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.

Patient perspectives on infection prevention and control in cancer care: a survey of knowledge and attitudes among persons with cancer and their next of kin.

BACKGROUND: With the growing prevalence of antimicrobial resistance, there may be a need to strengthen infection prevention and control (IPC) measures in cancer care. When developing clinical guidelines, it is important to incorporate patient perspectives. AIM: To determine the knowledge of, and attitudes towards, IPC among persons with cancer and their next of kin in Norway. METHODS: Through discussions in expert panels and a pilot study, a survey was developed consisting of 13 knowledge statements to be judged true/false and 40 attitude items to be judged using a Likert scale and was sent to a panel of people with cancer experience on August 22nd, 2023. The mean correct responses and attitude scores were reported. FINDINGS: Of 551 respondents, the mean correct response to IPC-related knowledge questions was 79% (95% confidence interval: 78-80). Respondents were most knowledgeable about hand hygiene (99%, 546/551), but least knowledgeable about its role in preventing antibiotic resistance (41%, 225/551). Strong support was noted for IPC, especially within the patient responsibilities theme, with a mean score of 4.83. However, there was a notable reluctance towards some selected intrusive IPC measures, such as reducing contact with close relations. CONCLUSION: This survey revealed a high level of knowledge and attitudes that support the importance of IPC among persons with cancer in Norway and their next of kin. We recommend including patient perspectives in future development of IPC guidelines.

Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon.

BACKGROUND: Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital. METHODS: It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance. RESULTS: 5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P < .001) and to 87.2% (postimplementation stage) (P < .001). Weekly ABHR usage increased significantly during implementation (5,670 ml), compared to baseline, (1242.5 ml, P = .001), and remained high in postimplementation (7,740 ml). CONCLUSIONS: Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.

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.

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

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.

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.

Using a human factors framework to assess clinician perceptions of and barriers to high reliability in hand hygiene.

BACKGROUND: Hand hygiene (HH) is critical to prevent health care-associated infections (HAIs). Clinician perspectives on maintaining high reliability are poorly defined. METHODS: We surveyed physicians, nurse practitioners, and physician assistants to understand perceptions of and barriers to high reliability in HH. The Systems Engineering Initiative for Patient Safety 2.0 model was used to develop an electronic survey exploring 6 human factors engineering (HFE) domains. RESULTS: Among 61 respondents, 70% perceived HH as "essential" to patient safety. While 87% reported alcohol-based hand rub (ABHR) availability as very effective in improving HH reliability, 77% reported dispensers to be "sometimes" or "often" empty. Clinicians in surgery/anesthesia were more likely than those in medical specialties to note skin irritation from ABHR (OR 4.94; 95% CI 1.37-17.81) and less likely to believe feedback was effective in improving HH (OR 0.26; 95% CI 0.08-0.88). One quarter of respondents indicated the layout of patient care areas was not conducive to performing HH. Staffing shortages and the pace and demands of work precluded HH for 15% and 11% of respondents, respectively. CONCLUSIONS: Aspects of organizational culture, environment, tasks, and tools were identified as barriers to high reliability in HH. HFE principles can be applied to more effectively promote HH.

Evidence-based hand hygiene: Liquid or gel handrub, does it matter?

