Atividade lúdica e educativa para higienização das mãos em tempos de pandemia: relato de experiência / Play and educational activity for hand hygienization in pandemic times: experience report / Actividad lúdica y educativa para la higiene de manos en tiempos de pandemia: informe de experiencia

Objetivo: descrever a experiência de uma atividade lúdica para reflexão da técnica de higienização das mãos entre profissionais de enfermagem frente ao atendimento de paciente com Coronavírus. Método: trata-se do estudo de um relato de experiência profissional sobre uma atividade educativa realizada com 25 profissionais que estão na linha de frente do COVID-19. Resultado: os participantes perceberam as falhas durante o procedimento de higienização das mãos e foram esclarecidos sobres as principais dúvidas sobre a técnica correta, tempo de fricção, quantidade de sabão a ser utilizado, fazendo com que suas práticas fossem postas à prova. Conclusão: a educação permanente é primordial para incentivar e realizar as técnicas adequadas, principalmente as que se referem às barreiras de exposição ao vírus. O aumento da qualidade na higienização das mãos, exige investimento na educação continuada para os profissionais de saúde e mudanças dos aspectos relacionados às crenças e à cultura desses profissionais.(AU)

Objective: to describe the experience of a playful activity to reflect on the hand hygiene technique among nursing professionals regarding the care of patients with Coronavirus. Method: this is a study of a professional experience report about an educational activity carried out with 25 professionals who are on the front line of COVID-19. Result: the participants realized the flaws during the hand hygiene procedure and were clarified about the main doubts about the correct technique, friction time, amount of soap to be used, causing their practices to be put to the test. Conclusion: the permanent education is essential to encourage and carry out appropriate techniques, mainly those related to the barriers of exposure to the virus. The increasing in quality of hand hygiene requires investment in continuing education for health professionals and changes in the aspects related to the beliefs and culture of these professionals.(AU)

Objetivo: describir la experiencia de una actividad lúdica para reflexión sobre la técnica de higienización de las manos entre profesionales de enfermería en relación al cuidado de pacientes con Coronavirus. Método: se trata de un estudio de un informe de experiencia profesional sobre una actividad educativa realizada con 25 profesionales que se encuentran en la primera línea del COVID-19. Resultado: los participantes se notaron las fallas durante el procedimiento de higienización de las manos y se aclararon las principales dudas sobre la técnica correcta, tiempo de fricción, cantidad de jabón a utilizar, haciendo con que sus prácticas sean puestas a prueba. Conclusión: la educación permanente es fundamental para incentivar y realizar las técnicas adecuadas, principalmente aquellos que se refieren a barreras de exposición al virus. El incremento de la calidad de la higienización de las manos requiere inversiones en educación continua para los profesionales de la salud y cambios en los aspectos relacionados con las creencias y la cultura de estos profesionales.(AU)

Public perceptions, individual characteristics, and preventive behaviors for COVID-19 in six countries: a cross-sectional study

BACKGROUND@#Public perceptions and personal characteristics are heterogeneous between countries and subgroups, which may have different impacts on health-protective behaviors during the coronavirus disease 2019 (COVID-19) pandemic. To assess whether self-reported perceptions of COVID-19 and personal characteristics are associated with protective behaviors among general adults and to compare patterns in six different countries.@*METHODS@#This cross-sectional study uses the secondary data collected through an online survey between 15 and 23 April 2020 across six countries (China, Italy, Japan, Korea, the UK, and the USA). A total of 5945 adults aged 18 years or older were eligible for our analysis. A logistic regression model was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) of three recommended behaviors (wearing a mask, handwashing, and avoiding social gatherings).@*RESULTS@#In most countries except for China, the participants who perceived wearing a mask as being extremely effective to curtail the pandemic were more likely to wear a mask (OR, 95%CI: Italy: 4.14, 2.08-8.02; Japan: 3.59, 1.75-7.30; Korea: 7.89, 1.91-31.63: UK: 9.23, 5.14-17.31; USA: 4.81, 2.61-8.92). Those who perceived that handwashing was extremely effective had higher ORs of this preventive behavior (OR, 95%CI: Italy: 16.39, 3.56-70.18; Japan: 12.24, 4.03-37.35; Korea: 12.41, 2.02-76.39; UK: 18.04, 2.60-152.78; USA: 10.56, 2.21-44.32). The participants who perceived avoiding social gathering as being extremely effective to curtail the pandemic were more likely to take this type of preventive behavior (OR, 95%CI: China: 3.79, 1.28-10.23; Korea: 6.18, 1.77-20.60; UK: 4.45, 1.63-11.63; USA: 4.34, 1.84-9.95). The associations between personal characteristics, living environment, psychological status, and preventive behaviors varied across different countries. Individuals who changed their behavior because of recommendations from doctors/public health officials were more likely to take preventive behaviors in many countries.@*CONCLUSIONS@#These findings suggest that higher perceived effectiveness may be a common factor to encourage preventive behaviors in response to the COVID-19 pandemic. These results may provide a better understanding of the homogeneity and heterogeneity of factors related to preventive behaviors and improve public health policies in various countries and groups.

