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Introduction: Efforts have been made to contain COVID-19. Human behavior, affected by knowledge and perceptions, may influence the course of disease. Methodology: A structured questionnaire was used to collect data from 422 participants. It consisted of 28 questions in four sections; seven questions about sociodemographic characteristics of participants, 12 questions to estimate level of knowledge about COVID-19, six questions to evaluate attitudes toward disease, and three questions to assess practices to prevent disease transmission. Results: Their overall understanding of COVID-19 was satisfactory. 69% of the participants had satisfactory levels of knowledge, and the main sources of information were social media platforms (79.70%) and television (70.90%). There was a significant difference in knowledge as a function of gender (p = 0.50), occupation (p = 0.012), and smoking (p = 0.041). The participants held optimistic attitudes and adopted appropriate protective measures. Most participants agreed that COVID-19 can cause death (64.7%), poses greater risks to elderly (93.4%) and those with chronic diseases (96.7%), it is mandatory to quarantine infected individuals (98.1%), preventive health measures are important (97.6%), and health authorities will succeed in controlling the pandemic (67.5%). There was a statistically significant association between satisfactory levels of knowledge and the practice of wearing masks and the adoption of protective measures (avoiding crowded places, frequent hand washing). Conclusions: Residents of Al-Jouf region in Saudi Arabia have satisfactory levels of knowledge, optimistic attitudes, and good practice during the rapid rise period of the pandemic. Awareness campaigns will improve any misbeliefs and risky behaviors.

Objective: The purpose of this study is to describe the personal hygiene and sanitation of food cutlery (bowl) on meatball cart traders at Makassar City. Methods: This research using descriptive observational with non-probability sampling techniques and accidental sampling method. Results: 80% respondents had good personal hygiene. Almost all respondents qualify the requirement of hand and finger hygiene, as well as hair hygiene. For clothes hygiene indicators, most qualify the requirements. As for the indicators of handwashing practices and the use of gloves, all respondents did not qualify the requirements. While the results of research related to food cutlery sanitation showed that knowledge that 86.7% were high, but many still did not know washing water requirements and bowl conditions when in storage. Conclusion: Most handlers attitude was categorized as adequate. It is suggested that the meatball cart traders always pay attention to hand hygiene and sanitation of cutlery to avoid bacterial contamination.

Introduction: Occupational skin diseases and hand contact dermatitis specifically are among the most common occupational diseases among the healthcare workers. Since surgical technologists have contact with allergens and irritant substances are more susceptible to hand contact dermatitis. Thus, the aim of this study was to evaluate the prevalence of occupational hand contact dermatitis and effective factors among surgical technologists in five educational centers affiliated to Mazandaran University of Medical Sciences. methods: The present cross-sectional study was conducted over 125 surgical technologists working in the hospitals affiliated with Mazandaran University of Medical Sciences who were selected via census sampling. Later, 97 participants who met the inclusion criteria were investigated. Data were collected by Nordic Occupational Skin questionnaire (NOSQ-2002) through interview and analyzed by SPSS software version 23. Results: The findings indicated that 68% of the examined technologists were female and 57.7% were over 37 years old. The prevalence of hand dermatitis was 45.4% (44 people). The highest prevalence was observed at the back of hands (24.7%) and between fingers (17.5%). Contact hand dermatitis had a significant correlation with the participants’ gender (p = 0.002), work experience (p = 0.028), and frequency of hand washes (p = 0.021). Moreover, having a history of eczema and allergy (P-Value≤ 0.01) was significantly effective in increasing hand contact dermatitis. Conclusion: The prevalence of hand contact dermatitis is high among surgical technologists. Therefore, hospital managers are required to plan for preventive measures and control the current situation. Furthermore, future researchers are recommended to carry out more studies on allergic dermatitis.

Creutzfeldt-Jakob disease (CJD) is a transmissible spongiform encephalopathy whose initial description is associated with two German authors, Alfons Maria Jakob and Hans Gerhard Creutzfeldt. As polemic as the issue about the Creutzfeldt’s merit in the first description of the disease, is his history during the Third Reich. Some evidence pointed to the idea that he was essentially against the Nazi ideology, though some did not. He was an official member of the SS, but his own wife was convicted by a Nazi court. Some authors have argued that Creutzfeldt helped save many patients during Aktion T4 operation, but, in fact, he could have done more. Even during the post-war period, he sent a letter to authorities reporting the name of a Nazi physician who worked as a medical reviewer at the euthanasia court, but he did not proceed any further when his letter initially failed to start an investigation. RESUMO A doença de Creutzfeldt-Jakob (DCJ) é uma encefalopatia espongiforme transmissível, cuja descrição original está associada ao nome de dois autores alemães, Alfons Maria Jakob e Hans Gerhard Creuztfeldt. Tão polêmica quanto a questão sobre o real mérito de Creutzfeldt na primeira descrição da doença, é sua história de vida durante o Terceiro Reich. Algumas evidências apontavam para a ideia de que ele era essencialmente contra a ideologia nazista, mas outras não. Ele foi um membro oficial da SS, mas sua própria esposa foi condenada por um tribunal nazista. Alguns autores têm argumentado que Creutzfeldt ajudou a salvar muitos pacientes durante a operação Aktion T4, mas, na verdade, ele poderia ter feito muito mais. Mesmo durante o período pós-guerra, ele enviou uma carta às autoridades revelando o nome de um médico nazista que havia se empregado como revisor médico na corte sobre eutanásia, mas ele não insistiu mais quando sua carta inicialmente não desencadeou uma investigação.

