Impacto de la implementación de la estrategia multimodal de la OMS para mejorar la higiene de manos en una Unidad de Cuidados Intensivos

Introducción: La higiene de manos (HM) es la principal medida para disminuir las IAAS, las que en las Unidades de Cuidados Intensivos (UCI) presentan una alta prevalencia. En Chile no existe información sobre el impacto de la estrategia multimodal de la OMS para la HM en adultos. El objetivo fue evaluar el impacto de la implementación de la estrategia en una UPC. Metodología: Estudio longitudinal con evaluación pre y post-intervención, entre los años 2018 y 2021, en la UCI del Hospital del Trabajador (HT), Santiago, Chile. La implementación se evaluó con pautas de cumplimiento de HM, consumo de jabón y productos en base alcohólica (PBA). El impacto se midió con las tasas de neumonía asociada a ventilación mecánica (NAVM), infecciones del torrente sanguíneo asociadas a CVC (ITS- CVC) y del tracto urinario por CUP (ITU-CUP), y la incidencia anual de dermatitis. Resultados: El cumplimiento de pautas aumentó de 91 a 96% (p < 0,05). El consumo total de productos para la HM aumentó de 0,17 a 0,31 L/día/cama y de PBA en 10%. Las tasas de IAAS pre y post-intervención fueron para NAVM de 10,3 y 8,4; ITS-CVC de 0,8 y 1,5 e ITU-CUP de 4,2 y 5,3 por 1.000 días de exposición. La incidencia anual de dermatitis disminuyó en 30% (p < 0,05). Conclusiones: La implementación de la estrategia multimodal se asoció a una disminución de las tasas de NAVM y de dermatitis en la UCI del HT.

Introduction: Hand hygiene is the main measure to decrease infections related to healthcare and the Intensive Care Unit has a high prevalence. In Chile there aren't reports about the impact of the World Health Organization multimodal hand hygiene improvement strategy. Aim: To assess the implementation impact of this strategy at the ICU. Methodology: Longitudinal study with pre- and postintervention evaluation during the years 2018-2021 at ICU. The implementation was assessed against hand hygiene compliance guidelines, soap consumption and alcohol-based products. The impact was evaluated with the rates of ventilator-associated pneumonia (VAP), catheter related bloodstream infection (CRBSI) and catheter associated urinary tract infection (CAUTI) and the annual dermatitis incidence. Results: The guidelines compliance increased from 91% to 96% (p < 0.05). The total product consumption increased from 0.17 to 0.31 Liters/day/bed. The use of alcohol-based products increased by 10%. HAI rates pre- and post-intervention were for VAP 10.3 and 8.4, CRBSI 0.8 and 1.5 and CAUTI 4.2 and 5.3. The annual dermatitis incidence decreased by 30.8% (p < 0.05). Conclusions: The strategy implementation benefited the decrease of VAP and the dermatitis prevention in ICU.

Ten years of hand hygiene excellence: a summary of outcomes, and a comparison of indicators, from award-winning hospitals worldwide.

BACKGROUND: Hand hygiene is a crucial measure for the prevention of healthcare-associated infections (HAIs). The Hand Hygiene Excellence Award (HHEA) is an international programme acknowledging healthcare facilities for their leadership in implementing hand hygiene improvement programmes, including the World Health Organisation's Multimodal Improvement Strategy. This study aimed at summarising the results of the HHEA campaign between 2010 and 2021 and investigating the relationship between different hand hygiene parameters based on data from participating healthcare facilities. METHODS: A retrospective analysis was performed on datasets from HHEA forms, including data on hand hygiene compliance, alcohol-based handrub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. Descriptive statistics were reported for each variable. The correlation between variables was inspected through Kendall's test, while possible non-linear relationships between hand hygiene compliance, ABHR consumption and HHSAF scores were sought through the Locally Estimated Scatterplot Smoothing or logistic regression models. A tree-structured partitioning model was developed to further confirm the obtained findings. RESULTS: Ninety-seven healthcare facilities from 28 countries in three world regions (Asia-Pacific, Europe, Latin America) were awarded the HHEA and thus included in the analysis. HHSAF scores indicated an advanced hand hygiene promotion level (median 445 points, IQR 395-480). System change (100 [95-100] points) and institutional safety climate (85 [70-95] points) showed the highest and lowest score, respectively. In most cases, hand hygiene compliance was above 70%, with heterogeneity between countries. ABHR consumption above 20 millilitres per patient-day (ml/PD) was widely reported, with overall increasing trends. HHSAF scores were positively correlated with hand hygiene compliance (τ = 0.211, p = 0.007). We observed a positive correlation between compliance rates and ABHR consumption (τ = 0.193, p < 0.001), although the average predicted consumption was stable around 55-60 ml/PD for compliance rates above 80-85%. Logistic regression and partitioning tree analyses revealed that higher HHSAF scores were more likely in the high-ABHR consumption group at cut-offs around 57-59 ml/PD. CONCLUSION: Ten years after its inception, the HHEA proves to be a valuable hand hygiene improvement programme in healthcare facilities worldwide. Consistent results were provided by the different hand hygiene indicators and the HHSAF score represents a valuable proxy measure of hand hygiene compliance.

Frequency of hand contact with hospital surfaces in hospitalized pediatric patients / Frecuencia de contacto de manos de pacientes pediátricos hospitalizados

Abstract Background: Hand hygiene (HH) is an important strategy for preventing health-care-associated infections (HAIs). Few programs focus on HH for family members and primary caregivers but fewer for patients. This study aimed to estimate the frequency with which hospitalized pediatric patients have hand contact with hospital surfaces. Methods: We conducted a cross-sectional descriptive observational study consisting of three phases: the first was the creation of an observation and data collection tool, the second was the training of the monitors, and the third was the observational study of hand contact and HH opportunities in hospitalized pediatric patients. Results: Over 3600 minutes of observation, 2032 HH opportunities were detected, averaging 33.8/h (SD 4.7) as determined by hand contact with hospital surfaces of hospitalized pediatric patients. In our study, infants and preschool children had the highest frequency of hand contact. Conclusion: The high frequency of hand contact of hospital surfaces by children suggests that hourly hand disinfection of patients and caregivers, objects and surfaces around the patients may be prevention measures that could be incorporated to reduce HAIs in pediatric hospitals.

Resumen Introducción: La higiene de manos es una estrategia importante para la prevención de infecciones asociadas a la atención sanitaria. Existen pocos programas centrados en la higiene de manos para los familiares y cuidadores primarios, y aún menos para el paciente. El objetivo de este estudio fue cuantificar la frecuencia con la que los pacientes pediátricos hospitalizados tienen contacto manual con superficies hospitalarias. Métodos: Se llevó a cabo un estudio observacional descriptivo transversal que constó de tres fases: la primera fue la creación de una herramienta de observación y registro de datos; la segunda fue la capacitación de los monitores y la tercera fue el estudio observacional del contacto manual y de las oportunidades de higiene de manos en pacientes pediátricos hospitalizados. Resultados: Durante los 3600 minutos de observación, se detectaron 2032 oportunidades, con una media de 33.8 (DE 4.7) por hora de oportunidades de higiene de manos establecidas por contacto manual con superficies de pacientes pediátricos hospitalizados. Los lactantes y los niños en edad preescolar presentaron la mayor frecuencia de contacto manual. Conclusiones: La alta frecuencia de contacto manual por parte del niño indica que medidas como la desinfección de las manos cada hora del paciente y del cuidador, así como de los objetos y superficies alrededor del paciente, podrían ser medidas útiles que deberían incluirse para prevenir las infecciones asociadas a la atención de la salud en los hospitales pediátricos.