Handwashing: a household social vaccine against COVID 19 and multiple communicable diseases

Handwashing is the most cost-effective measure for prevention of a wide spectrum of diseases from respiratory, intestinal, soil transmitted helminthiasis, health-care associated illness to infection with pandemic potential like SARS, MERS and COVID 19. Experts view that handwashing can be the greatest investment in the mankind as it reduces under nutrition, morbidity, mortality and paves way for growth, development, educational attainment of people and thereby achieving healthier communities. Though the evidence of handwashing on health is two centuries old but change in human behaviour seems critical in both developing and developed countries. Hand hygiene is rarely practiced during crucial moments and even rarely soap is used. Therefore emphasis should be given towards a societal shift in behaviour change among children, caretakers and people of all age groups. Every school, community and hospital should be provided with Safe water, Sanitation and adequate Hygiene (WASH) services. Hand hygiene to be given top priority in national health plans by which millions of unnecessary deaths and burden on health care system can be avoided. Nevertheless under the looming threat of the current COVID 19 pandemic, where the exact epidemiology is still evolving and a vaccine doesn’t seem feasible as an immediate measure to control the disease, handwashing should be considered as a ‘social vaccine’ for everyone at every household level.

A study to identify knowledge, attitude and practices prevalent amongst the caregivers of children below five years presenting with acute diarrhoea in a tertiary care centre

Background: Diarrhoeal infections are the second leading cause of death worldwide in under-five children covering 9% of the total deaths. The objective of the study was to assess and compare mothers' knowledge, attitude and practice regarding prevention and management of diarrhoea in children.Methods: A cross-sectional hospital-based observational study was conducted in a tertiary centre amongst all 356 children between age group 2 months to 60 months admitted with acute watery diarrhea. A pre-tested questionnaire and face-to-face interviews with the mothers was used as a data collection tool.Results: Most of the mothers 282 (79.2%) were 20-30-year-old, 51.4% were illiterate, 57.3% were unemployed and 27.2% were daily wage labourers. 44.6% people came from rural background and 78.9% belonged to lower socio-economic strata. 30.3% were exclusively breastfed and 69.7% were on top feeds. Animal milk was taken by 62.1%, 46.6% had dilution and 50.6% used bottles for feeding. 70.5% of mothers washed their hands at the time of feeding of their child, 93.8% mother covered food in their houses while only 26.7% of mothers gave freshly cooked food. Mother's outlook on various aspects of diarrhea was sought. Very few mothers considered poor sanitation (2.5%) andcontaminated water (12.6%) as a source of diarrhea. Only 8.7% mothers knew about the role of ORS in diarrhea and maximum (53.4%) considered that diarrhea could not be avoided by any measure.Conclusions: Mother's knowledge regarding causes, management and prevention of diarrhea needs to be upgraded to allow better utilisation of health resources by the families.

Conocimientos, actitudes y prácticas sobre la adherencia al lavado de manos en personal de salud / Knowledge, attitudes and practices related to the adherence of handwashing in health personnel

