Factors affecting hand hygiene practice during the COVID-19 pandemic in the Zimbabwean population: a qualitative study.

BACKGROUND: Practicing hand hygiene is recommended as one of the key preventive measures for reducing the transmission of COVID-19 and other infectious agents. However, it is often not practiced frequently enough or correctly by the public. We aimed to identify barriers to and facilitators of hand hygiene in the Zimbabwean population during the COVID-19 pandemic. METHODS: A qualitative study was conducted with a purposive sample of health workers, village health workers, church leaders, traditional healers, teachers, youth leaders and the general population selected from ten districts across the country from September to October 2022. Semistructured interviews were conducted with 3 key informant interviews per site. In addition, one homogenous focus group discussion was also conducted per site using a focus group discussion guide. The data were recorded on audiotapes, transcribed verbatim, and translated into English. All the analyses were performed manually using thematic analysis. RESULTS: Two themes were identified as facilitators of hand hygiene. These include individual factors (knowledge of hand hygiene practices and how they are performed) and access-related factors (access to hand washing infrastructure, soap, and sanitizers). Among the barriers to hand hygiene, four themes were identified: individual factors (knowledge gaps in proper hand washing, lack of conviction about hand hygiene, and habitual behaviour), access-related factors (lack of access to hand washing infrastructure, soap, and sanitizers), safety concerns (concern about the side effects of sanitizers), and sociocultural and religious factors (social customs, cultural beliefs, values, and religious practices). CONCLUSION: During public health emergencies, there is a need for people to access uninterrupted, on-premises water supplies to promote compliance with hand hygiene. The provision of clean water and hand washing facilities is critical for vulnerable communities to afford them the opportunity to improve quality of life and facilitate resilience in the event of future pandemics. Community engagement is important for identifying vulnerability factors to provide appropriate mitigatory measures.

Knowledge, Attitudes, and Practices of Hand Hygiene, Mask Use, and Social Distancing among Public Hospital and Polyclinic Nurses in Barbados during the Coronavirus 2019 Pandemic.

BACKGROUND: Nurses are essential members of the healthcare workforce and were among the first-line carers for patients in community and hospital settings during the COVID-19 pandemic. As a result, they were at a heightened risk of infection, resulting in several reported deaths among nursing staff. Several preventive measures were adopted to contain the spread of the COVID-19 virus. This study aims to explore the knowledge, attitudes, and practices (KAP) of nurses regarding hand hygiene, mask wearing, and social distancing measures in healthcare settings in Barbados during the COVID-19 pandemic. METHOD: An online survey of nurses working in public hospitals and polyclinics (public primary care clinics) in Barbados from March 2021 to December 2021 was conducted. A nonsystematic convenience sampling method was employed to recruit nurses who were readily available and willing to participate. A questionnaire captured the sociodemographic information and knowledge and practices related to hand hygiene, the use of face masks, and social distancing. Each correct response received one mark. Overall knowledge scores were categorized as poor (<60%), average (60-80%), or good (>80-100%). RESULTS: Of the 192 participants, the majority were female (82.8%) and had >5 years of experience (82%). The findings revealed that 45.8% had poor knowledge of hand hygiene, and that the knowledge of 43.8% of respondents was average. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 2.1 times increased odds (95% confidence interval 1.0, 4.2) of having good knowledge compared to other nursing categories. Regarding mask wearing, 53.6% of nurses had average knowledge, and 27.1% had good knowledge. Multivariable logistic regression showed that, after adjustment for age and gender, registered nurses had 3.3 times increased odds (95% confidence interval 1.5, 7.4) of having good knowledge compared to nursing assistants. A total of 68.6% of respondents followed the correct steps of handwashing every time, and 98.3% wore a mask in public places. More than half of the nurses (51.2%) kept a safe distance from others to avoid spreading SARS-CoV-2; one-third were in a crowded place(s) in the past three months, and 55.8% usually followed guidelines for social isolation as recommended by the WHO. CONCLUSIONS: The study identified knowledge deficiencies related to hand hygiene and wearing masks among nurses. It is imperative to provide additional training on infection control measures.

