Grip and pinch strength prediction models based on hand anthropometric parameters: an analytic cross-sectional study.

BACKGROUND: Hand grip strength (HGS) and pinch strength are important clinical measures for assessing the hand and overall health. OBJECTIVE: The aim of the present study is to predict HGS and pinch strength based on 1 hand anthropometry, and (2) body anthropometric parameters using machine learning. METHODS: A Secondary analysis was conducted on 542 participant aged 30-60 years from the Persian Organizational Cohort study in Mashhad University of Medical Sciences. Artificial Neural Network (ANN) were fitted as prediction model. The dataset was divided into two sets: a training set, which comprised 70% of the data, and a test set, which comprised 30% of the data. Various combinations of the hand anthropometric, demographic, and body anthropometric parameters were used to determine the most accurate model. RESULTS: The optimal HGS model, using the input of gender, body mass, and hand anthropometric parameters of length (both total length and palm), maximum width, maximum breadth, and hand shape index, achieved nearly equal accuracy to the model that incorporated all variables (RMSE = 5.23, Adjusted R2 = 0.67). As for pinch strength, gender, hand length (both total length and palm), maximum width, maximum breadth, hand shape index, hand span, and middle finger length came closest to the model incorporating all variables (RMSE = 1.20, Adjusted R2 = 0.52). CONCLUSION: This ANN model showed that hand anthropometric parameters of total length, palm length, maximum width, maximum breadth, and the hand shape index, emerge as optimal predictors for both HGS and HPS. Body anthropometric factors (e.g., body mass) play roles as predictors for HGS, whereas their influence on pinch strength appears to be less pronounced. LEVEL OF EVIDENCE: Level III (Diagnosis). TRIAL REGISTRATION: Not applicable.

Evaluating hand hygiene knowledge, attitudes, and practices among healthcare workers in post-pandemic H1N1 influenza control: a cross-sectional study from China.

Background: This study evaluates the knowledge, attitudes, and practices (KAP) of hand hygiene among healthcare workers, crucial for preventing healthcare-associated infections (HAIs) in medical facilities. Methodology: This cross-sectional study assessed hand hygiene KAP among healthcare workers across various settings in Hubei, China utilizing a stratified random sampling approach from, December 25, 2023-to-April 25, 2024. A bilingual electronic survey, adapted from validated tools, was disseminated via email and social media to ensure a broad reach. Participants included diverse healthcare professionals who met specific inclusion criteria. Responses were analyzed using R software, employing descriptive and inferential statistics to identify key predictors of hand hygiene behavior and to confirm the reliability of the survey instrument. Results: The survey of 2,265 healthcare workers revealed that 77% demonstrated comprehensive knowledge of hand hygiene, 80% exhibited positive attitudes, and 94% practiced effective hand hygiene. Notable findings include a significant understanding of hand hygiene's role in preventing respiratory illnesses (58%) and HAIs (41% agreed, 39% unsure). High compliance in practices like washing hands for at least 20 s was evident (84%), though gaps in confidence about hand hygiene techniques were noted (33% confident, 56% unsure). Binary logistic regression analysis indicated that younger healthcare workers (21-30 years) were more likely to exhibit both knowledge (OR = 7.4, 95% CI = 1.44-136, p = 0.059) and positive attitudes (OR = 4.48, 95% CI = 1.73-11.8, p < 0.001) compared to other age groups. Significant associations were found between higher income levels and positive attitudes toward hand hygiene (OR for ≥80,000 = 3.19, 95% CI = 2.05-5.02, p < 0.001), and between knowledge and practices, suggesting that well-informed individuals are more likely to adhere to recommended practices. Conclusion: The findings reveal robust hand hygiene knowledge but uncover critical confidence gaps among healthcare workers, urging immediate, targeted educational interventions to fortify adherence and prevent infection outbreaks.

Clinical Effectiveness of a 3-Step Versus a 6-Step Hand Hygiene Technique: A Randomized Controlled Cross-over Study.