Introducción: El lavado de manos deficiente, sigue siendo un problema hospitalario. Cumplir con las recomendaciones internacionales ofrece seguridad en el cuidado. Objetivo: Identificar el nivel de conocimiento, actitudes y prácticas en la técnica del lavado de manos en personal de salud en un hospital pediátrico de La Habana. Metodología: Estudio descriptivo a 145 trabajadores (31,7 por ciento médicos, 35,2 por ciento enfermeros, 22,8 por ciento médicos residentes y 10,3 por ciento estudiantes). De 13 servicios el cuerpo de guardia, sala de respiratorio, cirugía, neurocirugía y quemados, fueron los que más participación tuvieron. El estudio se realizó en tres etapas: 1. Observación directa de la técnica del lavado de manos. 2. Observación de la calidad del lavado de manos mediante lámpara fluorescente. 3. Medida del conocimiento acerca del lavado de manos y actitud mediante encuesta. Resultados: En la primera etapa, el 51,7 por ciento calificó de inadecuado, en la segunda etapa el 64,8 por ciento también tuvo una evaluación inadecuada y en las encuestas, el conocimiento alcanzó solo 52,4 por ciento, considerado inapropiado. La actitud ante esta actividad fue calificada de inadecuado en el 53,1 por ciento, con un mejor porcentaje en el personal de enfermería. Conclusiones: Los conocimientos, actitudes y prácticas sobre el lavado de manos es deficiente, por lo que debe diseñarse un programa de capacitación en todos los niveles, sea pregrado, posgrado o formación continua, donde exista responsabilidad individual de cada profesional sanitario, y se insista en ello(AU)

Introduction: Deficient handwashing is still a problem in hospitals. The compliance of the international recommendations on this matter provides security in the care. Objective: To identify the level of knowledge, attitudes and practices in the technique of handwashing in a pediatric hospital in Havana. Methodology: Descriptive study applied to 145 workers (31.7 percent doctors, 35.2 percent nurses, 22.8 percent residents, and 10.3 percent students) of 13 services. Emergencies, Respiratory, Surgery, Neurosurgery and Caumatology were the services with more participation. The study was conducted in three stages: 1. Direct observation of the technique of handwashing. 2. Quality observation of the handwashing using fluorescent lamp. 3. Extent of knowledge on handwashing and attitudes through survey. Results: In the first stage, the 51.7 percent the handwashing was assessed as inappropriate, in the second stage the 64.8 percent was also evaluated as inadequate, and in the surveys, the 52.4 percent had an incorrect knowledge; the attitude towards this activity was described as inappropriate in the 53.1 percent , with a better percentage in the nursing staff. Conclusions: The knowledge, attitudes and practices on handwashing were poor, so it must be designed a training program at all levels, whether undergraduate, graduate or continuing training, where individual responsibility of each healthcare professional exists, and should be highlithed(AU)

Socio-demographic characteristics, breast feeding practices and household sanitation as risk factors for diarrhoeal illness in under five children

Background: Acute diarrhoeal disease among children under 5 years remains a major cause of morbidity and mortality. In India, diarrhoea attributes to 13% of under-5 mortality. As most diarrhoeal diseases have feco-oral route of transmission, the source of water supply, sanitary measures and personal hygiene are important factors in prevention of same. This study aims to determine various risk factors for diarrhoeal illnesses.Methods: A descriptive cross-sectional observational case-control study done among under-5 children hospitalized during rainy months in paediatric ward of tertiary care centre. Information regarding participant's age, sex, immunization status and breast feeding practices collected from the mother or caregiver of the child using a structured questionnaire.Results: Out of 55 cases and 55 controls enrolled, there was no significant difference in birth weight, gender, immunization status, socio economic profile, hygiene practices and sanitation facility between two groups. Statistically significant difference (p 0.01717) was seen in wasting associated with cases and controls however no difference in proportion of stunting was noted. The cases showed early age of start of complimentary feeding (5.86' 1.38m) and less duration of total breast feeding (15.94'4.09m) as compared to controls. Bottle feeding was seen in 69% cases as compared to 53% controls.Conclusions: In socio economically and environmentally similar conditions, faulty feeding is a significant risk factor for diarrhoeal illness in under 5 children. Wasting is also a significant risk factor associated with the same.

Efectividad de un programa educativo en el lavado de manos del personal de salud / Effectiveness of an Educational Program in Handwashing for the Health Personnel