Hand Washing Practice and Food Insecurity are Associated With Undernutrition of Breastfeeding Mothers in Rural Ethiopia: A Cross-sectional Study.

Background: Breastfeeding mothers are prone to undernutrition. However, factors contributing to maternal undernutrition are not exhaustively understood. Hence, this study aimed to determine prevalence of undernutrition among breastfeeding mothers and identify associated factors. Methods: A cross-sectional study was conducted among 606 breastfeeding mothers from selected rural districts in Oromia and Sidama regional states of Ethiopia. Data were collected through an interviewer-administered questionnaire. Nutritional status was assessed using body mass index (BMI) and mid-upper-arm-circumference (MUAC). Logistic regression analysis was used to identify factors associated with maternal undernutrition. Results: One out of ten breastfeeding mothers was found undernourished as determined by BMI (12.6%) and MUAC (10.7%). Mothers who did not practice hand washing after cleaning children's bottom were 2 and 3 times more likely to be undernourished compared to their counters, as measured by BMI (AOR = 2.29, P = .002) and MUAC (AOR = 3.03, P < .001), respectively. Mothers living in mildly or moderately food insecure households (AOR = 2.37, P = .019) were more than two times more likely to be undernourished as determined by MUAC. Mothers who breastfed children in the age range of 9 to 11 (AOR = 2.79, P = .025) or 12 to 23 (AOR = 2.57, P = .018) months were more than two and half times more likely to be undernourished as determined by BMI. Conclusions: Maternal undernutrition is a medium-level public health problem in rural districts of Oromia and Sidama regional states in Ethiopia. The lack of hand washing practice after cleaning a child's bottom, household food insecurity and higher child age increased the odds of maternal undernutrition. Mothers should prioritize and improve their nutritional care as the age of their breastfed child increases. Nutrition programs in rural districts of Ethiopia should also aim to improve personal hygiene practices and food insecurity integrated with implementation researches to evaluate program's impact on nutritional status of breastfeeding mothers.

Hygiene Behavior and COVID-19 Pandemic: Opportunities of COVID-19-Imposed Changes in Hygiene Behavior.

In Ethiopia, the WHO strategies to stop coronavirus transmission were implemented rapidly. As a result, there was a rapid change in hygiene behavior, which are basic for preventing COVID-19 and other contagious diseases. This research was designed to examine the sustainability of the COVID-19 imposed hygiene behaviors for future challenges. The study was conducted in 2 major nexus areas in Addis Ababa. The data were collected using a questionnaire and spot-check from 622 respondents selected by systematic random sampling. The questionnaire was given at every 15th interval in several spots of the site. Observational hygiene-check was done through observing key personal hygiene conditions. Proportion, χ2 test, and Poisson's regression were applied for the analysis. The χ2-test analyses showed that the hand washing frequency before, during, and post-COVID-19 was statistically significant (P < .005). Findings from the spot-check also show that the hands of 76.8%, the nails of 68.7%, and the hairs of 70.7% of the respondents were clean. The major driving factors for the rapid changes in hygiene behavior were the awareness developed (95%), the fear and panic (90%), and increased access to water and soap (63%). Nevertheless, the major reasons for failing to continue the COVID-19-imposed good hygiene practice in the post-COVID-19 times include the decline in infection and death rates (26%) and the decline in facility access (20%). Hand washing frequency significantly changed during the COVID-19 pandemic indicating that the practice as part of the preventive strategy was successful. However, as this was mainly due to the fear and panic in the community, the COVID-19 imposed hand washing practice did not bring real and sustainable behavioral changes. This indicates that for long-lasting changes in hygiene behavior, continuous and better approach need to be introduced.

Differential COVID-19 preventive behaviors among Asian subgroups in the United States.