BACKGROUND: Recent studies put under scrutiny the prevailing hand hygiene guidelines, which incorporate quantitative parameters regarding handrub volume and hand size. Understanding the criticality of complete (i.e., efficient) hand hygiene in healthcare, objectivization of hand hygiene related parameters are paramount, including the formulation of the ABHR. Complete coverage can be achieved with optimal Alcohol-Based Hand Rub (ABHR) provided. The literature is limited regarding ABHR formulation variances to antimicrobial efficiency and healthcare workers' preference, while public data on clinically relevant typical application differences is not available. This study was designed and performed to compare gel and liquid format ABHRs (the two most popular types in Europe) by measuring several parameters, including application time, spillage and coverage. METHODOLOGY: Senior medical students were invited, and randomly assigned to receive pre-determined ABHR volumes (1.5 or 3 ml). All the 340 participants were given equal amounts of gel and liquid on two separate hand hygiene occasions, which occurred two weeks apart. During the hand hygiene events, by employing a digital, fully automated system paired with fluorescent-traced ABHRs, disinfectant hand coverage was objectively investigated. Furthermore, hand coverage in relation to the participants' hand sizes was also calculated. Additional data collection was performed regarding volume differences and their effect on application time, participants' volume awareness (consciousness) and disinfectant spillage during the hand hygiene events. RESULTS: The 1.5 ml ABHR volume (commonly applied in healthcare settings) is insufficient in either formulation, as the non-covered areas exceeded significant (5%+) of the total hand surface area. 3 ml, on the contrary, resulted in almost complete coverage (uncovered areas remained below 1.5%). Participants typically underestimated the volume which they needed to apply. While the liquid ABHR spreads better in the lower, 1.5 ml volume compared to the gel, the latter was easier handled at larger volume. Drying times were 30/32 s (gel and liquid formats, respectively) when 1.5 ml handrub was applied, and 40/42 s when 3 ml was used. As the evaporation rates of the ABHR used in the study are similar to those available on the market, one can presume that the results presented in the study apply for most WHO conform ABHRs. CONCLUSION: The results show that applying 1.5 ml volume was insufficient, as large part of the hand surface remained uncovered (7.0 ± 0.7% and 5.8 ± 1.0% of the hand surface in the case of gel and liquid, respectively) When 3 ml handrub was applied drying times were 40 and 42 s (gel and liquid, respectively), which is a very long time in daily clinical practice. It looks like we cannot find a volume that fits for everyone. Personalized, hand size based ABHR volumes may be the solution to find an optimal balance between maximize coverage and minimise spillage and drying time. 3 ml can be a good volume for those who have medium size hands. Large handed people should use more handrub to reach appropriate coverage, while small-handed ones may apply less to avoid massive spillage and not to take unrealistically long to dry.

Surgical Infection Reduction Program of the Observatory of Surgical Infection (PRIQ-O): Delphi prioritization and consensus document on recommendations for the prevention of surgical site infection.

Surgical site infection is the most frequent and avoidable complication of surgery, but clinical guidelines for its prevention are insufficiently followed. We present the results of a Delphi consensus carried out by a panel of experts from 17 Scientific Societies with a critical review of the scientific evidence and international guidelines, to select the measures with the highest degree of evidence and facilitate their implementation. Forty measures were reviewed and 53 recommendations were issued. Ten main measures were prioritized for inclusion in prevention bundles: preoperative shower; correct surgical hand hygiene; no hair removal from the surgical field or removal with electric razors; adequate systemic antibiotic prophylaxis; use of minimally invasive approaches; skin decontamination with alcoholic solutions; maintenance of normothermia; plastic wound protectors-retractors; intraoperative glove change; and change of surgical and auxiliary material before wound closure.

Compliance with a novel hand hygiene protocol tailored to non-sterile healthcare workers in the operating theatre.

BACKGROUND: Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCWs) in the operating theatre (OT) is challenging as there are no tailored protocols or observation tools. AIM: To develop and test a hand hygiene protocol tailored to non-sterile HCWs in the OT. METHODS: In this prospective observational study, nine hospitals in the Rotterdam-Rijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95% confidence intervals (CI) were calculated by type of hospital and type of HCW. FINDINGS: The protocol has three sections: (1) written general hand hygiene rules; (2) written hand hygiene rules specific for anaesthesia and surgery; and (3) visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing area. Average HHC of 48.0% (95% CI 45.2-61.2%) was observed in OTs across all hospitals. HHC was highest in the two specialized hospitals (64.0%, 95% CI 30.6-89.8%; 76.7%, 95% CI 62.8-84.5%) and lowest in the academic teaching hospital (23.1%, 95% CI 0.0-45.8%). In terms of type of HCW, HHC was lowest among anaesthesiologists (31.6%, 95% CI 19.2-62.4%) and highest among OT assistants (57.4%, 95% CI 50.1-78.2%). CONCLUSION: This uniform way of observing HHC in the OT enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50%; this needs to be addressed, particularly in teaching hospitals and among physicians.

Quantification of diurnal variation in "glove hygiene" compliance in COVID ICUs: An exploratory study.