Introducción: Las infecciones asociadas a la asistencia sanitaria están entre las causas más frecuentes de morbi-mortalidad de pacientes hospitalizados. El lavado de manos parece un tema sencillo dentro de la sanidad, sin embargo, no siempre funciona como debería. Objetivo: Evaluar la efectividad de un programa educativo en el lavado de manos del personal de salud. Métodos: Estudio cuasiexperimental desarrollado en tres etapas (diagnóstica, intervención y evaluación) en el Hospital "Lucía Íñiguez", Holguín, durante 2016, con 50 trabajadores seleccionados al azar. La información se obtuvo antes y después de aplicado el programa educativo mediante una guía de observación y un cuestionario. Se realizó análisis descriptivo de la información, que incluyó frecuencias absolutas y porcentajes para variables cualitativas; medias, medianas, desviaciones estándar con intervalos de confianza (95 por ciento para variables cuantitativas). Para estudiar la efectividad del programa educativo se compararon los resultados obtenidos antes y después de su aplicación mediante la prueba exacta de Wilcoxon para datos apareados. Se valoraron niveles de significación inferiores al 0,05. Resultados: Predominó el personal de enfermería (70 por ciento), después de aplicado el programa educativo todos los parámetros evaluados sobre el lavado de manos mejoraron y disminuyó la cantidad de trabajadores en los que se aisló algún tipo de germen en los cultivos de las manos realizados. Conclusiones: El lavado de manos de los trabajadores, luego de las acciones realizadas varió favorablemente, aumentó el tiempo utilizado aunque no siempre se llegó al establecido. Los gérmenes disminuyeron, se logró modificar conductas y disminuir el riesgo de infecciones(AU)

Introduction: Infections associated with healthcare are among the most frequent causes of morbidity and mortality in hospitalized patients. Handwashing seems like a simple issue in healthcare; however, not always does it work as it should. Objective: To assess the effectiveness of an educational program in washing for the health personnel. Methods: Quasiexperimental study carried out in three stages (diagnosis, intervention, and evaluation) at Lucía Íñiguez Hospital in Holguín, during 2016, with 50 randomly selected workers. The information was obtained through an observation guide and a questionnaire, before and after the educational program was applied. Descriptive analysis of the information was carried out, which included absolute frequencies and percentages for qualitative variables; means, medians, standard deviations with confidence intervals (95 percent) for quantitative variables. To study the effectiveness of the educational program, the results obtained before and after its application were compared using the paired data Wilcoxon test. Significance levels below 0.05 were assessed. Results: There was a predominance of the nursing staff (70 percent). After applying the educational program, all evaluated parameters on handwashing improved and the number of workers in whom some type of germ was isolated in the cultures carried out was reduced. Conclusions: Handwashing among the workers, after the actions carried out, varied favorably. The time used increased, although the established one was not always reached. Germs decreased, behaviors were modified, and the risk of infections decreased(AU)

Assessment of hand hygiene practices among rural population in Davangere

Background: Handwashing is well-recognized preventive tool for disease prevention. Handwashing with soap has been viewed as one of the most cost-effective ways of reducing the global infectious disease burden. Hence, the present study was conducted with an aim to study handwashing practices in rural communities. Objectives: The objectives are as follows: (i) To assess the handwashing practices in rural areas, (ii) to identify the factors associated with handwashing practices, and (iii) to determine the association between handwashing and certain infections. Materials and Methods: A cross-sectional study was conducted among 128 respondents, residing in Kukkuwada village, Davangere Taluk. Data were collected by house to house surveys using semi-structured and pre-tested questionnaire. Data were entered into Microsoft Excel and analyzed using SPSS version 16.0. Results: A total of 128 (44 males and 84 females) individuals participated in the study. The majority were from 21 to 40 years age-group (49.2%). All of them practiced handwashing after defecation. A majority, 80 (62.5%) were using soap and water, 12 (9.4%) used water and antiseptic solution for handwashing, and 36 (28.1%) used only water for handwashing. Handwashing practices (medium and technique) were significantly associated with history of episode of diarrhea and upper respiratory tract infection in the past 3 months. Conclusions: Among all the study participants who practiced handwashing, majority of them used water with soap and is influenced by factors such as age, frequency of health facility visits, and previous infections. The findings were found encouraging, and we recommend measures for sustainable practice.