BACKGROUND: Given the observed within-Asian disparity in COVID-19 incidence, we aimed to explore the differential preventive behaviors among Asian subgroups in the United States. METHODS: Based on data from the Asian subsample (N = 982) of the 2020 Health, Ethnicity, and Pandemic survey, we estimated the weighted proportion of noncompliance with Centers for Disease Control and Prevention (CDC) guidelines on preventive behaviors and COVID-19 testing by Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian). We examined these subgroup differences after adjusting for demographic factors and state-level clustering. RESULTS: Filipinos demonstrated the lowest rate of noncompliance for mask-wearing, social distancing, and handwashing. As compared with the Filipinos, our logistic models showed that the Chinese and the 'other Asians' subgroup had significantly higher risk of noncompliance with mask-wearing, while the Japanese, the Vietnamese, and other Asians were significantly more likely to report noncompliance with social distancing. CONCLUSIONS: The significant variation of preventive behavior across Asian subgroups signals the necessity of data disaggregation when it comes to understanding the health behavior of Asian Americans, which is critical for future pandemic preparedness. The excess behavioral risk among certain Asian subgroups (especially those 'other Asians') warrants further investigation and interventions about the driving forces behind these disparities.

Correlation of menstrual hygiene management with cervical intraepithelial neoplasia and cervical cancer.

Purpose: To find the correlation of menstrual hygiene management (MHM) with cervical intraepithelial neoplasia and cervical cancer. Materials and Methods: This case-control study was conducted in a tertiary care teaching hospital for 1 year. One hundred cases (CIN or cervical cancer) and 135 controls (normal cervical cytology, Swede's score below 5, or normal cervical histology) were surveyed about MHM practices through a predesigned, semi-structured questionnaire by interview method. Data were analyzed on SPSS version 17.0 statistical analysis software through Chi-square test and bivariate regression analysis. Results: All Poor MHM practices except frequency of change of absorbent were significantly more commonly seen in women with CIN or Cervical cancer as compared to controls (P < 0.001). The bivariate regression analysis showed that old age, illiteracy, and the use of old cloth are significant risk factors for cervical cancer. Conclusion: Poor menstrual hygiene practices of using old cloth and disposal in open are significant risk factors of cervical cancer. Good MHM practices should be widely publicized and implemented in the community to reduce the risk of cervical cancer.

Factors associated with hand washing effectiveness: an institution-based observational study.

BACKGROUND: Few studies have investigated how the effectiveness of hand washing in removing hand contaminants is influenced by the performance and duration of each step involved. We conducted an observational study by recruiting participants from a university campus, with the aim to comprehensively evaluate how performance, duration and demographic factors influence hand washing effectiveness. METHODS: A total of 744 videos were collected from 664 participants in July-October 2022 and independently evaluated by two infection control experts through labelling videos for correct and incorrect performance of each step. The individual hand washing effectiveness was determined by quantifying the percentage of residual fluorescent gel on the dorsum and palm areas of each participant's hands. A logistic regression analysis was conducted to identify factors that were significantly associated with better hand washing effectiveness. An exposure-response relationship was constructed to identify optimal durations for each step. Approximately 2300 hand images were processed using advanced normalization algorithms and overlaid to visualize the areas with more fluorescence residuals after hand washing. RESULTS: Step 3 (rub between fingers) was the most frequently omitted step and step 4 (rub the dorsum of fingers) was the most frequently incorrectly performed step. After adjustment for covariates, sex, performance of step 4 and step 7 (rub wrists), rubbing hands during rinsing, and rinsing time were significantly associated with hand washing effectiveness. The optimal overall hand washing time was 31 s from step 1 to step 7, and 28 s from step 1 to step 6, with each step ideally lasting 4-5 s, except step 3. The palms of both hands had less fluorescence residuals than the dorsums. The areas where residuals most likely appeared were wrists, followed by finger tips, finger webs and thumbs. CONCLUSIONS: Performance and duration of some hand washing steps, sex and rinsing time were associated with hand washing effectiveness. The optimal duration might be applied to all seven steps to achieve the best decontamination results. Further studies are needed to refine hand hygiene standards and enhance compliance.

The effect of a health extension program on improving water, sanitation, and hygiene practices in rural Ethiopia.