The coronavirus disease 2019 (COVID-19) pandemic has upended every aspect of life in the United States and forced Americans to rethink their daily activities, including how they work, attend school, secure food, obtain health care, and maintain social connections. For vulnerable populations that were already facing significant barriers to health, such as people experiencing homelessness, the pandemic has only generated new hardships and exacerbated existing inequities. (Am J Public Health. Published online ahead of print November 19, 2020: e1-e3. https://doi.org/10.2105/AJPH.2020.305961).

Since the Okinawan islands are located in the southernmost part of Japan, where the climate is subtropical, several episodes of influenza epidemics occur during the summer season. More recently, we have demonstrated that summer influenza epidemics occur every year. After the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in January 2020, measures to avoid disease transmission have been widely promoted in Japan, such as the use of masks, handwashing, remote work, and cancellation of large events. These measures might also have reduced the spread of other infectious diseases, such as the seasonal influenza. Based on this background, we evaluated weekly influenza activity in the 2019/2020 season. After the SARS-CoV-2 pandemic, the summer influenza in the Okinawa prefecture disappeared in 2020. The reasons for the disappearance of summer influenza in Okinawa are discussed herein.

Background Supply driven programs that are not closely connected to community demand and demand-driven programs that fail to ensure supply both risk worsening inequity. Understanding patterns of uptake of behaviors among the poorest under ideal experimental conditions, such as those of an efficacy trial, can help identify strategies that could be strengthened in routine programmatic conditions for more equitable uptake. WASH Benefits Bangladesh was a randomized controlled efficacy trial that provided free-of cost WASH hardware along with behavior change promotion. The current paper aimed to determine the impact of the removal of supply and demand constraints on the uptake of handwashing and sanitation behaviors across wealth and education levels. Methods The current analysis selected 4 indicators from the WASH Benefits trial— presence of water and soap in household handwashing stations, observed mother’s hand cleanliness, observed visible feces on latrine slab or floor and reported last child defecation in potty or toilet. A baseline assessment was conducted immediately after enrolment and endline assessment was conducted approximately 2 years later. We compared change in uptake of these indicators including wealth quintiles (Q) between intervention and control groups from baseline to endline. Results For hand cleanliness, the poorest mothers improved more [Q1 difference in difference, DID: 16% (7, 25%)] than the wealthiest mothers [Q5 DID: 7% (− 4, 17%)]. The poorest households had largest improvements for observed presence of water and soap in handwashing station [Q1 DID: 82% (75, 90%)] compared to the wealthiest households [Q5 DID: 39% (30, 50%)]. Similarly, poorer household demonstrated greater reductions in visible feces on latrine slab or floor [Q1DID, − 25% (− 35, − 15) Q2: − 34% (− 44, − 23%)] than the wealthiest household [Q5 DID: − 1% (− 11, 8%). For reported last child defecation in potty or toilet, the poorest mothers showed greater improvement [Q1–4 DID: 50–54% (44, 60%)] than the wealthier mothers [Q5 DID: 39% (31, 46%). Conclusion By simultaneously addressing supply and demand-constraints among the poorest, we observed substantial overall improvements in equity. Within scaled-up programs, a separate targeted strategy that relaxes constraints for the poorest can improve the equity of a program. Trial registration WASH Benefits Bangladesh: ClinicalTrials.gov, identifier: NCT01590095. Date of registration: April 30, 2012 ‘Retrospectively registered’.

BACKGROUND AND OBJECTIVES: In response to the COVID-19 pandemic outbreak and to ensure the safety of epidemic prevention in the hospital, the hospital has established mitigation strategies in advance including risk assessment and effect analysis to control hospital visitors and accompanying persons. The study aims to assess the effectiveness of mitigation strategies implemented to effectively prevent the invasion and spread of the virus. METHOD: Conduct a status analysis in accordance with the Healthcare Failure Mode and Effect Analysis (HFMEA) 4-step model, construct a response workflow, confirm the failure mode and potential causes, perform hazard matrix analysis and decision tree analysis, and formulate risk control management measures. RESULTS: For the 4 main processes and 9 subprocesses of the accompanying carers and contract caregivers entering the hospital, 26 potential failure modes and 42 potential causes of failure were analyzed. Following implementing improvement measures including strategies targeting the accompanying person, mitigation workflow failure rates decreased from 42 to 13 items, the pass rate for the maximum body temperature cutoff increased from 53.1% to 90.8%, and the compliance rate of hand washing increased from 89.5% to 100%. CONCLUSION: The HFMEA model can effectively implement preventive risk assessment and workflow management of high-risk medical procedures. The model can adjudicate the health of hospital visitors during the epidemic/pandemic, provide epidemic/pandemic education training and preventive measure health education guidance for hospital visits, and improve their epidemic prevention cognition. When combined, these strategies can prevent nosocomial infection to achieve the best anti-epidemic effect.

