Isolation and identification of microorganisms associated with automated teller machines on Federal Polytechnic Ede campus.

Automated Teller Machines (ATM) are visited everyday by millions of people. This machine is accessible to the general public irrespective of class, age or race. The contact point of all ATM machines is the hand which on their own are 'vaults' of microorganisms. An elaborate survey was taken for complete assessment of possible microbial contamination in the Federal Polytechnic Ede campus. Selected ATM machines on campus were used as case study to characterize, identify and determine the degree of bacterial contamination of microorganisms and their potential as reservoir of microbes. Swabs were collected from each ATM screen, buttons, floor, user's hand, and exposure of plates. After collection of the samples, they were plated in nutrient agar. The results showed the presence of increased bacterial count subsequently, most pathogens on characterization revealed the genus of the particular organisms E. coli, Pseudomonas, Staphylococcus aureus, Klebsiella, Micrococcus, Salmonella and Serratia. The study showed the potential hazard inherent in ATM machine usage and draws attention to our level of hand hygiene compliance.

The COVID-19 pandemic as a factor of hospital staff compliance with the rules of hand hygiene: assessment of the usefulness of the "Clean Care is a Safer Care" program as a tool to enhance compliance with hand hygiene principles in hospitals.

INTRODUCTION: Hand cleansing and disinfection is the most efficient method for reducing the rates of hospital-acquired infections which are a serious medical and economic problem. Striving to ensure the maximum safety of the therapeutic process, we decided to promote hand hygiene by implementing the educational program titled "Clean Care is a Safer Care". The occurrence of the COVID-19 pandemic affected the compliance with procedures related to the sanitary regime, including the frequency and accuracy of hand decontamination by medical personnel. OBJECTIVE: The objective of the study was to assess the usefulness of the educational program titled "Clean Care is a Safer Care" as a tool for increasing compliance with hand hygiene principles. METHODS: We monitored the compliance with the hygiene procedure before implementation of the program as well as during the hand hygiene campaign by means of direct observation as well as the disinfectant consumption rates. RESULTS: In the initial self-assessment survey, the hospital had scored 270/500 points (54%). Preliminary audit revealed the hygiene compliance rate at the level of 49%. After broad-scaled educational efforts, the semi-annual audit revealed an increase in hand hygiene compliance rate up to 81% (hospital average) while the final audit carried out after one year of campaigning revealed a compliance rate of 77%. The final score for the hospital increased to 435/500 points. CONCLUSIONS: COVID-19 pandemic dramatically increased accuracy of proper hand hygiene procedures and consumption of disinfectant agents. The educational program has succeeded to reach its goal; however, long-term educational efforts are required to maintain and improve the quality of provided services.

Assessment of healthcare worker's hand hygiene and infection prevention practices of their personal belongings in a healthcare setting: a survey in pre COVID-19 era and literature review on standard disinfection practices.

BACKGROUND: Healthcare workers' (HCW) hands and personnel belongings are vehicles of transmission of nosocomial infections. Knowledge, attitude, and practice of hand hygiene have been extensively studied suggesting adequate knowledge but poor compliance. Similar data on aprons, mobile phone and stethoscope disinfection practices are lacking. This becomes an extensively important topic of discussion in current COVID-19 pandemic where inadequacy in hygiene practices is devastating. AIM: To study the knowledge, attitude, and infection prevention practices of HCWs aprons, electronic devices, stethoscopes, and hands. METHODS: A cross sectional questionnaire-based survey was conducted among HCWs of Medicine ward and ICU. RESULTS: Sixty-six HCWs responded to the survey. Awareness that hands, aprons, mobile phones, stethoscopes could cause cross transmission and knowledge of correct practices was present in majority of the respondents. Hand hygiene was performed by 65.2% of the respondents before touching a patient and 54.5% after touching the patient surroundings while 13.6% performed only when it was visibly soiled. Mobile phones and stethoscopes were disinfected by 13.6 and 30.3% of the respondents after each patient encounter, respectively. Aprons were washed after using them at a stretch for a median duration of 5 days (1-30 days). Forgetfulness, lack of reinforcement, lack of time, inadequate awareness on standard disinfection practices and fear of damaging electronic devices from disinfectants use were reasons for poor compliance. CONCLUSIONS: There is an urgent need to spread awareness and formulate standard guidelines on disinfection practices especially for mobile phones, stethoscopes, and aprons in addition to reinforcing hand hygiene practices.