BACKGROUND: To make basic primary health care services accessible, especially to the rural community, the government of Ethiopia launched the Health Extension Program (HEP) in 2004. Most of components of HEP are dedicated to hygiene and sanitation. Few studies have assessed the role of the Health Extension Program in improving water, hygiene, and sanitation (WASH) practices in Ethiopia. This study explored the role of health extension workers (HEWs) in influencing household water treatment practices, latrine ownership, latrine use and ownership, and the use of hand-washing facilities on the incidence of diarrheal diseases among the children under five years of age in rural Ethiopia. METHODS: Using a cross sectional design, we conducted a national assessment that covered all nine regions of Ethiopia. We conducted face-to-face interviews among a sample of 6430 rural households using a structured questionnaire and an observation checklist to collect data from March 2018 to May 2019. Multilevel logistic regressions models were used to determine the relationships between the exposure of households to HEWs and WASH practice outcomes such as the use of water from an improved water source, household water treatment practices, availability of hand-washing and hand-washing with soap and water, availability of latrines, and use of latrines as well as the incidence of diarrheal diseases among children age 5 and younger. Our models were adjusted for covariates and confounders and P-values less than 5% were set to determine statistical significance. RESULTS: We found that 72.7% of rural households had some type of latrine and 27.3% reported practicing open defecation. A total of 71.5% of rural households had access to drinking water from improved water sources, but only 9.4% reported practicing household water treatment. Exposure to HEWs was positively associated with household water treatment practices (AOR: 1.46; 95% CI = 1.01-2.10) and latrine availability (AOR: 1.44; 95% CI = 1.15-1.80). Among the households who were either visited by HEWs at their home or the that visited health posts to meet with the HEWs, being exposed to WASH health education by HEWs was significantly associated with the availability of a hand-washing facility (AOR: 5.14; 95% CI = 4.11-6.42) and latrine availability (AOR: 1.48; 95% CI = 1.10-2.01). However, we did not find a relationship between the incidence of diarrhea among children age 5 and under and exposure to HEWs (AOR: 2.09; 95% CI = 0.73- 6.62). CONCLUSION: Our results show a significant association between exposure to the Health Extension Program/ HEWs and improved household water treatment practices, latrine construction, and the availability of hand-washing facilities in rural Ethiopia, suggesting the need to strengthen efforts to change WASH behavior through the Heath Extension Program. On the other hand, further investigation is needed regarding the spillover effect of latrine use practices and the reduction of the incidence of diarrheal diseases.

Access to Information, and Concerns, Myths and Truths about Food Safety during the COVID-19 Pandemic: An Overview of the Portuguese Population.

The COVID-19 pandemic raised questions and concerns about the possibility of the virus being transmitted through food, as the virus was found in sewage, shrimps and packages of frozen food. During the first wave of COVID-19, concerns about the transmission of SARS-CoV-2 through food arose. As the number of cases began to increase rapidly, so did the availability of information regarding the virus and ways to prevent infection. A significant portion of this information was disseminated by the media and the general public. Identifying and understanding the main doubts and concerns about food hygiene and safety raised by the Portuguese population during the first wave of COVID-19 is important in order to understand whether these issues have influenced their practices and what lessons can be learnt for food safety and hygiene education. The aims of this work were (1) to understand the doubts and concerns of the Portuguese population regarding food safety and hygiene during the first wave of COVID-19, and how these issues were clarified, (2) to analyze the population's opinion on food/hygiene myths and truths related to the transmission and prevention of the infection, and (3) to understand how the first wave of COVID-19 may have influenced the population's practices linked to food handling and consumption. The main doubts of the respondents were related to food handling (41.6%) and the possibility of transmission of COVID-19 through food (17%). Television was the main source of information used to clarify these doubts (32.9%), followed by a guideline issued by the Directorate-General of Health (30.7%). However, most respondents (50.9%) said that they had only found answers to some of their questions. Most respondents reported washing and disinfecting hands before (85% and 63.4%, respectively) and after (73.8% and 57.3%, respectively) the handling and organization of food purchases. Most respondents did not believe the myths about COVID-19 and food safety, but this depended on their level of education. Some practices may have changed as a result of the pandemic, particularly with regard to washing and disinfecting hands and food, as well as kitchen hygiene.

Mothers' hand washing practices and associated factors among model and non-model households in the rural community of Bibugn district, north west Ethiopia: The context of the Ethiopian health extension package.