Helzer and Pizarro (2011) reported 2 studies that showed an influence of cleanliness cues on political attitudes. Specifically, when standing near a hand-sanitizer dispenser (signal of cleanliness and purity), individuals rated their political attitudes more conservative, compared with individuals who were standing near an empty wall. The present study reports 2 failed attempts to replicate the results of Study 1 in Helzer and Pizarro (2011). Additionally, a meta-analysis was conducted by combining the results of Helzer and Pizarro (2011), the failed replications reported here, and a third failed replication reported by Allison-Godfrey, Bronson, Luby, Salazar, and Holmes (2015). The meta-analysis revealed a very small effect of the presence of cleanliness cues on political attitudes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background Since the outbreak of SARS-CoV-2, authorities have preached the importance of personal hygiene, including hand washing and disinfection. Objective To evaluate changes in the frequency of hand washing and hand care, the onset of hand eczema (HE) and risk factors associated with HE since the outbreak of SARS-CoV-2 in Munich in January 2020. Materials & Methods All dermatologic outpatients at the university hospital between April 6 and April 19 were asked to complete a structured questionnaire. Results Data of 512 patients with a median age of 49 years (243 females, 267 males) were analysed. The frequency of hand washing and hand disinfection increased after the outbreak of SARS-CoV-2 (p < 0.001, respectively). While symptoms associated with HE were reported by 29.9% (149/499) of patients, the actual diagnosis of HE was reported less frequently by 11.2% (53/473) with a median duration of 120 days. Frequent hand disinfection (p = 0.039), atopic dermatitis (p = 0.006) and young age (p = 0.0499) were identified as risk factors for symptoms of HE. Hand care was performed more frequently during the pandemic than before (p < 0.001). A high frequency of hand care during the pandemic was not significantly associated with symptoms of HE (p = 0.172), but was associated with self-recognition of HE symptoms (p = 0.002). Conclusion After the outbreak of SARS-CoV-2, the frequency of hand hygiene measures increased. A considerably high prevalence of HE symptoms was associated with frequent hand disinfection, atopic dermatitis and young age. Awareness of HE should be raised in order for preventive measures to be taken earlier.

BackgroundEntertainment-education (E-E) media can improve behavioral intent toward health-related practices. In the era of COVID-19, millions of people can be reached by E-E media without requiring any physical contact. We have designed a short, wordless, animated video about preventive COVID-19 behaviors that can be rapidly distributed through social media channels to a global audience. The E-E video’s effectiveness, however, remains unclear.Methods/designThis is a multi-site, parallel group, randomized controlled trial comparing the effectiveness of an E-E video on COVID-19 against (i) an attention placebo control (APC) video and (ii) no video. For our primary outcomes, we will measure knowledge about preventive COVID-19 behaviors. We will also use a list randomization approach to measure behavioral intent toward preventative COVID-19 behaviors. In each trial arm, participants will be randomized to a control list or a control list plus an item about social distancing, washing hands, cleaning household surfaces, sharing of eating utensils, and the stockpiling of essential goods. Using an online platform, we will recruit 17,010 participants (aged 18–59 years) from the USA, the UK, Germany, Spain, France, and Mexico.Trial registrationGerman Clinical Trials Register#DRKS00021582. Registered on May 12, 2020.DiscussionThis trial will utilize several randomization procedures, list experimentation methods, and state-of-the-art online technology to demonstrate the effectiveness of an E-E video to improve knowledge of, and behavioral intent toward, the prevention of COVID-19. Our results will inform future E-E video campaigns for COVID-19 and similar public health intervention needs.

Observational data suggest maternal handwashing with soap prevents neonatal mortality. We tested the impact of a chlorhexidine-based waterless hand cleansing promotion on the behavior of mothers and other household members. In rural Bangladesh in 2014, we randomized consenting pregnant women to chlorhexidine provision and hand cleansing promotion or standard practices. We compared hand cleansing with chlorhexidine or handwashing with soap before baby care, among mothers and household members in the two groups, and measured chlorhexidine use in the intervention arm. Chlorhexidine was observed in the baby’s sleep space in 97% of 130 intervention homes, versus soap in 59% of 128 control homes. Hand cleansing before baby care was observed 5.6 times more frequently among mothers in the intervention arm than in the controls (95% CI = 4.0–7.7). Hand cleansing was significantly more frequently observed in the intervention arm among women other than the mother (RR = 10.9) and girls (RR = 37.0). Men and boys in the intervention arm cleansed hands before 29% and 44% of baby care events, respectively, compared with 0% in the control arm. The median number of grams consumed during the neonatal period was 176 (IQR = 95–305 g), about 7.8 g/day (IQR = 4.2–13.8 g). Promotion of waterless chlorhexidine increased hand cleansing behavior among mothers and other household members. Discrepancy between observed use and measured chlorhexidine consumption suggested courtesy bias in structured observations. A waterless hand cleanser may represent one component of the multimodal strategies to prevent neonatal infections in low-resource settings.

Objectives To explore whether a school-based water, sanitation and hygiene programme, which includes group hygiene activities, contributes to the formation of independent handwashing and toothbrushing habits among Filipino children. Methods In this cluster-randomised trial, twenty primary schools were randomly allocated to the intervention or control arm. Intervention schools received group handwashing facilities and implemented daily group handwashing and toothbrushing activities. A soap use to toilet event ratio was calculated to measure children’s independent handwashing behaviour after toilet use, and dental plaque accumulation on Monday morning was measured as a proxy indicator for children’s independent toothbrushing behaviour at home. Results Four months after implementation, handwashing and toothbrushing behaviours did not significantly differ between intervention and control schools. The mean soap use in intervention schools and control schools was 0.41 g and 0.30 g per toilet event, respectively (p = 0.637). Compared to baseline, mean plaque scores reduced by 4.2% and 3.5% in intervention and control schools, respectively (p = 0.857). Conclusions Although health benefits have been established, school-based group handwashing and toothbrushing may not be sufficient to increase children’s uptake of independent hygiene behaviours.

