An audit of central venous catheter insertion and management practices in two French university hospitals.

OBJECTIVE: To assess the compliance with French guidelines for the prevention of central venous catheter (CVC)-related infections in two university hospitals. METHODS: An observational audit was conducted in 7 wards using a digital tool. RESULTS: The prerequisite of hand hygiene (HH) were respected by 90% of health-care worker; 86% performed HH prior to equipment preparation and 59% repeated it prior to infusion. Wearing gloves when necessary and rinsing were respected in 46.7% and 75.6% of the observations. CONCLUSION: Findings showed an acceptable level of adherence to recommended practices for CVC management. However, barriers of unrespect evidence-based recommendations need to be investigated in depth.

Compliance and adherence to hand hygiene practices for effective infection control.

Hand hygiene (HH) is the most effective way to curb the spread of healthcare-associated infections. Nonetheless, healthcare personnel encounter difficulties in adhering to WHO HH recommendations. This study aimed to investigate HH compliance and adherence after the implementation of an action plan in a municipal hospital in Moscow. An initial evaluation of HH compliance among clinical health workers was carried out in June 2022 according to the WHO HH guidelines followed by a 3-month re-audit of HH practices. The results were compared to the baseline to evaluate compliance and adherence to HH among healthcare personnel. From June to September 2022, there were 2,732 moments of contact with patients or their immediate surroundings. The HH total compliance rate significantly (p < 0.05) increased from 52.3% in June 2022 to 83.3% in September 2022 with a 75% overall total compliance rate. The profession-specific total compliance rate was highest among nurses (79.6%) and lowest among ancillary staff (69.7%). Staff were also more adherent to the before-moments compared to the after-moments of the HH guidelines. Monthly re-audits and providing feedback resulted in a significant improvement in compliance and adherence with HH guidelines after implementation of the action plan.

Determinants of hand hygiene compliance among healthcare workers in intensive care units: a qualitative study.

BACKGROUND: Practicing hand hygiene is a cost-effective method to decrease the occurrence of Healthcare-Associated Infections (HAIs). However, despite their simplicity, adhering to hand hygiene methods among healthcare workers (HCWs) can be highly challenging. We aim to examine the factors influencing hand hygiene compliance as perceived by HCWs working in the intensive care units (ICUs) at several major hospitals in Riyadh, Saudi Arabia. METHOD: This qualitative study was conducted by adopting a content analysis to examine the interviews of HCWs who are currently working in the ICUs of various major hospitals located in the capital city of Riyadh, Saudi Arabia. RESULTS: We interviewed 49 HCWs working in ICUs, with an average age of 38 and 8 years of experience. The HCWs comprised doctors (n = 12), anesthesiologists (n = 6), and nurses (n = 31). There were 34 females and 15 males among the participants. Our analysis revealed several factors that impact hand hygiene compliance, including individual, work/environment, team, task, patient, organizational, and management concerns. Several obstacles and possibilities for enhancement have been identified. CONCLUSION: The results of this study would enhance our comprehension of hand hygiene practices and serve as a foundation for creating future strategies and assessment methods to enhance compliance with hand hygiene protocols in ICUs.

Evaluating the tolerability and acceptability of a locally produced alcohol-based handrub and hand hygiene behaviour among health workers in Sierra Leone: a longitudinal hospital-based intervention study.

BACKGROUND: Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers. METHODS: A longitudinal hospital-based intervention study was conducted in accordance with the WHO's standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3-5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures. RESULTS: Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants' self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product's drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml). CONCLUSION: The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.

Electronic monitoring versus manual paper-based monitoring for hand hygiene compliance: a comprehensive health economic assessment analysis.