Outbreak investigation of Serratia marcescens bloodstream infection in an obstetric ward for high-risk pregnant women.

BACKGROUND: Serratia marcescens is a gram-negative bacterium that is widespread in the environment. S. marcescens bacteremia can be fatal during pregnancy and cause persistent chorioamnionitis. This study reports an outbreak of Serratia marcescens bloodstream infection (BSI) among high-risk pregnant women in an obstetric ward. The purpose of this study is to report our experience with the usefulness of the ATP test in hospital environmental management and to confirm that bloodstream infections of patients with the same strain were correlated by WGS testing. METHODS: This retrospective study collected the data of inpatients with S. marcescens bacteremia in obstetric ward for high-risk pregnant women from August 22, 2021, to October 14, 2021. We performed: an adenosine triphosphate (ATP) bioluminescence test in the environment with a high-contact area; environmental culture; on-site monitoring and staff education; and whole-genome sequencing (WGS) to evaluate genetic relationships among S. marcescens isolates. RESULTS: S. marcescens BSI occurred in four consecutive patients. None of the patients had central venous catheters. An ATP bioluminescence test revealed that high-contact areas and areas for injection preparation were not clean (≥ 1000 relative light units). However, S. marcescens was not identified in the environmental cultures, likely due to intensive environmental cleaning and discarding of potentially contaminated specimens before the culture test. On-site monitoring and education were conducted for 1 month. There were no further reports of BSI until 6 months after the last patient was discharged. WGS performed on three isolates from three patients indicated that the isolated S. marcescens was likely from the same strain. CONCLUSIONS: We controlled an S. marcescens outbreak by improving environmental cleaning as well as education of and behavior changes in healthcare workers. Using the ATP bioluminescence test can provide feedback on environmental cleaning and education. WGS played a role in determining the spread of BSI caused by the same strain.

Impact of control measures including decolonization and hand hygiene for orthopaedic surgical site infection caused by MRSA at a Japanese tertiary-care hospital.

BACKGROUND: Meticillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen in orthopaedic surgical site infections (SSIs). However, few studies have investigated the transmission process of orthopaedic MRSA SSI. AIM: To investigate the transmission process of orthopaedic MRSA SSI using epidemiological and molecular analyses and to determine a method to prevent MRSA SSI in nosocomial orthopaedic surgery. METHODS: Active MRSA surveillance, preoperative decolonization and contact precautions for MRSA-positive cases was performed at our institution. Changes in epidemic strains were evaluated and the possibility of transmission from patients in an orthopaedic ward of a Japanese tertiary-care hospital was assessed by genotyping stored MRSA strains. In addition, data on the prevalence of MRSA SSI, MRSA colonization, and use of an alcohol antiseptic agent (mL/patient-days) during 2005-2022 were retrospectively assessed. FINDINGS: SCCmec type II strain in the SSI group decreased over time, associated with fewer outbreaks. Even during a period of high infection rates, no cases of transmission-induced SSI from nasal MRSA carriers were identified. The infection rate correlated negatively with the use of an alcohol antiseptic agent (r = -0.82; P < 0.0001). Two cases among five nasal carriers developed MRSA SSI caused by strains different from those related to nasal colonization. CONCLUSION: The infection control measures for transmission from the hospital reservoirs including strict adherence to hand hygiene and decolonization of carriers is likely to be important for the prevention of orthopaedic MRSA SSI. However, the need for contact precautions for decolonized nasal carriers might be low.

A single plain ring is not associated with increased bacterial load on hands: An experimental study among healthcare worker students undertaking mock surgery.

BACKGROUND: Adequate hand hygiene is considered as one of the most effective strategies in healthcare-related infection prevention. The potential negative effect of rings in hand disinfection and thus, in increased nosocomial infections rates is still controversial. Therefore, the present study was designed with the purpose of examining if rings frequently exposed to surgical scrubbing were associated or not with increased bacterial counts. METHODS: 32 volunteers were randomized into 4 groups: A (no rings), B (participants wore a ring), C (no rings and performed surgical scrubbing with chlorhexidine every 48 h) and D (participants wore a ring and performed surgical scrubbing every 48 h). Glove juice samples were obtained at day 0 (T0) and after a 90-min mock-surgery on day 14 (T1). Quantitative (number of UFC/mL) and qualitative data (microorganism type) were collected as study variables. RESULTS: All groups were comparable at T0. All ring carriers obtained negative cultures at T1. Ring presence was not associated with higher bacterial counts; comparisons between A vs B groups and C vs D groups showed no statistically significant differences (p = 0.076 and 1.000). T1 negative cultures were more frequent in participants performing surgical scrubbing every second day (93.8 % vs 75 %), although this difference did not reach statistical significance (p = 0.332). CONCLUSIONS: The presence of single plain ring does not seem to be associated with an increased hand bacterial load. Regular surgical scrubbing with chlorhexidine impregnated sponges reduces bacterial contamination of hands, even in the presence of plain rings.

Higiene das mãos dos profissionais de saúde: perspectivas do estudante de enfermagem no papel de paciente/familiar / Higiene de manos de los profesionales de la salud: perspectiva de estudiantes de enfermería en el papel de paciente/familiar / Healthcare professionals' hand hygiene: perspectives of nursing student's in patients/relatives role

Resumo Objetivo Investigar as opiniões e atitudes dos estudantes de enfermagem no papel de pacientes ou familiares de pacientes, a respeito do comportamento de higiene das mãos dos profissionais de saúde e da participação dos pacientes na campanha de higiene das mãos. Métodos Estudo transversal prospectivo realizado entre 2021-2022 no Nursing Department, Faculty of Health Sciences, de duas universidades turcas. A amostra do estudo foi composta por 330 alunos. Os dados foram coletados por meio de questionário autoaplicável. A taxa de resposta do questionário foi de 89,43%. O teste qui-quadrado foi utilizado na análise dos dados. Resultados A média de idade dos estudantes foi de 19,80±1,30 anos, 76,1% eram do sexo feminino, 50,9% afirmaram ter recebido instrução sobre Infecções Associadas aos Cuidados de Saúde (IACS). Enquanto 30,1% dos estudantes relataram realizar a higiene das mãos "9 a 11 vezes" em sua vida diária, 54,6% relataram "12 a 15 vezes" no hospital, e 96,4% dos estudantes se perguntaram se os profissionais de saúde realizavam a higiene das mãos antes de fornecer cuidados durante as internações. De acordo com 30,5% dos estudantes, lembretes dos pacientes e seus familiares sobre a realização da higiene das mãos antes do contato com os pacientes os deixariam satisfeitos. Houve diferença estatisticamente significativa entre a instrução anterior dos estudantes sobre IACS e a higiene das mãos como cuidado importante a pacientes hospitalizados (p<0,05). Conclusão Os estudantes de enfermagem apresentaram conhecimento suficiente sobre a higiene das mãos e uma atitude positiva frente aos comportamentos de higiene das mãos dos profissionais de saúde. Estudantes de enfermagem como pacientes e familiares dos pacientes podem ser incluídos nas campanhas de higiene das mãos dos profissionais de saúde, desde que as etapas do programa sejam bem planejadas.