High school students have limited food safety knowledge and lack safe food handling skills. However, youth of high school age are frequently employed in food service and will prepare food for themselves. This study was conducted to evaluate the effectiveness of a food safety educational intervention for changing students' food handling behaviors, and the theory of planned behavior was used to construct factors that contribute to behavior change. A combination of stationary and wearable (GoPro) cameras was used to observe the food handling practices of high school students in key areas, including food thermometer use, hand washing and hand drying, glove changing, and environmental cleaning. The percentage of correct food handling techniques was measured categorically, and the number of groups who complied with thermometer use and environmental cleaning guidelines was recorded. The percentage of students using correct hand washing, hand drying, and glove changing techniques significantly increased in the postobservation cooking session. However, the percentage of correct hand washing and glove changing events remained

The pandemic COVID‐19 disease affects people dramatically overall the globe by illness and death. Several strategies are applied to restrict the spread of this disease such as lockdown, adequate social distance in different activities, hand disinfection and the use of masks. Potential hazard outdoors comes from released viruses, which may remain in the air for a while and settle down afterward and contaminating surfaces. Solar ultraviolet radiation (UVR) is known to act as a natural environmental virucide. The virucidal effectivity of UVR depends on a first order on the sensitivity of the virus against UVR as well as on the amount of incoming UVR. Here, we present estimates of the potential of solar UVR in inactivating SARS‐CoV‐2 in the environment. This is done by combining DNA‐damaging surface solar UVR retrieved by satellites and the available information on fluence for inactivation of Coronaviridae. Our results show that solar UVR has a high potential to inactivate these viruses, but the degree depends strongly on location and season. In the subtropics (Sao Paulo, 23.5°S), the daily survival fraction is lower than 10−4 during the whole year, while close at norther latitudes (Reykjavik, 64°N), such a reduction can be found in June and July only., Solar ultraviolet radiation (UVR) acts as a natural environmental virucide by damaging nucleic acids and with that inactivating a virus. Its virucidal effectivity depends on the sensitivity of the virus against UVR as well as on the amount of incoming UVR. Here, we present estimates for in inactivating SARS‐CoV‐2 in the environment. This is done by combining DNA‐damaging solar UVR retrieved by satellites and the available information on fluence for inactivation of Coronaviridae. Our results show that solar UVR has a high potential to inactivate these viruses, but the degree depends strongly on location and season.

Older adults have a disproportionately higher COVID-19 risk; however, there is limited research investigating adherence to the major COVID-19 mitigation behaviors (handwashing, masking, social distancing) for older populations. We examined COVID-19 risk factors and predictors for adherence to COVID-19 mitigation behaviors among a national sample of US older adults.Data were retrieved for 3257 respondents from a nationally representative prospective sample of US Medicare beneficiaries aged ≥65 years. COVID-19 variables were collected in 2020, whereas all other data were collected in 2019.We used multiple logistic regression to analyze COVID-19 risk factors and predictors for handwashing, masking, and social distancing to minimize COVID-19 spread. All models applied survey sampling weights.Factors significantly associated with increased odds of COVID-19 diagnosis among US older adults were Hispanic ethnicity (adjusted odds ratio [aOR] = 2.83, P = .01), income (aOR = 0.71, P = .04), residential care or nursing home (aOR = 2.62, P = .01), and generalized anxiety disorder (aOR = 2.38, P = .04). We identified multiple factors significantly associated with adherence to handwashing, masking, and social distancing. Most notably, older males had a significantly lower odds of practicing all three COVID-19 mitigation behaviors, and Black older adults had a significantly higher odds of masking (aOR = 7.94, P .001) and social distancing (aOR = 2.33, P = .01).When prioritizing COVID-19 prevention efforts for older adults, risk factors that should be considered are race and ethnicity, income, residential setting, and anxiety. To effectively mitigate COVID-19 disease spread, public health professionals must also recognize sociodemographic and health factors may influence whether older adults adhere to handwashing, masking, and social distancing.

Objectives: This study aimed to assess the spatial distribution and determinant factors of handwashing practice using essential handwashing agents (soap and water) among households in Ethiopia.Methods: A two-stage stratified cluster sampling technique was used. Mixed-effect logistic regression analysis was also used to identify determinants of handwashing practice with essential agents.Results: In Ethiopia, household handwashing practices with essential agents had spatial variation (Moran’s Index 0.62, p < 0.001). The Amhara and Somali regions were identified as significant hotspots with low handwashing practice using essential agents.Conclusion: In Ethiopia, handwashing practice with essential agents showed spatial variation across the country with a very low rate. Areas with low handwashing practice with essential agents need high priority in the allocation of resources to ensure communities’ access to fixed and portable handwashing facilities, soap, and reliable water supplies. Households with low access to improved sanitation facilities, low wealth status, and low educational status should be targeted for the intervention.

Background The approval of ethanol by the Biocidal Products Regulation has been under evaluation since 2007. This follows concern over alcohol uptake from ethanol-based hand rubs (EBHR). If ethanol is classified as carcinogenic, mutagenic, or reprotoxic by the European Chemicals Agency (ECHA), then this would affect infection prevention and control practices. Aim A review was performed to prove that ethanol is toxicological uncritical and indispensable for hand antisepsis because of its unique activity against non-enveloped viruses and thus the resulting lack of alternatives. Therefore, the following main points are analyzed: The effectiveness of ethanol in hand hygiene, the evidence of ethanol at blood/tissue levels through hand hygiene in healthcare, and the evidence of toxicity of different blood/tissue ethanol levels and the non-comparability with alcoholic consumption and industrial exposure. Results EBHR are essential for preventing infections caused by non-enveloped viruses, especially in healthcare, nursing homes, food industry and other areas. Propanols are effective against enveloped viruses as opposed to non-enveloped viruses but there are no other alternatives for virucidal hand antisepsis. Long-term ingestion of ethanol in the form of alcoholic beverages can cause tumours. However, lifetime exposure to ethanol from occupational exposure Conclusion The body of evidence shows EBHRs have strong efficacy in killing non-enveloped viruses, whereas 1-propanol and 2-propanol do not kill non-enveloped viruses, that pose significant risk of infection. Ethanol absorbed through the skin during hand hygiene is similar to consumption of beverages with hidden ethanol content (