Study of knowledge and practices related to handwashing in school going children of a rural community

Background: A questionnaire-based study was conducted in rural schools of Maval taluka of Pune district to assess the knowledge about hand washing practices and behavior in school going children. It is well known that hand contamination plays a major role in faeco-oral transmission of diseases. Hand washing is well recognized preventable tool in disease prevention.Methods: A questionnaire-based study on hand washing practices and behavior in school going children in Maval taluka was carried out on 340 volunteers (students) from grade 6 to 8 of rural area of Maval taluka, Pune District. Maharashtra. Statistical analysis was done by using percentages and proportions.Results: A total of 340 students from grade 6 to 8 participated in the study. Majority were from age 11-13 years (n= 147). Almost all (n=320, 93%) were knowing the practice of handwashing. Majority (n=209,61%) were using soap in some form for cleaning of hands. Many (n=250,73%) were having practice of washing hands before meals. Almost all (n=309, 91%) were knowing the reason for washing of hands. The benefits and prevention of diseases were known to majority of students (n= 295,87%) Nail trimming was done once a week in almost all students.(n=250,73%) Reason for trimming of nails was known to many (n=326, 96% ) as it prevents the spread of the disease, only (n=14,4% ) were not aware' of the reason for trimming of the nails. About (n=201, 59 %) of mothers had formal education upto tenth std.Conclusions: Majority of the students used water and soap for hand washing and knew the importance of hand cleaning to prevent many diseases.

Association Between Toilet Availability and Handwashing Habits and the Incidence of Stunting in Young Children in Tanjung Pinang City, Indonesia

@#Introduction: Stunting is a short or very short body state that exceeds -2 SD (Standard Deviation) below the median length based on height by age. The purpose of this study was to determine the effect of the availability of toilets meeting the requirements and habits of washing hands with soap on the incidence of stunting in children aged 2459 months in Bugis Village in Tanjung Pinang City. Method: This study was observational with a cross-sectional approach. The procedure of data analysis was done by quantitative analysis. Large sample of 82 children aged 24-59 months.. The sampling technique uses simple random sampling. Data collection uses observation and interviews. Statistical tests using the test Chi-square. Results: the study showed that there is an association between stunting in children and the availability of toilets meeting hygiene requirements (p-value= 0.016) and handwashing habit with soap (p-value= 0.013). Conclusion: the incidence of stunting in children aged 24-59 months in Bugis Village Tanjungpinang City is influenced by the availability of qualified toilets in each house and the habit of washing hands with soap.

A study on assessment of knowledge, attitude and practice on handwashing among nursing students of Sree Venkateswara College of Nursing, Chittoor, Andhra Pradesh

Background: Handwashing is the act of cleaning one's hands for the purpose of removing soil, dirt & microorganisms. Through review of literature it is understood that the most nosocomial infections are thought to be transmitted by the hands of healthcare workers, handwashing is considered the single most important intervention to prevent nosocomial infections. This study was conducted to assess the knowledge, attitude and practices (KAP) on handwashing among the nursing students and to identify the areas of gap in their KAP along with the provisions for handwash.Methods: A descriptive, cross-sectional study was conducted among 192 nursing students at S.V. College of Nursing, Chittoor during October 2018 using pre-validated self-reported questionnaire. Statistical analysis was done with SPSS 20.0 software and Chi-Square test was used with “P” value<0.05 taken as statistically significant.Results: Among all respondents 85% were aware about washing their hands during all common critical times, but practicing was observed in 08% only. 50% felt that alcohol based handrub is effective than handwashing with soap and water, but facilitated 10% only. While the final year students all (100%) were well aware about all critical times of handwashing, whereas 1st and 2nd years 71% and 3rd year students 87% were aware (p=0.002).Conclusions: There is a need of orientation and arrangements for proper handwashing to be improved.

Bioluminiscencia: Herramienta de Medición y Análisis en Lavado de Manos Clínico Aplicado a la Odontología / Bioluminiscence Measurement Tool and Analysis in Clinical Hand Washing Technique Applied to Dentistry

