A systems approach to managing the risk of healthcare acquired infection in an acute hospital setting supported by human factors ergonomics, data science, data governance and AI.

Innovative approaches are needed for managing risk and system change in healthcare. This paper presents a case study of a project that took place over two years, taking a systems approach to managing the risk of healthcare acquired infection in an acute hospital setting, supported by an Access Risk Knowledge Platform which brings together Human Factors Ergonomics, Data Science, Data Governance and AI expertise. Evidence for change including meeting notes and use of the platform were studied. The work on the project focused on first systematically building a rich picture of the current situation from a transdisciplinary perspective. This allowed for understanding risk in context and developing a better capability to support enterprise risk management and accountability. From there a linking of operational and risk data took place which led to mapping of the risk pattern in the hospital.

Innovative ways of supporting the processes for managing risk, developing accountability and building resilience and system change in healthcare are needed.This paper presents a study that took place over two years, taking a systems approach to managing the risk of healthcare acquired infection in an acute hospital setting, supported by Human Factors Ergonomics, Data Science, Data Governance and AI.The work focused on systematically building a proactive capability to understand all data sources and harness their ability to support the proactive management of the risk of healthcare acquired infection.

Effectiveness of ultraviolet-C disinfection systems for reduction of multi-drug resistant organism infections in healthcare settings: A systematic review and meta-analysis.

This study aimed to summarise the findings of the studies assessing the effectiveness of ultraviolet C (UV-C) room disinfection in reducing the incidence rate of healthcare-associated multi-drug-resistant organism (MDRO) infections. A systematic screening was conducted using PubMed, EMBASE, and Scopus for randomised controlled trials (RCTs), quasi-experimental studies, and before-after studies, which assessed the efficacy of the UV-C disinfectant system in reducing the incidence of MDRO infections. A random-effects model was used for the analysis. Effect sizes were described as incidence rate ratio (IRR) with 95% confidence intervals (CI). Nine studies were included, all of which were conducted in the USA. No statistically significant reduction in Clostridioides difficile (CD) (IRR: 0.90, 95% CI; 0.62-1.32) and vancomycin-resistant enterococcal (VRE) infection rates (IRR 0.72, 95% CI; 0.38-1.37) was observed with the use of UV-C, but the risk of Gram-negative rod infection was reduced (IRR 0.82, 95% CI; 0.68-0.99).

[Recommendations and tools for healthcare professionals]. / Les recommandations à suivre et les outils pour les professionnels de santé.

The recommendations for the general public as well as the tools offered to healthcare professionals for their practices are consistent with the 2022-2025 national strategy for the prevention of infections and antibiotic resistance. They therefore cover both infection prevention and the proper use of antibiotics.

Selective inhibition of carbonic anhydrase IX and XII by coumarin and psoralen derivatives.

A small library of coumarin and their psoralen analogues EMAC10157a-b-d-g and EMAC10160a-b-d-g has been designed and synthesised to investigate the effect of structural modifications on their inhibition ability and selectivity profile towards carbonic anhydrase isoforms I, II, IX, and XII. None of the new compounds exhibited activity towards hCA I and II isozymes. Conversely, both coumarin and psoralen derivatives were active against tumour associated isoforms IX and XII in the low micromolar or nanomolar range of concentration. These data further corroborate our previous findings on analogous derivatives, confirming that both coumarins and psoralens are interesting scaffolds for the design of isozyme selective hCA inhibitors.

A Review of Recent Deep Learning Approaches in Human-Centered Machine Learning.

After Deep Learning (DL) regained popularity recently, the Artificial Intelligence (AI) or Machine Learning (ML) field is undergoing rapid growth concerning research and real-world application development. Deep Learning has generated complexities in algorithms, and researchers and users have raised concerns regarding the usability and adoptability of Deep Learning systems. These concerns, coupled with the increasing human-AI interactions, have created the emerging field that is Human-Centered Machine Learning (HCML). We present this review paper as an overview and analysis of existing work in HCML related to DL. Firstly, we collaborated with field domain experts to develop a working definition for HCML. Secondly, through a systematic literature review, we analyze and classify 162 publications that fall within HCML. Our classification is based on aspects including contribution type, application area, and focused human categories. Finally, we analyze the topology of the HCML landscape by identifying research gaps, highlighting conflicting interpretations, addressing current challenges, and presenting future HCML research opportunities.