Hand hygiene at critical time-points (as established by the World Health Organization's model 'Five Moments for Hand Hygiene') remains the leading measure for minimizing the risk of healthcare-associated infections. While many interventions have been tested to improve hand hygiene compliance (HHC) of healthcare workers (HCWs), little is known about the relationship between HHC and empathy of HCWs.To investigate the relationship between moment-specific HHC rates and empathy of HCWs at both individual and ward levels.HHC data were collected via observation and self-report, and empathy levels were measured using an established questionnaire. The survey was conducted on 38 wards of three tertiary care hospitals in Germany. Observation data were obtained via in-house observations conducted ≤8 months before or after the survey.Evidence for the expected correlation between empathy of HCWs and moment-specific HHC was found for both observed HHC (Moment 1: r=0.483, P=0.031; Moment 2: r=588, P=0.006) and self-reported HHC (Moment 1: r=0.093, P=0.092; Moment 2: r=0.145, P=0.008). In analyses of variance, the critical interaction effect between empathy (i.e. lower vs higher empathy) and designated time-point of hand hygiene (i.e. before vs after reference task) was also significant.Empathy of HCWs should be considered as an important factor in explaining differences between moment-specific HHC rates. In consequence, empathy comes into focus not only as a crucial factor for high-quality patient care, but also as an important contributor to improving HHC.

Background The role of social ties, other-regarding preferences, and cultural traits in boosting community resilience and minimizing citizens’ vulnerability to crises such as COVID-19 is increasingly being recognized. However, little is presently known about the possible routes through which such personal preferences and cultural norms pertinent to social behaviors are formulated. Thus, in this paper, factors that can be potentially associated with individuals to self-regulate strict hand hygiene practices before the pandemic, during the state of emergency, and after the state of emergency was lifted in Japan are investigated. Focus is given to the handwashing education in primary school, a cultural practice originating from the old Shinto tradition, and individuals’ reciprocal inclinations. As people in Japan are known to be highly conscious of hygiene in all aspects of their daily life and are less likely to contract an infection, evidence obtained in this specific context could contribute to the better understanding of individuals’ health-related behaviors in general, and during crises in particular. Methods Using the data derived from a four-wave nationwide longitudinal online survey, we examined the extent to which elementary school education, childhood cultural experiences at shrines, and individual other-regarding preferences are associated with self-regulating hand hygiene practices prior to the pandemic and people’s efforts to comply with the government-imposed measures aimed at preventing the spread of COVID-19 infection during the state of emergency. We also investigated the long-term trends in the relationships among these factors (i.e., after the abolishment of the state of emergency) using panel data. Results Our findings reveal that childhood education and cultural experiences related to handwashing practices, as well as reciprocal inclinations, are significantly associated with Japanese attitudes toward personal hygiene (beyond handwashing practices) prior to, during, and after the state of emergency. In recognition of the possible effects of recall bias and measurement errors, several important attempts to mitigate these issues were made to strengthen the value of our findings. Conclusions The importance of school education received during childhood, as well as culture and other-regarding preferences, in the individual attitudes toward hand hygiene in adulthood highlighted in this study contributes to the better understanding of the role that these factors play in the variations in voluntary compliance with strict hand hygiene practices before and during an uncertain and prolonged crisis.

The objective of our study was to develop and test observational methods to evaluate COVID-19 preventive hygiene behaviors and physical distancing, and to evaluate the effectiveness of a government mandate on indoor fully covered mask wearing. An observational study was conducted of 4,736 individuals from April to October 2021 using 5-hour and rapid (10-minute) structured observations and spot checks to evaluate mask-wearing, handwashing, and physical-distancing behaviors, and the functionality of handwashing stations in 161 indoor public spaces across Bukavu, Democratic Republic of the Congo (DRC). Sixteen percent of individuals entering indoor public spaces were wearing a mask that fully covered their nose and mouth (fully covered mask wearing). Fully covered mask wearing was lowest inside schools (1%), universities (2%), religious establishments (22%), and health facility wards (28%). Overall physical distancing of more than 1-m inside indoor public spaces was 22%, and was lowest inside schools and religious establishments (7%). Thirty-nine percent of handwashing stations had water and a cleansing agent present. Ten percent of individuals washed their hands with a cleansing agent before entering an indoor space. Overall, fully covered mask wearing was similar for 5-hour and rapid structured observations (16% versus 15%). The odds of fully covered mask wearing was significantly greater with increased government enforcement of mask wearing in public spaces through fines (odds ratio, 2.72; 95% CI, 1.02–7.30). This study presents rigorous methods using structured observations to assess government mandates and programs on COVID-19 preventive hygiene behaviors in indoor public spaces in settings globally.