BACKGROUND: Hand hygiene compliance (HHC) monitoring is almost always done in daytime. Documentation of HHC in health care workers (HCWs) is limited during odd hours and nighttime. The objective of the study was to determine diurnal variation in HHC in different categories of health care workers in tertiary care hospital in North India. METHODS: A prospective, observational study was conducted in 3 COVID-19 intensive care units (ICUs) with closed-circuit television (CCTV) cameras. Dedicated infection control nurses monitored HHC among various HCWs (doctors, nursing staff, technicians, hospital and sanitary attendants) during day and nighttime, in 20-minute durations. The difference in HHC by-professional category and for each WHO moment was assessed using χ² test and P value. RESULTS: A total of 705 opportunities were observed over a period of 7 days, with overall compliance of 53%. Day and nighttime compliance was recorded to be 60.7% and 42.1%, respectively (P < .001). HCC was highest amongst resident doctors with little diurnal variation. However, nurses and housekeeping staff exhibited significant diurnal variation. The compliance at "after" moments was much higher than "before" moments in all professional categories. CONCLUSION: There was a significant decrease in compliance during nighttime, amongst all HCWs, with maximum variation exhibited by nursing staff. The present study underlines the importance of monitoring HHC at odd hours, to elicit a more accurate picture round the clock. Health care facilities monitoring compliance only during the daytime may substantially overestimate HHC.

Do task and item difficulty affect overestimation of one's hand hygiene compliance? A cross-sectional survey of physicians and nurses in surgical clinics of six hospitals in Germany.

BACKGROUND: One barrier to hand hygiene compliance is overestimation of one's own performance. Overconfidence research shows that overestimation tends to be higher for difficult tasks, which suggests that the magnitude of overestimation also depends on how it is assessed. Thus, we tested the hypothesis that overestimation was stronger for hand hygiene indications with low compliance (i.e., high difficulty), and the hypothesis that self-reported overall compliance based on a single item is higher than based on "5 Moments of Hand Hygiene" (WHO-5) items, since the single item implies an aggregation across indications. METHODS: In the WACH trial (German Clinical Trials Register [DRKS] ID: DRKS00015502), a questionnaire survey was conducted among physicians and nurses in nine surgical clinics (general/visceral surgery or orthopedics/trauma surgery) of six German hospitals. Self-reported compliance was assessed both by a single item and the WHO-5-items using percentage scales. These were compared with each other and with direct observations. Relative frequencies of the WHO-5 indications used to calculate the WHO-5-based self-reported overall compliance rate were estimated by a systematized review of the literature (see appendix). In analysis, t-tests, Chi2-tests and multiple linear regressions were used. RESULTS: Ninety-three physicians (response rate: 28.4%) and 225 nurses (30.4%) participated. Significant compliance differences between physicians and nurses were found for direct observations and were in favor of nurses, while no such differences were found for self-reports. Across the WHO-5, overestimation showed inverse correlations with observed compliance (physicians: r = -0.88, p = 0.049; nurses: r = -0.81, p = 0.093). Support for the hypothesis that the self-reported overall compliance based on one item is higher than that based on WHO-5 items was found for physicians (M = 87.2 vs. 84.1%, p = 0.041; nurses: 84.4 vs. 85.5%, p = 0.296). Exploratory analyses showed that this effect was confined to orthopedic/trauma surgeons (89.9 vs. 81.7%, p = 0.006). CONCLUSION: Among physicians, results indicate stronger hand hygiene overestimation for low-compliance indications, and when measurements are based on a single item versus the five WHO-5 items. For practice, results contribute to infection prevention and control's understanding of overestimation as a psychological mechanism that is relevant to professional hand hygiene.

Physical structure and supplies for hand hygiene in the CCU of a public hospital / Estrutura física e insumos destinados à higienização das mãos no CTI de um hospital público / Estructura física e insumos destinados a la higienización de manos en la UCI de un hospital público

Background and Objectives: healthcare-associated infections (HAIs) are a serious public health problem worldwide. They occur mainly in Critical Care Units (CCUs), where physical structure and supplies do not favor hand hygiene (HH) compliance among health professionals. Thus, the present study aimed to describe and assess the physical structure and supplies for HH practice in a CCU of a public cancer hospital in the North region, Pará, Brazil. Methods: this is a descriptive, observational and cross-sectional study with a quantitative approach. Data were collected through a questionnaire based on the Guide to the Implementation of the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. Results: the study identified that there were 17 functioning beds and 6 interdicted, in addition to 11 sinks on site, but only 5 had liquid soap and paper towels, all with water. Ten alcohol dispensers were identified, but only 7 were functioning and replenished. None of the professionals found had a pocket alcoholic bottle. Conclusion: the study concluded that the physical structure and supplies found in the investigated CCU are partially adequate for carrying out hand disinfection. However, improvements in these structures must be implemented as well as periodic audits and permanent health education activities, aiming to remind professionals about HH practice correctly.(AU)