BACKGROUND: Monitoring hand hygiene compliance (HHC) of healthcare providers (HCPs) in healthcare facilities is critical for hand hygiene (HH) promotion. However, less is known about the cost and effectiveness of different HHC monitoring tools. In this study, we aimed to compare various health economic indicators corresponding to electronic system-based monitoring (ESM) and manual paper-based monitoring (MPM) for HHC to provide evidence-based advice for HHC monitoring measures targeted selecting. METHODS: A before and after study in 40 clinical departments with 4,524 healthcare providers was conducted from December 2022 to January 2023 (MPM implementation phase) and March 2023 to May 2023 (ESM implementation phase). The cost-effectiveness, cost-efficiency, the extent of the Hawthorne effect, and indirect cost-benefit of the two monitoring methods were compared. RESULTS: The total cost spent on ESM for the 40 departments (17,702.92 CNY) was 4,123.76 CNY lower than that of MPM (21,826.68 CNY). The HHC of MPM (80.16%) was higher than that of ESM (69.82%) (p < 0.01). In high- and medium-risk departments, the cost-effectiveness ratio of ESM (7,977.90 CNY and 13,794.60 CNY, respectively) was lower than that of MPM (9,039.61 CNY and 14,549.05 CNY, respectively). In low-risk departments, the cost-effectiveness ratio of ESM (3,910.77 CNY) was higher than that of MPM (3,899.06 CNY). Compared with ESM, the incremental cost of MPM in all departments was 4,123.76 CNY, the incremental effectiveness was 10.34%, and the incremental cost-effectiveness ratio was 39,881.62 CNY. Between the two monitoring methods, the efficiency of ESM (48.11%) in all departments was higher than that of MPM (14.20%) (p < 0.01). The cost-efficiency ratio of MPM in all departments (155,775.56 CNY) was higher than that of ESM (36,796.76 CNY). The extent of Hawthorne effect of MPM of HHC in all departments (43.99%) was higher than that of ESM (35.69%) (p < 0.01). When ESM was used as the HHC monitoring approach, the HAI rates (1.39%) in all departments were higher than that when MPM was used (1.34%) (p = 0.562). When the payment willingness was less than 40,000 CNY, the ESM method was the better option for cost-effectiveness; When the input exceeded this threshold, the MPM method was the better option for cost-effectiveness. CONCLUSIONS: ESM exhibited notable advantages over MPM in terms of cost-effectiveness, cost-efficiency, cost-benefit, and the Hawthorne effect.

Application of the behaviour-centred design to understand facilitators and deterrents of hand hygiene among healthcare providers: findings from a formative phase of a cluster randomised trial in the Kampala Metropolitan area.

BACKGROUND: Hand hygiene is known to reduce healthcare-associated infections. However, it remains suboptimal among healthcare providers. In this study, we used the Behaviour-centered Design approach to explore the facilitators and deterrents to hand hygiene among healthcare providers in the Kampala Metropolitan area, Uganda. METHODS: We conducted a formative qualitative study as part of a cluster randomised trial in 19 healthcare facilities (HCFs). The study used 19 semi-structured and 18 key informant interviews to collect data on hand hygiene status and facilitators and deterrents of hand hygiene. Research assistants transcribed verbatim and used a thematic framework aided by Nvivo 14.0. to undertake analysis. We used thick descriptions and illustrative quotes to enhance the credibility and trustworthiness of our findings. RESULTS: About 47.4% of the HCFs had sufficient hand hygiene infrastructure, and 57.9% did not report total compliance with hand hygiene during patient care. The physical facilitator for hand hygiene was the presence of constant reminders such as nudges, while the biological included the frequency of patient contact and the nature of clinical work. The only biological deterrent was the heavy workload in HCFs. The executive brain facilitators included knowledge of workplace health risks, infection prevention and control (IPC) guidelines, and a positive attitude. A negative attitude was the executive brain deterrent to hand hygiene. Recognition, rewards, and fear of infections were the only motivated brain facilitators. Behavioural setting facilitators included proximity to functional hand hygiene infrastructure, the existence of active IPC committees, good leadership, and the availability of a budget for hand hygiene supplies. Behavioural setting deterrents included the non-functionality and non-proximity to hand hygiene infrastructure and inadequate supplies. CONCLUSIONS: The study revealed low compliance with hand hygiene during the critical moments of patient care and inadequacy of hand hygiene infrastructure. The deterrents to hand hygiene included a heavy workload, negative attitude, inadequate supplies, non-functionality, and long distance to hand washing stations. Facilitators included constant reminders, fear of infections, frequency of patient contact and nature of clinical work, positive attitude, knowledge of IPC guidelines, recognition and reward, good leadership, availability of budgets for hand hygiene supplies, availability and proximity to hand hygiene supplies and infrastructure and active IPC committees. TRIAL REGISTRATION: ISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020.

