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Handwashing is an essential prevention step in foodservice, This randomized comparative study assessed the effectiveness of three training methods -virtual reality (VR), Glo-Germ (GT), and traditional face-to-face training (CT)- in improving handwashing practices among foodservice workers (n = 129). Training focused on the World Health Organization’s 11-step handwashing process. Handwashing in the workplace was observed, in a pre- and post-test design, with microbiological swabs also taken. There was an increase in time spent on handwashing that was noticeable across all three groups (p < 0.05) with the highest in the VR group (50.16 ± 26.04 sec.). The mean number of handwashing steps increased across all groups, and the highest increase (8.91 ± 1.49 steps) was observed in the VR group. A statistically significant difference was observed among all groups regarding correctly performed steps, and the VR group showed the highest number of steps (p < 0.01). These findings suggest that VR-based training has value for enhancing hand hygiene practices in foodservice settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion Relevance to Clinical Practice Reporting Method Patient Contribution The infection prevention behaviours of kidney transplant recipients have been investigated, but the factors affecting these have not. Therefore, the present study aimed to examine the infection prevention behaviours of kidney transplant recipients and the factors related to these.The sample of this descriptive, cross‐sectional study included 148 kidney transplant recipients being followed in a kidney transplant outpatient clinic. Data were collected with a sociodemographic and clinical characteristics form, the Adherence to Measures against Infections Questionnaire and the Self‐Control and Self‐Management Scale between November 2022 and May 2023.The mean age of the patients was 50.29 ± 13.11 years. The rate of self‐reported hand hygiene was 51%. Age caused a significant difference in receiving a vaccine against pneumonia and wearing a mask. The rate of self‐reported behaviour of rinsing vegetables was higher among the married patients compared to single patients. Self‐management created a significant difference in receiving a vaccine against influenza and pneumonia, eating salad in a café or restaurant and wearing a mask outside home and consuming raw food, delicatessen products and street food (p < 0.05).This study revealed that the kidney transplant recipients displayed incomplete infection prevention behaviours including hand hygiene. Infection prevention behaviours differed in terms of age and self‐control and self‐management. Education and interventions are needed to improve the infection prevention behaviours of kidney transplant recipients.This study illustrates the characteristics of, and relationship between, sociodemographic factors and self‐management of infection prevention behaviours in kidney transplant recipients.Strengthening the reporting of cross‐sectional studies (STROBE) was followed.The study demonstrates that there is a need for interventions that will improve both the self‐management levels and infection protection behaviours of patients. Studies conducted in this direction will lead to a decrease in the infection rates of patients. [ABSTRACT FROM AUTHOR]

Background: The skin microbiota maintains a physical and immunological barrier to the environment. Little is known about how the microbiome changes over time or the effect of hand hygiene practices and moisturizer use. Objectives: To assess sex‐specific changes in skin bacteria over time, and how the microbiome is related to self‐reported hand eczema, hand hygiene practices and use of moisturizers. Methods: Swab samples from the dorsal hand were collected at baseline and 6.5 years later during the COVID‐19 pandemic, in 168 participants from the RHINESSA study in Bergen, Norway. The skin samples were analysed by 16S rRNA amplicon sequencing. Results: The alpha diversity of the hand microbiome increased from baseline to follow‐up, and beta diversity differed by sex at both time points. The relative abundance increased for several bacteria from baseline to follow‐up, with sex‐specific differences. Current hand eczema and aggravating hand eczema during the COVID‐19 pandemic were associated with an increase in Staphylococcus. High hand washing frequency at home was associated with lower alpha diversity and with higher abundance of Staphylococcus, Corynebacterium, Finegoldia, and Pseudomonas and lower abundance of Propionibacterium and Pelomonas. The alpha diversity increased with increasing time passing between hand washing and sampling, whereas more frequent moisturizer use was associated with significantly lower alpha diversity, and a change in abundance for some bacteria, such as more Pseudomonas. Conclusions: This longitudinal study revealed an overall increase in skin microbial diversity over a 6‐year period, which was unexpected since follow‐up was performed during the COVID‐19 pandemic when vigorous hand hygienic practices were introduced. Sex‐specific differences were identified at both time points. Individuals with hand eczema seem to develop a more dysbiotic skin bacterial community over time. Hand washing and use of moisturizers, with typically gender‐specific habitual patterns, may lead to change in bacterial composition. [ABSTRACT FROM AUTHOR]

Introduction: Hand hygiene compliance is one of the key performance indicators for infection prevention and control programmes, patient safety and quality of health services. WHO guidelines and the patient centred approach stress the need to increase patient involvement in hand hygiene promotion in healthcare settings. Patients' and health care workers' perspectives are critical for developing interventions to foster patient involvement in promoting hand hygiene. This study explored perceptions of health care workers and patients towards patients' involvement in hand hygiene promotion. Methods: An exploratory qualitative study was conducted in four health facilities: three public, and one private non-profit in central Uganda. We conducted key informant interviews (KIIs) with health care workers and focus group discussions (FGDs) with patients. Respondents were asked their views about a patient reminding a health care worker to practice hand hygiene and how best this can be done. Interviews were audio-recorded, and transcribed. Thematic content analysis was used. Results: We led seven FGDs grouped by sex (6 participants each), with patients from different units of the study health care facilities and 23 KIIs with the in-charges of the health care facilities, wards, and infection control committee members. The majority of the KIIs were in the age category 30 to 45 years (10/23), females (14/23), and 7/23 were nurses by cadre. For the FGD participants, the majority were aged 30 to 45 years (23/42), 24/42 were females, 21/42 had attained secondary education as their highest level of education and 21/42 were Catholics. The health care workers' and patients' views towards patients' participation in promoting hand hygiene among health care workers are presented according to the four themes that emerged: i) Patients reminding health care workers to practice hand hygiene was offensive; ii) Patients fear of negative response from health care workers, including being denied or receiving poor quality services; iii) Role of management in influencing hand hygiene (patient reminding a health care workers to wash hands could be acceptable in private health facilities compared to the public ones); iv) Suggestions on how patients' reminders to health care workers can be done, included empowering patients to do the reminders in a friendly and polite approach to the HCW. Conclusion: Patients are reluctant to remind health workers to practice hand hygiene, because they feel it is confrontational and embarrassing, while health care workers find it offensive. Patient involvement seems to threaten patient-provider relationships. However patient empowerment was reported to be critical in promoting it and this is in-line with the hand hygiene guidelines. [ABSTRACT FROM AUTHOR]

Background: Daycare centres play a critical role in early childhood development but are high-risk environments for infectious disease transmission due to close physical contact, shared toys, inadequate hygiene, and poor ventilation. These risks are especially concerning in low- and middle-income countries (LMICs) like Nigeria, where resources for infection control may be limited. This study aimed to identify and characterise virulence genes in bacterial isolates from daycare centres in Ile-Ife, Nigeria, to assess infection risks. Methods: Between November 2017 and July 2019, 233 samples were collected from 76 children, 33 daycare workers, and 124 fomites in 17 daycare centres. The bacterial isolates were analysed using conventional PCR and RAPD analysis to detect the presence of virulence genes. The frequency of crucial virulence genes and the prevalence of each bacterial species were recorded. Results: Key virulence genes were detected, including fimH in Klebsiella species (22.73% of Gram-negative isolates), algD in Pseudomonas aeruginosa (50%), and icaA and cna in Staphylococcus aureus (16.67%). Staphylococcus aureus was the most prevalent species (35%), followed by Klebsiella (28%) and Pseudomonas aeruginosa (20%). Conclusion: This study highlights the presence of virulent bacterial pathogens in daycare environments, posing a severe infection risk to children. To mitigate these risks, it is essential to implement enhanced infection control measures, such as regular microbial screening, improved hand hygiene practices, and disinfection protocols for fomites. Training programs for daycare workers on hygiene practices and routine monitoring could also significantly reduce infection transmission. These interventions are vital for safeguarding the health of daycare children in Nigeria and similar settings globally. [ABSTRACT FROM AUTHOR]