Justificativas e objetivos: as infecções relacionadas à assistência a saúde (IRAS) são um grave problema de saúde pública mundial. Ocorrem principalmente nos Centros de Terapia Intensiva (CTI), onde a estrutura física e insumos não favorecem a adesão da higienização das mãos (HM) entre os profissionais de saúde. Dessa forma, o presente estudo teve como objetivo descrever e avaliar a estrutura física e de insumos destinados à prática de HM em um CTI de um hospital público oncológico da região Norte, Pará, Brasil. Métodos: trata-se de um estudo descritivo, observacional e transversal com abordagem quantitativa. Os dados foram coletados através de um questionário baseado no Guia para a Implementação da Estratégia Multimodal da Organização Mundial da Saúde (OMS) para a Melhoria da Higiene das Mãos. Resultados: o estudo identificou que existiam 17 leitos funcionantes e 6 interditados, além de 11 pias no local, porém apenas 5 possuíam sabão líquido e papel toalha, todas com água. Foram identificados 10 dispensadores de álcool, porém apenas 7 estavam funcionantes e reabastecidos. Nenhum dos profissionais encontrados possuíam frasco alcoólico de bolso. Conclusão: o estudo concluiu que a estrutura física e os insumos encontrados no CTI investigado estão parcialmente adequados para a realização da prática de desinfecção das mãos. Contudo, devem ser implementadas melhorias nessas estruturas, bem como auditorias periódicas e atividades de educação permanente em saúde, visando relembrar os profissionais sobre a prática de HM de forma correta.(AU)

Justificación y objetivos: las infecciones asociadas a la atención de la salud (IAAS) son un grave problema de salud pública a nivel mundial. Ocurren principalmente en Unidades de Cuidados Intensivos (UCI), donde la estructura física y los suministros no favorecen la adherencia a la higiene de manos (HM) entre los profesionales de la salud. Así, el presente estudio tuvo como objetivo describir y evaluar la estructura física y los insumos para la práctica de la HM en una UCI de un hospital oncológico público de la región Norte de Pará, Brasil. Métodos: se trata de un estudio descriptivo, observacional, transversal con enfoque cuantitativo. Los datos fueron recolectados a través de un cuestionario basado en la Guía para la Implementación de la Estrategia Multimodal para la Mejora de la Higiene de Manos de la Organización Mundial de la Salud (OMS). Resultados: el estudio identificó que había 17 camas en funcionamiento y 6 intervenidas, además de 11 lavabos en el lugar, pero solo 5 tenían jabón líquido y toallas de papel, todas con agua. Se identificaron 10 dispensadores de alcohol, pero solo 7 funcionaban y se reponían. Ninguno de los profesionales encontrados tenía una botella de alcohol de bolsillo. Conclusión: el estudio concluyó que la estructura física y los insumos encontrados en la UCI investigada son parcialmente adecuados para la realización de la práctica de desinfección de manos. Sin embargo, se deben implementar mejoras en estas estructuras, así como auditorías periódicas y actividades de educación continua en salud, con el objetivo de recordar a los profesionales sobre la práctica correcta de HM.(AU)

Hand Hygiene among Anesthesiologists and Microorganisms Contamination in Anesthesia Environments: A Single-Center Observational Study.

Objective: To investigate the baseline levels of microorganisms' growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital. Methods: This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital. Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination. Results: Microorganisms' growth results showed that 20% (5/25) of anesthesiologists' hands carried microorganisms (> 10 CFU/cm 2) before patient contact began. Female anesthesiologists performed hand hygiene better than did their male counterparts, with fewer CFUs ( P = 0.0069) and fewer species ( P = 0.0202). Our study also found that 55.6% (5/9) of ready-to-use operating rooms carried microorganisms (> 5 CFU/cm 2). Microorganisms regrowth began quickly (1 hour) after disinfection, and increased gradually over time, reaching the threshold at 4 hours after disinfection. Staphylococcus aureus was isolated from the hands of 20% (5/25) of anesthesiologists and 33.3% (3/9) of operating rooms. Conclusion: Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene, daily cleaning rate of the operating room may be insufficient, and we would suggest that there should be a repeat cleaning every four hours.

Behavioural intention of hand hygiene compliance in an average Ecuadorian hospital.