Occupational dermatosis, have raised extensively due hand hygiene with soap or alcohol-based sanitizers in the context of COVID-19 pandemic, once these products break the skin. In this perspective, this study aims to identify the most important skin injuries related to hand hygiene amongst health workers during the COVID-19 pandemic. An integrative review has been carried on through a search strategy involving terms and key words in three databases (Medline, Scopus and Embase). An unbiased evaluator selected observational studies that analyzed the outcomes of interest involving individuals between 30 and 49 years old, published in 2020 and 2021, with restriction of language (only English). Initially, 290 articles have been found, but only 15 met the inclusion criteria. 14 of them were cross-sectional studies and 1 was a prospective study. 70% (11 studies) identified Irritant Contact Dermatitis as the main occupational dermatosis on account of excessive hand hygiene. Dryness, desquamation and erythema were the main skin lesions found in 12 studies (80%). With regard to risk , three articles (20%) mention that the frequency of more than 20 times of hand wash as an important risk factor. Moreover, 9 studies observed that the hydration of the skin hand as a protective factor. Four articles (25%) pointed that alcohol-based sanitizers are less aggressive to the skin, when compared to hand wash with soap and water. After the review, the results have found that Irritant Contact Dermatitis is the most important skin injury that affects health care workers during the COVID-19 pandemic. Las dermatosis profesionales, en la lucha contra el coronavirus, se vieron estimuladas por la higiene de manos, ya que acaba provocando roturas en la piel. En esta perspectiva, este estudio tiene como objetivo identificar las principales lesiones cutáneas relacionadas con la higiene de manos en trabajadores de la salud durante la pandemia de COVID-19. Esta es una revisión integradora desarrollada en tres bases de datos (Medline, Scopus y Embase) a través de una estrategia de búsqueda que involucra descriptores y términos clave. Un evaluador seleccionó estudios observacionales, con personas de 30 a 49 años, publicados entre 2020 y 2021, con restricción de idioma (solo en inglés). Inicialmente se llegó a 290 estudios, pero solo se revisaron y sintetizaron 15, 14 transversales y 1 prospectivo. En general, 11 (70%) de los expedientes mencionan la dermatitis irritante primaria como dermatosis principal. La sequedad, la descamación y el eritema fueron las lesiones más asociadas, puntuadas en 12 (80%) de ellas. En cuanto a los riesgo, 3 (20%) de las encuestas citan la frecuencia de lavado de manos más de 20 veces al día. Además, 9 (60%) de la base de datos seleccionada eligieron la hidratación de manos como principal factor protector contra las dermatosis, así como 4 (25%) de ellos indican el uso de desinfectantes a base de alcohol en lugar del jabón como opción. Tras analizar los artículos, los resultados de los estudios mostraron que la dermatitis de contacto irritante primaria es la principal lesión que afecta a los profesionales sanitarios durante la pandemia de COVID-19. As dermatoses ocupacionais, no combate ao Coronavírus, foram estimuladas pela higienização das mãos, uma vez que acaba levando a ruptura da pele. Nessa perspectiva, este estudo tem como objetivo identificar as principais lesões cutâneas relacionadas à higienização das mãos em trabalhadores da saúde durante a pandemia da COVID-19. Trata-se de uma revisão integrativa desenvolvida em três bases de dados (Medline, Scopus e Embase) por meio de uma estratégia de busca envolvendo descritores e termos-chave. Um avaliador selecionou estudos observacionais, com indivíduos na faixa etária de 30 a 49 anos, publicados entre 2020 e 2021, com restrição de idioma (somente Língua Inglesa). Inicialmente, 290 estudos foram alcançados, mas apenas 15 foram revisados e sintetizados, sendo 14 transversais e 1 prospectivo. De forma geral, 11 (70%) dos arquivos elencaram a dermatite por irritante primário como principal dermatose. O ressecamento, a descamação e o eritema foram as lesões mais associadas, pontuadas em 12 (80%) deles. Quanto aos fatores de risco, 3 (20%) das pesquisas citam a frequência do ato de lavagem das mãos por mais de 20 vezes ao dia. Ademais, 9 (60%) da base de dados selecionada elegem a hidratação da mão como fator de proteção principal contra as dermatoses, assim como 4 (25%) deles apontam a utilização de desinfetantes a base de álcool em detrimento de sabão como escolha. Após análise dos artigos, os resultados dos estudos apontaram que a dermatite de contato por irritante primário é a principal lesão que acomete profissionais de saúde durante a pandemia da COVID-19.

This research aimed to qualitatively explore whether the determinants of handwashing behaviour change according to the duration of displacement or the type of setting that people are displaced to. We conducted an exploratory qualitative study in three different post-conflict settings in Northern Iraq–a long-term displacement camp, a short-term displacement camp, and villages where people were returning to post the conflict. We identified 33 determinants of handwashing in these settings and, of these, 21 appeared to be altered by the conflict and displacement. Determinants of handwashing behaviour in the post-conflict period were predominantly explained by disruptions to the physical, psychological, social and economic circumstances of displaced populations. Future hygiene programmes in post-conflict displacement settings should adopt a holistic way of assessing determinants and design programmes which promote agency, build on adaptive norms, create an enabling environment and which are integrated with other aspects of humanitarian response.

SUMMARY OBJECTIVE: This study aimed to characterize hand hygiene behavioural intention by hospital services clusters in a medium-sized hospital in an Ecuadorian city. METHODS: This is a cross-sectional study based on the World Health Organization Hand Hygiene Knowledge Questionnaire for Health-Care Workers. The responses on hand hygiene behavioural intention for the Five Moments for hand hygiene according to the World Health Organization were recorded in three categories: before patient contact, before and after sterile technique and management of body fluids, and after contact with the environment of the patient. The variables were the knowledge regarding the source of germs causing nosocomial infections, the optimal time to achieve disinfection with alcohol, hospital services clusters (clinical medicine, surgery, and therapeutic services), and history of previous formal hand hygiene training. The variables in each moment were analysed using a saturated log-linear model. RESULTS: The average age of participants was 34 years (Q1 32.1–Q3 36.4). Of them, 62% belonged to the clinic cluster and 87.6% had previous formal hand hygiene training. The incorrect response rates for before and after sterile technique and management of body fluids, before patient contact, and after contact with the environment of the patient were 30.2, 88.4, and 99.2%, respectively. In before patient contact, the incorrect responses for optimal time depended on the department (worse surgery cluster situation), and in before and after sterile technique and management of body fluids and after contact with the environment of the patient, the incorrect responses for source of germs depended on the previous formal hand hygiene training and the department (worse surgery and clinic clusters). CONCLUSION: The incorrect answer related to hand hygiene behavioural intention was high compared to other reports, and the worse situation was found in after contact with the environment of the patient and before patient contact. These data suggest the need of strengthening permanently the hand hygiene programme.