Introduction Methods Community and consumer involvement Results Conclusion PLAIN LANGUAGE SUMMARY Throughout the COVID‐19 pandemic, outpatient hand therapy services were restricted. The use of telehealth was adopted to continue to provide care to patients with hand injuries.This survey aims to investigate patient satisfaction with hand therapy delivered via telehealth in a NSW public tertiary referral metropolitan setting and explore whether this differs for specific hand injury/conditions and treatments offered.Patients using hand therapy services via telehealth between 28 June 2021 and 27 May 2022 responded to a bespoke electronic survey. Participants were grouped depending on their particular injury/condition and treatment received. Analysis was conducted using MS Excel, and correlations were determined by using Fisher's exact test.No consumers were involved in the study design or analysis.Sixty‐eight of 262 patients responded to the survey (26% response rate). Overall results showed high patient satisfaction (n = 55, 81%) with hand therapy delivered via telehealth with most patients agreeing that telehealth should be offered going forward (n = 59, 87%). Benefits reported by patients included convenience, reduced travel time and parking issues, and time saving. Patients receiving therapy for ‘finger thumb bony injury with K wires’ demonstrated a statistically significant association of lower satisfaction with telehealth (n = 3, 43%, P = 0.02). Patients receiving wound care over telehealth were just as satisfied with their experience (n = 15, 82%) as overall results (n = 55, 81%).The survey suggests that patients are satisfied with their experience of telehealth for hand therapy. Patients with finger thumb bony injuries with k wires may be less suitable for telehealth. Wound care appears to be well received over telehealth in a hand therapy population.There is little evidence to guide hand therapists in which conditions or injuries patients find can be managed well with telehealth. Patients who answered a survey about their experience with telehealth for their hand therapy management overall reported satisfaction with the experience. Some patients had undergone surgery for broken fingers and thumbs using wires to hold the bone together while it healed. These patients were less likely to find telehealth satisfactory for their hand therapy care. Most patients requiring wound care over telehealth found this satisfactory. [ABSTRACT FROM AUTHOR]

Aims Design Methods Results Conclusion Impact This study aimed to examine the effect of the hand hygiene education on middle school students' behavioral scores related to hand hygiene practices.The research adheres to a quasi‐experimental design suitable for the pre‐test Posttest model with a control group.The population of the study consists of a total of 1159 students, comprising 5th, 6th, 7th, and 8th graders. During the first semester of the 2021–2022 academic year, face‐to‐face education was conducted at a middle school located in Ankara. Two face‐to‐face training sessions were conducted to increase awareness of hand hygiene.The groups indicate homogeneity in terms of demographic characteristics. The mean hand hygiene behavior score was 56.45 ± 8.03 before the education in the intervention group, which increased to 59.79 ± 7.62 after the education. In the control group, the mean score was 55.98 ± 7.89 before the education and 57.15 ± 7.63 after the education. It was found that after the educational program, there was a statistically significant increase in hand hygiene behavior scores of the groups.The research findings indicate a beneficial impact of hand hygiene education on students' average behavioral scores.To foster lasting behavioral changes from a young age, it is advisable to implement hygiene education in schools periodically, including targeted interventions for middle school students. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusion Healthcare‐associated infections are still a worrying health problem that complicates patient care and increases morbidity and mortality. The incidence of infections in hemodialysis patients is still high and they constitute the second cause of hospitalization and death in this category.The study's objective was to evaluate nursing and medical staff's involvement in hospital hygiene.This is an observational study that took place within the hemodialysis unit of a Moroccan university hospital from March 2021 to June 2021. A surface swabbing technique for bacteriological examination was also carried out.The study revealed some shortcomings regarding hand hygiene which was respected by the nurses in only 17.5% of sessions and in 42.2% by the doctors. Other shortcomings in asepsis measures, were also noted such as the non‐change of gloves after skin preparation (1.03%) and before manual compression. The serological status of patients concerning HBV, HVC, and HIV was also not always known (31.1%). The bacteriological samples from the surfaces also showed colonization of the medical devices and the ultrasound scanner used for the ultrasound‐guided introduction of the central catheters. The results of the study showed some deviations concerning the recommendations; however, they are comparable to other studies conducted internationally, especially in terms of hand hygiene.Our study results highlight some shortcomings adherence to hygiene measures like inconsistent disinfection of medical devices and dialysis stations, as well as insufficient hand hygiene practices among some staff members. However, we observed an improvement in practices following the implementation of awareness‐raising sessions. To maintain improved hygiene practices and prevent infections, it is crucial to provide ongoing training for staff, ensure adequate resources, and regularly monitor compliance with hygiene standards. [ABSTRACT FROM AUTHOR]

Background: Hand hygiene is one of the most important hygiene measures to prevent healthcare-associated infections. Well-functioning hand rub dispensers are the foundation of hand hygiene but are often overlooked in research. As the point of origin for hand hygiene, dispensers not only promote compliance through ease of use, but also strongly influence the amount of hand rub used per disinfection. This work investigates how dispenser types and conditions affect dispensed volumes and usability. Methods: Data from 5,014 wall-mounted or point-of-care dispensers was collected from 19 German healthcare facilities during installation of an electronic hand hygiene monitoring system, including dispenser type and dispensed hand rub volumes. Of these dispensers, 56.2% were metal dispensers, and the majority (89.5%) were wall-mounted. For one hospital, 946 wall-mounted dispensers were analyzed in detail regarding pump material, damages, functionality, cleanliness, and filling levels. Results: Dispensed volumes varied across and within dispenser types, ranging from 0.4 mL to 4.4 mL per full actuation, with the largest volumes generally dispensed by plastic dispensers with a preset of 1.0 to 3.0 mL per actuation. In general, most dispensers dispense more hand rub per full actuation than specified by the manufacturer. When different types of dispensers are used within a healthcare facility, vastly different volumes can be dispensed, making reliable and reproducible disinfection difficult for healthcare workers. In the detailed analysis of 946 dispensers, 27.1% had cosmetic defects, reduced performance, or were unusable, with empty disinfectant being the most common reason. Only 19.7% of working dispensers delivered their maximum volume on the first full actuation. Conclusion: Even though several studies addressed the variability in dispensed volumes of hand hygiene dispensers, studies dealing with dispenser types and functionality are lacking, promoting the common but false assumption that different dispensers may be equivalent and interchangeable. Variability in dispensed volumes, coupled with frequent dispenser defects and maintenance issues, can be a major barrier to hand hygiene compliance. To support healthcare workers, more attention should be paid to 'dispenser compliance', selecting dispensers with similar volume ranges and proper maintenance. [ABSTRACT FROM AUTHOR]

Background: Streptococcus pyogenes (Group A Streptococcus, GAS) is a significant pathogen that causes diverse infections, ranging from pharyngitis to severe invasive diseases. Asymptomatic carriage in children is pivotal for transmission. The COVID-19 pandemic's health measures, including mask wearing and enhanced hand hygiene, likely influenced GAS transmission dynamics. This study evaluated the impact of these precautions on the prevalence of asymptomatic pharyngeal GAS carriage among schoolchildren in the southern West Bank, Palestine. Methods: This cross-sectional study was conducted in two phases: pre-COVID-19 (November 2019–January 2020) and post-COVID-19 (November 2023–April 2024). Throat swabs were collected from 701 children (345 pre-COVID-19, 356 post-COVID-19) via cluster sampling. The samples were tested with the ABON Strep A rapid test and confirmed by culture. Sociodemographic, health, and household data were also collected. The statistical analyses included descriptive statistics, chi-square tests, and binary logistic regression. Results: The prevalence of asymptomatic pharyngeal GAS carriage declined from 15.7% pre-COVID-19 to 10.4% post-COVID-19 (p = 0.038). Significant reductions were observed among urban residents (23.5–10.1%, p = 0.003) and those from medium socioeconomic backgrounds (16.0–9.1%, p = 0.008). Compared with urban residents, rural residents had lower GAS carriage rates (adjusted OR = 0.505, p = 0.023). Carriage rates also decreased among children with frequent sore throats (17.6–7.3%, p = 0.007) and those using private wells (52.5–14.9%, p < 0.001). Higher BMI was a significant risk factor (adjusted OR = 17.68, p < 0.001), whereas frequent tooth brushing (adjusted OR = 0.055, p < 0.001) and hand washing (adjusted OR = 0.367, p < 0.001) were protective factors. Conclusions: COVID-19-related health precautions were correlated with a significant reduction in asymptomatic GAS carriage among Palestinian children. These findings suggest that public health measures, such as mask wearing and hand hygiene, can influence the transmission of respiratory pathogens. Ongoing surveillance and targeted interventions are essential for managing GAS infections, particularly in resource-limited settings. [ABSTRACT FROM AUTHOR]