Background: Hand-washing with soap is one of the most cost-effective ways of reducing the global infectious disease burden, particularly diarrhea and acute respiratory infections. The World Health Organization and United Nations Children's Fund report shows that in twenty-eight developing countries, more than one quarter of the population had no hand washing facility at home. This study aimed to assess hand washing practice and associated factors among mothers from model and non-model households in Bibugn district, North West Ethiopia. Methods: A community-based comparative cross-sectional survey was employed. A multi-stage sampling technique was used to select households. Data was collected using a structured interview questionnaire and analyzed using SPSS version 20. A descriptive analysis was presented using texts, tables, and figures. Bi-variable and multivariable logistic regression was used to detect the potential difference between variables. Results: Mothers' hand washing practice with water and soap/ash at critical times was 20.3%. Hand washing practice at critical times shows significant differences between model and non-model households. Mothers' who had knowledge 3.49 times (AOR: 3.49, 95% CI: 2.05, 5.96), access to adequate water 2.22 times (AOR: 2.22, 95% CI: 1.36, 3.77), and hand washing facilities 1.88 times (AOR: 1.88, 95% CI: 1.18, 2.98) were more likely to practice hand washing than their counterparts. Conclusion: One fifth of mothers practice hand washing with water and soap or ash at critical times in the study area. Model households were better at hand washing practice than non-model households'. Expanding the model household program, availing hand-washing facilities, increasing water accessibility, and strengthening awareness creation were important to improving hand-washing practice.

Influence of setting-dependent contacts and protective behaviours on asymptomatic SARS-CoV-2 infection amongst members of a UK university.

We survey 62 users of a university asymptomatic SARS-CoV-2 testing service on details of their activities, protective behaviours and contacts in the 7 days prior to receiving a positive or negative SARS-CoV-2 PCR test result in the period October 2020-March 2021. The resulting data set is novel in capturing very detailed social contact history linked to asymptomatic disease status during a period of significant restriction on social activities. We use this data to explore 3 questions: (i) Did participation in university activities enhance infection risk? (ii) How do contact definitions rank in their ability to explain test outcome during periods of social restrictions? (iii) Do patterns in the protective behaviours help explain discrepancies between the explanatory performance of different contact measures? We classify activities into settings and use Bayesian logistic regression to model test outcome, computing posterior model probabilities to compare the performance of models adopting different contact definitions. Associations between protective behaviours, participant characteristics and setting are explored at the level of individual activities using multiple correspondence analysis (MCA). We find that participation in air travel or non-university work activities was associated with a positive asymptomatic SARS-CoV-2 PCR test, in contrast to participation in research and teaching settings. Intriguingly, logistic regression models with binary measures of contact in a setting performed better than more traditional contact numbers or person contact hours (PCH). The MCA indicates that patterns of protective behaviours vary between setting, in a manner which may help explain the preference for any participation as a contact measure. We conclude that linked PCR testing and social contact data can in principle be used to test the utility of contact definitions, and the investigation of contact definitions in larger linked studies is warranted to ensure contact data can capture environmental and social factors influencing transmission risk.

Behavioral changes of preventive activities of influenza among children in satellite cities of a metropolitan area of Tokyo, Japan, by the COVID-19 pandemic.

OBJECTIVE: In children in a metropolitan area of Tokyo, Japan, behavioral change and influenza infection associated with the frequency of nonpharmaceutical interventions (NPI) was assessed from the 2018-2019 season (Preseason) and the 2020-2021 season (coronavirus disease 2019 [COVID-19] season). METHODS: We conducted an exclusive survey among children attending preschool, elementary school, and junior high school in the Toda and Warabi regions, Japan, during the 2018-2019 (Preseason, distributed via mail) and 2020-2021 seasons (COVID-19 season, conducted online). The proportion of preventive activities (hand washing, face mask-wearing, and vaccination) was compared in the Preseason with that of the COVID-19 season. The multivariate logistic regression model was further applied to calculate the adjusted odds ratio (AOR) with 95% confidence intervals (CIs) for influenza infection associated with NPI frequency (hand washing and face mask wearing) in each Preseason and COVID-19 season. RESULTS: The proportion of vaccinated children who carried out hand washing and face mask wearing was remarkably higher during the COVID-19 season (48.8%) than in the Preseason (18.2%). A significant influenza infection reduction was observed among children who washed hands and wore face masks simultaneously (AOR, 0.87; 95% CI, 0.76-0.99; P = 0.033). CONCLUSIONS: A strong interest and performance in the intensive measures for the prevention of influenza under the COVID-19 pandemic was demonstrated. Positive association was observed from a combination of NPI, hand washing, and face mask-wearing and influenza infection. This study's findings could help in activities or preventive measures against influenza and other communicable diseases in children.