Is there a relationship between nurses' hand hygiene beliefs, practices and ethical sensitivity?

BACKGROUND: Hand hygiene is the most important way to prevent health care-associated infections. It is important for all nurses that come in physical contact with patients the most to follow hand hygiene rules. AIM: This study aimed to determine the relationship between nurses' hand hygiene beliefs and practices and their ethical sensitivity. METHOD: This descriptive and cross-sectional study was conducted with nurses working in internal medicine, surgery and intensive care clinics of a university hospital between June and August 2022. A total of 350 nurses participated in the study. A Personal Information Form, the Ethical Sensitivity Questionnaire (ESQ), the Hand Hygiene Practice Inventory (HHPI), and the Hand Hygiene Beliefs Scale (HHBS) were used for data collection. RESULTS: Findings support that nurses have moderate ethical sensitivity (88.36 ± 26.33), good hand hygiene beliefs (85.60 ± 9.21) and practice (66.14 ± 5.90). Despite there being no statistical significance in evaluating the relationship between hand hygiene practice and ethical sensitivity (p = 0.253, r = -0.061), there was a statically significant inverse relationship between hand hygiene beliefs and ethical sensitivity (p = 0.001, r = -0.172). The hand hygiene compliance score of the nurses who received only ethics training after nursing school (p = 0.000); the hand hygiene belief (p = 0.011) and hand hygiene practice (p = 0.007) scores of those who received both ethics and hand hygiene training were higher. CONCLUSIONS: It can be said that the ethical sensitivity of nurses does not affect their hand hygiene practices, and the hand hygiene and ethics education they receive after school education increases their hand hygiene beliefs and practices.

Indication-based and patient-based hand hygiene performance among nurses working at a university hospital.

The traditional method of monitoring hand hygiene (HH) based on specific indications does not ensure that HH is performed for all required indications during patient care. This study aimed to compare HH performance rates (HHPRs) based on specific indications versus overall patient care among nurses at a university hospital. The study retrospectively analyzed HH monitoring data for 1398 indications from 543 patients and 190 nurses. Observations were conducted continuously, tracking a single healthcare worker from before patient contact until the end of the contact within a 30-min period. The indication-based HHPR was found to be 89.1%, while the patient-based HHPR was 78.1%. In the context of patient-based HHPR, the lowest rates were observed among nurses in the emergency room (48.3%) and those with less than 1 year of work experience (66.7%). Moreover, the largest discrepancy between indication-based and patient-based HHPR was noted among emergency room nurses with less than 1 year of experience. This significant difference underscores the need for patient-based HH monitoring, particularly for nurses in emergency settings and those with limited experience.

The Effect of Simulation-Based Training on the Hand Hygiene Knowledge and Practices of Palliative Caregivers: A Double-Blind, Randomized, Controlled Single-Center Study.