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

The COVID-19 pandemic and other infectious diseases continue to threaten public health, particularly in densely populated informal settlements. Effective hand hygiene, supported by alcohol-based hand sanitizers (ABHS), plays a critical role in preventing disease transmission. This study assessed the quality, safety, and compliance of ABHS used in informal settlements around Cape Town. A total of 78 samples were collected from spaza shops, with 72 analyzed using gas chromatography with flame ionization detection. The results showed that 76% of ethanol-based sanitizers met compliance standards, while 24% did not. Isopropanol compliance (≥70%) was only observed in 36% of samples, with 64% failing to meet Centers for Disease Control and Prevention (CDC) guidelines. Overall, 74% of hand sanitizers complied with recommended alcohol concentrations by the U.S. Food and Drug Administration (FDA) and CDC, while 26% posed a health risk due to non-compliance. These findings emphasize the urgent need for stricter regulation and public education to ensure effective hand sanitizers are used, thereby reducing infection risks in vulnerable populations. The study aims to inform public health policies and improve regulatory standards. [ABSTRACT FROM AUTHOR]

Introduction:Ventilator associated pneumonia (VAP) complicates the course of 8-28% of patients receiving mechanical ventilation. The present study was conducted with an aim to know the outcome of VAP and to identify pathogens, compare the bacteriological profile, duration of mechanical ventilation and length of hospitalization. Material and methods:The current study was a prospective observational study, conducted in Department of General Medicine. Cases were taken from patients on mechanical ventilation admitted to MICU in Hospital. A Study population included 101 patients after meeting inclusion and exclusion criteria. Out of 101 patients who developed VAP. Result:The incidence of VAP 15.04%. Majority of the patients were in age group between 31 to 40 years(20%), with predominantly male preponderance 65.3%. The occurrence of late VAP 64.40%was more common than early VAP 35.60%. Incidence is directly proportional to duration of mechanical ventilation and re-intubation is a strong risk factor for development of VAP. Conclusion:Simple and effective measure to prevent ventilator associated pneumonia should be employed in all ICU settings including staff education, hand hygiene, oral hygiene with chlorhexidine, nursing in semi recumbent position, promoting nasogastric feeds, performing closed suction of endotracheal tubes, minimising re-intubation and daily interruption of sedation. The incidence of patients who are being admitted to ICU and requiring mechanical ventilation is increasing. [ABSTRACT FROM AUTHOR]

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

Objective: To assess the compliance with French guidelines for the prevention of central venous catheter (CVC)-related infections in two university hospitals. Methods: An observational audit was conducted in 7 wards using a digital tool. Results: The prerequisite of hand hygiene (HH) were respected by 90% of health-care worker; 86% performed HH prior to equipment preparation and 59% repeated it prior to infusion. Wearing gloves when necessary and rinsing were respected in 46.7% and 75.6% of the observations. Conclusion: Findings showed an acceptable level of adherence to recommended practices for CVC management. However, barriers of unrespect evidence-based recommendations need to be investigated in depth. [ABSTRACT FROM AUTHOR]

Objective: Health care associated infections (HAIs) are major threat to patient safety in a hospital. Inadequate hand hygiene (HH) practice plays a very important role in transmission of HAIs. Material and Methods: The present study was a prospective interventional study, divided into 3 phases: preintervention, intervention phase, and post-intervention. A total of 40 HCWs, including doctors, nurses, and cleaning staff had given consent to participate in the study. Using standard formulas HH complete adherence rate (HHCAR), HH partial adherence rate (HHPAR), and HH total adherence rate (HHTAR) were calculated. Results: HHCAR, HHPAR, and HHTAR were estimated to be 18.03%, 49.53%, 67.57% respectively. HHCAR in the pre-intervention and post-intervention phases were 2.4% and 22.37%, respectively, reflecting a significant improvement in HH compliance (푃<.001); whereas the improvement in HHPAR was found to be marginal, from 46.16% in the pre-intervention phase to 50.46% in the post-intervention phase. The HHTAR significantly improved to 72.83% in post intervention phase from 48.58 in pre-intervention phase. Conclusion: The present study demonstrated a statistically significant improvement in HH compliance following a multimodal educational intervention in the neurosurgery ICU of a tertiary care hospital. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAIs) caused by multidrug-resistant organisms (MDROs) represent a global threat to human health and well-being. Because transmission of MDROs to patients often occurs via transiently contaminated hands of healthcare personnel (HCP), hand hygiene is considered the most important measure for preventing HAIs. Environmental surfaces contaminated with MDROs from colonized or infected patients represent an important source of HCP hand contamination and contribute to transmission of pathogens. Accordingly, facilities are encouraged to adopt and implement recommendations included in the World Health Organization hand hygiene guidelines and those from the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America/Association for Professionals in Infection Control and Epidemiology. Alcohol-based hand rubs are efficacious against MDROs with the exception of Clostridiodes difficile, for which soap and water handwashing is indicated. Monitoring hand hygiene adherence and providing HCP with feedback are of paramount importance. Environmental hygiene measures to curtail MDROs include disinfecting high-touch surfaces in rooms of patients with C. difficile infection daily with a sporicidal agent such as sodium hypochlorite. Some experts recommend also using a sporicidal agent in rooms of patients colonized with C. difficile, and for patients with multidrug-resistant Gram-negative bacteria. Sodium hypochlorite, hydrogen peroxide, or peracetic acid solutions are often used for daily and/or terminal disinfection of rooms housing patients with Candida auris or other MDROs. Products containing only a quaternary ammonium agent are not as effective as other agents against C. auris. Portable medical equipment should be cleaned and disinfected between use on different patients. Detergents are not recommended for cleaning high-touch surfaces in MDRO patient rooms, unless their use is followed by using a disinfectant. Facilities should consider using a disinfectant instead of detergents for terminal cleaning of floors in MDRO patient rooms. Education and training of environmental services employees is essential in assuring effective disinfection practices. Monitoring disinfection practices and providing personnel with performance feedback using fluorescent markers, adenosine triphosphate assays, or less commonly cultures of surfaces, can help reduce MDRO transmission. No-touch disinfection methods such as electrostatic spraying, hydrogen peroxide vapor, or ultraviolet light devices should be considered for terminal disinfection of MDRO patient rooms. Bundles with additional measures are usually necessary to reduce MDRO transmission. [ABSTRACT FROM AUTHOR]

Background: Lack of appropriate knowledge, incorrect beliefs and misinformation misleads people about the risks they face and how best to protect themselves. A study was conducted to explore the knowledge, beliefs and misinformation regarding COVID-19 in Zimbabwe. Methods: A qualitative study was conducted in September-October 2022 with a purposive sample of religious leaders, women leaders, youth leaders, health workers, village health workers, teachers, traditional healers, transporters, and the general population selected from ten sites across the country. In total there were 128 participants (30 key informants and 98 focus group discussion participants). At each site, 3 key informant interviews and one homogenous focus group discussion were conducted using semi-structured interviews and focus group discussion guides, respectively. The data were recorded on audiotapes, transcribed verbatim, and translated into English. Manual thematic analysis of the data was performed. Findings: Three themes were identified in this study: (1) beliefs about COVID-19, (2) knowledge about COVID-19 (knowledge of origin, definition, transmission, signs and symptoms and recommended preventive measures), and (3) misinformation about COVID-19 (regarding its nature, existence and recommended preventive measures). There was awareness of the origin, transmission, signs and symptoms of COVID-19 among the participants. Participants reported that Zimbabwean communities were conversant with public health measures such as maintaining social distancing, wearing masks, and maintaining hand hygiene. However, misinformation was also observed to have circulated among the communities. Conclusion: Participants demonstrated good knowledge of COVID-19. However, the misinformation circulating in the country calls for the government to establish structures to monitor the legitimacy of information coming through different sources and invest in providing information through trusted sources. In any disease outbreak, the government should engage its citizenry to understand their knowledge, beliefs and any misinformation that might influence adherence to disease preventive measures. [ABSTRACT FROM AUTHOR]