Resumen Objetivo Investigar las opiniones y actitudes de los estudiantes de enfermería en el papel de pacientes o familiares de pacientes respecto al comportamiento de higiene de manos de los profesionales de la salud y de la participación de los pacientes en la campaña de higiene de manos. Métodos Estudio transversal prospectivo realizado entre 2021 y 2022 en el Nursing Department, Faculty of Health Sciences, de dos universidades turcas. La muestra del estudio estuvo compuesta por 330 alumnos. Los datos se recopilaron mediante cuestionario autoaplicado. El índice de respuesta del cuestionario fue de 89,43 %. Se utilizó la prueba ji cuadrado en el análisis de los datos. Resultados El promedio de edad de los estudiantes fue de 19,80±1,30 años, el 76,1 % era de sexo femenino, el 50,9 % afirmó haber recibido instrucción sobre infecciones asociadas a los cuidados de la salud (IACS). Mientras el 30,1 % de los estudiantes relató realizar la higiene de manos "9 a 11 veces" en su vida diaria, el 54,6 % relató "12 a 15 veces" en el hospital, el 96,4 % de los estudiantes se preguntó si los profesionales de la salud realizaban la higiene de manos antes de brindar cuidados durante las internaciones. El 30,5 % de los estudiantes estuvo satisfecho con los recordatorios de los pacientes y sus familiares sobre la realización de la higiene de manos antes del contacto con los pacientes. Hubo diferencia estadísticamente significativa entre la instrucción anterior de los estudiantes sobre IACS y la higiene de manos como cuidado importante en pacientes hospitalizados (p<0,05). Conclusión Los estudiantes de enfermería presentaron conocimientos suficientes sobre la higiene de manos y una actitud positiva frente a los comportamientos de higiene de manos de los profesionales de la salud. Puede incluirse a los estudiantes de enfermería como pacientes y familiares de los pacientes en las campañas de higiene de manos de los profesionales de la salud, siempre que las etapas del programa estén bien planificadas.

Abstract Objective To investigate the views and attitudes of nursing students, as patients or relatives, on healthcare professionals' hand hygiene behavior and patient participation hand hygiene campaign. Methods This prospective cross-sectional study was conducted in the nursing departments of the health and science faculties at two Turkish universities between 2021-2022. The study sample comprised 330 students. Data were collected using a self-administered questionnaire. The response rate of the questionnaire was 89.43%. Chi-square test was used in data analysis. Results The mean age of students was 19.80±1.30 years, 76.1% were female, 50.9% stated they had received education regarding healthcare-associated infections (HAI). While 30.1% of students reported they performed hand hygiene "9-11 times" in their daily lives, 54.6% reported performing "12-15 times" in the hospital, and 96.4% of students expressed wondering if healthcare professionals performed hand hygiene before offering care during hospitalizations. Among students, 30.5% stated that reminders from patients and their relatives about performing hand hygiene before contact with patients would make them happy. There was a statistically significant difference between students' previous training in HAIs and hand hygiene as an important inpatient care (p<0.05). Conclusion Nursing students had sufficient knowledge of hand hygiene and a positive attitude towards hand hygiene behaviors of healthcare professionals. Nursing students, such as patients and their relatives, can be included in hand hygiene campaigns for healthcare professionals, provided that the program steps are well planned.

Adesão à técnica de higiene das mãos: estudo observacional / Adhesión a la técnica de higiene de manos: estudio observacional / Adherence to hand hygiene technique: an observational study

Resumo Objetivo Verificar a adesão e a qualidade da técnica de higiene das mãos realizada por profissionais de saúde nos momentos preconizados e identificar os fatores impactantes. Métodos Estudo observacional, com 41 profissionais de Unidade de Terapia Intensiva Adulto de um hospital de ensino brasileiro. A coleta de dados foi de setembro a dezembro de 2021, utilizando questionário sociodemográfico e formulário de observação da Organização Mundial da Saúde. Foram aplicados testes estatísticos de análise binomial e modelo de regressão logística de efeitos mistos e adotou-se nível de significância de 0,05. Resultados Um total de 1.055 oportunidades de Higiene das Mãos foram observadas, a taxa de adesão foi de 23,98% e pode-se verificar que os profissionais não executaram a técnica preconizada. O teste binomial verificou maior adesão aos momentos "após" quando comparados aos momentos "antes" (p< 0,001) e foi constatado impacto negativo do uso de luvas (p< 0,001). O modelo logístico reforçou a maior adesão nos momentos "após". Ainda que a adesão esteja baixa entre todas as categorias profissionais, o modelo logístico demonstrou mais chances de higiene das mãos pelos enfermeiros. Conclusão A adesão à higiene das mãos foi consideravelmente baixa principalmente considerando a técnica adequada. Foi verificado impacto negativo do uso de luvas na adesão higiene das mãos. Os profissionais demonstraram maiores chances de aderirem a higiene das mãos nos momentos "após" quando comparados aos momentos "antes".

Resumen Objetivo Verificar la adhesión y la calidad de la técnica de higiene de manos realizada por profesionales de la salud en los momentos recomendados e identificar los factores impactantes. Métodos Estudio observacional con 41 profesionales de una unidad de cuidados intensivos adulta de un hospital universitario brasileño. La recopilación de datos se realizó de septiembre a diciembre de 2021, mediante un cuestionario sociodemográfico y un formulario de observación de la Organización Mundial de la Salud. Se aplicaron pruebas estadísticas de análisis binominal y el modelo de regresión logística de efectos mixtos, y se adoptó un nivel de significación de 0,05. Resultados Se observó un total de 1.055 oportunidades de higiene de manos. El índice de adhesión fue del 23,98 % y se pudo verificar que los profesionales no ejecutan la técnica recomendada. La prueba binominal verificó una mayor adhesión en los momentos "después" comparado con los momentos "antes" (p<0,001) y se constató un impacto negativo del uso de guantes (p<0,001). El modelo logístico reforzó la mayor adhesión en los momentos "después". Aunque la adhesión sea baja en todas las categorías profesionales, el modelo logístico demostró mayor probabilidad de higiene de manos por parte de los enfermeros. Conclusión La adhesión a la higiene de manos fue considerablemente baja, sobre todo si se considera la técnica adecuada. Se verificó un impacto negativo del uso de guantes en la adhesión a la higiene de manos. Los profesionales demostraron mayores probabilidades de adhesión a la higiene de manos en los momentos "después" comparado con los momentos "antes".

Abstract Objective To verify adherence and quality of hand hygiene techniques performed by health professionals at recommended times and identify impacting factors. Methods This is an observational study, with 41 professionals from the Adult Intensive Care Unit of a Brazilian teaching hospital. Data collection took place from September to December 2021, using a sociodemographic questionnaire and observation form from the World Health Organization. Statistical tests of binomial analysis and mixed-effects logistic regression model were applied, and a significance level of 0.05 was adopted. Results A total of 1,055 hand hygiene opportunities were observed; the adherence rate was 23.98%; and it can be seen that professionals did not perform the recommended technique. The binomial test verified greater adherence to moments "after" when compared to moments "before" (p< 0.001) and a negative impact of using gloves was found (p< 0.001). The logistical model reinforced greater adherence in moments "after". Even though adherence is low among all professional categories, the logistical model demonstrated more chances of hand hygiene by nurses. Conclusion Adherence to hand hygiene was considerably low, especially considering the appropriate technique. A negative impact of using gloves on hand hygiene adherence was verified. Professionals demonstrated greater chances of adhering to hand hygiene in the moments "after" when compared to moments "before".