Background: The aim of this study is to assess the clinical effectiveness of the 3-step hand hygiene (HH) technique (3-HT) compared with the 6-step HH technique (6-HT; World Health Organization 6-step technique) using an alcohol-based hand rub. Methods: A randomized controlled crossover trial was conducted from November to December 2023 in 10 wards of a tertiary A-level hospital according to CONSORT guidelines. The 240 healthcare workers (HCWs) were randomly divided into the 3-HT intervention group or the 6-HT control group. The trial was conducted in 2 stages, and the effectiveness of each indicator in the 2 groups was compared after a washout period of 2 weeks. Results: Compared with the 6-HT, the 3-HT has demonstrated significant superiority in all indicators of HH compliance as well as the accuracy rate of HH practices. The total HH median times for the 3-HT and 6-HT were 16.00 (interquartile range, 15.00-20.00) and 32.50 (30.00-40.00) seconds, respectively (P < .05). The reduction factors for bacterial colony-forming unit counts did not differ and the colony-forming unit counts were not significantly different. Bacillus, Staphylococcus, and Micrococcus were detected before and after the use of hand rubs. HCWs preferred the 3-HT over the 6-HT. There were no significant difference in healthcare-associated infections rate between the 2 techniques. Conclusions: The 3-HT was significantly superior to the 6-HT in terms of the HH eligibility rate, compliance, and HH time. The safety and feasibility of the 3-HT were verified by assessing microorganism count.

Risk factors that limit use of oral JAK inhibitors in chronic hand eczema: Findings from the Danish Skin Cohort.

Background: Oral Janus kinase inhibitors (JAKis) have black-box warnings of infections, cancer risk, and cardiovascular and venous thromboembolic events. They may be used off-label for chronic hand eczema (CHE). Objectives: Assess the prevalence of risk factors potentially impacting oral JAKi safety in CHE patients. Methods: In the Danish Skin Cohort, CHE patients were examined for risk factors affecting oral JAKi use at baseline and followed for 12 months. Data were collected through register linkage (eg, cancer history) and through patient interviews (eg, smoking habits). Results: Of 941 adults with CHE (66.2% women; mean age 55.5 [SD 13.3] years), 768 (81.6%) patients had at least one risk factor potentially impacting oral JAKi use, of which 682 (72.5%) had nonmodifiable risk factors. Most common risk factors were current or former heavy smoking (62.8%, n = 591), obesity (28.1%, n = 264), hypercholesterolemia (21.5%, n = 202), and hypertension (18.8%, n = 177). Among patients without any risk factors at baseline (n = 173), 20.2% (n = 35) developed ≥1 risk factor during the following 12 months. Limitations: Certain risk factors may be underreported. Conclusion: Most CHE patients have risk factors limiting appropriateness of oral JAKi use. Health care providers should assess risk factors in their patients when choosing treatment for CHE.

Case report: Hand-arm vibration syndrome in a dental technician.

Occupational exposure to vibration using hand-held tools may cause hand-arm vibration syndrome (HAVS) among workers. We report the case of a 39-year-old lady with a 5-year work exposure to repetitive wrist movements and vibration from hand tools in the dental fabrication laboratory, working as a dental technician. She presented with a 3-year history of chronic pain over the wrists and positive symptoms of numbness and tingling in the hands, pain and discomfort of the fingers during cold exposure, and poor grip strength. Symptoms over the right hand were worse than the left. She is right-hand dominant. She had bilateral median nerve neuropathy at the wrist. Nerve conductive tests were consistent with minimal bilateral carpal tunnel syndrome. MRI showed evidence of soft tissue damage from repetitive strain injury of the right wrist. Neurosensory grading for hand-vibration syndrome (HAVS) using the Stockholm Workshop Scale (SWS) was performed and she was graded as Stage 1SN with numbness or tingling symptoms. Using the International Consensus Criteria (ICC) grading for HAVS, she was graded Stage N1 with numbness and/or tingling (symptoms) of finger. A workplace risk health assessment (WHRA) was performed, and exposure scores for her work tasks in dental fabrication and risk levels were determined using the HSE (Health and Safety UK) Assessment of Repetitive Tasks (ART) tool. The processes of teeth setting using dental burs (exposure score 23), divestment work with stone clippers (score 20), and use of pneumatic drills (score 21) were deemed high-risk activities for repetitive strain injury. The use of carving tools (score 12), packing with the use of flask clamps, and trimming (score 14) were classified as medium high-risk activities for repetitive strain injuries. Workplace modifications and workplace vibration exposure level monitoring protocols were subsequently established with the stabilization of the patient's symptoms.