Background: Monitoring hand hygiene compliance (HHC) of healthcare providers (HCPs) in healthcare facilities is critical for hand hygiene (HH) promotion. However, less is known about the cost and effectiveness of different HHC monitoring tools. In this study, we aimed to compare various health economic indicators corresponding to electronic system-based monitoring (ESM) and manual paper-based monitoring (MPM) for HHC to provide evidence-based advice for HHC monitoring measures targeted selecting. Methods: A before and after study in 40 clinical departments with 4,524 healthcare providers was conducted from December 2022 to January 2023 (MPM implementation phase) and March 2023 to May 2023 (ESM implementation phase). The cost-effectiveness, cost-efficiency, the extent of the Hawthorne effect, and indirect cost-benefit of the two monitoring methods were compared. Results: The total cost spent on ESM for the 40 departments (17,702.92 CNY) was 4,123.76 CNY lower than that of MPM (21,826.68 CNY). The HHC of MPM (80.16%) was higher than that of ESM (69.82%) (p < 0.01). In high- and medium-risk departments, the cost-effectiveness ratio of ESM (7,977.90 CNY and 13,794.60 CNY, respectively) was lower than that of MPM (9,039.61 CNY and 14,549.05 CNY, respectively). In low-risk departments, the cost-effectiveness ratio of ESM (3,910.77 CNY) was higher than that of MPM (3,899.06 CNY). Compared with ESM, the incremental cost of MPM in all departments was 4,123.76 CNY, the incremental effectiveness was 10.34%, and the incremental cost-effectiveness ratio was 39,881.62 CNY. Between the two monitoring methods, the efficiency of ESM (48.11%) in all departments was higher than that of MPM (14.20%) (p < 0.01). The cost-efficiency ratio of MPM in all departments (155,775.56 CNY) was higher than that of ESM (36,796.76 CNY). The extent of Hawthorne effect of MPM of HHC in all departments (43.99%) was higher than that of ESM (35.69%) (p < 0.01). When ESM was used as the HHC monitoring approach, the HAI rates (1.39%) in all departments were higher than that when MPM was used (1.34%) (p = 0.562). When the payment willingness was less than 40,000 CNY, the ESM method was the better option for cost-effectiveness; When the input exceeded this threshold, the MPM method was the better option for cost-effectiveness. Conclusions: ESM exhibited notable advantages over MPM in terms of cost-effectiveness, cost-efficiency, cost-benefit, and the Hawthorne effect. [ABSTRACT FROM AUTHOR]

Background: The control of the Soil-Transmitted Helminths (STH) infections primarily relies on the school-based Preventive Chemotherapy (PCT) with mebendazole. Given the efficacy of ivermectin on STH, the control of the latter is expected to be potentialized in areas where ivermectin is also distributed for onchocerciasis and/or lymphatic filariasis control/elimination. This study aimed to assess the prevalence and intensity of STH in the Lomie Health District where annual school-based deworming campaigns and community-directed treatments with Ivermectin have been underway for almost two decades. Methodology/principal findings: A quantitative cross-sectional study was conducted in 10 schools of the Lomie Health District, East Region, Cameroon. Stool samples were collected from school-aged children and analysed using the Kato-Katz technique. Semi-structured questionnaires were administered to enrolees to assess compliance with water, sanitation, and hygiene (WASH). Of the 491 children (median age: 9 years; IQR: 7–10) enrolled, 83.9% (95% CI: 80.3–87.1) were infected with at least one STH species. Trichuris trichiura was the predominant species (78.5%), and no hookworm was found. The prevalence trend slightly decreased between 1987 and 2010 (~8%) and remained unchanged since 2010 (p-value = 0.05). Overall, 46.8% and 41.8% of children were heavy-to-moderately infected with Ascaris lumbricoides and T. trichiura. Poor hand hygiene (OR: 2.24, 95% IC: 1.4–3.4, p-value = 0.0002) and the use of river as a source of drinking water (OR: 14.8, 95% IC: 6.9–33.3, p-value = 0.0001) were the main risk factors associated with the STH infection in Lomie Health District. Conclusions/significance: The persistent high prevalence and intensity of STH infection despite 16 years of mebendazole-based PCT and expected collateral impact of ivermectin mass distribution, points to plausible implementation gaps, poor compliance to WASH or sub-optimal efficacy of the anthelminthics used. This study highlights the need to further assess the cause of the persistent high prevalence and implement context-adapted control measures in order to curb STH transmission. Author summary: Soil-transmitted helminthiasis (STH) is a disease caused by intestinal worms, mainly common in impoverished settings lacking access to water, sanitation, and hygiene structures. Annual mass distribution of mebendazole to at risk groups is the main control strategy. Ivermectin, another community mass-distributed treatment for onchocerciasis and/or lymphatic filariasis control/elimination, also showed a collateral impact on STH control. The Lomie Health District is a predominantly rural setting where annual school-based deworming campaigns and/or community-based preventive chemotherapy with ivermectin for onchocerciasis are ongoing. This study aimed to assess the current prevalence and intensity of STH infection among school-aged children in the Lomie Health District. STH transmission remains substantially high despite the mebendazole-based annual deworming exercises in schools and community-based ivermectin preventive chemotherapy. The current prevalence of the infection is similar to the baseline level 16 years earlier, at the commencement of the MDA strategies. Further studies are needed to understand the contextual determinants of the high STH prevalence to inform targeted interventions to reducing the transmission of the infection in the Lomie Health District. [ABSTRACT FROM AUTHOR]

Alcohol-based hand rubs are generally recommended for infection control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Hand hygiene agents, including ozonated water (OW), have been used as an alternative because alcohol-based products may cause skin damage. A few reports are available on the virucidal activity of OW against SARS-CoV-2; therefore, this study examined the inhibitory effect of 0.4, 1.0, and 4.0 ppm OW on the Omicron variant infection to VeroE6 cells expressing transmembrane protease serine 2 by calculating the median tissue culture infectious dose (TCID50) using the E1052–20 test method of the American Society of Testing Materials International. Additionally, viral RNA copies were measured in culture supernatants of control or OW. Each OW concentration demonstrated ≥5.6 log10 TCID50 reduction, corresponding to ≥99.999% reduction of infectious virus, while the control phosphate-buffered saline showed no inactivation effect. More than 5 log10 copies/mL reduction of viral RNA was observed in the culture supernatant of each OW compared with the control. These findings suggest that exposure of SARS-CoV-2 to at least 0.4 ppm OW for 5 s is sufficient for viral inactivation and that OW can be used as an alternative hand hygiene agent to prevent SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Background: Hand hygiene is known to reduce healthcare-associated infections. However, it remains suboptimal among healthcare providers. In this study, we used the Behaviour-centered Design approach to explore the facilitators and deterrents to hand hygiene among healthcare providers in the Kampala Metropolitan area, Uganda. Methods: We conducted a formative qualitative study as part of a cluster randomised trial in 19 healthcare facilities (HCFs). The study used 19 semi-structured and 18 key informant interviews to collect data on hand hygiene status and facilitators and deterrents of hand hygiene. Research assistants transcribed verbatim and used a thematic framework aided by Nvivo 14.0. to undertake analysis. We used thick descriptions and illustrative quotes to enhance the credibility and trustworthiness of our findings. Results: About 47.4% of the HCFs had sufficient hand hygiene infrastructure, and 57.9% did not report total compliance with hand hygiene during patient care. The physical facilitator for hand hygiene was the presence of constant reminders such as nudges, while the biological included the frequency of patient contact and the nature of clinical work. The only biological deterrent was the heavy workload in HCFs. The executive brain facilitators included knowledge of workplace health risks, infection prevention and control (IPC) guidelines, and a positive attitude. A negative attitude was the executive brain deterrent to hand hygiene. Recognition, rewards, and fear of infections were the only motivated brain facilitators. Behavioural setting facilitators included proximity to functional hand hygiene infrastructure, the existence of active IPC committees, good leadership, and the availability of a budget for hand hygiene supplies. Behavioural setting deterrents included the non-functionality and non-proximity to hand hygiene infrastructure and inadequate supplies. Conclusions: The study revealed low compliance with hand hygiene during the critical moments of patient care and inadequacy of hand hygiene infrastructure. The deterrents to hand hygiene included a heavy workload, negative attitude, inadequate supplies, non-functionality, and long distance to hand washing stations. Facilitators included constant reminders, fear of infections, frequency of patient contact and nature of clinical work, positive attitude, knowledge of IPC guidelines, recognition and reward, good leadership, availability of budgets for hand hygiene supplies, availability and proximity to hand hygiene supplies and infrastructure and active IPC committees. Trial registration: ISRCTN Registry with number ISRCTN98148144. The trial was registered on 23/11/2020. [ABSTRACT FROM AUTHOR]