Recontamination of Healthcare Surfaces by Repeated Wiping with Biocide-Loaded Wipes: "One Wipe, One Surface, One Direction, Dispose" as Best Practice in the Clinical Environment.

The wiping of high-touch healthcare surfaces made of metals, ceramics and plastics to remove bacteria is an accepted tool in combatting the transmission of healthcare-associated infections (HCAIs). In practice, surfaces may be repeatedly wiped using a single wipe, and the potential for recontamination may be affected by various factors. Accordingly, we studied how the surface to be wiped, the type of fibre in the wipe and how the presence of liquid biocide affected the degree of recontamination. Experiments were conducted using metal, ceramic and plastic healthcare surfaces, and two different wipe compositions (hygroscopic and hydrophilic), with and without liquid biocide. Despite initially high removal efficiencies of >70% during initial wiping, all healthcare surfaces were recontaminated with E. coli, S. aureus and E. faecalis when wiped more than once using the same wipe. Recontamination occurred regardless of the fibre composition of the wipe or the presence of a liquid biocide. The extent of recontamination by E. coli, S. aureus and E. faecalis bacteria also increased when metal healthcare surfaces possessed a higher microscale roughness (<1 µm), as determined by Atomic Force Microscopy (AFM). The high propensity for healthcare surfaces to be re-contaminated following initial wiping suggests that a "One wipe, One surface, One direction, Dispose" policy should be implemented and rigorously enforced.

Five-year microbiological monitoring of wards and operating theatres in southern Italy.

INTRODUCTION: Nosocomial infections are one of the greatest problems in public health. Several studies have highlighted the role played by the hospital environment as a possible source of transmission of nosocomial pathogens. METHODS: A five-year monitoring of bacterial contamination on healthcare workers hands, surfaces most closely in contact with inpatient wards, operating theatres and "at rest" and "in use" operating theatre air samples. For the samples, we used sterile swabs, contact slides, manual API, and automated VITEK systems for identification. RESULTS: In the five-year period, a total of 9396 samples were collected and analysed. In ward patients, 4398 samplings were carried out with 4.7%, 9.4%, 7%, 10.8% and 7.9% positive results respectively from 2010 to 2014. For hands, 648 samplings were carried out, with a positivity of 40.74%. In operating theatres, 4188 samples were taken, with a positivity of 11.9%. Regarding air in empty and full theatres, 1962 samplings were carried out with a positivity rate equal to 31.9%. The monitoring showed a low rate of contamination with a progressive decrease in the fiveyear period on operating theatres surfaces and hands, while there was an increase in the surgical site wards and in the air of operating rooms. CONCLUSIONS: Our investigation has revealed the presence of pathogens on the assessed surfaces and the need for environmental monitoring, which can be a valuable tool for reducing contamination.

Modeling environmental contamination in hospital single- and four-bed rooms.

UNLABELLED: Aerial dispersion of pathogens is recognized as a potential transmission route for hospital acquired infections; however, little is known about the link between healthcare worker (HCW) contacts' with contaminated surfaces, the transmission of infections and hospital room design. We combine computational fluid dynamics (CFD) simulations of bioaerosol deposition with a validated probabilistic HCW-surface contact model to estimate the relative quantity of pathogens accrued on hands during six types of care procedures in two room types. Results demonstrate that care type is most influential (P < 0.001), followed by the number of surface contacts (P < 0.001) and the distribution of surface pathogens (P = 0.05). Highest hand contamination was predicted during Personal care despite the highest levels of hand hygiene. Ventilation rates of 6 ac/h vs. 4 ac/h showed only minor reductions in predicted hand colonization. Pathogens accrued on hands decreased monotonically after patient care in single rooms due to the physical barrier of bioaerosol transmission between rooms and subsequent hand sanitation. Conversely, contamination was predicted to increase during contact with patients in four-bed rooms due to spatial spread of pathogens. Location of the infectious patient with respect to ventilation played a key role in determining pathogen loadings (P = 0.05). PRACTICAL IMPLICATIONS: We present the first quantitative model predicting the surface contacts by HCW and the subsequent accretion of pathogenic material as they perform standard patient care. This model indicates that single rooms may significantly reduce the risk of cross-contamination due to indirect infection transmission. Not all care types pose the same risks to patients, and housekeeping performed by HCWs may be an important contribution in the transmission of pathogens between patients. Ventilation rates and positioning of infectious patients within four-bed rooms can mitigate the accretion of pathogens, whereby reducing the risk of missed hand hygiene opportunities. The model provides a tool to quantitatively evaluate the influence of hospital room design on infection risk.