Historia cultural sobre el conocimiento de higiene y lavado de manos en las mujeres nahuas del México Antiguo / História cultural sobre os conhecimentos de higiene e lavagem das mãos das mulheres Nahua no México Antigo / Cultural history on the knowledge of hygiene and hand washing in the Nahua women of Ancient Mexico

Introducción. El trabajo de cuidados ha sido el núcleo fundamental de análisis y objeto de estudio tradicional de la Enfermería. Las investigaciones que durante mucho tiempo se han realizado se han centrado mayoritariamente en la producción de cuidados desde la mirada cientificista y hegemónica de la ciencia una ciencia de la enfermería llena de conocimientos técnicos y mecánicos desde una visión parcial de estos, una visión eurocentrista y anglosajona con "valor" académico, dejando al margen los trabajos que se realizan fuera de estos ámbitos y que no están plagados de números y cosas "tangibles". Metodología. Se trata de una investigación histórico cultural, que pretende deconstruir y cristalizar el conocimiento femenino en torno a la higiene y al lavado de manos, por medio de la transdisciplinariedad, haciendo uso de la heurística y la hermenéutica analógica. Hallazgos. Las mujeres nahuas del México Antiguo, dice Clementina Battcock en el Seminario de Historia de las Mujeres en el México Antiguo (Battcock, 2018, 2021), que la historia de las mujeres en el México Antiguo es una historia acallada, "bajita", por lo cual las historiadoras e historiadores han ido construyendo un debate profundo sobre las aportaciones de las mujeres. A través de la heurística seguida se logró encontrar la valiosa recopilación de libros, hecha por Andrés de Olmos denominada "Huehuetlatolli", también denominados la "antigua palabra", gracias a estos escritos se sabe la forma de educación que brindaban mujeres y hombres sabios (tlamatini, mujeres u hombres que saben algo, que conocen las cosas) Discusión. La higiene en la sociedad náhuatl era un método de cuidado para la salud individual y colectiva. Estudiar estos fenómenos como sustento de la la historia del cuidado en la sociedad mexicana gracias al pueblo nahua, es una fuente de información que robustece el cuerpo histórico académico de la profesión de enfermería en México y Latinoamérica Conclusiones. La participación de las mujeres en la educación y en otros ámbitos ha tenido un realce inconmensurable, equiparable con el conocimiento hegemónico proveniente de Europa, las mujeres histórica y universalmente son quienes se han encargado de ilustrar y enseñar desde el seno del hogar las normas básicas de convivencia y civilidad, y aunque ha sido un papel de cierta forma impuesto, no se debe dejar de lado que el conocimiento empírico de todas estas mujeres es valioso y digno de darse a conocer

Introduction. The work of care has been the fundamental nucleus of analysis and traditional object of study of nursing. The research that has been carried out for a long time has focused mainly on the production of care from the scientificist and hegemonic viewpoint of science, a nursing science full of technical and mechanical knowledge from a partial view of this, a Eurocentric and Anglo-Saxon view with academic "value", leaving aside the work that is carried out outside these fields and which is not full of numbers and "tangible" things. Methodology. This is cultural-historical research, which aims to deconstruct and crystallize feminine knowledge around hygiene and hand washing, by means of transdisciplinarity, making use of heuristics and analogical hermeneutics. Findings. Nahua women in Ancient Mexico, says Clementina Battcock in the Seminar on the History of Women in Ancient Mexico (Battcock, 2018, 2021), that the history of women in Ancient Mexico is a silenced history, "bajita", for which historians and historians have been building a deep debate on the contributions of women. Through the heuristics followed, it was possible to find the valuable compilation of books, made by Andrés de Olmos called "Huehuetlatolli", also called the "ancient word", thanks to these writings we know the form of education provided by wise women and men (tlamatini, women or men who know something, who know things). Discussion. Hygiene in the Nahuatl society was a method of care for individual and collective health. Studying these phenomena as a support for the history of care in Mexican society thanks to the Nahua people, is a source of information that strengthens the academic historical body of the nursing profession in Mexico and Latin America. Conclusions. The participation of women in education and in other fields has had an immeasurable enhancement, comparable to the hegemonic knowledge coming from Europe, women historically and universally have been in charge of illustrating and teaching from the bosom of the home the basic rules of coexistence and civility, and although it has been a role somewhat imposed, it should not be left aside that the empirical knowledge of all these women is valuable and worthy of being made known

Introdução. O trabalho de cuidar tem sido o núcleo fundamental de análise e o objeto tradicional de estudo da enfermagem. A investigação que se realizou durante muito tempo centrou-se principalmente na produção de cuidados a partir da visão cientificista e hegemónica da ciência, uma ciência de enfermagem cheia de conhecimentos técnicos e mecânicos a partir de uma visão parcial desta, uma visão eurocêntrica e anglo-saxónica com "valor" académico, deixando de lado o trabalho que se realiza fora destes campos e que não está cheio de números e coisas "tangíveis". Metodologia. Trata-se de uma investigação histórico-cultural, que tem como objetivo desconstruir e cristalizar o conhecimento feminino sobre higiene e lavagem das mãos através da transdisciplinaridade, utilizando a heurística e a hermenêutica analógica. Conclusões. No Seminário de Clementina Battcock sobre a História das Mulheres no México Antigo (Battcock, 2018, 2021), Clementina Battcock afirma que a história das mulheres no México Antigo é uma história silenciada, "baixa", razão pela qual os historiadores têm vindo a construir um debate aprofundado sobre os contributos das mulheres. Através da heurística seguida, foi possível encontrar a valiosa compilação de livros escritos por Andrés de Olmos chamada "Huehuetlatolli", também chamada de "palavra antiga", graças a estes escritos conhecemos a forma de educação fornecida por mulheres e homens sábios (tlamatini, mulheres ou homens que sabem algo, que sabem coisas). Discussão. A higiene na sociedade Nahuatl era um método de cuidado da saúde individual e colectiva. O estudo destes fenómenos como base para a história dos cuidados na sociedade mexicana graças ao povo Nahua é uma fonte de informação que reforça o corpo académico histórico da profissão de enfermeiro no México e na América Latina. Conclusões. A participação das mulheres na educação e em outros campos teve uma importância incomensurável, comparável ao conhecimento hegemónico proveniente da Europa. Histórica e universalmente, as mulheres foram encarregadas de ilustrar e ensinar as regras básicas de convivência e civilidade a partir do seio do lar, e embora tenha sido um papel um tanto imposto, não se deve esquecer que o conhecimento empírico de todas essas mulheres é valioso e digno de ser divulgado

Historia cultural sobre el conocimiento de higiene y lavado de manos en las mujeres nahuas del México Antiguo / História cultural sobre os conhecimentos de higiene e lavagem das mãos das mulheres Nahua no México Antigo / Cultural history on the knowledge of hygiene and hand washing in the Nahua women of Ancient Mexico

