Updates and future directions regarding hand hygiene in the healthcare setting: insights from the 3rd ICPIC alcohol-based handrub (ABHR) task force.

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose threats to global health. Effective hand hygiene is essential for preventing HAIs and the spread of AMR in healthcare. We aimed to highlight the recent progress and future directions in hand hygiene and alcohol-based handrub (ABHR) use in the healthcare setting. In September 2023, 42 experts in infection prevention and control (IPC) convened at the 3rd International Conference on Prevention and Infection Control (ICPIC) ABHR Taskforce in Geneva, Switzerland. The purpose of this meeting was to provide a synthesis of recent evidence and formulate a research agenda on four critical areas for the implementation of effective hand hygiene practices: (1) ABHR formulations and hand rubbing techniques, (2) low-resource settings and local production of ABHR, (3) hand hygiene monitoring and technological innovations, and (4) hand hygiene standards and guidelines.

Systematic scoping review of automated systems for the surveillance of healthcare-associated bloodstream infections related to intravascular catheters.

INTRODUCTION: Intravascular catheters are crucial devices in medical practice that increase the risk of healthcare-associated infections (HAIs), and related health-economic adverse outcomes. This scoping review aims to provide a comprehensive overview of published automated algorithms for surveillance of catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI). METHODS: We performed a scoping review based on a systematic search of the literature in PubMed and EMBASE from 1 January 2000 to 31 December 2021. Studies were included if they evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We assessed the design of the automated systems, including the definitions used to develop algorithms (CLABSI versus CRBSI), the datasets and denominators used, and the algorithms evaluated in each of the studies. RESULTS: We screened 586 studies based on title and abstract, and 99 were assessed based on full text. Nine studies were included in the scoping review. Most studies were monocentric (n = 5), and they identified CLABSI (n = 7) as an outcome. The majority of the studies used administrative and microbiological data (n = 9) and five studies included the presence of a vascular central line in their automated system. Six studies explained the denominator they selected, five of which chose central line-days. The most common rules and steps used in the algorithms were categorized as hospital-acquired rules, infection rules (infection versus contamination), deduplication, episode grouping, secondary BSI rules (secondary versus primary BSI), and catheter-associated rules. CONCLUSION: The automated surveillance systems that we identified were heterogeneous in terms of definitions, datasets and denominators used, with a combination of rules in each algorithm. Further guidelines and studies are needed to develop and implement algorithms to detect CLABSI/CRBSI, with standardized definitions, appropriate data sources and suitable denominators.

Predictive performance of automated surveillance algorithms for intravascular catheter bloodstream infections: a systematic review and meta-analysis.

BACKGROUND: Intravascular catheter infections are associated with adverse clinical outcomes. However, a significant proportion of these infections are preventable. Evaluations of the performance of automated surveillance systems for adequate monitoring of central-line associated bloodstream infection (CLABSI) or catheter-related bloodstream infection (CRBSI) are limited. OBJECTIVES: We evaluated the predictive performance of automated algorithms for CLABSI/CRBSI detection, and investigated which parameters included in automated algorithms provide the greatest accuracy for CLABSI/CRBSI detection. METHODS: We performed a meta-analysis based on a systematic search of published studies in PubMed and EMBASE from 1 January 2000 to 31 December 2021. We included studies that evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We estimated the pooled sensitivity and specificity of algorithms for accuracy and performed a univariable meta-regression of the different parameters used across algorithms. RESULTS: The search identified five full text studies and 32 different algorithms or study populations were included in the meta-analysis. All studies analysed central venous catheters and identified CLABSI or CRBSI as an outcome. Pooled sensitivity and specificity of automated surveillance algorithm were 0.88 [95%CI 0.84-0.91] and 0.86 [95%CI 0.79-0.92] with significant heterogeneity (I2 = 91.9, p < 0.001 and I2 = 99.2, p < 0.001, respectively). In meta-regression, algorithms that include results of microbiological cultures from specific specimens (respiratory, urine and wound) to exclude non-CRBSI had higher specificity estimates (0.92, 95%CI 0.88-0.96) than algorithms that include results of microbiological cultures from any other body sites (0.88, 95% CI 0.81-0.95). The addition of clinical signs as a predictor did not improve performance of these algorithms with similar specificity estimates (0.92, 95%CI 0.88-0.96). CONCLUSIONS: Performance of automated algorithms for detection of intravascular catheter infections in comparison to manual surveillance seems encouraging. The development of automated algorithms should consider the inclusion of results of microbiological cultures from specific specimens to exclude non-CRBSI, while the inclusion of clinical data may not have an added-value. Trail Registration Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42022299641; January 21, 2022). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022299641.