In hospital operating theatres, inadvertent violations of behavioural rules by novices may increase risk. Virtual reality (VR) can provide a training environment to ease the burden for healthcare professionals. Our work develops and tests a VR training program for correct operating room (OR) etiquette. The VR simulator incorporates realistic 3D models as well as corresponding character and object interactions. The simulator provides a comprehensive interactive educational game covering hand hygiene and disinfection, surgical attire and OR behaviour. 13 clinical trainees and experts assessed acceptance and perceived benefit of the simulator. This evaluation shows promise in supporting clinical staff education. Future developments aim to enhance effectiveness, including the integration of hand tracking and a more detailed selection of interactive tasks. [ABSTRACT FROM AUTHOR]

Objectives To outline the procedural implementation and optimization of rapid diagnostic test (RDT) results for bloodstream infections (BSIs) and to evaluate the combination of RDTs with real-time antimicrobial stewardship team (AST) support plus clinical surveillance platform (CSP) software on time to appropriate therapy in BSIs at a single health system. Methods Blood culture reporting and communication were reported for four time periods: (i) a pre-BCID [BioFire® FilmArray® Blood Culture Identification (BCID) Panel] implementation period that consisted of literature review and blood culture notification procedure revision; (ii) a BCID implementation period that consisted of BCID implementation, real-time results notification via CSP, and creation of a treatment algorithm; (iii) a post-BCID implementation period; and (iv) a BCID2 implementation period. Time to appropriate therapy metrics was reported for the BCID2 time period. Results The mean time from BCID2 result to administration of effective antibiotics was 1.2 h (range 0–7.9 h) and time to optimal therapy was 7.6 h (range 0–113.8 h) during the BCID2 Panel implementation period. When comparing time to optimal antibiotic administration among patients growing ceftriaxone-resistant Enterobacterales, the BCID2 Panel group (mean 2.8 h) was significantly faster than the post-BCID Panel group (17.7 h; P  = 0.0041). Conclusions Challenges exist in communicating results to the appropriate personnel on the healthcare team who have the knowledge to act on these data and prescribe targeted therapy against the pathogen(s) identified. In this report, we outline the procedures for telephonic communication and CSP support that were implemented at our health system to distribute RDT data to individuals capable of assessing results, enabling timely optimization of antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Background: School-based water, sanitation and hygiene (WASH) may improve the health and attendance of schoolchildren, particularly post-menarcheal girls, but existing evidence is mixed. We examined the impact of an urban school-based WASH programme (Project WISE) on child health and attendance. Methods: The WISE cluster-randomised trial, conducted in 60 public primary schools in Addis Ababa, Ethiopia over one academic year, enrolled 2–4 randomly selected classes per school (~ 100 pupils) from grades 2 to 8 (aged 7–16) in an 'open cohort'. Schools were assigned 1:1 by stratified randomisation to receive the intervention during the 2021/2022 or the 2022/2023 academic year (waitlist control). The intervention included improvements to drinking water storage, filtration and access, handwashing stations and behaviour change promotion. Planned sanitation improvements were not realised. At four unannounced classroom visits post-intervention (March–June 2022), enumerators recorded primary outcomes of roll-call absence, and pupil-reported respiratory illness and diarrhoea in the past 7 days among pupils present. Analysis was by intention-to-treat. Results: Of 83 eligible schools, 60 were randomly selected and assigned. In total, 6229 eligible pupils were enrolled (median per school 101.5; IQR 94–112), 5987 enrolled at study initiation (23rd November–22nd December 2021) and the remaining 242 during follow-up. Data were available on roll-call absence for 6166 pupils (99.0%), and pupil-reported illness for 6145 pupils (98.6%). We observed a 16% relative reduction in odds of pupil-reported respiratory illness in the past 7 days during follow-up in intervention vs. control schools (aOR 0.84; 95% CI 0.71–1.00; p = 0.046). There was no evidence of effect on pupil-reported diarrhoea in the past 7 days (aOR 1.15; 95% CI 0.84–1.59; p = 0.39) nor roll-call absence (aOR 1.07; 95% 0.83–1.38; p = 0.59). There was a small increase in menstrual care self-efficacy (aMD 3.32 on 0–100 scale; 95% CI 0.05–6.59), and no evidence of effects on other secondary outcomes. Conclusions: This large-scale intervention to improve school WASH conditions city-wide had a borderline impact on pupil-reported respiratory illness but no effect on diarrhoeal disease nor pupil absence. Future research should establish relationships between WASH-related illness, absence and other educational outcomes. Trial registration: ClinicalTrials.gov, number NCT05024890. [ABSTRACT FROM AUTHOR]

In modern times, surgical site infections (SSIs) are defined as infections occurring within 30 days after surgery (or 1 year in patients with implants) at the incision or deep tissue level. Purulent drainage should be observed and organisms from the site should be isolated for epidemiological purposes. Most of the factors contributing to SSIs are patient-related, as the majority of infections are caused by endogenous flora. It has also been suggested that unclean operating hands due to glove contamination do not affect rates of postoperative infections. While the traditional surgical scrub has so far stood the test of time, it is important to consider its environmental impact. There have been multiple attempts to reduce the carbon footprint of the surgical hand scrub, including usage of a different model of tap but there is an easier option available to us: hand rubbing. It takes up significantly less water, as reported by some of the studies given above. It is also particularly beneficial in resource-limited settings. All studies except one reported that hand rub solutions are also more affordable, making them accessible in poorer countries and hospitals. Our study results similarly suggest that waterless hand rubbing is at least as effective as hand scrubbing in preventing SSIs, and is a viable solution to address water scarcity concerns. [ABSTRACT FROM AUTHOR]

In light of the close contact between patient and clinician during ophthalmic examinations and the multiple opportunities for pathogen transmission, we identified and evaluated potential pathogen transmission routes through high-touch surfaces in an outpatient ophthalmology clinic. A circuit simulation was performed to replicate a patient's journey through an ophthalmology clinic with various stations. Fluorescent oil and powder were applied to the hands of Simulated Patient A who went through the circuit. Routine disinfection of surfaces in the slit lamp environment and hand hygiene by the ophthalmologist were conducted prior to Simulated Patient B going through the same circuit with untagged hands. Ultraviolet black light was used to identify fluorescent marker contamination after Simulated Patient B completed the circuit. Fluorescent marker contamination was found on the hands of all the simulated patients and staff, various items of the simulated patients, multiple equipment surfaces—particularly the ophthalmologist's working table and slit lamp environment—and miscellaneous objects like appointment cards and files. Fluorescent marker contamination on Simulated Patient B's untagged hands despite proper hand hygiene being performed prior suggests suboptimal surface disinfection following Simulated Patient A's circuit. Through this pilot study, we recognised the key role that ophthalmic high-touch surfaces play in fomite transmission and that thorough disinfection of high-touch surfaces is essential on top of proper hand hygiene. With the contact sequences delineated in this pilot study, specific cues for hand hygiene and surface disinfection may be implemented at suitable intervals during contact with high-touch surfaces. Environmental decontamination adjuncts could also be considered to reinforce surface disinfection. [ABSTRACT FROM AUTHOR]

In Dar es Salaam, mortality from road traffic injuries is roughly double the global rate. Most civilians are transported to hospitals by laypeople. We examined the impact of a bleeding control course among taxi drivers. Before-after study; participants were trained in hemorrhage control and equipped with a first aid kit. Primary outcomes were perceived bleeding control knowledge, perceived ability to apply bleeding control skills, and intention to intervene. Surveys were administered before, after, and 3 mo after training. Data were measured on a 1-5 Likert scale. Among 186 participants, knowledge increased from 1.70 (95% confidence interval [CI] 1.55-1.85) before training to 4.67 (95% CI 4.55-4.78) after training and was sustained at 3 mo 4.69 (95% CI 4.61-4.77). Ability to apply skills increased from 2.12 (95% CI 1.96-2.27) before training to 4.68 (95% CI 4.59-4.78) after training and was sustained at 3 mo 4.67 (95% CI 4.57-4.76). Intention to intervene increased from 2.69 (95% CI 2.47-2.92) before training to 4.66 (95% CI 4.55-4.76) after training and was sustained at 3 mo 4.57 (95% CI 4.48-4.67). 83 interventions occurred. Transport to health-care facilities occurred 58 times. Care was transferred to a doctor or nurse 39 times. This course increased participant's perceived bleeding control knowledge, ability to apply skills, and intention to intervene. Participants utilized skills in the field, transported the injured, and handed off care. This course should be evaluated globally in similar contexts. • A bleeding control course increases knowledge, ability to apply skills, and willingness to intervene among Tanzanian motorcycle taxi drivers. • Following training, participants applied hemorrhage control interventions following road traffic crashes 83 times in 3 mo. • Training motorcycle taxi drivers in first aid is a cost-effective way to increase prehospital care in urban areas where formal EMS does not exist. [ABSTRACT FROM AUTHOR]