Introducción. El trabajo de cuidados ha sido el núcleo fundamental de análisis y objeto de estudio tradicional de la Enfermería. Las investigaciones que durante mucho tiempo se han realizado se han centrado mayoritariamente en la producción de cuidados desde la mirada cientificista y hegemónica de la ciencia una ciencia de la enfermería llena de conocimientos técnicos y mecánicos desde una visión parcial de estos, una visión eurocentrista y anglosajona con "valor" académico, dejando al margen los trabajos que se realizan fuera de estos ámbitos y que no están plagados de números y cosas "tangibles". Metodología. Se trata de una investigación histórico cultural, que pretende deconstruir y cristalizar el conocimiento femenino en torno a la higiene y al lavado de manos, por medio de la transdisciplinariedad, haciendo uso de la heurística y la hermenéutica analógica. Hallazgos. Las mujeres nahuas del México Antiguo, dice Clementina Battcock en el Seminario de Historia de las Mujeres en el México Antiguo (Battcock, 2018, 2021), que la historia de las mujeres en el México Antiguo es una historia acallada, "bajita", por lo cual las historiadoras e historiadores han ido construyendo un debate profundo sobre las aportaciones de las mujeres. A través de la heurística seguida se logró encontrar la valiosa recopilación de libros, hecha por Andrés de Olmos denominada "Huehuetlatolli", también denominados la "antigua palabra", gracias a estos escritos se sabe la forma de educación que brindaban mujeres y hombres sabios (tlamatini, mujeres u hombres que saben algo, que conocen las cosas) Discusión. La higiene en la sociedad náhuatl era un método de cuidado para la salud individual y colectiva. Estudiar estos fenómenos como sustento de la la historia del cuidado en la sociedad mexicana gracias al pueblo nahua, es una fuente de información que robustece el cuerpo histórico académico de la profesión de enfermería en México y Latinoamérica Conclusiones. La participación de las mujeres en la educación y en otros ámbitos ha tenido un realce inconmensurable, equiparable con el conocimiento hegemónico proveniente de Europa, las mujeres histórica y universalmente son quienes se han encargado de ilustrar y enseñar desde el seno del hogar las normas básicas de convivencia y civilidad, y aunque ha sido un papel de cierta forma impuesto, no se debe dejar de lado que el conocimiento empírico de todas estas mujeres es valioso y digno de darse a conocer.

Introduction. The work of care has been the fundamental nucleus of analysis and traditional object of study of nursing. The research that has been carried out for a long time has focused mainly on the production of care from the scientificist and hegemonic viewpoint of science, a nursing science full of technical and mechanical knowledge from a partial view of this, a Eurocentric and Anglo-Saxon view with academic "value", leaving aside the work that is carried out outside these fields and which is not full of numbers and "tangible" things. Methodology. This is cultural-historical research, which aims to deconstruct and crystallize feminine knowledge around hygiene and hand washing, by means of transdisciplinarity, making use of heuristics and analogical hermeneutics. Findings. Nahua women in Ancient Mexico, says Clementina Battcock in the Seminar on the History of Women in Ancient Mexico (Battcock, 2018, 2021), that the history of women in Ancient Mexico is a silenced history, "bajita", for which historians and historians have been building a deep debate on the contributions of women. Through the heuristics followed, it was possible to find the valuable compilation of books, made by Andrés de Olmos called "Huehuetlatolli", also called the "ancient word", thanks to these writings we know the form of education provided by wise women and men (tlamatini, women or men who know something, who know things). Discussion. Hygiene in the Nahuatl society was a method of care for individual and collective health. Studying these phenomena as a support for the history of care in Mexican society thanks to the Nahua people, is a source of information that strengthens the academic historical body of the nursing profession in Mexico and Latin America. Conclusions. The participation of women in education and in other fields has had an immeasurable enhancement, comparable to the hegemonic knowledge coming from Europe, women historically and universally have been in charge of illustrating and teaching from the bosom of the home the basic rules of coexistence and civility, and although it has been a role somewhat imposed, it should not be left aside that the empirical knowledge of all these women is valuable and worthy of being made known.

Introdução. O trabalho de cuidar tem sido o núcleo fundamental de análise e o objeto tradicional de estudo da enfermagem. A investigação que se realizou durante muito tempo centrou-se principalmente na produção de cuidados a partir da visão cientificista e hegemónica da ciência, uma ciência de enfermagem cheia de conhecimentos técnicos e mecânicos a partir de uma visão parcial desta, uma visão eurocêntrica e anglo-saxónica com "valor" académico, deixando de lado o trabalho que se realiza fora destes campos e que não está cheio de números e coisas "tangíveis". Metodologia. Trata-se de uma investigação histórico-cultural, que tem como objetivo desconstruir e cristalizar o conhecimento feminino sobre higiene e lavagem das mãos através da transdisciplinaridade, utilizando a heurística e a hermenêutica analógica. Conclusões. No Seminário de Clementina Battcock sobre a História das Mulheres no México Antigo (Battcock, 2018, 2021), Clementina Battcock afirma que a história das mulheres no México Antigo é uma história silenciada, "baixa", razão pela qual os historiadores têm vindo a construir um debate aprofundado sobre os contributos das mulheres. Através da heurística seguida, foi possível encontrar a valiosa compilação de livros escritos por Andrés de Olmos chamada "Huehuetlatolli", também chamada de "palavra antiga", graças a estes escritos conhecemos a forma de educação fornecida por mulheres e homens sábios (tlamatini, mulheres ou homens que sabem algo, que sabem coisas). Discussão. A higiene na sociedade Nahuatl era um método de cuidado da saúde individual e colectiva. O estudo destes fenómenos como base para a história dos cuidados na sociedade mexicana graças ao povo Nahua é uma fonte de informação que reforça o corpo académico histórico da profissão de enfermeiro no México e na América Latina. Conclusões. A participação das mulheres na educação e em outros campos teve uma importância incomensurável, comparável ao conhecimento hegemónico proveniente da Europa. Histórica e universalmente, as mulheres foram encarregadas de ilustrar e ensinar as regras básicas de convivência e civilidade a partir do seio do lar, e embora tenha sido um papel um tanto imposto, não se deve esquecer que o conhecimento empírico de todas essas mulheres é valioso e digno de ser divulgado.

Knowledge, Attitude and Practice of Hand Hygiene among Healthcare Workers Caring for Children with Leukaemia in the Paediatric Oncology Ward of King Saud Medical City, Saudi Arabia.

Background: Hands are the most common vehicle of pathogen transmission in a healthcare setting. Therefore, hand hygiene is the leading method of reducing healthcare-associated infections. This study aimed to determine the knowledge, attitude and practice (KAP) of hand hygiene and predictors for poor hand hygiene practice among healthcare workers who care for children with leukaemia in the paediatric oncology ward of King Saud Medical City (KSMC) in Saudi Arabia. Methods: One hundred and ninety medical doctors and nurses, who were registered with the Saudi Commission for Health Specialities, were selected to participate in this cross-sectional study using a simple sampling technique. Their KAP of hand hygiene was assessed using a self-structured questionnaire and the collected data was analysed using IBM® SPSS® version 26.0. Results: Of the 190 healthcare workers, 74.7% were nurses and 25.3% were medical doctors. Among the participants, 53.7% (102) had good knowledge of hand hygiene, 51.6% (98) had positive attitudes towards hand hygiene and 55.8% (106) practised satisfactory hand hygiene. Bachelor education level (adjusted OR = 2.736; 95% CI = 1.101, 6.799; P = 0.030), postgraduate education level (adjusted OR = 6.256; 95% CI = 2.171, 18.028; P = 0.001), poor knowledge (adjusted OR =2.575; 95% CI = 1.263, 5.246; P = 0.009) and negative attitude (adjusted OR = 4.702; 95% CI = 1.263, 5.246; P < 0.001) were the significant predictor variables of unsatisfactory hand hygiene practice among healthcare workers. Conclusion: The performance of hand hygiene among healthcare workers is still far less than optimal, particularly in settings like oncology units. Effective programmes are needed to increase their awareness of hand hygiene KAP, while strict guidelines are needed to reduce nosocomial infections.

Hope in Every Breath: Navigating the Therapeutic Landscape of Cystic Fibrosis.