Are emojis ready to promote the WHO 5 moments for hand hygiene in healthcare?

BACKGROUND: Hand hygiene is universally recognized as a cornerstone measure for the prevention of healthcare-associated infections. Although the WHO "My five Moments for hand hygiene" poster has been used for more than a decade to delineate hand hygiene indications and promote action, adherence levels among healthcare workers are still notoriously low and disquieting. To compensate for the lack of effective hand hygiene communication, we aimed to evaluate emojis as possible surrogates for the non-verbal aspects of hand hygiene behaviour. METHODS: Following a thorough review of the Unicode version 12.0, the most applicable emojis to the terms used in the WHO 5 Moments poster were extracted. We developed a self-administered questionnaire to assess the view of infection prevention and control (IPC) practitioners regarding the use of emojis to show the WHO 5 Moments. Completed questionnaires were collected and analysed to determine the suitability of the existing emojis to illustrate a unified emoji poster. Data were analysed using R (version 3.6.3). RESULTS: A total of 95 IPC practitioners completed the questionnaire from May to October 2019 from different countries. Of these, 69 (74%) were female, and the mean age of the participants was 44.6 ± 10.87 years. We found appropriate emojis for six of the words used in the poster, including for touching (72%), for patient (63%), for clean (53%), for procedure (56%), for body fluid (58%), and for exposure risk (71%). The existing emojis proposed for the words "hygiene", "aseptic", and "surrounding" seemed to be less satisfactory. CONCLUSIONS: In summary, the findings of this study indicate that the existing emojis may not be able to substitute the words used in the WHO 5 Moments poster. Emojis might be helpful to address hand hygiene indications in healthcare that may eventually play a role in promoting this measure. However, emojis should be further studied to choose the most appropriate ones and avoid ambiguity and misinterpretation. More emojis to convey health related messages are needed. We recommend further research in this area to evaluate the effect of using emojis in healthcare-related behaviours.

The Epidemiology of Gender Dysphoria in Iran: The First Nationwide Study.

Gender dysphoria (GD) is defined as a persistent and distressful incongruence between one's gender identity and one's at-birth-assigned sex. Sex reassignment has been religiously accepted for transgender individuals in postrevolutionary Iran since 1987; however, very little is known about how many individuals seek and receive such treatment annually. This study provides the first nationwide effort to assess the prevalence of GD in Iran as a function of diagnosis. The medical records of all transgender individuals referred to the Iranian Legal Medicine Organization between March 2012 and March 2017 were reviewed. All individuals diagnosed with GD were contacted. A total of 839 medical records meeting study criteria were received and evaluated. The prevalence of transgender individuals was estimated to be 1.46 per 100,000 Iranians with a transwoman (TW)/ transman (TM) ratio of 1:2. The mean age of individuals with GD at the time of referral was 25.22 (SD = 6.25) years for TW and 25.51 (SD = 5.66) years for TM. The findings are twofold. First, gender dysphoria is less prevalent in Iran than has been reported in Western countries. Second, the sex ratio is skewed toward at-birth-assigned females, which differs from what has been reported in Western countries. These findings have been interpreted in light of Iran's legal system, which is based on Islamic penal codes. These findings are of utmost importance for both health providers and legislators, as it can illustrate a more accurate picture of the transgender population in Iran.

Assessing the accuracy of a new hand hygiene monitoring device (SmartRub®): from the laboratory to clinical practice.

