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

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

Laboratory Validation and Field Assessment of Petroleum Laboratory Technicians' Dermal Exposure to Crude Oil Using a Wipe Sampling Method.

Crude oil may cause adverse dermal effects therefore dermal exposure is an exposure route of concern. Galea et al. (2014b) reported on a study comparing recovery (wipe) and interception (cotton glove) dermal sampling methods. The authors concluded that both methods were suitable for assessing dermal exposure to oil-based drilling fluids and crude oil but that glove samplers may overestimate the amount of fluid transferred to the skin. We describe a study which aimed to further evaluate the wipe sampling method to assess dermal exposure to crude oil, with this assessment including extended sample storage periods and sampling efficiency tests being undertaken at environmental conditions to mimic those typical of outdoor conditions in Saudi Arabia. The wipe sampling method was then used to assess the laboratory technicians' actual exposure to crude oil during typical petroleum laboratory tasks. Overall, acceptable storage efficiencies up to 54 days were reported with results suggesting storage stability over time. Sampling efficiencies were also reported to be satisfactory at both ambient and elevated temperature and relative humidity environmental conditions for surrogate skin spiked with known masses of crude oil and left up to 4 h prior to wiping, though there was an indication of reduced sampling efficiency over time. Nineteen petroleum laboratory technicians provided a total of 35 pre- and 35 post-activity paired hand wipe samples. Ninety-three percent of the pre-exposure paired hand wipes were less than the analytical limit of detection (LOD), whereas 46% of the post-activity paired hand wipes were less than the LOD. The geometric mean paired post-activity wipe sample measurement was 3.09 µg cm-2 (range 1.76-35.4 µg cm-2). It was considered that dermal exposure most frequently occurred through direct contact with the crude oil (emission) or via deposition. The findings of this study suggest that the wipe sampling method is satisfactory in quantifying laboratory technicians' dermal exposure to crude oil. It is therefore considered that this wipe sampling method may be suitable to quantify dermal exposure to crude oil for other petroleum workers.

Development of an Economical Method to Reduce the Extractable Latex Protein Levels in Finished Dipped Rubber Products.

Natural rubber latex (NRL) allergy is caused by the extractable latex proteins in dipped rubber products. It is a major concern for the consumers who are sensitive to the allergenic extractable proteins (EP) in products such as NRL gloves. Objective of this research was to develop an economical method to reduce the EP in finished dipped NRL products. In order to reduce the EP levels, two natural proteases, bromelain from pineapple and papain from papaya, were extracted and partially purified using (NH4)2SO4. According to the newly developed method, different glove samples were treated with a 5% solution of each partially purified enzyme, for 2 hours at 60°C. Residual amounts of in treated samples were quantified using the modified Lowry assay (ASTM D5712-10). Bromelain displayed a 54 (±11)% reduction of the EP from the dipped rubber products, whereas it was 58 (±8)% with papain. These results clearly indicate that the selected natural proteases, bromelain, and papain contribute significantly towards the reduction of the total EP in finished NRL products. Application of bromelain enzyme for the aforementioned purpose has not been reported up to date, whereas papain has been used to treat raw NRL towards reducing the EP.

Challenges encountered in providing integrated HIV, antenatal and postnatal care services: a case study of Katakwi and Mubende districts in Uganda.

BACKGROUND: Integration of sexual and reproductive health (SRH), HIV/AIDS and maternal health (MH) services is a critical strategy to confront the HIV/AIDS epidemic, high maternal mortality and the unmet need for contraception. In 2011 the AIDS Information Centre (AIC) in partnership with the Ministry of Health implemented SRH, HIV/AIDS and MH integration services in the districts of Katakwi and Mubende in Uganda. This paper documents challenges encountered in providing these integrated services in the two districts. METHODS: This was a cross-sectional qualitative study conducted in Mubende and Katakwi districts in Uganda. Data were collected using 10 focus group discussions with 89 women attending ANC and postnatal care and 21 key informant interviews with district managers and health workers who were involved in the integrated service delivery. Content thematic approach was used for data analysis. RESULTS: The study findings indicate that various challenges were encountered in integrating HIV, ANC and PNC services. Major challenges included inadequate staff, gaps in knowledge of service providers especially with regard to provision of long-term family planning, limited space, shortage of critical supplies such as HIV test kits, drugs and gloves. CONCLUSION: These findings indicate that the delivery of integrated HIV, SRH and MH services is hampered greatly by health system challenges and depict the need for additional staffing in health facilities, capacity building of health workers and health managers as well as ensuring sufficient supplies to health facilities for smooth implementation of integrated SRH, HIV and MH services.