The effects of some tumor markers on human erythrocyte (HCA-I and HCA-II), bovine erythrocyte (BCA) and bovine lung (CA-IV) carbonic anhydrase enzyme activities in vitro.

OBJECTIVE: The influence of prostatic acid phosphatase (PAP) and human chorionic gonadotropin (HCG), tumor markers have been investigated on human erythrocyte carbonic anhydrase (HCA-I and HCA-II) and bovine erythrocyte (BCA) and bovine lung carbonic anhydrase (CA-IV) in vitro. BACKGROUND: Tumor markers are substances that can often be detected in higher-than-normal amounts in the blood, urine, or body tissues of some patients with certain types of cancer. Tumor markers are produced either by the tumor itself or by the body in response to the presence of cancer or certain benign (noncancerous) conditions. In addition to their role in cancer diagnosis, some tumor marker levels are measured before treatment to help doctors plan appropriate therapy. RESULTS AND CONCLUSION: All of the tumor markers were determined to have inhibition effect, on human CA-I, CA-II, bovine erythrocyte CA (BCA) and bovine lung CA-IV isoenzymes. The effect of each tumor marker on CA was investigated by Wilbur-Andersen method modified by Rickly et al Inhibition effects of two different tumor markers on human CA-I, CA-II, bovine erythrocyte CA (BCA) and bovine lung CA-IV isoenzymes were determined by using the CO2-Hydratase method by plotting activity % vs (tumor markers). I50 values of tumor markers exhibiting inhibition effects were found by means of these graphs (Tab.1, Fig. 2, Ref. 20).

Perspective of health professionals on hand hygiene.

OBJECTIVE: To identify the practices reported by health professionals on hand hygiene; To determine how the practices of hand hygiene are related to socio-demographic and professional variables and variables in the context of practice. MATERIAL AND METHODS: A descriptive-correlational and cross-sectional study conducted in a hospital in central Portugal, in May and June, 2012. 71 health professionals participated, with 23.9% physicians, 64.8% nurses and 11.3% operating assistants, in paediatrics, neonatology and paediatric emergencies. The majority was female (91.5%) and 32.4% are between the ages of 31 and 40 years. A questionnaire developed from DGS (General Health Directorate) recommendations was applied with questions on socio-demographic and professional characteristics as well as on the context of practice. RESULTS: The professionals are motivated to perform hand hygiene (98.6%). In self-assessment, they practice hand hygiene appropriately, however the results revealed that 43.7% of subjects reported little knowledge concerning the interference of ornaments on the practice of hand hygiene, 38% of the sample reported the steps of the hand washing technique improperly, and approximately 43% of the sample does not practice hygiene at the correct times. The majority of the participants who use a proper technique are nurses, with significant differences with regards to doctors and operating assistants (P=.001). CONCLUSIONS: Most have knowledge about the practice of hand hygiene; however, some professional groups need to improve their practice of proper technique and the correct time to do so. Approximately a third did not attend specific training, leading us to reflect on the need to invest in training.

A microbiological survey approach to understanding the virulence factors of Pseudomonas species in healthcare sinks.

BACKGROUND: Hospital water is involved in both the prevention and spread of healthcare-associated infections (HCAIs). Handwashing is key to reducing the transmission of pathogens, yet numerous outbreaks have been found to be caused by organisms within sinks, taps and showers. Pseudomonas aeruginosa and increasingly non-aeruginosa Pseudomonas cause waterborne HCAI, however, little is known about the virulence potential of Pseudomonas species found within hospital environments. METHODS: Swabs were taken from 62 sinks within two newly opened wards at Great Ormond Street Hospital, samples were taken before and after the wards opened to understand the impact of patient occupancy on sink micro-organisms. Culturable bacteria were identified by MALDI-TOF and virulence factors assessed through phenotypic methods. RESULTS: A total of 106 bacterial isolates were recovered including 24 Pseudomonas isolates. Of these 25% were identified as P. oleovorans, 21% P. aeruginosa, 17% P. composti, 13% P. alicalipha, 8% P. monteilii, 4% P. putida, 4% P. stutzeri and 8% could only be identified to genus level by MALDI-TOF. Differences were seen in both the number of Pseudomonas isolates and virulence production between the two wards, overall 25% of the Pseudomonas isolates produced pigment, 58% were capable of haemolysis, 87.5% were able to swim, 83.3% were capable of twitching motility, 33.3% produced alkaline protease and 8.3% produced gelatinase. CONCLUSIONS: Results suggest that patients may be back-contaminating sinks with colonizing organisms which has ongoing implications for infection prevention and control. Additionally, this work highlights the ability of non-aeruginosa Pseudomonas to produce virulence factors traditionally associated with P. aeruginosa.