Cystic fibrosis (CF) has long posed a complex challenge to medical science. Still, the tides are turning with remarkable progress in prognosis and demographics, thanks to cutting-edge medical management and treatment breakthroughs. It affects multiple systems, necessitating a comprehensive approach to its management. This article thoroughly reviews the latest advancements in CF treatment across three key areas: respiratory care, infection prevention, and pharmacological management. In respiratory care, emphasis is placed on airway clearance therapies and nebulized saline, while infection prevention strategies encompass hand hygiene, respiratory etiquette, and environmental cleaning and disinfection. Pharmacological management explores pancreatic enzyme replacement therapy (PERT), antimicrobial treatments, cystic fibrosis transmembrane regulator (CFTR) modulators, and promising gene therapies. Patient education and support are highlighted as crucial components of effective CF management, while mental health assessments are emphasized due to CF patients' susceptibility to anxiety and depression. This review highlights the tremendous progress made in the management of CF. Integrating early detection, infection prevention, pharmacological interventions, gene therapy, and patient support is revolutionizing the care and quality of life for individuals with CF.

Assessment of the infrastructure of a COVID-19 unit and health professionals' perception about safety attitudes / Avaliação da infraestrutura de uma unidade COVID-19 e a percepção de profissionais de saúde sobre as atitudes de segurança / Evaluación de la infraestructura de una unidad COVID-19 y la percepción de los profesionales de la salud sobre las actitudes de seguridad

Background and objectives: does the COVID-19 Intensive Care Unit have a favorable structure to sanitize the hands of health professionals? What is the perception of health professionals about the organizational safety of that sector? It aims to assess the structure for hand hygiene in an Intensive Care Unit for patients with COVID-19 and the perception of safety attitude by health professionals. Methods: an analytical, cross-sectional study with 62 health professionals from a university hospital in the state of Mato Grosso, Brazil. The unit structure commands for hand alignment and safety attitudes were used. Results: flaws were found in the infrastructure that can hinder and prevent hand hygiene by professionals at the point of care. The safety attitude was impaired in all domains. No difference was found between the median scores regarding professional categories. Conclusion: investment is urgently needed in improving infrastructure with alcoholic preparation supply at the point of assistance. The study demonstrates the negative impact of the perception of low management involvement in patient safety actions and poor infrastructure for hand hygiene.(AU)

Justificativa e objetivos: a Unidade de Terapia Intensiva COVID-19 possui estrutura favorável para a higienização das mãos dos profissionais de saúde? Qual a percepção dos profissionais de saúde acerca da segurança organizacional do referido setor? Tem como objetivo avaliar a estrutura para higiene das mãos de uma Unidade de Terapia Intensiva destinada a pacientes com COVID-19 e a percepção da atitude de segurança pelos profissionais de saúde. Métodos: estudo analítico, transversal, com 62 profissionais de saúde de um hospital universitário do estado de Mato Grosso, Brasil. Foram utilizados os questionários de estrutura da unidade para higienização das mãos e o de atitudes de segurança. Resultados: constataram-se falhas na infraestrutura que podem dificultar e impedir a realização da higiene das mãos pelos profissionais no ponto da assistência. A atitude de segurança esteve prejudicada em todos os domínios. Não foi encontrada diferença entre as medianas dos escores com relação às categorias profissionais. Conclusão: se faz urgente o investimento na melhoria da infraestrutura com fornecimento de preparações alcoólicas no ponto da assistência. O estudo demonstra o impacto negativo da percepção do baixo envolvimento da gestão nas ações de segurança do paciente e infraestrutura precária para higiene das mãos.(AU)

Justificación y objetivos: ¿La Unidad de Cuidados Intensivos COVID-19 cuenta con una estructura favorable para la higiene de manos de los profesionales de la salud? ¿Cuál es la percepción de los profesionales de la salud sobre la seguridad organizacional en ese sector? Tiene como objetivo evaluar la estructura para la higiene de manos en una Unidad de Cuidados Intensivos destinada a pacientes con COVID-19 y la percepción de actitudes de seguridad por parte de los profesionales de la salud. Métodos: estudio transversal analítico con 62 profesionales de la salud de un hospital universitario en el estado de Mato Grosso, Brasil. Se utilizaron los comandos de la estructura de la unidad para la alineación de las manos y las actitudes de seguridad. Resultados: se encontraron fallas en la infraestructura que pueden dificultar e impedir la realización de la higiene de manos por parte de los profesionales en el punto de atención. La actitud de seguridad se vio afectada en todos los dominios. No se encontró diferencia entre las medianas de las puntuaciones con respecto a las categorías profesionales. Conclusión: urge invertir en mejorar la infraestructura con el suministro de preparados alcohólicos en el punto de atención. El estudio demuestra el impacto negativo de la percepción de una baja implicación de la dirección en las acciones de seguridad del paciente y una infraestructura deficiente para la higiene de manos.(AU)

Clean hands, safe care: how knowledge, attitude, and practice impact hand hygiene among nurses in Najran, Saudi Arabia.

Introduction: Healthcare-acquired infections are infections that patients acquire while receiving treatment for a medical or surgical condition and can occur in all care facilities. Hospital-acquired infections and the spread of antimicrobial resistance can be reduced by implementing proper preventive measures, including hand hygiene. Aim: This study aimed to assess nurses' knowledge and attitudes toward hand hygiene guidelines in Najran city, determine compliance levels, identify factors contributing to non-compliance, and provide recommendations for interventions to improve hand hygiene practices and reduce healthcare-associated infections risk. Subject and methods: This cross-sectional study was conducted among nurses working in the selected government hospitals in Najran City, Saudi Arabia. A self-administered questionnaire was distributed among the targeted nurses using an online survey. The questionnaire includes socio-demographic characteristics such as age, gender, and marital status. The questionnaire had 25 items to measure knowledge, 10 to measure attitude, 6 to measure practices, and 4 to measure the impact of COVID-19 on hand hygiene practices. Results: Among the 386 nurses recruited, 88.3% were females, and 25.6% were aged between 31 to 35 years old. Overall, good knowledge, positive attitude, and good practice levels were found in 42.5, 48.4, and 94%, respectively. The common factor influencing hand hygiene practice was the prevention of cross-infection (88.1%). The total knowledge score mean was 18 ± 3.4 (highest possible score: 25). The total attitude score mean was 37.5 ± 6.1 (highest possible score: 50). The total practice score mean was 26.9 ± 2.8 (highest possible score: 30). A higher score indicates higher KAP of hand hygiene. Factors associated with increased KAP were being older in age (Z = 6.446; p < 0.001), gender female (Z = 9.869; p < 0.001), being a Filipino nurse (H = 117.8; p < 0.001), working in a surgery department (H = 28.37; p < 0.001), having more than 10 years of experience (Z = 6.903; p < 0.001), living in shared accommodation (H = 87.22; p < 0.001), having associated chronic disease (Z = 4.495; p < 0.001), and receiving formal training in hand hygiene (Z = 2.381; p = 0.017). There was a positive highly statistically significant correlation between knowledge score and attitude score (r = 0.556), between knowledge score and practices score (r = 0.303), and between attitude score and practices score (r = 0.481). Conclusion: In light of the results, we can say that the nurses' knowledge, attitude, and practice in regards to hand hygiene were deemed acceptable. We noticed that female nurses who were older and had more experience, as well as those who had received formal hand hygiene training, displayed better KAP compared to their counterparts. Moreover, we found a significant and positive correlation between the scores for knowledge, attitude, and practice. Nonetheless, additional research is necessary to establish the extent of KAP concerning hand hygiene.