This study aimed to investigate the effect of simulation-based training on hand hygiene knowledge and practices among palliative caregivers. The study was conducted with 60 caregivers in a palliative care clinic between December 2022 and September 2023. The participants were divided into two groups by simple randomization. The intervention and control groups received the same hand hygiene theoretical education and demonstration. The intervention group also received additional simulation-based hand hygiene practices recommended by the World Health Organization. A pretest-posttest design was used to assess hand hygiene knowledge and practices. Data were collected with personal information, hand hygiene knowledge, and hand hygiene practice forms. Analysis of covariance was performed to compare posttest scores between the groups. Simulation-based hand hygiene training programs offer an effective and feasible strategy to improve the hand hygiene knowledge and practices of caregivers. It should be integrated into clinical areas to increase palliative caregivers' hand hygiene knowledge and practices. Evidence-based practices can be improved by increasing randomized controlled studies on the effectiveness of simulation-based hand hygiene training for caregivers. Trial Registration: The study was registered at ClinicalTrials.gov with registration number NCT05848596.

Perform hand hygiene and the doors will open - the effectiveness of new system implementation on paediatric intensive care unit visitors' handwashing compliance.

Hand hygiene (HH) performance on entering intensive care units (ICUs) is commonly accepted but often inadequately performed. We developed a simple, inexpensive module that connects touchless dispensers of alcohol sanitiser (TDAS) to the automatic doors of a paediatric ICU, and assessed the impact of this intervention on HH compliance of hospital staff and visitors. A prospective observational study was conducted over a 3-week period prior to the intervention, followed by a 4-week period post intervention. HH performance was monitored by a research assistant whose office location enabled direct and video-assisted observation of the ICU entrance. A total of 609 entries to the ICU was recorded. Overall HH performance was 46.9% (92/196) before and 98.5% (406/413) after the intervention. Our findings suggest that HH performance on entering an ICU can be improved via a mechanism that makes operation of an automatic door dependent on use of a TDAS system, and thus contribute to infection control.

Nationwide multicenter questionnaire surveys on countermeasures against antimicrobial resistance and infections in hospitals.

BACKGROUND: The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship. METHODS: We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses. RESULTS: The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses. CONCLUSIONS: Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.

Hand hygiene during facility-based childbirth in Cambodia: a theory-driven, mixed-methods observational study.

BACKGROUND: Despite current efforts to improve hand hygiene in health care facilities, compliance among birth attendants remains low. Current improvement strategies are inadequate, largely focusing on a limited set of known behavioural determinants or addressing hand hygiene as part of a generalized set of hygiene behaviours. To inform the design of a facility -based hand hygiene behaviour change intervention in Kampong Chhnang, Cambodia, a theory-driven formative research study was conducted to investigate the context specific behaviours and determinants of handwashing during labour and delivery among birth attendants. METHODS: This formative mixed-methods research followed a sequential explanatory design and was conducted across eight healthcare facilities. The hand hygiene practices of all birth attendants present during the labour and delivery of 45 women were directly observed and compliance with hand hygiene protocols assessed in analysis. Semi-structured, interactive interviews were subsequently conducted with 20 key healthcare workers to explore the corresponding cognitive, emotional, and environmental drivers of hand hygiene behaviours. RESULTS: Birth attendants' compliance with hand hygiene protocol was 18% prior to performing labour, delivery and newborn aftercare procedures. Hand hygiene compliance did not differ by facility type or attendants' qualification, but differed by shift with adequate hand hygiene less likely to be observed during the night shift (p = 0.03). The midwives' hand hygiene practices were influenced by cognitive, psychological, environmental and contextual factors including habits, gloving norms, time, workload, inadequate knowledge and infection risk perception. CONCLUSION: The resulting insights from formative research suggest a multi-component improvement intervention that addresses the different key behaviour determinants to be designed for the labour and delivery room. A combination of disruption of the physical environment via nudges and cues, participatory education to the midwives and the promotion of new norms using social influence and affiliation may increase the birth attendants' hand hygiene compliance in our study settings.

Human factors and ergonomics at time of crises: the Italian experience coping with COVID-19.