RESUMEN: El estudio fue realizado en 40 estudiantes de ambos sexos, que cursaban 2° año el año 2017 de la carrera de Odontología, en estudiantes de la Universidad de La Frontera. El objetivo fue evaluar la efectividad de la técnica de Lavado de Manos Clínico (LMC) demostrando el grado de eficiencia, mediante Bioluminiscencia. La técnica que permite una medición cuantitativa rápida de los residuos orgánicos de superficie, por la cuantificación de cantidad de Adenosín Trifosfato (ATP). Empleándose un Luminómetro, 3M™ Clean-Trace™, se programó la medición de contaminación en dos puntos claves, región interdigital e hiponiquio, en ambas manos, por medio de la lectura de Unidades Relativas de Luz (URL). Se analizó la contaminación previa a la técnica de LMC y posterior al desarrollo de la técnica, en las regiones indicadas, por medio de Hisopado v/s aprobación/rechazo considerando como Aprobado <250 URL y Rechazado >251 URL., nivel de contaminación v/s sexo, y distribución de aprobación/rechazo tanto antes y después de realizada la técnica de LMC. El muestreo previo al LMC determinó en todas las localizaciones muestreadas existen rangos de aprobación/ rechazo entre 35-42,5 % / 57,5-65 %, encontrándose la mayor contaminación en ambas manos en hiponiquio. Posteriormente de realizada la técnica de LMC el rango de corte de aprobación/rechazo fue de 80-90 % / 10-20 %, el porcentaje más alto se pesquisó en mano izquierda hiponiquio. Para el análisis estadístico se utilizó el programa estadístico SPSS Statistics for Windows, análisis descriptivo, prueba t- test, prueba de Levene. Un valor de p < 0,05 para significancia. Obteniéndose diferencias significativas en análisis del valor la media, según zonas de muestreo y rangos de aprobación/rechazo en URL, que varían entre p=0,000 y p=0,015, que se presentó en mano izquierda zona interdigital posterior al LMC. Según la media concluimos que las regiones hisopadas tanto previas y posteriores a la ejecución del LMC en hiponiquio la piel está más contaminada, que es paradojal ya que la técnica incorpora un acento en esta localización, tiene un mejor acceso y contacto con jabón y agua.

SUMMARY: The study was conducted in 40 undergraduate students of both sexes, who were in the 2nd year of the 2017 year enrolled in the Undergraduate Dentistry Program of the Universidad de La Frontera. The objective was to evaluate the effectiveness of a Clinical Hand Washing technique (CML), demonstrating the degree of efficiency and implementing improvement behaviors of the technique using Bioluminescence. This technique allows a rapid quantitative measurement of organic residues on a surface by quantifying the amount of Adenosine Triphosphate (ATP). For that purpose, a Luminometer, 3M™ Clean-Trace™, was used to obtain the contamination level in two key points, Interdigital Region and Hyponychium, of both hands by quantification of Relative Light Units (URL). Hand contamination prior to CML and after the development of the technique was tested in the Interdigital and Hyponychium regions of both hands, through surface ATP swab considering as Approved <250 URL and Rejected > 251 URL. Also, the level of contamination v/s sex, and approval/rejection distribution before and after the CML were tested. The approval/rejection range for pre-CML sampling at all selected locations was 35-42.5 % / 57.5-65 %, fin ding the highest contamination rate in Hyponychium in both hands. After performing the CML we obtained 90 % of approval in all sites, with a 10 % rejection rate; the highest percentage was surveyed on left hand Hyponychium. Statistical analysis was performed using SPSS Statistics for Windows, a descriptive analysis, test t-test for independent samples, test of homogeneity of Levene variances. A p value <0.05 was established for statistical significance. There were significant differences in analysis of the mean value, according to sampling zones and URL approval / rejection ranges, ranging from p = 0.000 to p = 0.015 (Interdigital region of left hand, post-LA TÉCNICA DE LMC). The left hand presented greater contamination in both swab areas both before and after the execution of CML. The most contaminated region was the Hyponychium, which was paradoxical, because the technique emphasizes the hygiene of this location and has better access and contact with soap and water.

Burden of Disease Attributable to Inadequate Drinking Water, Sanitation, and Hygiene in Korea

BACKGROUND: Diarrheal and intestinal infectious disease caused by inadequate drinking water, sanitation, and hygiene (WASH) is not only a great concern in developing countries but also a problem in low-income populations and rural areas in developed countries. In this study, we assessed the exposure to inadequate WASH in Korea and estimated the burden of disease attributable to inadequate WASH. METHODS: We used observational data on water supply, drinking water, sewage treatment rate, and hand washing to assess inadequate WASH conditions in Korea, and estimated the level of exposure in the entire population. The disease burden was estimated by applying the cause of death data from death registry and the morbidity data from the national health insurance to the population attributable fraction (PAF) for the disease caused by inappropriate WASH. RESULTS: In 2013, 1.4% of the population were exposed to inadequate drinking water, and 1.0% were living in areas where sewerage was not connected. The frequency of handwashing with soap after contact with excreta was 23.5%. The PAF due to inadequate WASH as a cluster of risk factors was 0.353 (95% confidence interval [CI], 0.275–0.417), among which over 90% were attributable to hand hygiene factors that were significantly worse than those in American and European high-income countries. CONCLUSION: The level of hand hygiene in Korea has yet to be improved to the extent that it shows a significant difference compared to other high-income countries. Therefore, improving the current situation in Korea requires a continuous hand washing campaign and a program aimed at all people. In addition, continuous policy intervention for improvement of sewage treatment facilities in rural areas is required, and water quality control monitoring should be continuously carried out.