Occurrence and prevalence of bacteria on door handles at the University of Port Harcourt Teaching Hospital and the multidrug resistance implications.

Background. The coronavirus disease 2019 (COVID-19) pandemic has heightened concerns regarding transmitting hospital-acquired infections through high-contact points in healthcare facilities, such as door handles, which can serve as reservoirs for pathogenic micro-organisms. With the increased infectivity of the serious acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, there is greater awareness of the risk of multidrug-resistant bacteria on these surfaces, necessitating strict surveillance prevention protocols. Objective. This study assesses the occurrence and prevalence of bacteria on toilet door handles at the University of Port Harcourt Teaching Hospital in Nigeria and the multidrug resistance implications. We examined the hospital infection level and overall sanitary conditions. Method. Experimental data from our study on hospital door handles in different locations were assessed. Eighty-six samples were collected from toilet door handles at the University of Port Harcourt Teaching Hospital. Ethical approval was obtained from the hospital departments and the university research ethics committee. Samples from private offices and doors without handles were excluded. Bacteria were isolated from the samples, and antibiotic sensitivity testing was performed. Result. Of the 329 bacteria isolated, 55.5 % were Gram-positive and 44.4 % Gram-negative. The most prevalent bacteria were Staphylococcus epidermidis , followed by Bacillus sp. The prevalence of multidrug-resistant bacteria was also low, with Enterococcus sp. having the highest prevalence of 28.57%, followed by Micrococcus sp. at 3.45 % and S. epidermidis at 1.96 %. Conclusion: The results show that, despite the occurrence of pathogenic micro-organisms, there has been a reduction in the prevalence of multidrug-resistant bacteria strains. This study can be used as an example for environmental microbiological surveillance in suspected outbreak investigations and assessment of sanitary conditions and the prevalence of multidrug-resistant bacteria in healthcare facilities.

Advancing residents' use of shared spaces in Nordic superblocks with intelligent technologies.

To support the sustainability of future cities, residents' living spaces need to be built and used efficiently, while supporting residents' communal wellbeing. Nordic superblock is a new planning, housing, and living concept in which residents of a neighborhood-a combination of city blocks-share yards, common spaces and utilities. Sharing living spaces is an essential element of this approach. In this study, our goal was to study the ways in which intelligent technology solutions-such as proactive, data-driven Artificial Intelligence (AI) applications-could support and even motivate the use of common areas in superblocks. To this end, we conducted a two-phase qualitative study: in the first phase, potential superblock residents (N = 12) shared their perspectives of sharing of living spaces in general, and more specifically of how intelligent technologies could support sharing spaces. In the second phase, two workshops with experts (N = 7) were held to gather understanding of possibilities of intelligent technologies in meeting the residents' expectations of space sharing. The results illustrate space sharing and communality as supportive factors for one another, enabled but also complicated by social interaction. Major possibilities for intelligent technologies to advance space sharing were seen in organizing the use of spaces and facilitating social interaction in the community. As an outcome, four roles incorporating several use purposes of intelligent technologies were found. The findings can inform the Human-Centered AI (HCAI) research and design improving sustainable living in future urban neighborhoods.

Antibiofilm and Anti-Quorum-Sensing Activities of Novel Pyrazole and Pyrazolo[1,5-a]pyrimidine Derivatives as Carbonic Anhydrase I and II Inhibitors: Design, Synthesis, Radiosterilization, and Molecular Docking Studies.