OBJECTIVE: This study aimed to characterize hand hygiene behavioural intention by hospital services clusters in a medium-sized hospital in an Ecuadorian city. METHODS: This is a cross-sectional study based on the World Health Organization Hand Hygiene Knowledge Questionnaire for Health-Care Workers. The responses on hand hygiene behavioural intention for the Five Moments for hand hygiene according to the World Health Organization were recorded in three categories: before patient contact, before and after sterile technique and management of body fluids, and after contact with the environment of the patient. The variables were the knowledge regarding the source of germs causing nosocomial infections, the optimal time to achieve disinfection with alcohol, hospital services clusters (clinical medicine, surgery, and therapeutic services), and history of previous formal hand hygiene training. The variables in each moment were analysed using a saturated log-linear model. RESULTS: The average age of participants was 34 years (Q1 32.1-Q3 36.4). Of them, 62% belonged to the clinic cluster and 87.6% had previous formal hand hygiene training. The incorrect response rates for before and after sterile technique and management of body fluids, before patient contact, and after contact with the environment of the patient were 30.2, 88.4, and 99.2%, respectively. In before patient contact, the incorrect responses for optimal time depended on the department (worse surgery cluster situation), and in before and after sterile technique and management of body fluids and after contact with the environment of the patient, the incorrect responses for source of germs depended on the previous formal hand hygiene training and the department (worse surgery and clinic clusters). CONCLUSION: The incorrect answer related to hand hygiene behavioural intention was high compared to other reports, and the worse situation was found in after contact with the environment of the patient and before patient contact. These data suggest the need of strengthening permanently the hand hygiene programme.

Resistência antimicrobiana na infecção urinária em unidade de terapia intensiva / Antimicrobial resistance in urinary tract infection in the intensive care unit / Resistencia a los antimicrobianos en la infección del tracto urinario en la unidad de cuidados intensivos

A infecção do trato urinário (ITU) nada mais é do que o acometimento das vias urinárias por microrganismo. Entre as infecções hospitalares de maior incidência está a infecção do trato urinário, acometendo mais mulheres do que homens. Uma das possíveis causas dessa infecção, em pacientes na unidade de terapia intensiva (UTI), é o uso de cateter vesical. Seu tratamento inadequado pode ocasionar uma pielonefrite, podendo adentrar à circulação sanguínea, gerando uma infecção sistêmica e levar o paciente a óbito. A resistência antimicrobiana é uma das principais dificuldades encontrada em UTI sendo considerado um problema de saúde pública. O objetivo deste trabalho foi realizar um breve relato, baseado na literatura, sobre a resistência antimicrobiana na infecção urinária em unidade de terapia intensiva adulta. Em ambientes hospitalares o principal microrganismo causador de ITU é Escherichia coli, sendo 55,5% das culturas positivas estão associadas a procedimentos invasivos, como as sondas vesicais de demora, como consequência este é o microrganismo que mais apresenta resistência aos antimicrobianos utilizados como a ampicilina, trimetoprima e ciprofloxacino. O uso indiscriminado de antibióticos deixa em evidência a necessidade de análise criteriosa da real necessidade de qual antimicrobianos usar, tempo de uso e forma correta de administração. Portanto é necessária a ação dos profissionais de saúde frente a atenção ao paciente, desde a higiene das mãos, uso do cateter, quando necessário observar a real necessidade do uso do antimicrobianos e que esse seja feito após cultura e antibiograma.

Urinary tract infection (UTI) is nothing more than the involvement of the urinary tract by a microorganism. Among the hospital infections with the highest incidence is urinary tract infections, affecting more women than men. One of the possible causes of this infection in patients in the intensive care unit (ICU) is the use of a bladder catheter. Its inadequate treatment can cause pyelonephritis, which can enter the bloodstream, generating a systemic infection and leading the patient to death. Antimicrobial resistance is one of the main difficulties encountered in ICUs and is considered a public health problem. The objective of this study was to present a brief report, based on the literature, on antimicrobial resistance in urinary tract infections in an adult intensive care unit. In hospital environments, the main microorganism that causes UTI is Escherichia coli, and 55.5% of positive cultures are associated with invasive procedures, such as indwelling urinary catheters, as a consequence, this is the microorganism that is most resistant to antimicrobials used, such as ampicillin, trimethoprim and ciprofloxacin. The indiscriminate use of antibiotics highlights the need for a careful analysis of the real need for which antimicrobials to use, time of use, and correct form of administration. Therefore, it is necessary for the action of health professionals in the care of the patient, from the hygiene of the professional to, the use of the catheter, when necessary to observe the real need for the use of antimicrobials and that this is done after culture and antibiogram.