Introduction The most frequent adverse events in healthcare are healthcare-associated infections, whose burden is highest in resource-limited settings. In addition, low resource settings often lack Hand Hygiene (HH) knowledge and reliable supply to disinfectant, a necessity emphasized by the past West African Ebola Epidemic and the ongoing COVID-19 pandemic. PASQUALE aims to increase patient safety by introducing the WHO multimodal HH strategy in the University Hospital Bouaké, Côte d’Ivoire. Methods Assessment of HH knowledge, perception and compliance was performed 12 months before, right after the intervention and at a ten months interval using questionnaires for knowledge and perception and direct observation for compliance. The intervention consisted of a HH training and the introduction of local production of alcohol-based hand-rub. In the absence of a control group, the effectiveness of the intervention was assessed by a before-and-after study. Results Baseline knowledge score was 14/25, increased significantly to 17/25 (p p Conclusion The WHO HH improvement strategy is an effective and pandemic-adaptable method to increase long-term HH compliance. This study emphasizes that the implementation of the strategy to build a robust system is of utmost importance.

Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs.

Background Healthcare-associated infections are a major threat to patient safety, particularly vulnerable elderly living in nursing homes, who have an increased risk of infections and mortality. Although good hand hygiene is the most effective preventive measure against infections, few studies of hand hygiene adherence have been conducted in nursing homes. The aim of this study is to investigate hand hygiene adherence in nursing homes with students as observers using a validated observation tool. In addition, to examine when healthcare workers perform hand hygiene and when they do not. Methods This observational study used the World Health Organization’s observation tool for studying hand hygiene indication and adherence: “My five moments for hand hygiene.” For 1 week each in February and March 2021, 105 first-year nursing students conducted 7316 hand hygiene observations at 20 nursing home wards in one large municipality in Norway. Results The overall adherence rate found in this study was 58.3%. Hand hygiene adherence decreased from 65.8% in February to 51.4% in March. The adherence varied largely between the different wards, from 26.4 to 83.1%, and by occupation status, indications of hand hygiene, and use of gloves. Nursing students were found to have the greatest adherence, followed by nurses. The use of gloves reduced adherence. Healthcare workers to a larger degree conduct hand hygiene after contact with patients than before approaching them. Conclusions Hand hygiene adherence is too low to protect all residents against healthcare-associated infections, and the findings from this study indicate that there are many factors that influence hand hygiene adherence, eg., education, occupation status and glove use Increasing healthcare workers’ knowledge and skills of hand hygiene is needed to reduce healthcare-associated infections and reminders of the importance of hand hygiene adherence must be an ongoing activity. Interventions to improve hand hygiene adherence in healthcare workers is needed to reduce infections and antibiotic use in nursing homes.

Hand hygiene actions are essential to reduce healthcare-associated infections and the development of antimicrobial resistance. In this cross-sectional study at two tertiary hospitals, Freetown, Sierra Leone, we observed hand hygiene compliance (defined as using handwash with soap and water or alcohol-based hand rub (ABHR) amongst healthcare workers between June and August 2021. Using the WHO Hand Hygiene tool, observations were made in relation to the type of opportunity, different wards and types of healthcare worker. Overall, 10,461 opportunities for hand hygiene were observed, of which 5086 (49%) resulted in hand hygiene actions. ABHR was used more often than handwash (26% versus 23%, p < 0.001). Overall, compliance was significantly better: after being with a patient/doing a procedure than before (78% after body fluid exposure risk compared with 24% before touching a patient—p < 0.001); in Paediatric (61%) compared with Medical wards (46%)—p < 0.001; and amongst nurses (52%) compared with doctors (44%)—p < 0.001. Similar patterns of compliance were observed within each hospital. In summary, hand hygiene compliance was sub-optimal, especially before being with a patient or before clean/aseptic procedures. Improvement is needed through locally adapted training, hand hygiene reminders in wards and outpatient departments, uninterrupted provision of ABHR and innovative ways to change behaviour.

Background Older adults are at a higher risk from COVID-19. Individual preventive behaviors including frequent hand washing, mask wearing, and social distancing play important roles in reducing the transmission of COVID-19 in the community. This study aimed to identify the determinants of three preventive behaviors of older adults during the COVID-19 pandemic by using an Integrated Social Cognition Model. Methods Using a prospective study design, 516 Chinese older adults from Hubei province of China (mean age = 67.55 years, SD = 6.60, 57.9% females) completed two online questionnaire surveys. The demographics, social cognition constructs (motivational self-efficacy, risk perception, attitude, subjective norm, health knowledge, intention, volitional self-efficacy, planning, action control) and three preventive behaviors were measured during the first-wave online survey from 18 May 2020 to 7 June 2020. One month later, three preventive behaviors were measured again during the second-wave online survey. Data were analyzed by structural equation modelling. Results Models showed attitude, motivational self-efficacy and subjective norm were consistent predictors of intention, motivational self-efficacy was a consistent predictor of volitional self-efficacy, planning and volitional self-efficacy were consistent predictors of action control, and health knowledge was a consistent predictor of behaviors across all three preventive behaviors. In addition, mediating relationships were found in the model of hand washing behavior. In particular, planning (β = .109, p = .042) and action control (β = .056, p = .047) mediated between volitional self-efficacy and hand washing respectively. Action control also mediated between planning and hand washing (β = .087, p = .044). Moreover, the inclusion of past behaviors in three models attenuated most of the structural relations. Conclusions The current study’s findings basically supported the Integrated Social Cognition Model and identified key modifiable determinants of preventive behaviors. Based on this model, future interventions aiming to promote COVID-19 preventive behaviors among older adults are warranted.