Nowadays, searching for new anti-infective agents with diverse mechanisms of action has become necessary. In this study, 16 pyrazole and pyrazolo[1,5-a]pyrimidine derivatives were synthesized and assessed for their preliminary antibacterial and antibiofilm activities. All these derivatives were initially screened for their antibacterial activity against six clinically isolated multidrug resistance by agar well-diffusion and broth microdilution methods. The initial screening presented significant antibacterial activity with a bactericidal effect for five compounds, namely 3a, 5a, 6, 9a, and 10a, compared with Erythromycin and Amikacin. These five derivatives were further evaluated for their antibiofilm activity against both S. aureus and P. aeruginosa, which showed strong biofilm-forming activity at their MICs by >60%. The SEM analysis confirmed the biofilm disruption in the presence of these derivatives. Furthermore, anti-QS activity was observed for the five hybrids at their sub-MICs, as indicated by the visible halo zone. In addition, the presence of the most active derivatives reduces the violacein production by CV026, confirming that these compounds yielded anti-QS activity. Furthermore, these compounds showed strong inhibitory action against human carbonic anhydrase (hCA-I and hCA-II) isoforms with IC50 values ranging between 92.34 and 168.84 nM and between 73.2 and 161.22 nM, respectively. Finally, radiosterilization, ADMET, and a docking simulation were performed.

What is critical for human-centered AI at work? - Toward an interdisciplinary theory.

Human-centered artificial intelligence (HCAI) has gained momentum in the scientific discourse but still lacks clarity. In particular, disciplinary differences regarding the scope of HCAI have become apparent and were criticized, calling for a systematic mapping of conceptualizations-especially with regard to the work context. This article compares how human factors and ergonomics (HFE), psychology, human-computer interaction (HCI), information science, and adult education view HCAI and discusses their normative, theoretical, and methodological approaches toward HCAI, as well as the implications for research and practice. It will be argued that an interdisciplinary approach is critical for developing, transferring, and implementing HCAI at work. Additionally, it will be shown that the presented disciplines are well-suited for conceptualizing HCAI and bringing it into practice since they are united in one aspect: they all place the human being in the center of their theory and research. Many critical aspects for successful HCAI, as well as minimum fields of action, were further identified, such as human capability and controllability (HFE perspective), autonomy and trust (psychology and HCI perspective), learning and teaching designs across target groups (adult education perspective), as much as information behavior and information literacy (information science perspective). As such, the article lays the ground for a theory of human-centered interdisciplinary AI, i.e., the Synergistic Human-AI Symbiosis Theory (SHAST), whose conceptual framework and founding pillars will be introduced.

Hand hygiene practices for prevention of health care-associated infections associated with admitted infectious patients in the emergency department: a systematic review.

BACKGROUND: In most high-income countries, emergency departments (ED) represent the principal point of access forcer by critically ill or injured patients. Unlike inpatient units, ED healthcare workers (ED HCWs) have demonstrated relative lack of adherence to hand hygiene (HH) guidelines, commonly citing frequency of intervention and high rates of admission, which reflect severity of cases encountered. AIM: Assessment of studies on hand hygiene compliance (HHC) by ED HCWs conducted between 2010 and 2020, seeking to estimate HHC rates and intervention strategies utilised to improve HHC in EDs. METHODS: Searches conducted in Web of Science, EBSCO HOST (CINHAL & Medline), PubMed, Embase, and Cochrane for full studies published between 2010 and 2020 on the topic of HHC in the ED. RESULTS: One hundred twenty-nine eligible articles were identified of which 79 were excluded. Fifty-one underwent full-text screening before 20 studies were deemed relevant. Of the eligible studies, fifteen (75%) had, as the primary outcome, HHC according to the WHO-recommended 5-moments. Twelve studies (60%) implemented multimodal or single intervention strategies. Eight studies were ambiguous regarding the nature of the approach adopted. In the nine observational studies where HHC was documented, an overall post-intervention median HHC rate of 45% (range 8-89.7%). CONCLUSION: Multimodal approaches appear to have enhanced HHC moderately among ED HCWs. Elevated complexity associated with critically ill patients, and ED overcrowding, are contributing factors to relatively low compliance rates observed. Strategies to improve HHC rates may need to acknowledge, and cater for, the context of an unpredictable environment.

Designing for Confidence: The Impact of Visualizing Artificial Intelligence Decisions.

