Establishing a Learning Model for Correct Hand Hygiene Technique in a NICU.

The ability of healthcare workers to learn proper hand hygiene has been an understudied area of research. Generally, hand hygiene skills are regarded as a key contributor to reduce critical infections and healthcare-associated infections. In a clinical setup, at a Neonatal Intensive Care Unit (NICU), the outcome of a multi-modal training initiative was recorded, where objective feedback was provided to the staff. It was hypothesized that staff at the NICU are more sensitive towards applying increased patient safety measures. Outcomes were recorded as the ability to cover all hand surfaces with Alcohol-Based Handrub (ABHR), modelled as a time-series of measurements. The learning ability to rub in with 1.5 mL and with 3 mL was also assessed. As a secondary outcome, handrub consumption and infection numbers were recorded. It has been observed that some staff members were able to quickly learn the proper hand hygiene, even with the limited 1.5 mL, while others were not capable of acquiring the technique even with 3 mL. When analyzing the 1.5 mL group, it was deemed an insufficient ABHR amount, while with 3 mL, the critical necessity of skill training to achieve complete coverage was documented. Identifying these individuals helps the infection control staff to better focus their training efforts. The training led to a 157% increase in handrub consumption. The setting of the study did not allow to show a measurable reduction in the number of hospital infections. It has been concluded that the training method chosen by the staff greatly affects the quality of the outcomes.

Education of hand hygiene in children during the pandemia / Egészségpedagógiai tapasztalatok a gyermekek kézmosásának oktatásában; higiénés nevelés a világjárványban.

Összefoglaló. Manapság, a COVID-19-járvány közepette, a megfelelo kézmosás segít megelozni vagy legalábbis lassítani a fertozo betegségek, például a SARS-CoV-2-fertozés terjedését. A kézmosás rutinjának megfelelo oktatás multilaterális tevékenységet igényel, amely a fiatalok ismeretén, egészségmagatartásán, attitudjein, tapasztalatain és motivációján alapul. A TANTUdSZ Ifjúsági Egészségnevelési Program kortársoktató pedagógiai és egészségtudományi egyetemi karok hallgatóival, valamint középiskolai kortárssegítokkel és mintegy 3000, magyarországi óvodás, általános és középiskolás diák bevonásával valósult meg, különbözo egészségfejlesztési területeken. A vizsgálatok egyik célja az oktatási program hatékonyságának értékelése érdekében a gyermekek kézhigiénés ismereteinek és készségeinek elemzése és összehasonlítása volt a beavatkozások elott és után. A jelen közleményben ismertetett longitudinális felmérés alsó tagozatos tanulók (n = 165) kézmosási készségének és attitudváltozásainak rövid és hosszú távú változását értékeli három idopontban. A mérések önkitöltos, anonim kérdoívvel és kéziszkenner-technológiával (Semmelweis Scanner) készültek, mely utóbbi mérési eszköz a különbözo kézterületek tisztaságát kvantitatív és digitális értékelésekkel detektálta. A beavatkozás eredményes volt mind rövid, mind hosszú távon a bemeneti (kezdeti) mérésekhez képest. Az eredmények azonban különbséget mutattak a gyakorlati készségek elsajátításának folyamatában. Jelentos elorelépés történt a kézmosás attitudjének változásában. Az életkor-specifikus egészségfejlesztési oktatási programokban, különösen a gyermekpopulációban, hangsúlyt kell fektetni az elméleti, a gyakorlati ismeretek, valamint az egészségmagatartás hosszú távú megorzésére is. Orv Hetil. 2021; 162(46): 1842-1847. Summary. Presently, in the midst of the COVID-19 pandemic, proper hand washing helps prevent or at least slow the spread of infectious diseases such as SARS-CoV-2 infection. Proper education in hand washing routines requires multilateral action based on young people's knowledge, health behaviors, attitudes, experiences, and motivations. The TANTUdSZ Youth Health Education Program was implemented with students of contemporary teaching faculties of pedagogical and health sciences as well as with secondary school peer helpers and with the involvement of about 3000 pre-school, primary and secondary school students in Hungary in various fields of health development. One of the aims of the studies was to analyze and compare children's hand hygiene knowledge and skills before and after the pedagogical interventions in order to evaluate the effectiveness of the educational program. The longitudinal survey described in this paper assesses the short- and long-term changes of primary school students' (from class 1 to 4; n = 165) hand washing skills and the attitudinal changes in their health behaviors at three time points. Measurements were performed using a self-completion, anonymous questionnaire and hand-held scanner technology (Semmelweis Scanner), the latter measuring device detecting the purity of different hand areas with quantitative and digital evaluations. The educational intervention was effective in both short and long term compared to input (initial) measurements. However, the results showed a difference in the process of acquiring practical skills. There has been a significant progress in changing attitudes to hand washing. Age-specific health promotion education programs, especially in the pediatric population, should also focus on the long-term preservation of theoretical, practical knowledge, and health behaviors. Orv Hetil. 2021; 162(46): 1842-1847.