In Pakistan, antimicrobial resistance (AMR) is expected to greatly increase the already high mortality and morbidity rates attributed to infections, making AMR surveillance and prevention a priority in the country. The aims of the project were to characterize the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare facility sink drains in Pakistan and to characterize how physical characteristics of sinks and healthcare facility rooms were associated with CRE in those sinks. The study took place in 40 healthcare facilities in Jamshoro Pakistan. Swabs were collected from sink drains in each facility that had a sink, and structured observations of sinks and facilities were performed at each facility. Swabs were plated on CHROMagar KPC to screen for carbapenem-resistant Enterobacteriaceae, which were then isolated on Mueller-Hinton agar plates. Antibiotic susceptibility was determined using the disk diffusion method to assess resistance to carbapenems, cephalosporins, and fluoroquinolones. Thirty-seven of the healthcare facilities had at least one sink, and thirty-nine total sinks were present and sampled from those healthcare facilities. Sinks in these facilities varied in quality; at the time of sampling 68% had water available, 51% had soap/alcohol cleanser at the sink, 28% appeared clean, and 64% drained completely. Twenty-five (64%) of the sink samples grew Enterobacteriaceae on CHROMagar KPC, sixteen (41%) of which were clinically non-susceptible to ertapenem. Seven of the 39 sampled sinks (18%) produced Enterobacteriaceae that were resistant to all three antibiotic classes tested. Several facilities and sink characteristics were associated with CRE. Sinks and drains can serve as undetected reservoirs for carbapenem-resistant Enterobacteriaceae. Control and remediation of such environments will require both systemic strategies and physical improvements to clinical environments.

Introduction: Community mitigation strategies (CMS) have demonstrated to be effective in the reduction of transmission and incidence of COVID-19, especially in the population with symptoms associated with the disease. The aim of this study was to evaluate the association between the presence of COVID-19 symptoms and adherence to CMS in Latin American adults. Methods: We carried out a secondary analysis of a database developed by the University of Maryland and Facebook social network during the COVID-19 pandemic. We included Latin American adults that used the Facebook platform and participated in a survey conducted from April 23 to May 23, 2020. The principal outcome variable was reported compliance with the three main CMS (physical distancing, use of face masks, and hand washing). The exposure variable included symptoms suspicious for COVID-19 defined as the presence of three or more symptoms of an acute clinical case of COVID-19. We performed generalized linear models of the Poisson family with a logarithmic link function to evaluate the association between the presence of COVID-19 symptoms and reported compliance with CMS. We calculated crude and adjusted prevalence ratios (PR) with their 95% confidence intervals (95%CI). Results: We analyzed 1,310,690 adults from Latin America; 48.1% were male and 42.9% were under 35 years of age. The prevalence of suspicious symptoms of COVID-19 was 18.5% and reported compliance with the three CMS was 45.3%. The countries with the highest proportion of reported compliance with the three CMS were Peru, Bolivia and Panama, while those with the lowest reported compliance were Costa Rica, Nicaragua and Honduras. In the adjusted model, people with suspicious symptoms for COVID-19 had a 14% lower compliance with the three CMS (aPR = 0.86; 95%CI: 0.85–0.87; p < 0.001). Conclusions: Less than half of the participants complied with the CMS, and those presenting suspicious symptoms for COVID-19 had lower reported compliance with the three CMS. University of Maryland Revisión por pares

ObjectivesHandwashing is known as the most preventive method for various infectious diseases. Health authorities have conducted various campaigns and public relations targeting the general population but few evaluations of these long-term interventions. This study aimed to investigate the association between experience of educational events or public relations (EXEP), attitude towards the effectiveness of handwashing (AEHW) and handwashing practice (HWP).SettingUsing a population-based cross-sectional study with a complex sample design, we explored the response outcomes of handwashing. Those outcomes were collected biennially using Community Health Survey among the years 2013, 2015, 2017 and 2019. We applied multivariate logistic regression for the association among sociodemographic factors, health conditions, EXEP, AEHW and HWP.ParticipantsTotal participants residing in Seoul were 23 139 (men 44.2%), 23 004 (men 44.4%), 22 955 (men 44.8%) and 22 930 (men 43.9%), in 2013, 2015, 2017 and 2019, respectively.ResultsOverall, participants with EXEP are more likely to be women, aged between the 30s and 60s, and with a higher educational level. Particularly, participants with EXEP had an increased association with HWP (OR 1.21, 95% CI 1.19 to 1.33) and AEHW (OR 1.50, 95% CI 1.38 to 1.63). In addition, AEHW also had an increased association with HWP (OR 1.67, 95% CI 1.53 to 1.81). The mediated effect of AEHW to HWP is not determined evidently.ConclusionThe results showed that EXEP is positively associated with HWP and AEHW among community-dwelling people. Our results confirm that educational activity can lead to more pronounced behavioural changes only when it forms a positive attitude.