Compliance and barriers to hand hygiene practice among professionals during the COVID-19 pandemic: an integrative review / Adesão e barreiras à prática de higienização das mãos entre profissionais na pandemia de COVID-19: revisão integrativa / Adherencia y barreras a la práctica de la higiene de manos entre profesionales en la pandemia de COVID-19: revisión integradora

Background and objectives: compliance and barriers to hand hygiene practice remains a challenge in health services, especially during the COVID-19 pandemic. This preventive measure needs to be encouraged at all levels of care to reduce health problems. This article aimed to identify the reasons for compliance and main barriers to hand hygiene practice among health professionals during the COVID-19 pandemic. Content: an integrative review, performed in the MEDLINE via PubMed, Scopus, Wiley Online Library, Western Pacific Region Index Medicus, LILACS, IBECS, BDENF and SciELO databases. To interpret the results, Nola Pender's theoretical perspective was used. The sample consisted of 13 articles, allowing the stratification of six themes: health professionals' attitude and behavior during the pandemic; assessment of the five moments in hospitals during the pandemic period; availability, use and types of resources; barriers and facilitators; team compliance before and during the COVID-19 pandemic; and technique quality and glove use considering the need for hand hygiene. Conclusion: hand hygiene practice needs to be expanded and encouraged among team members, as there were barriers that hindered compliance during the COVID-19 pandemic.(AU)

Justificativa e objetivos: adesão à prática de higienização das mãos permanece um desafio nos serviços de saúde, principalmente durante a pandemia de COVID-19. Essa medida preventiva necessita ser estimulada em todos os níveis de assistência para redução de agravos à saúde. Este artigo teve por objetivo identificar os motivos de adesão e principais barreiras à pratica de higienização das mãos entre profissionais de saúde durante a pandemia de COVID-19. Conteúdo: revisão integrativa, realizada nas bases de dados MEDLINE via PubMed, Scopus, Wiley Online Library, Index Medicus do Pacífico Ocidental, LILACS, IBECS, BDENF e SciELO. Para interpretação dos resultados, utilizou-se a perspectiva teórica de Nola Pender. A amostra foi constituída por 13 artigos, possibilitando a estratificação de seis temas: atitude e comportamento dos profissionais de saúde durante a pandemia; avaliação dos cinco momentos em hospitais no período pandêmico; disponibilidade, utilização e tipos de recursos; barreiras e facilitadores; adesão da equipe no antes e durante a pandemia de COVID-19; e qualidade da técnica e utilização de luvas diante da necessidade de higienização das mãos. Conclusão: a prática de higienização das mãos precisa ser ampliada e incentivada entre a equipe, visto que houve barreiras que dificultaram a adesão durante a pandemia de COVID-19.(AU)

Justificación y objetivos: la adherencia y las barreras para la práctica de la higiene de manos sigue siendo un desafío en los servicios de salud, especialmente durante la pandemia de COVID-19. Es necesario fomentar esta medida preventiva en todos los niveles de atención para reducir los problemas de salud. Este artículo tuvo como objetivo identificar las razones de la adherencia y las principales barreras para la práctica de la higiene de manos entre los profesionales de la salud durante la pandemia de COVID-19. Contenido: revisión integradora, realizada en bases de datos MEDLINE vía PubMed, Scopus, Wiley Online Library, Western Pacific Region Index Medicus, LILACS, IBECS, BDENF y SciELO. Para interpretar los resultados se utilizó la perspectiva teórica de Nola Pender. La muestra estuvo compuesta por 13 artículos, lo que permitió la estratificación de seis temas: actitud y comportamiento de los profesionales de la salud durante la pandemia; evaluación de los cinco momentos en los hospitales durante el período de pandemia; disponibilidad, uso y tipos de recursos; barreras y facilitadores; adherencia del equipo antes y durante la pandemia de COVID-19; y calidad de la técnica y uso de guantes ante la necesidad de higiene de manos. Conclusión: la práctica de la higiene de manos necesita ser ampliada y fomentada entre el equipo, ya que hubo barreras que dificultaron la adherencia durante la pandemia de COVID-19.(AU)

Alcohol preparation consumption for hand hygiene in outpatient clinics and Day Hospitals: an integrative review / Consumo de preparação alcoólica para higienização das mãos em ambulatórios e Hospitais-Dia: revisão integrativa / Consumo de preparados alcohólicos para higiene de manos en Hospitales-Día y ambulatorios: revisión integradora

Background and Objective: the alcoholic preparation consumption indicator is a measure that can help monitor compliance with hand hygiene, however there is no guidance regarding the profile for application of consumption reference published by the World Health Organization for many health institutions. Thus, the study sought information available in scientific literature to support the definition of alcohol preparation consumption for hand hygiene in outpatient clinics and Day Hospitals. Method: an integrative review for the period between 2010 and 2021, conducted in the Scopus, Web of Science, SciELO, PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Database on Nursing and Latin American and Caribbean Literature on Health Sciences databases, through the Virtual Health Library. Five articles were selected, being divided into two categories: Milliliters of alcoholic preparation for each hand hygiene, identifying the expected average volume of 3 ml, and Consumption of alcohol-based hand rub per patient-day, observing the prevalence of studies in general hospitals. A study brought the perspective regarding consumption in a Nursing Home. Conclusion: in the review, no articles related to outpatient clinics and Day Hospitals were found. The selected studies demonstrate that alcohol preparation consumption for hand hygiene is different depending on the profile of the sector and the patient treated and that both the minimum volume for each hand hygiene and the opportunities are not considered for analysis of the indicator.(AU)

Justificativa e Objetivo: o indicador de consumo de preparação alcoólica é uma medida que pode auxiliar no monitoramento da adesão à higienização das mãos, entretanto não existe direcionamento quanto ao perfil para aplicação da referência de consumo publicada pela Organização Mundial da Saúde para muitas instituições de saúde. Assim, o estudo buscou analisar as informações disponíveis na literatura científica para subsidiar a definição do consumo de preparação alcoólica para higienização das mãos em instituições ambulatoriais e Hospitais-Dia. Método: revisão integrativa referente ao período entre 2010 e 2021, realizada nas bases de dados Scopus, Web of Science, SciELO, PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Banco de Dados em Enfermagem e Literatura Latino-Americana e do Caribe em Ciências da Saúde, através da Biblioteca Virtual em Saúde. Foram selecionados cinco artigos que abordam o tema, sendo divididos em duas categorias: Mililitros de preparação alcoólica para cada higienização das mãos, identificando-se o volume médio previsto de 3 ml, e Consumo de preparação alcoólica por paciente/dia, observando-se a prevalência de estudos em hospitais gerais. Um estudo trouxe a perspectiva referente ao consumo em uma Instituição de Longa Permanência. Conclusão: na revisão, não foram encontrados artigos relacionados a ambulatórios e Hospitais-Dia. Os estudos selecionados demonstram que o consumo de preparação alcóolica é diferente dependendo do perfil do setor e do paciente atendido e que tanto o volume mínimo para cada higienização das mãos quanto as oportunidades geralmente não são considerados para análise do indicador.