BACKGROUND: We developed SmartRub® powered by iQati®, an electronic device composed of a wristband and an alcohol-based handrub pocket-sized dispenser that measures and provides feedback on the duration of hand friction and the volume poured during each hand hygiene action. We aimed to assess the accuracy of SmartRub®. METHODS: The specificity, sensitivity, positive and negative predictive values (PPV and NPV) of SmartRub® were assessed in a 3-phased experiment: (1) laboratory-controlled conditions with volunteers; (2) pre-planned clinical path with volunteers and (3) real clinical conditions with healthcare workers. The accuracy of SmartRub® was evaluated by quantifying its ability to correctly capture true hand hygiene actions and to not record other actions performed while wearing the device. RESULTS: In the laboratory, 7 volunteers performed 816 actions. Overall sensitivity was 94.1% (95% CI 91.4-96.2%) with a PPV of 99.0% (95% CI 97.3-99.6%) and specificity was 99.0% (95% CI 97.5-99.7%) with a NPV of 94.4% (95% CI 91.9-96.1%). During the pre-planned clinical path phase, 13 volunteers performed 98 planned paths and a total of 967 actions were performed. Overall sensitivity was 94.6% (95% CI 92.2-96.5%) with a PPV of 84.3% (95% CI 81.6-86.7%) and specificity was 82.4% (95% CI 78.7-85.7%) with a NPV of 93.9% (95% CI 91.3-95.7%). During the real clinical conditions phase, 17 healthcare workers were observed for a total of 15 h and 3 min while they performed 485 actions. Sensitivity was 96.8% (95% CI 93.8-98.6%) with a PPV of 98.3% (95% CI 95.6-99.3%) and specificity was 98.3% (95% CI 95.7-99.5%) with a NPV of 96.8% (95% CI 93.9-98.4%). CONCLUSIONS: Smartrub® is a highly reliable device for capturing hand hygiene actions under a range of conditions, from the laboratory to clinical care activities.

Decontaminating N95/FFP2 masks for reuse during the COVID-19 epidemic: a systematic review.

BACKGROUND: With the current COVID-19 pandemic, many healthcare facilities have been lacking a steady supply of filtering facepiece respirators. To better address this challenge, the decontamination and reuse of these respirators is a strategy that has been studied by an increasing number of institutions during the COVID-19 pandemic. METHODS: We conducted a systematic literature review in PubMed, PubMed Central, Embase, and Google Scholar. Studies were eligible when (electronically or in print) up to 17 June 2020, and published in English, French, German, or Spanish. The primary outcome was reduction of test viruses or test bacteria by log3 for disinfection and log6 for sterilization. Secondary outcome was physical integrity (fit/filtration/degradation) of the respirators after reprocessing. Materials from the grey literature, including an unpublished study were added to the findings. FINDINGS: Of 938 retrieved studies, 35 studies were included in the analysis with 70 individual tests conducted. 17 methods of decontamination were found, included the use of liquids (detergent, benzalkonium chloride, hypochlorite, or ethanol), gases (hydrogen peroxide, ozone, peracetic acid or ethylene oxide), heat (either moist with or without pressure or dry heat), or ultra violet radiation (UVA and UVGI); either alone or in combination. Ethylene oxide, gaseous hydrogen peroxide (with or without peracetic acid), peracetic acid dry fogging system, microwave-generated moist heat, and steam seem to be the most promising methods on decontamination efficacy, physical integrity and filtration capacity. INTERPRETATION: A number of methods can be used for N95/FFP2 mask reprocessing in case of shortage, helping to keep healthcare workers and patients safe. However, the selection of disinfection or sterilization methods must take into account local availability and turnover capacity as well as the manufacturer; meaning that some methods work better on specific models from specific manufacturers. SYSTEMATIC REGISTRATION NUMBER: CRD42020193309.

Hand hygiene in health care: 20 years of ongoing advances and perspectives.

Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.

Planning and management to control and eliminate HTLV-1 infection in Iran.