A novel wireless health monitor by using a wearable rubber glove with three-dimensional scanning elastic electrodes to measure acupuncture bio-potentials and impedances of a whole palm.

This paper proposes a novel wearable wireless-sensing technology on a glove to measure the bio-potentials and impedances of acupunctures on a whole palm in a non-invasive manner. Moreover, the device can transmit the information to a remote cloud server to learn at normal condition, and take measurement later for health condition analysis and monitoring. An example is given how to measure the acupuncture impedances and bio-potentials on a palm. One can see if certain acupuncture's impedance or bio-potential is not follow the Ohm's law or voltage divider rule along a meridian, then the health condition of the corresponding organ maybe with some problem. This discovery is not found in the previous literatures.

Management of Chronic Hand Eczema.

Management of hand eczema is complex because of the broad range of different pathogeneses, courses, and prognoses. Furthermore, the efficacy of most available treatments is not well established and the more severe forms can have a major impact on the patient's quality of life. Patient education, preventive measures, and the use of emollients are the mainstays in the management of hand eczema. High-potency topical corticosteroids are the treatment of choice, with calcineurin inhibitors used for maintenance. Phototherapy or systemic treatments are indicated in patients who do not respond to topical treatments. Switching from topical treatments should not be delayed to avoid sensitizations, time off work, and a negative impact on quality of life. Alitretinoin is the only oral treatment approved for use in chronic hand eczema.

Student perceptions and effectiveness of an innovative learning tool: Anatomy Glove Learning System.

A trend in anatomical education is the development of alternative pedagogical approaches to replace or complement experiences in a cadaver laboratory; however, empirical evidence on their effectiveness is often not reported. This study aimed to evaluate the effectiveness of Anatomy Glove Learning System (AGLS), which enables students to learn the relationship between hand structure and function by drawing the structures onto a worn glove with imprinted bones. Massage therapy students (n = 73) were allocated into two groups and drew muscles onto either: (1) the glove using AGLS instructional videos (3D group); or (2) paper with palmar/dorsal views of hand bones during an instructor-guided activity (2D group). A self-confidence measure and knowledge test were completed before, immediately after, and one-week following the learning conditions. Self-confidence of hand anatomy in the 3D group gradually increased (3.2/10, 4.7/10, and 4.8/10), whereas self-confidence in the 2D group began to decline one-week later (3.2/10, 4.4/10, and 3.9/10). Knowledge of hand anatomy improved in both groups immediately after learning, (P < 0.001). Students' perceptions of AGLS were also assessed using a 10-pt Likert scale evaluation questionnaire (10 = high). Students perceived the AGLS videos (mean = 8.3 ± 2.0) and glove (mean = 8.1 ± 1.8) to be helpful in improving their understanding of hand anatomy and the majority of students preferred AGLS as a learning tool (mean = 8.6 ± 2.2). This study provides evidence demonstrating that AGLS and the traditional 2D learning approach are equally effective in promoting students' self-confidence and knowledge of hand anatomy.

Delivery, immediate newborn and cord care practices in Pemba Tanzania: a qualitative study of community, hospital staff and community level care providers for knowledge, attitudes, belief systems and practices.

BACKGROUND: Deaths during the neonatal period account for almost two-thirds of all deaths in the first year of life and 40 percent of deaths before the age of five. Most of these deaths could be prevented through proven cost-effective interventions. Although there are some recent data from sub-Saharan Africa, but there is paucity of qualitative data from Zanzibar and cord care practices data from most of East Africa. We undertook a qualitative study in Pemba Island as a pilot to explore the attitudes, beliefs and practices of the community and health workers related to delivery, newborn and cord care with the potential to inform the main chlorhexidine (CHX) trial. METHODS: 80 in-depth interviews (IDI) and 11 focus group discussions (FGD) involving mothers, grandmothers, fathers, traditional birth attendants and other health service providers from the community were undertaken. All IDIs and FGDs were audio taped, transcribed and analyzed using ATLAS ti 6.2. RESULTS: Poor transportation, cost of delivery at hospitals, overcrowding and ill treatment by hospital staff are some of the obstacles for achieving higher institutional delivery. TBAs and health professionals understand the need of using sterilized equipments to reduce risk of infection to both mothers and their babies during delivery. Despite this knowledge, use of gloves during delivery and hand washing before delivery were seldom reported. Early initiation of breastfeeding and feeding colostrum was almost universal. Hospital personnel and trained TBAs understood the importance of keeping babies warm after birth and delayed baby's first bath. The importance of cord care was well recognized in the community. Nearly all TBAs counseled the mothers to protect the cord from dust, flies and mosquitoes or any other kind of infections by covering it with cloth. There was consensus among respondents that CHX liquid cord cleansing could be successfully implemented in the community with appropriate education and awareness. CONCLUSION: The willingness of community in accepting a CHX cord care practice was very high; the only requirement was that a MCH worker needs to do and demonstrate the use to the mother. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01528852.