Hand hygiene status among inpatients and their families in infectious diseases departments in Yantai City / 中国感染控制杂志

Objective To understand the status of hand hygiene(HH) among patients hospitalized in departments of infectious diseases and their families in Yantai City, and provide reference for HH intervention.Methods Patients and their families(n=221) in departments of infectious diseases of secondary and above levels of hospitals as well as infectious diseases hospitals in Yantai in July-August 2015 were selected for questionnaire survey, education and implementation status of HH were investigated;hand bacteriological sampling was performed on some patients and their families (n=62) to investigate effect of hand-washing.Results 61.99% of patients and their families had received verbal HH education, only 18.55% indicated to have seen health care workers(HCWs) to perform the six step hand-washing method;50.68% of the respondents didn't understand the six step hand-washing method, and 85.52% never performed the six step hand-washing, the main reason is that they didn't know how to perform.93.21% of patients(n=206) and their families believed that hand-washing was important.The cognition of HH opportunities in daily life was relatively higher(61.54%-94.51%),and in hospital environment was relatively lower(36.15%-49.23%),only 36.15% of the families washed hands before left the hospital.Unqualified rate of detection results of sampling of hands of patients with infectious diseases and their families was 83.87%.Conclusion Patients with infectious diseases and their families are deficient in HH knowledge and behavior, medical institutions should carry out systematic and standard HH education to reduce the risk of healthcare-associated infection.

Moderation and Mediation Effects of Self-efficacy and Perceived Behavioral Control on the Relationship between Knowledge of and Compliance with Handwashing in Nursing Students / 기본간호학회지

PURPOSE: The aim of this study was to examine the relationship between handwashing knowledge and handwashing compliance in nursing students and to identify the moderation and mediation effects of self-efficacy and perceived behavioral control on the relationship. METHODS: The participants were 172 nursing college students who completed the self-report measures. Data were analyzed using t-test, ANOVA, and Pearson correlation coefficient, Multiple regression analysis was used to test moderation and mediation effects. RESULTS: The score for knowledge of handwashing was higher in participants who had completed fundamentals of nursing practicum (t=−6.54, p<.001) and the score for compliance with handwashing was higher in participants who had completed clinical practicum (t=−3.81, p<.001) or fundamentals of nursing practicum (t=−5.97, p<.001). Self-efficacy showed a significant moderation effect (z=2.21, p=.027) but not a mediation effect while perceived behavioral control had a significant mediation effect but not a moderation effect on the relationship between knowledge of handwashing and compliance. CONCLUSION: Findings indicate that clinical practicum and fundamentals of nursing practicum were helpful to nursing students in acquiring knowledge and in practicing proper handwashing technique. These findings suggest that continuing and repetitive education programs on handwashing need to be enhanced and strategies to strengthen self-efficacy and perceived behavioral control need to be included in education programs.

Development of the portuguese version of the instrument for assessing hygiene - HI23 / Desenvolvimento da versão em português do instrumento para avaliação em higiene- HI23

Hand hygiene is part of standard precautions and it has been emphasized that education of this practice depends on the individual's experience in general hygiene. The Hygiene Inventory (HI-23) assess the domains General Hygiene, in the fields of Hands, Personal, Household and Food. Aim: To make the transcultural adaptation of the HI-23 scale for Portuguese­Brazil and to investigate and describe the hygiene behavior according to the HI-23 scale among dental students. Material and Methods: The cross-cultural adaptation process consisted in five steps: two translations, two back translations, review committee, pre-test with a population sample, and reproducibility and reliability of the instrument adapted. For the intra-examiner reproducibility it was applied kappa statistics. The statistical Cronbach's alpha verified the reliability of the HI-23 scale adapted to Portuguese. The adapted instrument was applied to 292 students of Dentistry from 1st to 5th year of graduation from a Faculty of Dentistry. Results: There was good reproducibility (0.43≥κ≥0.81) and good internal consistency (Cronbach's alpha=0.75) for the questions of the questionnaire. The adapted instrument applied among academics, showed that students have good and adequate hygiene pattern for most questions, except for the hygiene in the preparation of food and utensils used to prepare them, in the time spent washing hands, and cleanliness regarding the exchange of clothing (pants/skirt). Conclusion: The transcultural adaptation of the instrument for the Brazilian version was successfully obtained. The instrument can be safely applied to measure the profile of hygiene among professional of the health area.