Employing patient-centric health education for the prevention of parasitic infections.

Background: Soil-transmitted infections such as Ascaris lumbricoides, Hookworm, Trichuris trichiura, and Strongyloides stercoralis are common in South India. Factors such as diet, sanitation, and living conditions play a role in the prevalence of helminthic diseases. Many individuals remain asymptomatic carriers. Timely intervention is essential to prevent these infections. Materials and Methods: This is a prospective, randomized intervention study that enrolled 52 participants, excluding children, all of whom had parasitic infections. A prevalidated questionnaire was given to assess the risk factors for parasitic diseases, and fecal examinations were conducted to identify parasitic infestations. The World Health Organization's hand hygiene self-assessment framework was used to evaluate handwashing skills. Subsequent posttesting and resampling of patients allowed for score comparison, assessment of reductions in parasitic load, determination of cure rates, and monitoring of patient readmission rates. Results: After the health education intervention, a statistically significant improvement (P < 0.01) was observed in patients' knowledge and attitudes toward parasitic infections, as shown by their posttest scores compared to their pretest scores. In addition, there were notable improvements in handwashing skills following the implementation of the handwashing educational program. Conclusion: This research confirms that health education is vital in promoting proper hand hygiene, reducing parasitic infections, and urging timely medical care for these conditions.

The genetic causal effect of hand grip strength on osteoporosis and falling risk: a Mendelian randomization study.

Background: Patients with osteoporosis (OP) are often associated with decreased hand grip strength and increased risk of falling. It remains unclear whether there is a genetic causal between hand grip strength and OP, falling risk. Methods: The Mendelian randomization study was used to investigate the genetic causal effect of low hand grip strength on total body bone mineral density (BMD) at different ages, OP, and falling risk. Genes for low hand grip strength, total body BMD at different ages, OP, and falling risk were obtained from published genome-wide association studies. Inverse variance weighted, MR-Egger, and weighted median were applied to perform the MR analysis. The Cochran's Q test, MR-Egger intercept test, MR-PRESSO global test, and leave-one-out analysis were used to detect the pleiotropy or heterogeneity. Results: The results showed strong evidence that low hand grip strength was positively associated with OP (OR: 1.006, 95% CI: 1.003-1.010; P= 0.0001) and falling risk (OR: 1.069, 95% CI: 1.013-1.129; P= 0.0160), and could not directly affect the different ages of total body BMD (P> 0.05). There was no heterogeneity or horizontal pleiotropy in the sensitivity analysis (all P> 0.05). Conclusion: The study found a positive causal relationship between low hand grip strength and higher risk of OP and falling, which should be taken into account in the development of future prevention and screening strategies for OP and falling.

Eccrine Poroma of the Palm: A Case Report and Literature Review.

Eccrine poroma is a non-cancerous tumor that arises from the intraepidermal portion of the eccrine sweat glands. It usually appears as a solitary lesion on an extremity, commonly on the foot or sole, and is often subject to delayed or inaccurate diagnosis in clinical settings. This article describes a rare case of eccrine poroma located on the palm. It discusses the clinical and histological features, diagnostic difficulties, recurrence risks, and the possibility of malignant transformation associated with this condition.

Implicit motor imagery: examining motor vs. visual strategies in laterality judgments among older adults.

Cognitive states like motor imagery (MI; simulating actions without overtly executing them) share a close correspondence with action execution, and hence, activate the motor system in a similar way. However, as people age, reduction in specific cognitive abilities like motor action simulation and action planning/prediction are commonly experienced. The present study examined the effect of visual-spatial processing for both typical and challenging upper-limb movements using the Hand Laterality Judgment Task (HLJT), in which participants were asked to judge whether the depicted hand is a left or right hand. Several main findings emerged: (1) Compared to younger adults, older adults exhibited slower responses and greater error rates in both Experiment 1 and 2. This suggests that visual-spatial transformations undergo alterations with age; (2) Older adults displayed higher error rates with realistic hands at both back and palm viewpoints of the hands compared to younger adults. However, this pattern did not hold for response times; (3) Participants responded faster to medial hand orientations (i.e., closer to the midline of the body) compared to lateral hand orientations (i.e., farther from the midline of the body) for palm-views in both Experiment 1 and Experiment 2. Given that we observed better performance on medial orientations compared to lateral orientations, this suggests that participants follow the same motor rules and biomechanical constraints of the represented movement. Novel information is provided about differences in individuals' use of strategies (visual vs. motor imagery) to solve the HLJT for both mannequin and real hands.