Factors influencing glove use in student nurses.

BACKGROUND: Gloves can prevent infection but their use among student nurses is inconsistent. AIM: To explore pre-registration student nurses' views of non-sterile glove use in clinical practice. METHOD: An online survey was conducted and focus groups carried out among third-year student nurses. RESULTS: The online survey showed that gloves were often worn inappropriately, while the focus groups revealed students conformed to their mentors' use of gloves. DISCUSSION: Student nurses' decisions on wearing gloves seem to be based on the culture of the clinical care environment rather than trust policy. Glove overuse deprives patients of therapeutic touch and may lead to contact dermatitis in nurses. CONCLUSION: All student nurses must be able to identify clinical situations when gloves are not indicated, using appropriate risk assessment.

Latex allergy in women's health care.

Latex allergy in midwifery and women's health care is not a new concept, with numerous case reports documenting adverse reactions in pregnant women to natural rubber latex in the birthing room. The practising midwife, nurse and sonographer need to be aware of the signs and symptoms of latex allergy and the implications of a severe reaction to latex not only to the woman but also the unborn child.

Low surface contamination by cis/oxaliplatin during hyperthermic intraperitoneal chemotherapy (HIPEC).

AIM: The aim of this study was to evaluate contamination by platinum drugs in the operating room during hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: Environmental sampling of 151 wipe samples from surfaces on the HIPEC devices and operating room floors was performed for platinum in six German hospitals during 19 HIPEC procedures. Additionally, 45 wipe samples from surgeons' and perfusionists' protective gloves were analyzed. RESULTS: Platinum concentrations from the HIPEC devices and operating room floors ranged from 0.07 to 110,000 pg/cm(2) (Median: 1.5 pg/cm(2)) with high contamination on the regulation knob and reservoir after HIPEC procedure, particularly when injecting the cytostatic drug into the reservoir via syringe. Samples from perfusionists' and surgeons' protective gloves ranged between 0.01 and 729 ng/pair. CONCLUSIONS: Although sporadically high platinum concentrations on surfaces on the HIPEC device and operating room floor were detected, our study revealed that low surface loads are definitely possible and can be documented by wipe samples. Important factors for achieving low surface contamination are the use of infusion bags instead of syringes for injection of the cytostatic solution, careful cleaning of the device after HIPEC and wearing of two pairs of gloves.

[The effects of wearing protective devices among residents and volunteers participating in the cleanup of the Hebei Spirit oil spill].

OBJECTIVES: To assess the protective effects of wearing protective devices among the residents and volunteers who participated in the cleanup of the Hebei Spirit oil spill. METHODS: A total of 288 residents and 724 volunteers were surveyed about symptoms, whether they were wearing protective devices and potential confounding variables. The questionnaires were administered from the second to the sixth week following the accident. Spot urine samples were collected and analyzed for metabolites of 4 volatile organic compounds (VOCs), 2 polycyclic aromatic hydrocarbons (PAHs), and 6 heavy metals. The association between the wearing of protective devices and various symptoms was assessed using a multiple logistic regression adjusted for confounding variables. A multiple generalized linear regression model adjusted for the covariates was used to test for a difference in least-square mean concentration of urinary biomarkers between residents who wore protective devices and those who did not. RESULTS: Thirty nine to 98% of the residents and 62-98% of volunteers wore protective devices. Levels of fatigue and fever were higher among residents not wearing masks than among those who did wear masks (odds ratio 4.5; 95% confidence interval 1.23-19.86). Urinary mercury levels were found to be significantly higher among residents not wearing work clothes or boots (p<0.05). CONCLUSIONS: Because the survey was not performed during the initial high-exposure period, no significant difference was found in metabolite levels between people who wore protective devices and those who did not, except for mercury, whose biological half-life is more than 6 weeks.