Several of the key organizational issues that we have had to face with the emergence of COVID-19 crisis are related to human factors/ergonomics (HFE) and the safety culture. During the crisis the main activities of the healthcare services have been profoundly affected. Patient safety and risk management units have also experienced the need to adapt rapidly. What can we do as HFE experts, now that the scenario has completely changed? We contend that: (a) we can favour and support the heuristics that are applied to manage the load of psycho-cognitive stress. (b) We can observe, collect strategies and develop analytic schemes, thereby creating a memory of the organization for improvement in the future. (c) And we can support in educating and engaging the public. This crisis has forced the community of healthcare experts to broaden their reflections: for the future to come, our communities of experts in the field of risk management HF/E, quality and safety of care and public health should play together an important role from the very beginning, from the time of peace.

The challenge of infection control in patients' homes.

Infection control is the responsibility of all nurses, but, traditionally, it has been seen as a priority only in hospitals. Infection control does not stop when a patient is discharged home, but should be practiced wherever clinical care takes place. Community nurses face a unique challenge as they work in patients' homes, and they must manage infection control in that unique environment. This article looks at practical ways to maintain infection control in patients' homes. It covers hand hygiene and personal protective equipment (PPE), including the five moments of hand hygiene, appropriate hand hygiene, the use of all PPE and when gloves are required and when they are not. It also discusses managing clinical equipment, both that taken into the home and that left with a patient, including decontamination, safe storage of sharps and waste management. It touches upon what can be done in a patient's home to reduce the risk of contamination, as well as infectious disease management, including specimens and wound infection management. Lastly, it talks about cross-infection and why staff health is also important.

Adherence to hand hygiene at five moments and specific protection in a tertiary care hospital during the COVID-19 pandemic.

INTRODUCTION: During the COVID-19 pandemic, adherence to hygiene measures is an objective aimed at reducing morbidity and mortality. OBJECTIVE: To evaluate adherence to hand hygiene and protection measures during the COVID-19 pandemic in a tertiary care hospital. METHODS: Cross-sectional study on health personnel handwashing at the five moments recommended by the World Health Organization, as well as on the use of specific personal protective equipment. RESULTS: One hundred and seventeen hand hygiene opportunities were observed in health personnel. Hand washing was observed in 40 (34 %) and omission in 76 (65 %). Adherence to the use of face shield was observed in five (4 %), and lack of adherence in 112 (96%). Adherence to the use of face mask was observed in 65 nursing professionals (87 %), with appropriate use of the mask in 56 of them (60 %) and use of face shield in one (1 %). CONCLUSION: Health personnel showed low proportions of adherence to hand hygiene and use of equipment for specific protection during the COVID-19 pandemic.

INTRODUCCIÓN: Ante la pandemia de COVID-19, el apego a las medidas de higiene es un objetivo para disminuir la morbimortalidad. OBJETIVO: Evaluar el apego a la higiene de manos y medidas de protección durante la pandemia de COVID-19 en un hospital de tercer nivel. MÉTODOS: Estudio transversal acerca del lavado de manos del personal de salud en los cinco tiempos recomendados por la Organización Mundial de la Salud, así como sobre el uso del equipo de protección personal específico. RESULTADOS: Fueron observadas 117 oportunidades de higiene de manos en personal de salud: 40 (34 %) respecto al lavado de manos y 76 (65 %) respecto a su omisión; sobre el apego al uso de careta en cinco (4 %) y sobre la falta de apego en 112 (96 %). Se identificó apego al uso de mascarilla en 65 profesionales de enfermería (87 %), uso adecuado de mascarilla en 56 de ellos (60 %) y uso de careta en uno (1 %). CONCLUSIÓN: El personal mostró baja proporción de apego a la higiene de manos y al uso de equipo para la protección específica durante la pandemia de COVID-19.

Evaluation of World Health Organization-Recommended Hand Hygiene Formulations.