La infección del tracto urinario (ITU) no es más que la afectación de las vías urinarias por un microorganismo. Entre las infecciones hospitalarias con mayor incidencia se encuentra la infección del tracto urinario, que afecta más a mujeres que a hombres. Una de las posibles causas de esta infección en pacientes en la unidad de cuidados intensivos (UCI) es el uso de una sonda vesical. Su tratamiento inadecuado puede causar pielonefritis, la cual puede ingresar al torrente sanguíneo, generando una infección sistémica y llevando al paciente a la muerte. La resistencia a los antimicrobianos es una de las principales dificultades encontradas en las UCI y se considera un problema de salud pública. El objetivo de este estudio fue presentar un breve informe, basado en la literatura, sobre la resistencia antimicrobiana en infecciones del tracto urinario en una unidad de cuidados intensivos de adultos. En ambientes hospitalarios, el principal microorganismo causante de ITU es Escherichia coli, y el 55,5% de los cultivos positivos están asociados a procedimientos invasivos, como sondas vesicales permanentes, por lo que este es el microorganismo más resistente a los antimicrobianos utilizados, como la ampicilina. ., trimetoprima y ciprofloxacino. El uso indiscriminado de antibióticos pone de relieve la necesidad de un análisis cuidadoso de la necesidad real de qué antimicrobianos utilizar, el momento de uso y la forma correcta de administración. Por lo tanto, es necesaria la actuación de los profesionales de la salud en el cuidado del paciente, desde la higiene del profesional, uso del catéter, cuando sea necesario observar la necesidad real del uso de antimicrobianos y que este se realice previo cultivo y antibiograma.

Higiene de las manos basada en indicadores de rendimiento / Hand Hygiene Based on Performance Indicators

Introducción: Las manos de los profesionales son el vehículo más común para la transmisión de microorganismos de un paciente a otro. En ese contexto, la higiene de las manos se considera una medida primaria muy relevante para controlar las infecciones asociadas a la atención sanitaria. Objetivo: Verificar la adherencia a las prácticas de higiene de las manos entre los profesionales de la salud en la Unidad de Cuidados Intensivos de un Hospital Universitario. Métodos: Estudio descriptivo de corte transversal con abordaje cuantitativo, realizado en la Unidad de Cuidados Intensivos de un Hospital Universitario Brasileiro en el año 2020. La población del estudio estuvo formada por 121 profesionales de la salud. La recogida de datos se produjo mediante la consulta de la base de datos puesta a disposición por el Comité de Control de Infecciones Hospitalarias del hospital. El análisis estadístico se procesó en el Statistical Package for the Social Sciences-SPSS versión 22, a través de estadísticas descriptivas simples. Resultados: La tasa de adherencia al saneamiento fue superior a 78,04 por ciento. Los residentes de enfermedades tuvieron la tasa de depresión más alta, 96,72 por ciento. Por otro lado, los médicos tuvieron solo 57,29 por ciento de su atención con higiene. Estos eventos indican que los profesionales de la salud de la Unidad de Cuidados Intensivos pueden estar preocupados por el riesgo de que se realicen los procedimientos, debido a la exposición a fluidos corporales y regiones contaminadas. Conclusiones: Se encontró adherencia insatisfactoria al saneamiento para todas las categorías profesionales durante el período de demostración de la investigación(AU)

Introduction: The hands of professionals are the most common vehicle for the transmission of microorganisms from one patient to another. In this setting, hand hygiene is considered a very relevant primary measure for controlling healthcare-associated infections. Objective: To verify adherence to hand hygiene practices among healthcare professionals in the intensive care unit of a university hospital. Methods: Descriptive and cross-sectional study, with a quantitative approach, carried out in 2020 in the intensive care unit of a Brazilian university hospital. The study population consisted of 121 health professionals. Data collection was done by consulting the database available under the committee for hospital infection control at the institutional level. The statistical analysis was done with the Statistical Package for the Social Sciences (SPSS), version 22, using simple descriptive statistics. Results: The sanitation adherence rate was over 78.04 percent. Internal Medicine residents had the highest depression rate, accounting for 96.72 percent. On the other hand, physicians had only 57.29 percent of their care with sanitation. These events indicate that healthcare professionals in the intensive care unit may be concerned about the risk of procedures being performed due to exposure to body fluids and contaminated areas. Conclusions: Unsatisfactory adherence to sanitation was found in all professional categories during the research demonstration period(AU)