The Effects of Wearing Protective Devices among Residents and Volunteers Participating in the Cleanup of the Hebei Spirit Oil Spill / 예방의학회지

OBJECTIVES: To assess the protective effects of wearing protective devices among the residents and volunteers who participated in the cleanup of the Hebei Spirit oil spill. METHODS: A total of 288 residents and 724 volunteers were surveyed about symptoms, whether they were wearing protective devices and potential confounding variables. The questionnaires were administered from the second to the sixth week following the accident. Spot urine samples were collected and analyzed for metabolites of 4 volatile organic compounds (VOCs), 2 polycyclic aromatic hydrocarbons (PAHs), and 6 heavy metals. The association between the wearing of protective devices and various symptoms was assessed using a multiple logistic regression adjusted for confounding variables. A multiple generalized linear regression model adjusted for the covariates was used to test for a difference in least-square mean concentration of urinary biomarkers between residents who wore protective devices and those who did not. RESULTS: Thirty nine to 98% of the residents and 62-98% of volunteers wore protective devices. Levels of fatigue and fever were higher among residents not wearing masks than among those who did wear masks (odds ratio 4.5; 95% confidence interval 1.23-19.86). Urinary mercury levels were found to be significantly higher among residents not wearing work clothes or boots (p<0.05). CONCLUSIONS: Because the survey was not performed during the initial high-exposure period, no significant difference was found in metabolite levels between people who wore protective devices and those who did not, except for mercury, whose biological half-life is more than 6 weeks.

Common misconceptions in contact dermatitis counseling.

Both physicians and patients hold many misconceptions when it comes to allergen avoidance. Ten commonly held misconceptions are exposed, allowing more accurate approach to the individual with cutaneous allergies.

AIDS care in Nigeria: are nurses comfortable performing procedures?

Nurses' feeling of comfort during care is important to stay on the job and for their choice of specialty of care. This study aimed to assess nurses' level of comfort in providing care to patients living with AIDS and to determine the sociodemographic variables that influence nurses' comfort. Nurses in four hospitals in Nigeria (n = 277) were surveyed using a questionnaire that elicited information on their demographic characteristics, previous AIDS encounter, and their comfort taking vital signs, casually handling, administering enema and mouth-to-mouth resuscitation, and in recommending exercise and physical therapy to patients living with AIDS. Nigerian nurses were uncomfortable with resuscitation and also showed discomfort not wearing gloves while handling these patients. Being single and male gender influenced nurses' comfort with vital signs and enema administration. Special orientation to include analysis of common tasks and procedures for new nurses assigned to AIDS units is suggested.

Swelling of four glove materials challenged by six metalworking fluids.

The performance of protective gloves against metalworking fluids (MWFs) has rarely been studied because of the difficult chemical analysis associated with complex MWFs. In the present study, glove swelling was used as a screening parameter of glove compatibility after challenge of the outer surfaces of chloroprene, latex, nitrile, and vinyl disposable gloves by six MWF concentrates for 2 hours in an ASTM F-739-type permeation cell without collection medium. Swelling relative to original thickness was up to 39% for latex, 7.6% for chloroprene, and 3.5% for nitrile. Shrinking up to 9.3% occurred for vinyl. Chloroprene and latex did not swell significantly for the semisynthetic and synthetic MWFs. Vinyl, previously not tested, was a good candidate for MWFs other than the soluble oil type. Although nitrile was recommended by the National Institute for the Occupational Safety and Health (NIOSH) for all types of MWFs, its swelling after 2-hour challenge was significant with Student t-tests for the soluble oil, synthetic, and semisynthetic MWFs. Glove swelling can be used as a screening chemical degradation method for mixtures such as MWFs with difficult chemical analysis. Further studies need to be conducted on the relationship between permeation and glove swelling.

Effect of aloe-vera impregnated gloves on hand hygiene attitudes of health care workers.

Following standard precautions and hand hygiene guidelines is important to health care workers and the patients they serve. The purpose of this study was to determine the effect of aloe-vera impregnated gloves on attitudes about hand hygiene among many health care workers and perceived sense of skin condition.

Are aloe-coated gloves effective in healthcare?

The moisturising properties of aloe vera have long been known. Examination gloves with aloe coatings are now available on the UK market for use in healthcare settings. This article examines the evidence surrounding the use of these gloves in the workplace to prevent dry, sore hands.