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

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

Effective hand hygiene-wash your hands and reduce the risk.

Neesha Ridley, Senior Lecturer, University of Central Lancashire, discusses the importance of hand hygiene in preventing healthcare-associated infections.

Carbapenem-Resistant Enterobacteriaceae Outbreak in a Medical Ward in Spain: Epidemiology, Control Strategy, and Importance of Environmental Disinfection.

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) are a growing public health problem. We describe an outbreak by CRE and the measures to control it in a hospitalization unit in Spain. Methods: In June 2015, the system of prevention and control of CRE implemented in the hospital detected an increase in the incidence of patients with CRE in a mixed hospitalization facility (geriatrics, internal medicine, and pneumology), with the appearance of four related patients in 2 weeks, three of them being nosocomial cases. A multidisciplinary group was created and carried out: weekly screenings, general cleaning, four training sessions for personnel, two hand hygiene observation studies and environmental sampling. A higher incidence of new cases was detected in three adjoining rooms, in which environmental decontamination was performed with vaporized hydrogen peroxide. Results: In 5 months, a total of 18 cases were detected, 14 of them were nosocomial. Four different clones of Klebsiella pneumoniae OXA-48 were responsible for 83.3% of the cases. Adherence to hand hygiene increased from 36% to 85% after the training sessions. Seven percent of the environmental samples were positive for CRE in rooms with high incidence, moving to 0% after decontamination with hydrogen peroxide. Three patients died, one of them possibly associated with clinical infection due to CRE. Conclusions: Multidisciplinary information strategies, personnel training, and control of environmental reservoirs are effective to address outbreaks of CRE.

Efficacy of covert closed-circuit television monitoring of the hand hygiene compliance of health care workers caring for patients infected with multidrug-resistant organisms in an intensive care unit.

BACKGROUND: To compare covert closed-circuit television (CCTV) monitoring to standard overt observation in assessing the hand hygiene (HH) conduct of health care workers (HCWs) caring for patients infected with multidrug-resistant organisms (MDROs). This was a cross-sectional study in a general intensive care unit of a 1,000-bed university hospital. METHODS: Forty-six general intensive care unit HCWs (staff physicians, registered nurses, and auxiliary workers) caring for contact isolation MDRO-infected patients. The study incorporated the following 3 phases: phase 1, establishment of interrater reliability between 2 simultaneous observers using the overt observation method; phase 2, establishment of interrater reliability between 2 simultaneous observers using the CCTV method; and phase 3, simultaneous monitoring of HH by both methods to evaluate the suitability of CCTV as an alternative to direct observation of the HH conduct of HCWs caring for MDRO-infected patients. RESULTS: Overall, 1,104 opportunities to perform HH were documented during 49 observation sessions. The compliance rate observed by the overt method (37.3%) was significantly higher than that observed when only the covert method was used (26.5%). However, simultaneous overt-covert observations were found to have intraclass correlation coefficients of >0.85. CONCLUSIONS: Covert CCTV observation of HCW HH compliance appears to provide a truer and more realistic picture than overt observation, probably because of its ability to neutralize the Hawthorne effect of overt observation. The high intraclass correlation coefficients between covert observation and overt observation supports this conclusion.

Extending the use of the World Health Organisations' water sanitation and hygiene assessment tool for surveys in hospitals - from WASH-FIT to WASH-FAST.

BACKGROUND: Poor water sanitation and hygiene (WASH) in health care facilities increases hospital-associated infections, and the resulting greater use of second-line antibiotics drives antimicrobial resistance. Recognising the existing gaps, the World Health Organisations' Water and Sanitation for Health Facility Improvement Tool (WASH-FIT) was designed for self-assessment. The tool was designed for small primary care facilities mainly providing outpatient and limited inpatient care and was not designed to compare hospital performance. Together with technical experts, we worked to adapt the tool for use in larger facilities with multiple inpatient units (wards), allowing for comparison between facilities and prompt action at different levels of the health system. METHODS: We adapted the existing facility improvement tool (WASH-FIT) to create a simple numeric scoring approach. This is to illustrate the variation across hospitals and to facilitate monitoring of progress over time and to group indicators that can be used to identify this variation. Working with stakeholders, we identified those responsible for action to improve WASH at different levels of the health system and used piloting, analysis of interview data to establish the feasibility and potential value of the WASH Facility Survey Tool (WASH-FAST) to demonstrate such variability. RESULTS: We present an aggregate percentage score based on 65 indicators at the facility level to summarise hospitals' overall WASH status and how this varies. Thirty-four of the 65 indicators spanning four WASH domains can be assessed at ward level enabling within hospital variations to be highlighted. Three levels of responsibility for WASH service monitoring and improvement were identified with stakeholders: the county/regional level, senior hospital management and hospital infection prevention and control committees. CONCLUSION: We propose WASH-FAST can be used as a survey tool to assess, measure and monitor the progress of WASH in hospitals in resource-limited settings, providing useful data for decision making and tracking improvements over time.