[Direct effect of contemporary health education programmes on the knowledge about hand hygiene and technique of hand washing in primary school age children]. / Kortárs egészségfejlesztési programok közvetlen hatása alsó tagozatos gyermekek kézhigiénés tudására és megfelelo kézmosási technikájára.

INTRODUCTION AND AIM: In the case of primary school children in Budapest (n = 165), data on their social status and their previous knowledge on hand hygiene were elicited with the help of pre-knowledge questionnaires issued by students of higher education. The aim of the research was introducing a novel pedagogical procedure - application and optimization of peer education in the development of proper hand hygiene among primary school students. METHOD: The knowledge-based survey was conducted after four (n = 85) and eight hours of teaching (n = 36). In addition, the effectiveness of hand washing was tested immediately before (n = 166) and after the four (n = 74) and eight hours of teaching (n = 35) with Semmelweis Scanner after rubbing the hand with fluorescent cream. RESULTS: Prior knowledge of hand hygiene significantly increased after the four-hour and eight-hour trainings. In the case of smaller children, the effect of the eight-hour training was more pronounced. Similar results were obtained with regards to the changes in the number of areas missed while rubbing the surface of the hand as a result of the teaching. CONCLUSION: Sociological surveys on hand hygiene knowledge and direct physical measurements indicate that training with appropriate pedagogical procedures is effective and contributes to the environmentally conscious hygiene culture of children aged 6 to 10. Orv Hetil. 2018; 159(12): 485-490.

[Hand hygiene technique assessment using electronic equipment in 26 Hungarian healthcare institutions]. / A kézhigiénés technika vizsgálata elektronikus ellenorzo berendezés segítségével 26 magyarországi betegellátó intézményben.

INTRODUCTION: Hand hygiene is probably the most effective tool of nosocomial infection prevention, however, proper feedback and control is needed to develop the individual hand hygiene practice. AIM: Assessing the efficiency of modern education tools, and digital demonstration and verification equipment during their wide-range deployment. METHOD: 1269 healthcare workers took part in a training organized by our team. The training included the assessment of the participants' hand hygiene technique to identify the most often missed areas. The hand hygiene technique was examined by a digital device. RESULTS: 33% of the participants disinfected their hands incorrectly. The most often missed sites are the fingertips (33% on the left hand, 37% on the right hand) and the thumbs (42% on the left hand, 32% on the right hand). CONCLUSION: The feedback has a fundamental role in the development of the hand hygiene technique. With the usage of electronic devices feedback can be provided efficiently and simply. Orv Hetil. 2017; 158(29): 1143-1148.

Education of hand rubbing technique to prospective medical staff, employing UV-based digital imaging technology.