Patients with haemodialysis catheters are susceptible to dialysis-associated infections, particularly bloodstream infections. There have been few systematic attempts to reduce this burden. Our study aimed to investigate the effect of a multimodal prevention strategy on dialysis-associated infection events (DAIE) among haemodialysis outpatients. A multicentre, stepped wedge, cluster-randomized controlled trial was done from October 2019 to September 2021. Outpatient dialysis facilities entered into the intervention phase in three randomly assigned clusters, at three predefined time points. The multimodal prevention strategy consisted of infection surveillance and hand hygiene (HH) compliance observation with active feedback and teaching aseptic procedures, and a patient flyer. The primary outcome was incidence rates of different DAIE, such as bloodstream infections, intravenous antimicrobial starts, and local access-site infections per 1000 dialysis. As secondary outcome, we analysed the HH compliance change. A total of 43 haemodialysis outpatient facilities with 11 251 patients and 1 413 457 proceeded haemodialysis were included in the DIPS-trial. Incidence rates were 0.71 DAIE per 1000 dialysis (95% CI, 0.65–0.78) in the control and 0.31 (95% CI, 0.27–0.36) in the intervention group. The univariable analysis yielded an incidence rate ratio (IRR) of 0.44 (95% CI, 0.33–0.59) for DAIE. Especially in patients with a central venous catheter, we saw a significant decrease in DAIE in the intervention group (IRR 0.4; 95% CI, 0.28–0.58). The HH observation combined with feedback and intensified training, resulted in an increase of HH compliance from 58–65%. A multimodal prevention strategy showed a significant preventive effect on DAIE among haemodialysis outpatients. This reduction also applied to bloodstream infections, especially in patients with a central venous catheter. [ABSTRACT FROM AUTHOR]

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A carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak in an intensive care unit (ICU) was contained by an improved infection-control measure that included a disinfectant policy. In our retrospective cohort study, we describe the epidemiological investigations and infection-control measures during this outbreak. Descriptive analysis was used to summarize patient demographics, neurological diseases, surgical treatment, underlying diseases, infection, and outcomes. In December 2023, two CARB-positive patients were observed in the ICU, and four more patients became CRAB-positive in January. During this outbreak, there was an overlap of hospitalization periods among the CRAB-positive patients, and CRAB was isolated from the environment; the isolated CRAB strain was identical. Infection-control measures, including hand hygiene, contact precautions and isolation, surveillance, decolonization, environmental cleaning, and disinfection, were reviewed and modified. The aim of this study was to examine the molecular background of the effectiveness of the disinfectant shift used during successful outbreak control. Experiments were carried out to study the phenotypic sensitivity and genetic background of different disinfectant agents. A thorough analysis of the detected CRAB strain included whole-genome sequencing (WGS), investigation of the qacE and qacEΔ1 genes' relative expression by qPCR after exposure to different disinfectant solutions, as well as an analysis of biofilm formation. WGS analysis of the CRAB strain identified that an ST2 high-risk clone was responsible for the outbreak, which produced OXA-83 and ADC-30 beta-lactamases; in addition, qacE and qacEΔ1 genes were also detected, which confer resistance to disinfectants containing quaternary ammonium compounds (QACs). A qPCR analysis demonstrated that after exposure to different disinfectants, the gene expression levels of qacE and qacEΔ1 increased and correlated with concentrations of QACs of disinfectants. During the outbreak, the standard-of-care QAC-based disinfectant was changed to a mainly alcohol-based agent in the ICU, which contributed to the successful control of this outbreak, and no additional patients were identified with CRAB. We conclude that continuous surveillance and hand hygiene training combined with fast identification and reaction to new cases, as well as an in-depth analysis of multidrug-resistant outbreak strains and investigation of their disinfectant tolerance/resistance during an outbreak, are essential to effectively control the spread of nosocomial pathogens. The smart policy of disinfectant agent selection played a crucial role in controlling the outbreak and ensuring patient safety in the ICU. [ABSTRACT FROM AUTHOR]

Natural rubber latex (NRL) and chlorhexidine are important causes of occupational allergy in healthcare settings. A significant reduction in NRL allergy has been reported in countries that have adopted latex-avoidance measures. However, healthcare workers (HCWs) in many developing countries continue to use powdered NRL gloves, increasing their risk of developing an allergy to NRL. Chlorhexidine is commonly used for hand hygiene and disinfecting patients' surfaces or wounds in emergency centres. However, only a few cases of occupational allergy to chlorhexidine have been reported among HCWs. Both NRL and chlorhexidine can induce IgE-mediated allergic reactions and irritant contact dermatitis. Unlike NRL, chlorhexidine can cause cell-mediated hypersensitivity. Allergic contact dermatitis resulting from wearing NRL gloves is due to rubber additives and not NRL allergens. Testing for allergic sensitisation is a crucial step in the clinical evaluation of these allergies. Avoiding exposure to the source of the problem remains the most effective method of managing these allergies. Powdered NRL gloves should be replaced with powder-free, low-protein or low-allergen NRL gloves or non-NRL alternatives. For chlorhexidine allergy, alternative products should be made available to sensitised HCWs. Adequate information about these allergies should be provided to all HCWs. In addition, the lowest effective concentration of chlorhexidine should be used and all chlorhexidine-containing products should be clearly labelled. [ABSTRACT FROM AUTHOR]

Background: The human hand has constant contact with the environment, hence requires regular hand hygiene. Hand hygiene has gained recognition because of the COVID-19 pandemic and is a largely effective, affordable preventive measure against infectious diseases. This study used both national and sub-national analyses to evaluate the effect of COVID-19 handwashing guidelines on instances of diarrhea in Ghana. Methods: Data on diarrhea cases spanning February 2018 and March 2022 were retrieved from the District Health Information Management System (DHIMS 2) using a data extraction guide. The data were summarized using descriptive statistics. The difference in diarrhea cases between the pre-COVID-19 and COVID-19 periods was measured using a two-sample t-test across Ghana's 16 administrative areas. Causal Impact package in R statistical software was employed to determine the impact of the introduction of COVID-19 hand hygiene protocols on diarrheal disease. Results: A total of 5,645,533 diarrheal cases reported between February 2018 and March 2022 through the routine MIS (DHIMS2) were examined. Fifty-three percent of the cases occurred before the introduction of the hand hygiene protocol. Descriptive statistics indicated a statistically significant decrease in average diarrheal cases during the hand hygiene implementation era (13,463 cases reduction, p<0.001). Sub-national analyses revealed significant reductions in various regions: Greater Accra, Ashanti, Ahafo, Central, Eastern, Northern, Upper East, Upper West, and Volta (p<0.05). Causal impact analysis confirmed 11.0% nationwide reduction in diarrheal cases attributed to the COVID-19 hand hygiene protocols (p<0.001). Conclusion: This study underscores the effectiveness of COVID-19 hand hygiene protocols in reducing diarrheal morbidity in Ghana, with varying regional impacts. These findings advocate for the sustenance of investments and commitments made at the COVID hand hygiene protocols, particularly in this era where the pandemic appears controlled. [ABSTRACT FROM AUTHOR]

Background: Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers. Methods: A longitudinal hospital-based intervention study was conducted in accordance with the WHO's standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3–5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures. Results: Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants' self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product's drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml). Conclusion: The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance. [ABSTRACT FROM AUTHOR]