Modelling the costs and consequences of reducing healthcare-associated infections by improving hand hygiene in an average hospital in England.

OBJECTIVE: To assess the potential clinical and economic impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance in a hypothetical general hospital in England, to reduce the incidence of healthcare-associated infections (HCAIs). METHODS: Decision analysis estimated the impact of introducing an electronic audit and feedback system into current practice to improve hand hygiene compliance among front-line healthcare practitioners (HCPs). RESULTS: The model assumed 4.7% of adult inpatients (ie, ≥18 years of age) and 1.72% of front-line HCPs acquire a HCAI in current practice. The model estimated that if use of the electronic audit and feedback system could lead to a reduction in the incidence of HCAIs of between 5% and 25%, then the annual number of HCAIs avoided could range between 184 and 921 infections per hospital and HCAI-related mortality could range between 6 and 31 deaths per annum per hospital. Additionally, up to 86 days of absence among front-line HCPs could be avoided and up to 7794 hospital bed days could be released for alternative use. Accordingly, the total annual hospital cost attributable to HCAIs could be reduced by between 3% and 23%, depending on the effectiveness of the electronic audit and feedback system. If introduction of the electronic audit and feedback system into current practice could lead to a reduction in the incidence of HCAIs by at least 15%, it would have a ≥0.75 probability of affording the National Health Service (NHS) a cost-effective intervention. CONCLUSION: If the introduction of the electronic audit and feedback system into current practice in a hypothetical general hospital in England can improve hand hygiene compliance among front-line HCPs leading to a reduction in the incidence of HCAIs by ≥15%, it would potentially afford the NHS a cost-effective intervention.

Why hand hygiene is not sufficient: modeling hygiene competence of clinical staff as a basis for its development and assessment.

Adhering to hygiene standards in daily clinical work is an important characteristic of qualitatively high-value medical care. In this regards, hand hygiene is often focused on in the literature. From the viewpoint of medical education research, we argue that this focus is too narrow to explain how staff who are working clinically with patients implement and adhere to standards of hygiene across a wide variety of tasks of their daily clinical routine. We present basic features of a differentiated concept of hygiene competence, which includes specialized knowledge, corresponding inner attitudes, and action routines that are customized to the needs of specific situations. Building on that, we present a current simulation-based course concept aimed at developing hygiene competence in medical education. Furthermore, we describe a test instrument that is designed according to the principle of a situational judgment test and that appears promising for the assessment of hygiene competence. The course and the measurement instrument are discussed in regards to their fit to the competence model and the related perspectives for research and teaching.

Stunting and associated factors among under-five children in Wukro town, Tigray region, Ethiopia: a cross sectional study.

OBJECTIVE: The objective of the study was to assess the prevalence of stunting and associated factors among under-five children of Wukro town, Tigray, Ethiopia, 2017-2018. RESULT: Totally 394 under-five children were participated in this study with a response rate of 98.5%. A total of 222 (56.3%) of respondents were females and 106 (26.95%) were in the age group of 12-23 month. One hundred ninety-eight (50.3%) of the participants were between 2 and 3 in birth order and 194 (49.2%) had 4 to 5 house hold size. The overall prevalence of stunting was 194 (49.2%). Being female and presence of washing facilities nearby latrine were significantly associated with stunting. Under-five female children were 35.4% lower odds of stunting compared to male children (p = .041, OR = .644, and 95% CI (.422, .983)).

Why are patients not more involved in their own safety? A questionnaire-based survey in a multi-ethnic North London hospital population.