Independent and interactive effects of particulate matter and meteorological factors on hand, foot and mouth disease in Fuyang.

Previous research has demonstrated the influence of environmental factor on the occurrence of infectious diseases. However, there is insufficient and conflicting evidence regarding the association between Hand, foot and mouth disease (HFMD) and environmental variables, particularly the interaction of environmental variables. This study aims to investigate the individual and interactive effects of particulate matter (PM) and meteorological factors on HFMD incidence in Fuyang. The generalized additive models were combined with distributed lag non-linear models to assess the individual effects between PM and meteorological factor on HFMD incidence in Fuyang. Subsequently, a product term was incorporated into the model to investigate the interaction between PM and meteorological factors. Temperature and PM2.5 were identified as the two primary risk factors for HFMD, with relative risks (RR) of 1.586(1.493,1.685) and 1.349(1.325,1.373), respectively. Furthermore, PM exhibited a synergistic effect with meteorological factors. For instance, the RR values for PM2.5 in relation to HFMD were 1.029 (95% CI: 1.024-1.035) and 1 0.117 (95% CI: 1 0.108 - 11 0.127) under different temperature group categories. Notably, HFMD predominantly affects children under the age of five years old and infants aged between zero to one year old demonstrate heightened susceptibility to environmental variables. The results showed that both PM and meteorological factors were risk factors for HFMD, with evidence of an interaction between these variables. These findings have important implications for local HFMD incidence prediction and the development of effective prevention strategies.

Improving manual dexterity using ergonomic wearable glove in patients with multiple sclerosis: A quasi-randomized clinical trial.

One main problem faced by people with multiple sclerosis (PwMS) is upper limb dysfunction, which can occur in the first decade of the disease and with the highest prevalence of disability in the progressive type of the disease. Then, PwMS may benefit from personalised and intensive treatment as provided by robotic devices. These innovative devices have increasingly been brought into the neurorehabilitation field, due to their ability to provide repetitive and task-oriented training. In this quasi-randomized study, we aim to evaluate the effects of robotic-assisted hand training, using the Hand TutorTM device, on hand functionality, active RoM, and manual dexterity, compared to conventional rehabilitation in PwMS. We enrolled 30 MS patients, who received 20 training sessions, each lasting 45 min with robotic-assisted hand training with Hand Tutor (n 15, experimental group) or conventional rehabilitation therapy (n 15, control group). All patients were evaluated at pre- and post-intervention with clinical scales for upper limb functionality (DASH, BBT, NHPT, and MI). In addition, only patients in the experimental group received an objective kinematic analysis of the hand and wrist movements, delivered by the Hand Tutor glove, both pre- and post-intervention. We found that PwMS in both groups statistically improved their upper limb functions, however the experimental group achieved better results in terms of manual dexterity. This promising rehabilitation training with Hand Tutor glove led to positive effects on upper limbs motor outcomes and kinematic parameters in patients with MS.

Equestrian-associated injuries of the hand: a retrospective analysis of injury mechanisms and patterns.