The aim of this study was to objectively assess the hand hygiene performance of medical students. Hand rubbing technique was evaluated by employing innovative UV-light-based imaging technology, identifying patterns and trends in missed areas after applying WHO's six-step protocol. This specially designed hand hygiene education and assessment program targeted 1,344 medical students at two distant sites in Central Europe. Students were introduced to a short video, presenting the basics of hand hygiene, and then received further demonstration from professional trainers, focusing on the correct execution of WHO's six-step technique. To verify the acquired skill, participants rubbed their hands with UV-marked alcohol-based solution. Digital images of the hands were recorded under UV light, followed by computer evaluation and assessment. Immediate objective visual feedback was given to the participants showing missed areas on their hands. The statistical analysis of missed spots was based on retrospective expert-driven manual evaluation. Significant difference in rubbing quality was found between female and male participants [35.3% (CI 95%: 33-38%) versus 29.0% (CI 95%: 27-31%), p < 0.001], dominant and non-dominant hands [43.4% (CI 95%: 39-48%) versus 34.9% (CI 95%: 32-38%), p = 0.002], and various zones of the hands' dorsal side. Based on the participants' feedback and the evaluation of the infection control specialists, it can be stated that the identification of typically missed patterns and the instant visual feedback have a vital role in improving the hand hygiene technique of prospective medical staff.

A large-scale assessment of hand hygiene quality and the effectiveness of the "WHO 6-steps".

BACKGROUND: Hand hygiene compliance is generally assessed by observation of adherence to the "WHO five moments" using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectively assess hand rub coverage of staff using a novel imaging technology and to look for patterns and trends in missed areas after the use of WHO's 6 Step technique. METHODS: A hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic. RESULTS: Despite the assessment taking place immediately after the training, only 72% of staff achieved satisfactory coverage. Failure to adequately clean the dorsal and palmar aspects of the hand occurred in 24% and 18% of the instances, respectively. Fingertips were missed by 3.5% of subjects. The analysis based on 4642 records showed that nurses performed best (77% pass), and women performed better than men (75% vs. 62%, p<0.001). Further risk indicators have been identified regarding age and occupation. CONCLUSION: Ongoing education and training has a vital role in improving hand hygiene compliance and technique of clinical staff. Identification of typical sites of failure can help to develop improved training.

Digital imaging for the education of proper surgical hand disinfection.

Nosocomial infections are the undesirable result of a treatment in a hospital, or a health care service unit, not related to the patient's original condition. Despite the evolution of medicine, fundamental problems with hand hygiene remain existent, leading to the spread of nosocomial infections. Our group has been working on a generic solution to provide a method and apparatus to teach and verify proper hand disinfection. The general idea is to mark the skin surfaces that were sufficiently treated with alcoholic hand rub. Digital image processing is employed to determine the location of these areas and overlay it on the segmented hand, visualizing the results in an intuitive form. A non-disruptive ultraviolet marker is mixed to a commercially available hand rub, therefore leaving the original hand washing workflow intact. Digital images are taken in an enclosed device we developed for this purpose. First, robust hand contour segmentation is performed, then a histogram-based formulation of the fuzzy c-means algorithm is employed for the classification of clean versus dirty regions, minimizing the processing time of the images. The method and device have been tested in 3 hospitals in Hungary, Romania and Singapore, on surgeons, residents, medical students and nurses. A health care professional verified the results of the segmentation, since no gold standard is available for the recorded human cases. We were able to identify the hand boundaries correctly in 99.2% of the cases. The device can give objective feedback to medical students and staff to develop and maintain proper hand disinfection practice.

Stery-hand: A new device to support hand disinfection.

Incomplete disinfection can cause serious complications in surgical care. The teaching of effective hand washing is crucial in modern medical training. To support the objective evaluation of hand disinfection, we developed a compact, mobile device, relying on digital imaging and image processing. The hardware consists of a metal case with matte black interior, ultra-violet lighting and a digital camera. Image segmentation and clustering are performed on a regular notebook. The hand washing procedures performed with a soap mixed with UV-reflective powder. This results the skin showing bright under UV light only on the treated (sterile) surfaces. When the surgeon inserts its hands into the box, the camera placed on the top takes an image of the hand for evaluation. The software performs the segmentation and clustering automatically. First, the hand contour is determined from the green intensity channel of the recorded RGB image. Then, the pixels of the green channel belonging to the hand are partitioned to three clusters using a quick, histogram based fuzzy c-means algorithm. The optimal threshold between the intensities of clean and dirty areas is extracted using these clusters, while the final approximated percentage of the clean area is computed using a weighting formula. The main advantage of our device is the ability to obtain objective and comparable result on the quality of hand disinfection. It may find its best use in the clinical education and training.