/74; 82.4%) patient care events had >1 contaminated touch point. Over 44% (782/1,774) of the gloved touch points were defined as contaminated for a median of 8.0 contaminated glove touch points per patient care event. All contaminated touches were with gloved hands (P <.001). CONCLUSIONS: Inappropriate glove use was frequently observed in this study. Contaminated gloves may be a significant cause of cross-contamination of pathogens in health care environments. Future research studies should evaluate strategies to improve glove use to reduce HAIs.

Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions-Is less more?

BACKGROUND: Guidelines recommend that health care personnel (HCP) wear gloves for all interactions with patients on contact precautions. We aimed to assess hand hygiene (HH) compliance during contact precautions before and after eliminating mandatory glove use. METHODS: We assessed HH compliance of HCP in the care of patients on contact precautions in 50 series before (2009) and 6 months after (2012) eliminating mandatory glove use and compared these results with the hospital-wide HH compliance. RESULTS: We assessed 426 HH indications before and 492 indications after the policy change. Compared with 2009, we observed a significantly higher HH compliance in patients on contact precautions in 2012 (52%; 95% confidence interval [95% CI], 47-57) vs 85%; 95% CI, 82-88; P < .001). During the same period, hospital-wide HH compliance also increased from 63% (95% CI, 61-65) to 81% (95% CI 80-83) (P < .001). However, the relative improvement (RI) of HH compliance during contact precautions was significantly higher than the hospital-wide relative improvement (RI, 1.6; 95% CI, 1.49-1.81 vs 1.29; 95% CI, 1.25-1.34), with a relative improvement ratio of 1.27 (95% CI, 1.15-1.41). CONCLUSION: Eliminating mandatory glove use in the care of patients on contact precautions increased HH compliance in our institution, particularly before invasive procedures and before patient contacts. Further studies on the effect on pathogen transmission are needed before revisiting the current official guidelines on the topic.