PURPOSE: Active patient participation in safety pathways has demonstrated benefits in reducing preventable errors, especially in relation to hand hygiene and surgical site marking. The authors sought to examine patient participation in a range of safety-related behaviours as well as factors that influence this, such as gender, education, age and language. DESIGN: A 20-point questionnaire was employed in a London teaching hospital to explore safety-related behaviours, particularly assessing patient's willingness to challenge healthcare professionals and engagement in taking an active role in their own care while in hospital. Data was also collected on participant demographic details including gender, age, ethnicity, English language proficiency and education status. RESULTS: 85% of the 175 patients surveyed would consider bringing a list of their medications to hospital, but only 60% would bring a list of previous surgeries. Only 45% would actively engage in the WHO Safer Surgery Checklist and over three quarters (80%) would not challenge doctors and nurses regarding hand hygiene, believing that they would cause offence. Female patients who had tertiary education, were fluent in English and less than 60 years of age were statistically more likely to feel responsible for their own safety and take an active role in safety-related behaviour while in hospital (p<0.05). CONCLUSIONS: Many patients are not engaged in safety-related behaviour and do not challenge healthcare professionals on safety issues. Older male patients who were not tertiary educated or fluent in English need to be empowered to take an active role in such behaviour. Further research is required to investigate how to achieve this.

Flawed self-assessment in hand hygiene: A major contributor to infections in clinical practice?

AIM: To assess the quality of self-assessment and the attitude of healthcare workers (HCWs) to hand hygiene (HH) as possible factors of unsatisfactory HH compliance in clinical practice. BACKGROUND: Noncompliance of HH causes healthcare-acquired infections (HAI) in patients. It is assumed that HH-related infections make up approximately 80% of all infections in clinical practice. Our observations suggest that self-assessment and attitude might be surprisingly important factors. DESIGN AND METHOD: The cross-sectional approach using questionnaire and direct observation was applied. We followed STROBE guidelines. In total, questionnaires of 639 HCWs of surgical departments were included in the study, and 127 HCWs had been also directly observed. RESULTS: High self-assessment regarding HH compliance and its knowledge was reported by 74% and 83% of HCWs, respectively. At the same time, only 51% of HCWs positively evaluated their colleagues with respect to HH. Similar to previous studies, we have found significant differences between physicians and nurses regarding the level of self-assessment, attitude and perception of HH. Physicians were more critical in self-assessment and considered HH less important compared to nurses. The observations revealed drawbacks in HH practices. The high level of self-overassessment might be a contributing factor to noncompliance with HH. CONCLUSIONS: It is necessary to establish systematic professional training and education of HCWs in relation to their HH, and to continuously monitor and evaluate the level of self-assessment in clinical practice, mainly in surgery. RELEVANCE TO CLINICAL PRACTICE: A reasonable objective level of self-assessment and attitude to HH are the most important conditions for preventing of HAI in patients.

The effect of incorporating covert observation into established overt observation-based hand hygiene promotion programs.

BACKGROUND: Covert observation (CO) is reliable for measuring hand hygiene compliance (HHC). However, the benefit of adding CO to overt observation (OO) is uncertain. We evaluated whether incorporating CO into an OO-based hand hygiene (HH) promotion program improves HH rate. METHODS: Health care worker's HH activities were observed through 5 monitoring sessions (2 in phases 1 and 2 and 1 in phase 3) of simultaneous CO and OO. An intervention was applied-barrier identification interview-only in phase 2. RESULTS: Overall HHC was 91.0% for OO, and 49.3% for CO. HHC in phase 1 was not changed by repeated CO (34.7% and 34.0%, P = .70). HHC based on CO increased to 66.9% in phase 2 after the application of an intervention (P < .01), but decreased to 57.5% in phase 3 (P < .01). HHC based on OO increased significantly between only the first and second sessions in phase 2 (90.8% and 94.5%, respectively, P = .01). DISCUSSION: Although CO did not significantly change behavior, HHC with CO responded promptly to the application and cessation of a new intervention. CONCLUSIONS: CO reflects HHC change more reliably than does OO. However, it is uncertain whether CO will improve HHC.

The evidence supporting WHO recommendations on the promotion of hand hygiene: a critique.