As a result of the coronavirus disease pandemic, commercial hand hygiene products have become scarce and World Health Organization (WHO) alcohol-based hand rub formulations containing ethanol or isopropanol are being produced for hospitals worldwide. Neither WHO formulation meets European Norm 12791, the basis for approval as a surgical hand preparation, nor satisfies European Norm 1500, the basis for approval as a hygienic hand rub. We evaluated the efficacy of modified formulations with alcohol concentrations in mass instead of volume percentage and glycerol concentrations of 0.5% instead of 1.45%. Both modified formulations met standard requirements for a 3-minute surgical hand preparation, the usual duration of surgical hand treatment in most hospitals in Europe. Contrary to the originally proposed WHO hand rub formulations, both modified formulations are appropriate for surgical hand preparation after 3 minutes when alcohol concentrations of 80% wt/wt ethanol or 75% wt/wt isopropanol along with reduced glycerol concentration (0.5%) are used.

Emergency management of 2019 novel coronavirus: implications for the dermatology department.

Since cases first emerged in December 2019, COVID-19 (a type of coronavirus) has rapidly become pandemic. This fast-tracked paper (published quickly) from China on COVID-19 is written by dermatologists at the epicentre of the outbreak in Wuhan. Dermatology clinic staff may be at risk because protective equipment is not routinely available, and skin lesions might possibly transmit the virus indirectly. These authors suggest preventive measures based on experience in this and previous coronavirus outbreaks. Online consultation for non-urgent patients reduces the numbers of patients attending clinics. Nurse-led triage, to identify patients with possible COVID-19, at the entrances of hospital and skin clinics directs patients with a cough or fever to a specific COVID-19 area and a dermatologist is consulted if the fever might be related to skin disease. Clinic staff wear N95 masks and observe hand hygiene during consultations. Patients are admitted to a ward only if routine blood tests and chest CT scans exclude COVID-19. Triage will not detect patients who are showing no symptoms but who are developing the disease, so the hospital should provide an on-call expert team to discuss inpatients suspected or diagnosed with COVID-19 and refer them to radiology, respiratory or intensive care colleagues as required. Confirmed cases are managed following local policies. Skin disorders in COVID-19 inpatients can usually be managed remotely using photographs, email and teleconferencing. If necessary a multidisciplinary team (a team of medical staff from different specialties) can meet in the clean area of the isolation ward. If the dermatologist must see the patient, all records should be provided in advance to minimise exposure time. With these precautions, as of 20th February 2020 no infected patients were detected in the Wuhan Dermatology Department. This is a summary of the study: Emergency management for preventing and controlling nosocomial infection of 2019 novel coronavirus: implications for the dermatology department.

Device associated -health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015-2017).

BACKGROUND: Device-associated health care-associated infections (DA-HAIs) in intensive care unit (ICU) patients constitute a major therapeutic issue complicating the regular hospitalisation process and having influence on patients' condition, length of hospitalisation, mortality and therapy cost. METHODS: The study involved all patients treated > 48 h at ICU of the Medical University Teaching Hospital (Poland) from 1.01.2015 to 31.12.2017. The study showed the surveillance and prevention of DA-HAIs on International Nosocomial Infection Control Consortium (INICC) Surveillance Online System (ISOS) 3 online platform according to methodology of the INICC multidimensional approach (IMA). RESULTS: During study period 252 HAIs were found in 1353 (549F/804M) patients and 14,700 patient-days of hospitalisation. The crude infections rate and incidence density of DA-HAIs was 18.69% and 17.49 ± 2.56 /1000 patient-days. Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI) and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 12.63 ± 1.49, 1.83 ± 0.65 and 6.5 ± 1.2, respectively. VAP(137) constituted 54.4% of HAIs, whereas CA-UTI(91) 36%, CLA-BSI(24) 9.6%.The most common pathogens in VAP and CA-UTI was multidrug-resistant (MDR) Acinetobacter baumannii (57 and 31%), and methicillin-resistant Staphylococcus epidermidis (MRSE) in CLA-BSI (45%). MDR Gram negative bacteria (GNB) 159 were responsible for 63.09% of HAIs. The length of hospitalisation of patients with a single DA-HAI at ICU was 21(14-33) days, while without infections it was 6.0 (3-11) days; p = 0.0001. The mortality rates in the hospital-acquired infection group and no infection group were 26.1% vs 26.9%; p = 0.838; OR 0.9633;95% CI (0.6733-1.3782). Extra cost of therapy caused by one ICU acquired HAI was US$ 11,475/Euro 10,035. Hand hygiene standards compliance rate was 64.7%, while VAP, CLA-BSI bundles compliance ranges were 96.2-76.8 and 29-100, respectively. CONCLUSIONS: DA-HAIs was diagnosed at nearly 1/5 of patients. They were more frequent than in European Centre Disease Control report (except for CLA-BSI), more frequent than the USA CDC report, yet less frequent than in limited-resource countries (except for CA-UTI). They prolonged the hospitalisation period at ICU and generated substantial additional costs of treatment with no influence on mortality. The Acinetobacter baumannii MDR infections were the most problematic therapeutic issue. DA-HAIs preventive methods compliance rate needs improvement.