The flip side of frequent sanitising and hand washing.

The stratum corneum is the outermost layer of the epidermis. It acts as an interface with the external environment and functions as a barrier that prevents microorganisms and allergens from penetrating the skin, while preventing bodily fluids, electrolytes and proteins from being lost in a process aimed at maintaining homeostasis. With the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an increase in hygiene practice, particularly hand washing and the use of hand sanitisers. These practices have undoubtedly assisted a great deal in combatting the rate of transmission and contributed immensely to saving lives. However, repeated hand washing and the use of sanitisers have both been linked with marked skin dryness and contact dermatitis. This especially holds true when the above-mentioned practices are carried out in the absence of intermittent hand moisturiser usage.

Changes in water treatment, hygiene practices, household floors, and child health in times of Covid-19: A longitudinal cross-sectional survey in Surkhet District, Nepal.

INTRODUCTION: Consistent and effective practice of water treatment, sanitation, and hygiene (WASH) behaviour is an indispensable requisite for realizing health improvements among children living in low-income areas with challenging hygienic conditions. Sustainably achieving such a behaviour change is challenging but more likely to be realized during epidemics, when health threats are high and the dissemination of information on preventative measures is intense. Our study conducted cross-sectional surveys in Surkhet District Nepal, before and during the Covid-19 pandemic to assess the impact of water safety interventions and hygiene training implemented before and during the pandemic on WASH conditions and practices and to assess the association of these changes with child health. METHODS: Information on WASH infrastructure, WASH behaviour, nutrition, and child health, including on parasitic infections, was obtained before and during the Covid-19 pandemic in spring 2018 and spring 2021, from 589 children aged between 6 months and 10 years and their caregivers. Data was collected through quantitative, structured face-to-face interviews, observations, health examinations of children including anthropometric measurements, analysis of children's stool, and water quality analysis. The association of changes in WASH factors with changes in child health was analysed using multivariate generalized estimating equations for repeated measures. RESULTS: Water safety management was significantly improved by the introduction of chlorination to piped water supply systems, which served 40% of households. In addition, the percentage of households using a ceramic water filter increased from 12.2% to 34.8%. Large and significant changes were observed in handwashing behaviour (frequency, use of soap and washing at critical times) and infrastructure: 35% of households constructed a new handwashing station. Kitchen and household hygiene also improved. An additional 22% of households improved the cleanliness of the toilet. The number of houses with a cemented floor increased by 20%. WASH changes were significantly associated with improved child health: the chlorination of piped water supply reduced odds ratios for diarrhoea (OR = 0.36, 95% CI = 0.15-0.88, p = 0.025), respiratory difficulties (OR = 0.39, 95% CI = 0.16-0.92, p = 0.033), fever (OR = 0.42, 95% CI = 0.26-0.71, p = 0.001) and cough (OR = 0.58, 95% CI = 0.36-0.93, p = 0.024), and. The frequency of handwashing with soap was associated with significantly reduced odds ratios for infections with Giardia lamblia (OR = 0.68, 95% CI = 0.50-0.91, p = 0.011), stunting and wasting (OR = 0.75, 95% CI = 0.66-0.92, p = 0.003) and fever (OR = 0.85, 95% CI = 0.75-0.96, p = 0.008),. The presence of a handwashing station at baseline was associated with significantly reduced odds ratios for respiratory difficulties (OR = 0.45, 95% CI = 0.26-0.78, p = 0.004). The construction of a handwashing station between baseline and endline was significantly associated with reduced odds ratios for pale conjunctiva (OR = 0.32, 95% CI = 0.17-0.60, p < 0.001), which is a clinical sign of iron deficiency and anaemia, respiratory difficulties (OR = 0.39, 95% CI = 0.17-0.89, p = 0.026) and cough (OR = 0.44, 95% CI = 0.26-0.76, p = 0.003). Using a clean container for the transport of drinking water was significantly associated with reduced odds ratios for infections with Giardia lamblia (OR = 0.39, 95% CI = 0.16-0.93, p = 0.033) and diarrhoea (OR = 0.48, 95% CI = 0.24-0.96, p = 0.038). Similarly, a cemented floor in the household was significantly associated with reduced odd ratios for diarrhoea (OR = 0.38, 95% CI = 0.16-0.87, p = 0.022) and infections with Giardia lamblia (OR = 0.44, 95% CI = 0.19-1.02, p = 0.056). CONCLUSION: WASH training and the promotion of preventative measures during the Covid-19 pandemic supported improved water safety management and hygiene behaviour, which resulted in a reduction in infectious diseases among children in the study area.