INTRODUCTION: Hand injuries are frequently caused by sports and are associated with long periods of inability to work and high economic health costs. After ball sports and cycling, the most common cause of hand injuries is horseback riding. Therefore, measures should be taken to prevent these risks and increase safety in sports, however data characterizing equestrian sports-associated injuries are limited. MATERIALS AND METHODS: A retrospective monocentric cohort study was performed including 39 patients (mean age: 35 ± 2.6 (range 9-65) years, female 89.7% who sustained an injury to the hand while practicing equestrian sports during 2016-2021 and presented to our hand surgery center. Data analysis was performed to characterize the trauma mechanism and injury patterns by evaluating the clinical information system and conducting telephone interviews. RESULTS: Overall, 53.8% of the injuries occurred while leading the horse owing to traction by bridles or a lead rope on the fingers, whereas only 33.3% were caused by a fall and 12.8% by a bite injury. The majority (87.2%) of cases were injuries to the phalanges (metacarpus: 7.7%; carpus: 5.1%). Fractures were present in 51.3% of cases. The most serious injuries included avulsion amputations in 23.1% of patients (10.3% subtotal; 12.8% total amputation). CONCLUSIONS: Equestrian-associated injuries occur more frequently during horse handling than riding, resulting in severe avulsion amputations due to traction of the lunge or bridle, requiring complex microsurgical treatment. We recommend that appropriate protective gloves are worn for prevention of hand injuries. Additionally, the use of self-opening panic hooks with overload protection can prevent excessive traction. LEVEL OF EVIDENCE: III.

A clinical trial evaluation of handwashing products and educational resources to improve hand hygiene in paediatric patients and school children.

Introduction: It is widely acknowledged that good hand hygiene (HH) is an important non-pharmaceutical method for reducing the transmission of infectious diseases. Children are at high risk of infection due to their immature immune systems. Hospital transmitted infections are a cause for concern worldwide, with poor HH suggested to be responsible for up to 20% of cases. Patients, in particular paediatric patients, are often overlooked when it comes to the promotion of hand hygiene compliance (HHC) in hospitals. This report describes the clinical evaluation of the 'Soaper Stars'; a collection of child-friendly HH products with linked educational resource, developed using the COM-B approach to behaviour change, and designed to encourage correct HH in paediatric patients and in schools. Method: The Soaper Star products were distributed on paediatric wards in five UK hospitals, and the use of the products around mealtimes was evaluated. Workshops teaching the 'why when and how' of handwashing were run in four UK primary schools with pre and post evaluations conducted to establish impact on knowledge. Over 300 children were involved. Results: The Soaper Stars products stimulated a 38% increase in HHC compared to when only hospital-issued products were available, and verbal feedback from families indicated that having the Soaper Star products encouraged improved HHC by all visitors, not just the patient. Workshops in four schools (283 pupils) showed an increase in knowledge around the transmission of infection and the need for good HH that was sustained for at least 4 weeks. Conclusion: The results of this study demonstrate that providing children with the age-appropriate knowledge about why HH is necessary, and the child-friendly means to maintain their HH, will lead to greater HHC, not just by individual children, but also their families.

Observational Health Data Science and Informatics and Hand Surgery Research: Past, Present, and Future.

Single center studies are limited by bias, lack of generalizability and variability, and inability to study rare conditions. Multicenter observational research could address many of those concerns, especially in hand surgery where multicenter research is currently quite limited; however, there are numerous barriers including regulatory issues, lack of common terminology, and variable data set structures. The Observational Health Data Sciences and Informatics (OHDSI) program aims to surmount these limitations by enabling large-scale, collaborative research across multiple institutions. The OHDSI uses the Observational Medical Outcomes Partnership (OMOP) Common Data Model (CDM) to standardize health care data into a common language, enabling consistent and reliable analysis. The OMOP CDM has been transformative in converting multiple databases into a standardized code with a single vocabulary, allowing for coherent analysis across multiple data sets. Building upon the OMOP CDM, OHDSI provides an extensive suite of open-source tools for all research stages, from data extraction to statistical modeling. By keeping sensitive data local and only sharing summary statistics, OHDSI ensures compliance with privacy regulations while allowing for large-scale analyses. For hand surgery, OHDSI can enhance research depth, understanding of outcomes, risk factors, complications, and device performance, ultimately leading to better patient care.

Atypical presentation of long-standing hand neurofibroma: A case report.