Prevention and treatment of the Human T-cell leukemia virus, type 1 (HTLV-1) which was discovered nearly 40 years ago, still remain challenging. The reported high prevalence of HTLV-1 in some countries around the world triggered an open letter to the World Health Organization (WHO), urging action against HTLV-1 infection in 2018. This highlights the importance of virus elimination strategies to eradicate HTLV-1 infection. In Iran, we have documented our experiences with the virus in order to achieve and promote the possible ways to manage, control, and eliminate HTLV-1. Although there has been considerable progress apropos of HTLV-1, a series of additional challenges need to be tackled to control HTLV-1 infection in Iran.

The COVID-19 pandemic and N95 masks: reusability and decontamination methods.

BACKGROUND: With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of extraordinary measures to minimize the negative health impact from an insufficient supply of masks. The decontamination, and reuse of healthcare workers' N95/FFP2 masks is a promising solution which needs to overcome several pitfalls to become a reality. AIM: The overall aim of this article is to provide the reader with a quick overview of the various methods for decontamination and the potential issues to be taken into account when deciding to reuse masks. Ultraviolet germicidal irradiation (UVGI), hydrogen peroxide, steam, ozone, ethylene oxide, dry heat and moist heat have all been methods studied in the context of the pandemic. The article first focuses on the logistical implementation of a decontamination system in its entirety, and then aims to summarize and analyze the different available methods for decontamination. METHODS: In order to have a clear understanding of the research that has already been done, we conducted a systematic literature review for the questions: what are the tested methods for decontaminating N95/FFP2 masks, and what impact do those methods have on the microbiological contamination and physical integrity of the masks? We used the results of a systematic review on the methods of microbiological decontamination of masks to make sure we covered all of the recommended methods for mask reuse. To this systematic review we added articles and studies relevant to the subject, but that were outside the limits of the systematic review. These include a number of studies that performed important fit and function tests on the masks but took their microbiological outcomes from the existing literature and were thus excluded from the systematic review, but useful for this paper. We also used additional unpublished studies and internal communication from the University of Geneva Hospitals and partner institutions. RESULTS: This paper analyzes the acceptable methods for respirator decontamination and reuse, and scores them according to a number of variables that we have defined as being crucial (including cost, risk, complexity, time, etc.) to help healthcare facilities decide which method of decontamination is right for them. CONCLUSION: We provide a resource for healthcare institutions looking at making informed decisions about respirator decontamination. This informed decision making will help to improve infection prevention and control measures, and protect healthcare workers during this crucial time. The overall take home message is that institutions should not reuse respirators unless they have to. In the case of an emergency situation, there are some safe ways to decontaminate them.

WHO Year of the Nurse and Midwife: More clean and educated hands for all.

For the last 10 years, the World Health Organization has been celebrating World Hand Hygiene Day on the 5th of May, bringing together the global healthcare ecosystem to celebrate hand hygiene. This day was created to raise awareness about the importance of hand hygiene in healthcare settings, as well as to focus on a specific annual topic to be highlighted to a global audience. The World Health Assembly designated 2020 as the Year of the Nurse and Midwife, and the slogan of this year's 5th of May was "Nurses and Midwifes: Clean Care is in Your Hands". This 5th of May helped us to highlight the need for increased staffing and hand hygiene training. In this paper we aimed to raise awareness about the global impact linked to adherence to proper hand hygiene practices by nurses and midwives.

"Nurses and midwives: clean care is in your hands": the 5th May 2020 World Health Organization SAVE LIVES: Clean Your Hands campaign.

In honor of Florence Nightingale's 200th birthday, the World Health Organization (WHO) has declared 2020 the "Year of the Nurse and Midwife". On May 5th of this year, for the annual celebration of the SAVE LIVES: Clean Your Hands campaign, WHO will focus on the essential role that nurses and midwives play in contributing to saving millions of lives per year. It is necessary to recognize the work and the immense responsibility that nurses and midwives carry since achieving Universal Health Coverage is highly reliant on them.