Justificación y Objetivos: el indicador de consumo de preparados alcohólicos es una medida que ayuda a monitorear la adherencia a la higiene de manos, pero no existe una orientación respecto al perfil de aplicación de la referencia publicada por la Organización Mundial de la Salud para muchas instituciones de salud. Así, el estudio buscó información disponible en la literatura científica para sustentar la definición del consumo de preparados alcohólicos en instituciones ambulatorias y Hospitales Día. Método: una revisión integrativa para el período comprendido entre 2010 y 2021, realizada en bases de datos Scopus, Web of Science, SciELO, PubMed/MEDLINE; Cumulative Index to Nursing and Allied Health Literature, Base de Datos de Enfermería y Literatura Latinoamericana y del Caribe en Ciencias de la Salud, a través de la Biblioteca Virtual en Salud. Se seleccionaron cinco artículos que abordaban el tema y se dividieron en dos categorías: Mililitros de preparación alcohólica para cada higiene de manos, identificando el volumen promedio esperado de 3 ml, y Consumo de preparación alcohólica por paciente-día, observando la prevalencia de estudios en hospitales generales. Un estudio trajo la perspectiva sobre el consumo en una Institución de Larga Estancia. Conclusión: en la revisión, no se encontraron artículos relacionados con ambulatorios y Hospitales Día. Los estudios seleccionados demuestran que el consumo de preparados alcohólicos para la higiene de manos es diferente según el perfil del sector y del paciente tratado y que tanto el volumen mínimo como las oportunidades no suelen ser considerados para el análisis del indicador.(AU)

Can COVID-19 pandemic surveillance reduce nosocomial urinary infections in urologic surgery?

INTRODUCTION: Since COVID-19 pandemic spread, strict preventive measures were adopted to reduce the risk of transmission. Antiseptic dispensers for hand hygiene were diffusely available for patients and hospital staff. To investigate the prophylactic role played by the strict antiseptic rules adopted during pandemic, the rates of nosocomial urinary infections in 2019 and 2020 were compared. MATERIALS AND METHODS: Patients' clinical pre-operative characteristics, symptoms, fever, and laboratory data were recorded pre- and post-operatively. Urological surgery was classified in five categories: 1. major surgery 2. upper urinary tract endoscopy, 3. lower urinary tract endoscopy, 4. minor surgery, and 5. Nephrostomy and ureteral stenting. Clavien-Dindo complication score was used. Statistical analysis was performed with R 3.4.2 software. RESULTS: Out of 495 patients, 383 (57.1%) underwent surgical intervention in pre-pandemic March-May 2019 period and 212 (42.9%) in the same pandemic 2020 interval. Preoperatively, 40 (14.1%) and 11 (5.2%) and 77 (27.3%) and 37 (17.5%) patients had fever (p < 0.003) and leukocytosis (p < 0.02), in 2019 and 2020 respectively. Urine culture was positive in 29 (10.2%) and 13 (6.2%) patients respectively (p = 0.22). Post-operatively, 54 (19.1%) and 22 (10.4%) patients and 17 (6.1%) and 2 (0.6%) patients showed fever (p < 0.003) and positive urineculture (p < 0.03), in 2019 and 2020 respectively. DISCUSSION AND CONCLUSION: Preoperative and post-operative clinical and laboratory signs of nosocomial urinary infection showed a statistically significant lower incidence during the pandemic period in 2020. This observation could be ascribed to the strong preventive measures, to the medical staff high adherence to hygiene and the diffuse availability of hand sanitizers.

Validity of self-reported compliance and behavioural determinants of observed compliance: an application of the COM-B hand hygiene questionnaire in nine Dutch hospitals.

BACKGROUND: Hand hygiene compliance (HHC) can be influenced by behavioural determinants, but knowledge on this remains scarce. The Capability, Opportunity, Motivation-Behaviour (COM-B) hand hygiene questionnaire was developed by Lydon et al. to gain insight into self-reported behavioural determinants and self-reported HHC. AIMS: To determine the validity of self-reported HHC using the COM-B questionnaire; and investigate the influence of self-reported behavioural determinants on observed HHC, taking environmental determinants into account. METHODS: This was a cross-sectional study, from September to November 2019, in nine hospitals in the Netherlands. Healthcare workers (HCWs) completed the COM-B questionnaire, and direct hand hygiene observations were performed. In addition, information on environmental determinants (workload, ward category, hospital type and ward infrastructure) was collected. Validity of self-reported HHC was determined using the intraclass correlation coefficient (ICC). Univariable and multi-variable regression analyses were performed to investigate the relationship between behavioural and environmental determinants and observed HHC. FINDINGS: The ICC showed no association between self-reported HHC and observed HHC [0.04, 95% CI -0.14 to 0.21]. In univariable regression analyses, ward category and the opportunity and motivation subscales were significantly associated with observed HHC. In multi-variable regression analysis, only ward category and the motivation subscale remained significant. CONCLUSION: Self-reported HHC is not a valid substitute for direct hand hygiene observations. Motivation (behavioural determinant) was significantly associated with HCC, while almost none of the environmental determinants had an effect on observed HHC. In further development of hand hygiene interventions, increasing the intrinsic motivation of HCWs should receive extra attention.

Fabrication, assessment, and potential anti-bacterial activity of sandalwood oil nanoemulsion and its hand rub sanitizer.

In the last decade, extensive research has been performed on developing hand sanitizers that can be used to eradicate the diseases that are caused due to poor hand hygiene. Essential oils possess antibacterial and antifungal properties and thus have great potential to replace the available antibacterial agents. In the present study, sandalwood oil-based nanoemulsion (NE) and sanitizer have been formulated and well characterized for their properties. Antibacterial activity was assessed using growth inhibition studies, agar cup, viability assay, etc. The sandalwood oil NE synthesized had oil to surfactant ratio of 1:0.5 (2.5% sandalwood oil and 0.5% Tween 80) and was observed to have a droplet diameter of 118.3 ± 0.92 nm, the zeta potential of - 18.8 ± 2.01 mV, and stability of 2 months. The antibacterial activity of sandalwood NE and sanitizer was evaluated against microorganisms. The antibacterial activity was assessed using the zone of inhibition value of sanitizer, which was in the range of 19 to 25 mm against all microorganisms. Morphological analysis showed distant changes in membrane shape and size and microorganisms' morphology. The synthesized NE was thermodynamically stable and efficient enough to be used in sanitizer, and the formulated sanitizer showed great antibacterial efficacy.

Compliance with hand hygiene practices and its appropriateness among healthcare workers during COVID-19 pandemic in public health facilities of Tamil Nadu, India.

Background: Compliance with appropriate hand hygiene practises is the most efficient and cost-effective intervention that can be implemented in the healthcare setting. Given its importance, we tried to capture the compliance with hand hygiene practises and their appropriateness among healthcare workers during the COVID-19 pandemic in public health facilities in Tamil Nadu. Methods: This cross-sectional study involved doctors, nurses, and allied healthcare professionals from various departments in 18 public healthcare facilities spanning six districts in Tamil Nadu. A random-intercept model was employed for the multivariable logistic regression analysis to evaluate the factors influencing hand hygiene compliance and its adequacy. The effect size was presented as an adjusted odds ratio (aOR) accompanied by a 95% confidence interval (CI). Results: In total, 2733 hand hygiene observations were made. Only during 19.4% (95%CI: 17.9%-20.9%) of these observations, hand washing was done. Only during 37.9% (95%CI: 33.9%-42.1%) of these observations, hand washing was done appropriately by following all the essential steps of hand hygiene. Nurses (aOR = 2.49; 95%CI: 1.90-3.26), healthcare workers in General Surgery (aOR = 2.18; 95%CI: 1.53-3.10) and Obstetrics & Gynaecology departments (aOR = 1.75; 95%CI: 1.26-2.43), working in inpatient departments (aOR = 2.64; 95%CI: 1.38-5.04) had significantly higher compliance to hand hygiene practices. Nurses (aOR = 2.58; 95%CI: 1.33-5.01) and General Medicine department healthcare workers (aOR = 1.98; 95%CI: 1.09-3.61) had significantly higher compliance to appropriate hand hygiene practices. Conclusion: Our study shows that only during one-fifth of the observations did healthcare workers do hand washing, and less than 10% did it appropriately by following all the essential steps of hand hygiene.