INTRODUCTION AND IMPORTANCE: A solitary neurofibroma of the hand is an uncommon condition that typically lacks distinct symptoms, often resulting in misdiagnosis and prolonged morbidity. While it primarily affects younger individuals, it can also present in older adults. This article discusses an extraordinary case of a long-standing neurofibroma in the hand. CASE PRESENTATION: A 70-year-old right-handed individual, known to have hypertension and a pacemaker, presented with a mass on the palm of his left hand. This mass was associated with tingling and mild pain, particularly after excessive use of the hand. Recently, he had experienced partial limitations in hand movement due to the mass's pressure. Following a thorough clinical assessment, he underwent surgical excision of the mass under local anesthesia. Histopathological findings confirmed the diagnosis of neurofibroma. The follow-up was generally uneventful, apart from some persistent tingling sensations. CLINICAL DISCUSSION: Solitary neurofibromas affecting small nerves are not frequently encountered in clinical practice and usually appear as a slowly progressive mass that may cause pain and tingling. There are no particular radiological approaches that can definitively diagnose this condition; however, histopathological findings have proven effective in confirming the diagnosis. CONCLUSION: Long-term hand neurofibroma is an infrequent disorder that typically lacks prominent symptoms, highlighting the critical need for medical assessment. Surgery is the only effective treatment for hand cases, providing both a definitive diagnosis and the possibility of being performed with regional anesthesia.

Impact of COVID-19 control measures on respiratory syncytial virus and hand-foot-and-mouth disease transmission in Hong Kong and South Korea.

The public health and social measures (PHSMs) for mitigation/control of COVID-19 pandemic influenced the transmission dynamics of many other infectious diseases, including respiratory syncytial virus (RSV) infection, and hand, foot and mouth disease (HFMD) and their disease-burden. This study aimed to infer the transmission dynamics of these respiratory viruses and assess the impact of COVID-19 PHSMs on their community activity. We developed a compartmental framework to infer the transmission dynamics of RSV and HFMD in Hong Kong and South Korea from January 2014 to May 2024. We assessed the impact of PHSMs by comparing the change in virus transmissibility, reproduction number and population susceptibility before, during, and after the COVID-19 pandemic period. A significant reduction in RSV and HFMD activity was observed starting in January 2020, with a resurgence since late 2021. Transmissibility of both diseases decreased by 46 % - 95 % during the lull, while population susceptibility was estimated to increase by maximum of 19 %. On relaxation of the PHSMs, the transmissibility were recovered up to 70 % in Hong Kong and nearly 100 % in South Korea in 2023 with significant epidemics for these viruses. Strict implementation of COVID-19 PHSMs led to low RSV and HFMD activity, but the absence of community infection resulted in reductions in population immunity, and slightly larger epidemics when these diseases re-emerged following the COVID-19 pandemic.

Page Turning Using Assistive Robot with Low-Degree-of-Freedom Hand.

This paper proposes a page-turning strategy using an assistive robot that has a low-degree-of-freedom robotic hand. The robotic hand is based on human object handling characteristics, which significantly reduces the number of fingers and joints required to handle various objects. The robotic hand has right and left planar fingers that can transform their shape to handle various objects. To turn a page, the robot uses the planar fingers to push the surface of the page and then rotates the fingers. The design concept, mechanism, sensor system, strategy for page turning, and control system of the robotic hand are presented. The experimental results show that the robot can turn pages using the proposed method; however, it sometimes failed to turn the page when the robotic hand height was too low and too close to the book because the rotation of the fingers was stopped by the book. When the hand detects excessive force during page turning, the control system changes the shape of the fingers and releases the force from the book. The experimental results show the effectiveness of the control system.

A Multimodal Bracelet to Acquire Muscular Activity and Gyroscopic Data to Study Sensor Fusion for Intent Detection.

Researchers have attempted to control robotic hands and prostheses through biosignals but could not match the human hand. Surface electromyography records electrical muscle activity using non-invasive electrodes and has been the primary method in most studies. While surface electromyography-based hand motion decoding shows promise, it has not yet met the requirements for reliable use. Combining different sensing modalities has been shown to improve hand gesture classification accuracy. This work introduces a multimodal bracelet that integrates a 24-channel force myography system with six commercial surface electromyography sensors, each containing a six-axis inertial measurement unit. The device's functionality was tested by acquiring muscular activity with the proposed device from five participants performing five different gestures in a random order. A random forest model was then used to classify the performed gestures from the acquired signal. The results confirmed the device's functionality, making it suitable to study sensor fusion for intent detection in future studies. The results showed that combining all modalities yielded the highest classification accuracies across all participants, reaching 92.3±2.6% on average, effectively reducing misclassifications by 37% and 22% compared to using surface electromyography and force myography individually as input signals, respectively. This demonstrates the potential benefits of sensor fusion for more robust and accurate hand gesture classification and paves the way for advanced control of robotic and prosthetic hands.