The number of Methicillin-resistant Staphylococcus aureus (MRSA) cases in communities and hospitals is on the rise worldwide. In this work, a nonlinear deterministic model for the dynamics of MRSA infection in society was developed to visualize the significance of awareness in interventions that could be applied in the prevention of transmission with and without optimal control. Positivity and uniqueness were verified for the proposed corruption model to identify the level of resolution of infection factors in society. Furthermore, how various parameters affect the reproductive number R 0 and sensitivity analysis of the proposed model was explored through mathematical techniques and figures. The global stability of model equilibria analysis was established by using Lyapunov functions with the first derivative test. A total of seven years of data gathered from a private hospital consisting of inpatients and outpatients of MRSA were used in this model for numerical simulations and for observing the dynamics of infection by using a non-standard finite difference (NSFD) scheme. When optimal control was applied as a second model, it was determined that increasing awareness of hand hygiene and wearing a mask were the key controlling measures to prevent the spread of community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA). Lastly, it was concluded that both CA-MRSA and HA-MRSA cases are on the rise in the community, and increasing awareness concerning transmission is extremely significant in preventing further spread. [ABSTRACT FROM AUTHOR]

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Purpose: The pressure on professionals within the healthcare workforce is increasing due to staffing shortages, economic demands and changing care models. Through boundary work theories, our study explores how task-shifting in hand osteoarthritis (OA) care impacts the professional boundaries and division of labor between rheumatologists and occupational therapists (OTs) in Norwegian specialist healthcare. Methodology: Seventeen semi-structured qualitative interviews were conducted at two hospitals in Norway. Participants included ten rheumatologists and five OTs. Data were analyzed using reflexive thematic analysis. Results: The analysis resulted in three themes (1) Forms of responsibility and task transfers, (2) Circumventing the rules to ensure efficient practices and appropriate patient care, (3) Broadening and specializing; movement of professional demarcations. Overall, we found that medical tasks in hand OA care are increasingly delegated to, and adopted by, OTs, blurring the rheumatologist-OT boundary. Some of the task delegations skirted Norwegian legal boundaries, in efforts to streamline clinic operations. OTs expanded their scope of practice by adopting new tasks, whereas rheumatologist increased their specialist status by shedding unwanted tasks. Conclusion: Task shifting between rheumatologists and OTs in hand OA care was characterized by boundary blurring activities. The results support a shift in hand OA management from rheumatologists to OTs. [ABSTRACT FROM AUTHOR]

Background:Hand foot mouth disease (HFMD), a disease of childhood is also reported in adults caused by Coxsackie virus A type 16. Clinical condition is characterized by vesicular eruptive lesion in mouth, hand, foot, buttock, or genitalia. Coxsackie virus is a member of picoranaviridae family that includes non-enveloped SSRNA viruses. Spread in humans in the case of HFMD is through oral route, by the shed virus from intestine of infected person or through upper respiratory tract by the secretions or vesicle fluid of the diseased individual. Incubation period is 3 to 6 days. Diagnosis of HFMD most of the time is based clinically depending on the patient’s age, symptoms and clinical presentation of rash. Samples include stool, oral samples, biopsy & vesicular scrapings. Viral culture is the gold standard. Treatment is mainly supportive, to maintain hydration, acetaminophen and NSAIDS to reduce temperature. Novel agents like pleconaril play a vital role in the management of viral infection cases. Hand hygiene is the main stay of prevention. [ABSTRACT FROM AUTHOR]

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Introduction: The aim of the study was to assess the prevalence and associated factors of hand hygiene (HH) and oral hygiene (OH) behavior in adolescents in Central America. Methods: In total, 15807 school-aged adolescents (mean age=14.4 years, SD=1.4) were analyzed using secondary data from the cross-sectional Global School-based Student Health Survey (GSHS) conducted in six Central American countries (El Salvador, Belize, Costa Rica, Guatemala, Honduras, and Panama) between 2009 and 2018. HH and OH were assessed by questionnaire. Adjusted logistic regression was used to determine the associations with suboptimal ('not always') HH (SHH) and suboptimal (<2 times/day) OH (SOH). Results: The proportion of SHH before meals was 44.5% (the highest in Panama 69.0%), SHH after toilet use was 21.5% (the highest in Panama 33.3%), SHH with soap was 51.0% (the highest in Honduras 83.1%), and SOH (<2 times tooth brushing/day) was 11.3% (the highest in Panama 13.0%). Male sex (AOR=1.10; 95% CI: 1.03–1.35, SHH after toilet use), health risk behavior, including history of alcohol intoxication (AOR=1.54; 95% CI: 1.32–1.81 for SHH before meals, AOR=1.49; 95% CI: 1.23–1.99 for SHH after toilet use, and AOR=1.35; 95% CI: 1.17–1.57 for SHH with soap), inadequate fruit intake (AOR=1.53; 95% CI: 1.33–1.76 for SHH before meals and AOR=1.57; 95% CI: 1.34–1.84 for SHH after toilet use), inadequate vegetable intake (AOR=1.24; 95% CI: 1.05–1.47 for SHH before meals), and sedentary behavior (AOR=1.45; 95% CI: 1.28–1.64 for SHH before meals and AOR=1.23; 95% CI: 1.11–1.37 for SHH with soap), and poor mental health, including having no close friends (AOR=1.53; 95% CI: 1.20–1.96 for SHH before meals, and AOR=1.51; 95% CI: 1.22–1.99 for SHH after toilet use), and suicidal ideation (AOR= 1.22; 95% CI: 1.01–1.47 for SHH after toilet use, and AOR=1.27; 95% CI: 1.11–1.45 for SHH with soap) were associated with SHH. Male sex (AOR=1.80; 95% CI: 1.55–2.10), having no close friends (AOR=1.98; 95% CI: 1.50– 2.60), and suicidal ideation (AOR=1.32; 95% CI: 1.05–1.68) increased the odds and soft drink intake (AOR=0.75; 95% CI: 0.64–0.88) decreased the odds of SOH. Conclusions: This study presents SHH and SOH behavior practices. Several factors, including sociodemographics, health risk behaviors, and poor mental health, were identified that were associated with SHH and SOH behaviors, which can help in designing school OH and HH health promotion. [ABSTRACT FROM AUTHOR]

Background: Infections due to Citrobacter species are increasingly observed in hospitalized patients and are often multidrug-resistant. Yet, the magnitude and burden of Citrobacter spp. resistance in the hospital setting have not been reported. We aimed to evaluate the epidemiology of Citrobacter spp. infections among hospitalized patients, their main resistance patterns and Citrobacter spp. involvement in hospital outbreaks. Methods: We conducted a systematic review and meta-analysis of published literature (PROSPERO registration Jan-2023, CRD42023390084). We searched Embase, Medline and grey literature for studies on hospitalized patients diagnosed with Citrobacter spp. infections, and nosocomial outbreaks due to Citrobacter spp. published during the years 2000–2022. We included observational, interventional, surveillance studies and outbreak reports. Outcomes of interest were the frequency of Citrobacter spp. infections among hospitalized patients and 3rd generation cephalosporin and/or carbapenem resistance percentages in these infections. We used random-effects models to generate pooled outcome estimates and evaluated risk of bias and quality of reporting of outbreaks. Results: We screened 1609 deduplicated publications, assessed 148 full-texts, and included 41 studies (15 observational, 13 surveillance and 13 outbreak studies). Citrobacter spp. urinary tract- and bloodstream infections were most frequently reported, with Citrobacter freundii being the main causative species. Hospital-acquired infection occurred in 85% (838/990) of hospitalized patients with Citrobacter infection. After 2010, an increasing number of patients with Citrobacter spp. infections was reported in observational studies. Pooled frequency estimates for Citrobacter spp. infections could not be generated due to lack of data. The pooled prevalence of ESBL and carbapenemase producers among Citrobacter isolates were 22% (95%CI 4–50%, 7 studies) and 18% (95%CI 0–63%, 4 studies), respectively. An increased frequency of reported Citrobacter outbreaks was observed after 2016, with an infection/colonization ratio of 1:3 and a case-fatality ratio of 7% (6/89 patients). Common outbreak sources were sinks, toilets, contaminated food and injection material. Implemented preventive measures included environmental cleaning, isolation of positive patients and reinforcement of hand hygiene. Only seven out of 13 outbreaks (54%) were definitively controlled. Conclusion: This review highlights the clinical importance of endemic and epidemic Citrobacter spp. in healthcare settings. As an emerging, multidrug‑resistant nosocomial pathogen it requires heightened awareness and further dedicated surveillance efforts. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of reducing healthcare-associated infections (HCAIs) depends on increasing healthcare providers' awareness, skills, and adherence to standard practices. Mhealth applications provide an innovative approach to enhancing access to information and resources while reducing time and expenses. Objective: The study aimed to develop and evaluate a mhealth application for healthcare providers that offers quick access to updated recommendations, evidence-based guidelines, and protocols for managing patients with HCAIs. Method: The study included the development of the app, followed by a pilot test of its usability among physicians and nursing staff by using the Mobile Application Usability Questionnaire (MAUQ). Results: The mhealth application, named HCAI Shield, was developed with four main menus. The menu includes HCAI's care bundle: hand hygiene, personal protective equipment, and standard precautions. The information has been gathered following standards established by both national and international organizations. Twenty-one participants took part in the evaluation, and the mean score for the application's usability was 5.28 ± 0.38. The areas of "ease of use," "interface and satisfaction" received high mean scores. Conclusion: The HCAI Shield app provides convenient access to evidence-based guidelines and standards for HCAI management. Further evaluation is recommended. [ABSTRACT FROM AUTHOR]