OBJECTIVE: To examine the quality of the evidence relied upon by the World Health Organisation (WHO) in promoting hand hygiene with campaigns such as "Save Lives: Clean Your Hands". RESULTS: The quality of evidence in the studies quoted by the WHO evidence document is highly variable and the methods used limited. In some of the quoted studies, hand hygiene was the primary outcome, rather than the clinically significant outcome of hospital acquired infection (HAI). When HAI was the primary outcome, it was often poorly defined and reported with scant detail. There was wide variation in the hand hygiene compliance achieved in the intervention studies. The majority of studies where the intervention was a campaign to promote hand hygiene used historical control data with variable attempts to account for the fact that HAI rates may have been declining prior to the hand hygiene intervention. The results from trials with a contemporaneous control were conflicting.

Knowledge, attitude, and practices regarding infection control measures among medical students.

OBJECTIVE: To assess the knowledge, attitude and reported practices of medical students regarding infection control measures. METHODS: The cross-sectional, questionnaire-based study was conducted at one public and one private medical university in Karachi from January to February 2016. The students enrolled were in their clinical years of the Bachelor of Medicine, Bachelor of Surgery course and their knowledge, attitude and practice were measured regarding infection control measures. SPSS 19 was used to analyse data. RESULTS: There were 413 medical students with a mean age of 21.78±1.10 years. Overall, 206(49.9%) students were from the private university and 207(50.1%) from the public institution. Students from the private institution had better knowledge compared to those from the public institution regarding hand hygiene (p<0.001), needlestick injuries (p<0.001) and surgical scrubbing (p=0.007), as well as better reported practices regarding hand hygiene (p<0.001) and surgical scrubbing (p=0.001). CONCLUSIONS: Knowledge and practices of medical students regarding the method of surgical scrubbing and needlestick injury protocols in particular needed improvement.

Oral health of quilombola and non-quilombola rural adolescents: a study of hygiene habits and associated factors. / Saúde bucal de adolescentes rurais quilombolas e não quilombolas: um estudo dos hábitos de higiene e fatores associados.

This study evaluated oral hygiene habits and their association with sociocultural, environmental factors and factors related to the use of dental services among Quilombola and non-Quilombola rural adolescents from inland Bahia. Thiswas a cross-sectional study conducted in 2015. Prevalence and prevalence ratios were estimated for the outcomes and multiple Poisson regression analysis with robust variance was performed. We interviewed 390 adolescents, of which 42.8% were Quilombola. Poor tooth brushing and non-flossing were found in 33.3% and 46.7% of adolescents, respectively. Poor tooth brushing was increased by male gender (PR = 1.45), not living with both parents (PR = 1.45), lower hand hygiene habit (PR = 1.72) and worse oral health self-assessment (PR = 1.38). Non-flossing was associated with economic level E (PR = 1.54), older age (PR = 0.91), lower hand hygiene habit (PR = 1.53) and worse oral health self-assessment (PR = 1.33). Different associated factors were observed between Quilombola and non-Quilombola. It is necessary to consider the specificities of the populations for the promotion of adolescent oral health and the importance of the intersectoriality between education and health and care to families.

Este estudo avaliou os hábitos de higiene bucal e sua associação com fatores socioculturais, ambientais e relacionados à utilização de serviços odontológicos entre adolescentes rurais quilombolas e não quilombolas do interior da Bahia. Foi um estudo transversal realizado em 2015. Estimaram-se prevalências e razões de prevalências para os desfechos e foi conduzida análise múltipla por regressão de Poisson com variância robusta. Foram entrevistados 390 adolescentes, 42,8% quilombolas. Escovação dentária insatisfatória e não uso do fio dental foram encontrados em 33,3% e 46,7% dos adolescentes, respectivamente. Mostraram aumentar a escovação dentária insatisfatória: sexo masculino (RP = 1,45), não morar com ambos os pais (RP = 1,45), menor hábito de lavar as mãos (RP = 1,72) e pior autoavaliação da saúde bucal (RP = 1,38). Com o não uso de fio dental, mostraram-se associados: nível econômico E (RP = 1,54), maior idade (RP = 0,91) menor hábito de lavar as mãos (RP = 1,53) e pior autoavaliação da saúde bucal (RP = 1,33). Distintos fatores associados foram observados entre quilombolas e não quilombolas. Ressalta-se a necessidade de se considerar as especificidades das populações para a promoção da saúde bucal dos adolescentes e a importância da intersetorialidade entre educação e saúde e a atenção às famílias.