A hand-washing community-based educational intervention to reduce abscess incidence among people who inject drugs: a cluster randomised controlled clinical trial protocol (the HAWA study protocol).

BACKGROUND: Besides the high prevalence of HIV and HCV infections, people who inject drugs (PWID) have a cumulative risk of acquiring skin and soft tissue infections (SSTI) from, among other things, social precariousness, homelessness/unstable housing, and unhygienic injecting practices. We propose to evaluate whether a two-component educational hand hygiene intervention which combines training in hand-washing with the supply of a single-use alcohol-based hand rub, called MONO-RUB, is effective in reducing injection-related abscesses in the PWID population. Specifically, we shall implement a nationwide, two-arm, multi-centre, cluster randomised controlled trial to evaluate the effectiveness and cost-effectiveness of this intervention in PWID. METHODS: HAWA is a community-based participatory research study to be conducted in 22 harm reduction centres (HR) in France (not yet recruiting); the latter will be randomised into two clusters: centres providing standard HR services and the intervention (i.e., intervention group) and those providing standard HR services only (i.e., control group). After randomization, each cluster will include 220 PWID, with an inclusion period of 12 months and an individual follow-up period of 6 months. For each participant, we will collect data at M0, M3 and M6 from photos of injection sites on the participant's body, a face-to-face injection-related SSTI questionnaire, and a CATI questionnaire. The primary outcome is the reduction in abscess prevalence between M0 and M6, which will be compared between the control and intervention arms, and measured from observed (photographs) and self-declared (SSTI questionnaire) data. We will also assess the cost-effectiveness of the intervention. DISCUSSION: The HAWA trial will be the first cluster randomized controlled trial to improve hand hygiene among PWID with a view to reducing SSTI. If effective and cost-effective, the intervention combined with the distribution of MONO-RUBs (or a similar cleaning product) may prove to be an important HR tool, helping to reduce the enormous burden of infection-related deaths and diseases in PWID. TRIAL REGISTRATION: NCT06131788, received on 2 January 2024.

Essential Oil-Based Soap with Clove and Oregano: A Promising Antifungal and Antibacterial Alternative against Multidrug-Resistant Microorganisms.

The transmission of microorganisms via hands is a critical factor in healthcare-associated infections (HAIs), underscoring the importance of rigorous hand hygiene. The rise of antimicrobial-resistant microorganisms, driven in part by the overuse of antibiotics in clinical medicine, presents a significant global health challenge. Antimicrobial soaps, although commonly used, may exacerbate bacterial resistance and disrupt skin microbiota, posing additional health risks and environmental hazards. Essential oils, with their broad-spectrum antimicrobial properties, offer a promising alternative. This study evaluates the antimicrobial activity of essential oils against various bacterial and fungal strains, including multidrug-resistant isolates. Using a range of in vitro and in vivo antimicrobial assays, including minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), and minimal fungicidal concentration (MFC), the essential oils were tested against a broad spectrum of pathogens. Additionally, the chemical composition of the oils was analyzed in detail using gas chromatography-mass spectrometry (CG-MS). Clove, oregano, and thyme oils demonstrated potent inhibition of all tested ATCC bacterial strains, with MIC values ranging from 3.125 to 50 µL/mL. These oils also showed significant activity against multidrug-resistant Escherichia coli and Pseudomonas aeruginosa strains. Notably, clove oil exhibited remarkable efficacy against fungal strains such as Aspergillus fumigatus and Trichophyton rubrum, with MIC values as low as 1.56 µL/mL. Synergy tests revealed that combinations of clove, oregano, and thyme oils yielded significantly lower MIC values than individual oils, indicating additive or synergistic effects. The formulation of a soap incorporating clove and oregano oils demonstrated efficacy comparable to synthetic antiseptics in vivo. These findings highlight the exceptional antimicrobial potential of essential oils, mainly clove and oregano, against resistant microorganisms, offering a viable alternative to conventional antimicrobial agents.