Hand-Washing at Critical Times and Associated Factors Among Mothers/Caregivers of Under-Five Year Children in Nefas Silk Lafto Sub-City, Addis Ababa, Ethiopia.

Background: Hand washing is the simplest, most affordable, and most effective means of limiting the spread of infections. Despite increasing efforts to improve hand washing at critical times (after defecation, after handling child/adult feces or cleaning child's bottom, after cleaning the environment, before preparing food, and before eating food), mothers/caregivers of under-five children fail to conduct it; but the reason appears unclear. Thus, this study sought to identify hand washing at critical times and associated factors among mothers/caregivers of under-five children in Nefas Silk Lafto Sub-City, Addis Ababa, Ethiopia. Methods: A facility-based cross-sectional study was conducted on April 1-15, 2019, and 312 mothers/caregivers participated. A pretested questionnaire was used to collect data from participants by interviewer-administered technique and the data were analyzed with the Statistical Package for Social Science version 20. The factors were determined by conducting logistic regression and the crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals. All statistical tests were conducted at a 5% level of significance. Results: The study revealed that 232 (74.4%; 95% CI [69.6%-79.2%]) mothers/caregivers washed their hands at critical times. The illiterate mothers/caregivers and mothers/caregivers who lacked tap water inside the home or the backyard had 66% (AOR = 0.34; 95%CI [0.17-0.69]) and 62% (AOR = 0.38; 95%CI [0.18-0.80]) reduced odds of washing hands at critical times, respectively. Mothers/caregivers from middle had (AOR = 4.56; 95%CI [1.84-11.33]), richer had (AOR = 5.61; 95%CI [2.11-15.30]), and the richest had (AOR = 6.14; 95%CI [2.24-16.72]) times increased likelihood of washing hands at critical times than the poorest. Conclusion: The majority of mothers/caregivers practiced hand washing at critical times, and improving maternal literacy, household economy, and availability of water sources in the backyard are needed to maintain and enhance the practice.

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

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

Job burnout is associated with poorer hand-washing behaviors among restaurant kitchen chefs: evidence from Jiangsu Province, China.

Inadequate hand-washing among chefs is a major contributor to outbreaks of foodborne illnesses originating in restaurants. Previous studies have found that mental health influences hygiene behaviors among food handlers, who have a high rate of job burnout. However, it is still unclear whether job burnout leads to restaurant kitchen chefs' poor hand washing behaviors (HWBs). In this study, we interviewed 453 restaurant kitchen chefs in Jiangsu Province, China regarding job burnout and HWBs during the summer (July-August) of 2020. The aims were to investigate job burnout (an individual internal motivation factor), identify determinants of job burnout, and examine the association between job burnout and HWBs. Variance analysis, post hoc multiple comparisons, linear regression models, and structural equation modeling were used to analyze the response data. This study revealed that chef age and the scale of the restaurant were significantly and negatively associated with reduced professional efficacy. Combined cuisine and pastry chefs had a more positive perception of their own professional efficacy than the other kitchen chefs, whereas the incidence of exhaustion was significantly higher in pastry chefs than in cuisine chefs and kitchen hands. Reduced professional efficacy was significantly and negatively associated with HWBs for all chefs. To improve the level of hand hygiene among chefs, measures should be taken to enhance chefs' professional efficacy. Furthermore, close attention should be paid to chefs in small-scale restaurants, younger chefs, cuisine chefs, pastry chefs, and kitchen hands.