Hand hygiene during COVID-19: Recommendations from the American Contact Dermatitis Society.

The recent COVID-19 pandemic has resulted in increased hand hygiene and hand cleansing awareness. To prevent virus transmission, the Centers for Disease Control and Prevention recommends frequent hand washing with soap and water. Hand hygiene products are available in a variety of forms, and while each of these formulations may be effective against COVID-19, they may also alter skin barrier integrity and function. As health care workers and the general population focus on stringent hand hygiene, the American Contact Dermatitis Society anticipates an increase in both irritant contact and allergic contact hand dermatitis. Alcohol-based hand sanitizers with moisturizers have the least sensitizing and irritancy potential when compared to soaps and synthetic detergents. This article provides an overview of the most frequently used hand hygiene products and their associations with contact dermatitis as well as recommendations from the American Contact Dermatitis Society on how to treat and prevent further dermatitis.

Hygiene along the continuum of care in the early post-natal period: an observational study in Nigeria.

BACKGROUND: Newborns delivered in healthcare facilities in low- and middle-income countries are at an increased risk of healthcare associated infections. Facility-based studies have focused primarily on healthcare worker behaviour during labour & delivery with limited attention to hygiene practices in post-natal care areas and largely ignore the wide variety of actors involved in maternal and neonatal care. METHODS: This exploratory mixed-methods study took place in six healthcare facilities in Nigeria where 31 structured observations were completed during post-natal care, discharge, and the first 6 hours after return to the home. Frequency of hand hygiene opportunities and hand hygiene actions were assessed for types of patient care (maternal and newborn care) and the role individuals played in caregiving (healthcare workers, cleaners, non-maternal caregivers). Qualitative interviews with mothers were completed approximately 1 week after facility discharge. RESULTS: Maternal and newborn care were performed by a range of actors including healthcare workers, mothers, cleaners and non-maternal caregivers. Of 291 hand hygiene opportunities observed at health facilities, and 459 observed in home environments, adequate hand hygiene actions were observed during only 1% of all hand hygiene opportunities. Adequate hand hygiene prior to cord contact was observed in only 6% (1/17) of cord contact related hand hygiene opportunities at healthcare facilities and 7% (2/29) in households. Discharge advice was infrequent and not standardised and could not be remembered by the mother after a week. Mothers reported discomfort around telling non-maternal caregivers to practice adequate hand hygiene for their newborn. CONCLUSIONS: In this setting, hand hygiene practices during post-natal care and the first 6 hours in the home environment were consistently inadequate. Effective strategies are needed to promote safe hand hygiene practices within the post-natal care ward and home in low resource, high-burden settings. Such strategies need to target not just mothers and healthcare workers but also other caregivers.