Background: Healthcare providers must have the knowledge to carry out clinical procedures. Placing and maintaining intravenous (IV) infusion is one of them. To perform it, conceptual knowledge is an elementary requirement. Methods: This is a descriptive quantitative study using a self-administered questionnaire. Section A consists of four items detailing medical students' socio-demographic data such as age, gender, ethnicity, and nationality. Section B includes 17 True/False items related to knowledge and understanding of peripheral intravenous cannulation (PIVC). Sixtynine semester 6 medical students were recruited. The goal of the research was to determine their knowledge of PIVC and if there is an association between sociodemographic data and knowledge of PIVC. Results: All 100% (n=69) respondents were aware of self-introduction, clarification of patient's identity, obtaining verbal consent, and hand hygiene importance. The majority (98.6%, n=68) had the knowledge to clean the insertion site before performing the procedure, aseptic technique maintenance, and gloves donning. More than half (53.6%; n=37) of respondents were not aware that an 18-gauge cannula was commonly used in adults for PIVC. Overall, findings showed 40.6% (n=28) of respondents have adequate knowledge about PIVC. There was a weak negative correlation indicating an association between socio-demographic variables and knowledge about PIVC (r = -.274, n=69, p<0.05). Conclusions: The majority of semester 6 year 3 medical students in a private university in Seremban, Negeri Sembilan, had good knowledge of PIVC. Teaching strategies by nursing lecturers can be improved further, for example, role-playing which can increase students' engagement and encourage critical thinking. This is to ensure that medical students are equipped with sufficient theoretical knowledge as it is important to produce doctors with great quality, confidence, and calibre. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare Workers (HCWs) have borne the major brunt of the Coronavirus Disease-2019 (COVID-19) pandemic, being at the forefront. With the disease being enigmatic and no proven treatment or vaccine available during the initial stages, personal protection in general, and hand hygiene, in particular, have been the mainstays for protection against the disease, exposing HCWs to more wet work. Wet work exposure is considered a major risk factor for the occurrence of Hand Eczema (HE). Aim: To estimate the prevalence of hand dermatitis and ascertain the risk factors among HCWs exposed to wet work while caring for COVID-19 patients. Materials and Methods: A cross-sectional study was conducted among HCWs managing COVID-19 patients in a dedicated COVID-19 hospital from July to December 2020. The diagnosis of HE was based on medical history and clinical examination. Clinical features like itching, redness, scaling, clustered papulovesicles, hyperkeratosis, or fissuring largely confined to the hands, with none or only minor involvement of other areas, were used in diagnosing HE. An association of various wet work exposures with HE among study participants was analysed. Categorical variables were analysed using the Chi-square test, and a p-value <0.05 was considered statistically significant. Results: A total of 390 HCWs, of which 203 (52.1%) were females, participated in the study. The majority, i.e., 329 (84.4%) of participants, were in the age range of 21-35 years. A total of 244 (62.6%) HCWs were performing duties for 30-40 hours per week. Among all 390 HCWs studied, 102 (26.2%) were found to have features of HE. High frequency of alcoholic hand disinfectant use (>20 times daily) was significantly associated with the occurrence of HE. Similarly, the high frequency of hand washing with soap at work (>20 times) significantly increased the risk of developing HE. A prior history of atopic diathesis was found to be a significant risk factor for fresh episodes of HE. Conclusion: The present study concludes that intensive hand hygiene during the prevailing COVID-19 pandemic leads to the occurrence of HE among HCWs. [ABSTRACT FROM AUTHOR]

The cultivation of hand hygiene behavior among school-age children is an important way to prevent the spread of diseases and ensure children's health. However, traditional health education methods lack personalized programs tailored to each child, which cannot effectively improve their hand hygiene awareness and behavior. In response to this issue, the study combines multi-objective particle swarm optimization algorithm to provide personalized hand hygiene behavior development recommendations for school-age children, improving their hand hygiene awareness and behavioral level. The study adopted multi-objective particle swarm optimization algorithm and convolutional neural network, combined with the personalized needs of school-age children and the goal of cultivating hand hygiene behavior, and proposed a health education plan based on intelligent recommendation algorithm. Through deep learning, match the hand hygiene needs of school-age children with corresponding health education plans to achieve personalized recommendations. The average accuracy of the health education recommendation plan for hand hygiene behavior cultivation of school-age children based on multi-objective particle swarm optimization algorithm reaches 99.07%. Meanwhile, after introducing convolutional neural networks, the feature matching error between the recommended scheme and school-age children ranges from 10-1 to 10-2. After testing, the designed algorithm performs more stably and has less fluctuations under different sparsity conditions. Health education solutions based on intelligent recommendation algorithms can provide personalized solutions for school-age children, effectively cultivate their hand hygiene behavior, and meet various health needs. [ABSTRACT FROM AUTHOR]

Research suggests that discounting of delayed rewards (i.e., tendency to choose smaller immediate rewards over large later rewards) is a promising target of intervention to encourage compliance with public health measures (PHM), such as vaccination compliance. The effects of delay discounting, however, may differ across the types of PHMs, given that the benefits of vaccination, unlike other PHMs (physical distancing, handwashing, and mask-wearing), are more temporally delayed. Here, we examined whether delay discounting predicts engaging in COVID-19 PHMs in approximately 7,000 participants recruited from 13 countries in June–August 2021. After controlling for demographic and distress variables, delay discounting was a negative predictor of vaccination, but a positive predictor of physical distancing (when restrictions are in place) and handwashing. There was no significant association between delay discounting and frequency of mask-wearing. It is possible that increasing vaccination compliance may require greater emphasis on future benefits of vaccination, whereas promotion of physical distancing and hand hygiene may require greater focus on the present moment. Further research is needed to investigate the nature of this relationship and its implications for public health messaging. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hand hygiene (HH) is pivotal in mitigating infectious disease transmission and enhancing public health outcomes. This study focuses on detailing the national surveillance system for alcohol-based hand rub (ABHR) consumption in healthcare facilities across Italy, presenting results from a comprehensive three-year evaluation period, from 2020 to 2022. It aims to delineate this surveillance system and report on ABHR consumption trends in various Regions/Autonomous Provinces (Rs/APs). Methods: ABHR consumption data, collected through the ABHR Italian national surveillance system, coordinated by the Istituto Superiore di Sanità (ISS), were analyzed. Statistical methods, e.g., the Mann–Whitney test, were used to assess trends in ABHR consumption, expressed in liters per 1000 patient days (L/1000PD). Results: The results show significant variation in ABHR consumption across Rs/APs and over the years studied. National median ABHR consumption decreased from 2020 to 2022, with a significant reduction from a median of 24.5 L/1000PD in 2020 to 20.4 L/1000PD in 2021 and 15.6 L/1000PD in 2022. Conclusions: The decline in ABHR consumption raises concerns about the ongoing adherence to HH practices in Italian healthcare settings. This underscores the essential role that systematic ABHR monitoring and improved surveillance play in enhancing HH compliance, suggesting that sustained and strategic efforts are fundamental to uphold high standards of hygiene and to effectively respond to fluctuating ABHR usage trends over time. Further research is needed to explore barriers to effective ABHR use and to develop targeted strategies to improve HH practices. [ABSTRACT FROM AUTHOR]