Explainable artificial intelligence aims to bring transparency to artificial intelligence (AI) systems by translating, simplifying, and visualizing its decisions. While society remains skeptical about AI systems, studies show that transparent and explainable AI systems can help improve the Human-AI trust relationship. This manuscript presents two studies that assess three AI decision visualization attribution models that manipulate morphological clarity (MC) and two information presentation-order methods to determine each visualization's impact on the Human-AI trust relationship through increased confidence and cognitive fit (CF). The first study, N = 206 (Avg. age = 37.87 ± 10.51, Male = 123), utilized information presentation methods and visualizations delivered through an online experiment to explore trust in AI by asking participants to complete a visual decision-making task. The second study, N = 19 (24.9 ± 8.3 years old, Male = 10), utilized eye-tracking technology and the same stimuli presentation methods to investigate if cognitive load, inferred through pupillometry measures, mediated the confidence-trust relationship. The results indicate that low MC positively impacts Human-AI trust and that the presentation order of information within an interface in terms of adjacency further influences user trust in AI. We conclude that while adjacency and MC significantly affect cognitive load, cognitive load alone does not mediate the confidence-trust relationship. Our findings interpreted through a combination of CF, situation awareness, and ecological interface design have implications for the design of future AI systems, which may facilitate better collaboration between humans and AI-based decision agents.

Hand hygiene monitoring and compliance system using convolution neural networks.

Hand hygiene monitoring and compliance systems play a significant role in curbing the spread of healthcare associated infections and the COVID-19 virus. In this paper, a model has been developed using convolution neural networks (CNN) and computer vision to detect an individual's germ level, monitor their hand wash technique and create a database containing all records. The proposed model ensures all individuals entering a public place prevent the spread of healthcare associated infections (HCAI). In our model, the individual's identity is verified using two-factor authentication, followed by checking the hand germ level. Furthermore, if required the model will request sanitizing/ hand wash for completion of the process. During this time, the hand movements are checked to ensure each hand wash step is completed according to World Health Organization (WHO) guidelines. Upon completion of the process, a database with details of the individual's germ level is created. The advantage of our model is that it can be implemented in every public place and it is easily integrable. The performance of each segment of the model has been tested on real-time images an validated. The accuracy of the model is 100% for personal identification, 96.87% for hand detection, 93.33% for germ detection and 85.5% for the compliance system respectively.

Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review.

BACKGROUND: Health care-associated infections (HCAI) in neonatal units in low- and middle-income countries (LMIC) are a major cause of mortality. This scoping review aimed to synthesise published literature on infection prevention and care bundles addressing neonatal HCAI in LMICs and to construct a Classification Framework for their components (elements). METHODS: Five electronic databases were searched between January 2001 and July 2020. A mixed-methods approach was applied: qualitative content analysis was used to build a classification framework to categorise bundle elements and the contents of the classification groups were then described quantitatively. FINDINGS: 3619 records were screened, with 44 eligible studies identified. The bundle element Classification Framework created involved: (1) Primary prevention, (2) Detection, (3) Case management, and Implementation (3 + I). The 44 studies included 56 care bundles with 295 elements that were then classified. Primary prevention elements (128, 43%) predominated of which 71 (55%) focused on central line catheters and mechanical ventilators. Only 12 elements (4%) were related to detection. A further 75 (25%) elements addressed case management and 66 (88%) of these aimed at outbreak control. INTERPRETATION: The 3 + I Classification Framework was a feasible approach to reporting and synthesising research for infection-relevant bundled interventions in neonatal units. A shift towards the use in infection prevention and care bundles of primary prevention elements focused on the neonate and on commonly used hospital devices in LMIC (e.g., self-inflating bags, suctioning equipment) would be valuable to reduce HCAI transmission. Detection elements were a major gap. FUNDING: This work was made possible in part by the John D. and Catherine T. MacArthur Foundation, the Bill & Melinda Gates Foundation, ELMA Philanthropies, The Children's Investment Fund Foundation UK, The Lemelson Foundation, and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University. The project leading to these results has also received the support of a fellowship from the "la Caixa" Foundation (ID 100010434). The fellowship code is LCF/BQ/EU19/11710040. EJAF is an Academic Clinical Fellow whose salary is funded by the UK National Institute for Health Research (NIHR). NES receives a Research Training Program Scholarship (Australian Commonwealth Government).

Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review.

BACKGROUND: There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. AIM: This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene. METHODS: CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. FINDINGS: Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the 'Five Moments'. However, recording of hand hygiene technique was not common. CONCLUSION: Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.