Promoting COVID-19 prevention strategies in student dormitory setting: A qualitative study.

OBJECTIVE: To explore the risk perceptions and COVID-19 prevention practices of dormitory residents in Indonesia. Participants: Nineteen dormitory residents, 3 staff and 1 dormitory manager were recruited from the Saint Theresa Avila student dormitory. Methods: This qualitative study used individual interviews and framework analysis. Results: Generally, the study confirms that there is a gap between risk perception and COVID-19 prevention practices among dormitory residents. There are barriers in accessing hand washing facilities and in complying with COVID-19 prevention protocols including not wearing masks, not following quarantine procedures and visiting friends' rooms. Conclusion: Dormitory managers and staff should repeatedly remind residents to wear masks and maintain safe distance through sending short messages on dormitory social media groups. In addition to psychological assistance and basic supplies during self-quarantine, providing sanitizer and installing posters detailing the hand-washing steps are essential at each hand-washing facility in the dormitory.

Using the health action process approach to predict facemask use and hand washing in the early stages of the COVID-19 pandemic in China.

Personal hygiene including wearing facemask and washing hands are instrumental to reduce transmission of COVID-19. The present study applied the health action process approach (HAPA) to examine the process from intention to protective behaviors in the early stages of the COVID-19 pandemic. A longitudinal online survey study was conducted among 229 individuals (61.6% females; M age = 25.37 years, SD age = 8.34 years) living in Hubei province, China. Action self-efficacy, outcome expectancy, risk perception, intention, planning and action control regarding facemask wearing and hand washing were assessed at baseline (Time 1), and behaviors were assessed a week later (Time 2). Data were collected from 30 January to 16 February 2020. Two structural equation models were specified to test the theory-driven determinants of the facemask wearing and hand washing respectively. The results showed that action self-efficacy predicted intentions to wear facemasks and wash hands. Intention and action control predicted both behaviors at Time 2. Associations between planning and behaviors were mixed. Mediation analyses revealed that action control significantly mediated the relationship between intention and both behaviors (facemask wearing: 90% CI [0.01, 0.12]; hand washing: 95% CI [0.01, 0.21]). Planning did not mediate the relationship between intention and the two behaviors. The findings illustrate that action self-efficacy is positively associated with intention to facemask wearing and hand washing, and action control contributes to bridging intention to behaviors. Both motivational and volitional factors warrant consideration in interventions to improve adherence to facemask wearing and hand washing in COVID-19.

Is simply washing hands before dialysis procedures sufficient for reducing peritoneal dialysis peritonitis?-A single center study from 2015 to 2020 in Yiwu, China.

INTRODUCTION: The study aimed to improve the qualified rate of hand hygiene and reduce the incidence of peritonitis in peritoneal dialysis (PD) patients. METHODS: A hand hygiene questionnaire was distributed to patients during home visits and outpatient visits in 2015 and 2020. Hand-washing practices were evaluated by collecting cultures from the hands of patients after hand washing, evaluating their household environment, and recording the antimicrobial resistance of pathogenic bacteria. RESULTS: Compared to patients in 2015, patients in 2020 had fewer errors in hand washing (p < 0.05), but the rate of qualification after hand washing was lower (p < 0.01). Furthermore, patients who used hand disinfectants after washing had a higher qualified rate. Coagulase-negative staphylococcus (CNS) was the most common isolated bacteria. From 2015 to 2020, the annual incidence of CNS PD peritonitis did not decrease, while the proportion of methicillin-resistant CNS decreased. CONCLUSION: The use of hand disinfectants after standard hand washing may help reduce the incidence of peritonitis in PD patients.