A higiene das mãos é parte das precauções padrão e tem sido enfatizado que a educação dessa prática depende da experiência individual em higiene geral. O Inventario em Higiene (HI-23) avalia os domínios Higiene Geral, Mãos, Pessoal, Doméstica e na Alimentação. Objetivo: Realizar a adaptação transcultural da escala HI-23 para o português-Brasil e investigar e descrever o comportamento em higiene segundo o HI-23, entre acadêmicos de Odontologia. Material e Métodos: O processo de adaptação transcultural consistiu em cinco etapas: duas traduções; duas retrotraduções, comitê de revisão, pré-teste com uma amostra da população alvo, reprodutibilidade e confiabilidade do instrumento adaptado. Para a reprodutibilidade intraexaminador foi aplicada a estatística kappa. A estatística alfa de Cronbach verificou a confiabilidade da escala HI-23 adaptada para o português. O instrumento adaptado foi aplicado a 292 estudantes de Odontologia do 1º ao 5º ano do curso de graduação de uma Faculdade de Odontologia. Resultados: Houve boa reprodutibilidade (0,43≥k≥0,81) e boa consistência interna (alfa de Cronbach=0,75) para as perguntas do questionário. O instrumento adaptado aplicado entre os acadêmicos, mostrou que os estudantes possuem um padrão de higiene bom e adequado para a maioria das questões, com exceção da higiene no preparo de alimentos e utensílios utilizados para prepará-los, no tempo gasto para lavagem das mãos e no asseio quanto a troca de vestimenta (calça/saia). Conclusão: A adaptação do instrumento para a versão brasileira foi obtida com sucesso. O instrumento pode ser aplicado com segurança para medir o perfil em higiene entre profissionais da área da saúde.

Sensibilidad in vitro a fluconazol y voriconazol de especies de Candida aisladas de las manos de trabajadores de salud y pacientes / In vitro susceptibility to fluconazole and voriconazole of Candida species isolated from the hands of health care workers and patients

Las manos del personal de salud se consideran importantes para la colonización e infección por Candida spp. El objetivo del estudio fue determinar la prevalencia y distribución de levaduras aisladas en las manos de trabajadores de salud y algunos pacientes, así como su sensibilidad in vitro frente al fluconazol y voriconazol. El estudio se realizó en tres servicios del Complejo Hospitalario Universitario “Ruíz y Páez”: unidad de cuidados intensivos, retén patológico y retén sano. El estudio de sensibilidad se realizó mediante el método de difusión con discos (Documento M44-A2). Se obtuvieron 79 aislamientos, de los cuales el 50,6% fue Candida albicans y el 49,4% especies no albicans. Las especies no albicans predominantes fueron C. tropicalis (n=25; 31,6%) seguidas del Complejo C. parapsilosis (n=13; 16,5%). El 87,3% y 91,1% de los aislados fue sensible al fluconazol y voriconazol, respectivamente. El 11,4% y 6,3% fue resistente al fluconazol y al voriconazol. Los resultados de este estudio demuestran que el estado de portador de levaduras en las manos del personal de salud es importante, por lo tanto es indispensable educarlos sobre el lavado adecuado de las manos, uso de guantes y uso de antisépticos para evitar o minimizar la posibilidad de transmisión de estos agentes.

The hands of health care workers are considered important for colonization and infection by Candida spp. The aim of the study was to determine the prevalence and distribution of yeasts isolated from the hands of health personnel and some patients and their in vitro susceptibility to fluconazole and voriconazole. The study was conducted in three services of the Hospital Universitario “Ruiz y Páez”: Neonatal Intensive Care Unit and Healthy and Pathologic Newborn Units. The susceptibility tests were performed by the disk diffusion method (document M44-A2). A total of 79 isolates were obtained, of which 50.6% were Candida albicans and 49.4% non-albicans species. Among the non-albicans species were C. tropicalis (n = 25; 31.6%) followed by C. parapsilosis complex (n = 13; 16.5%). 87.3% and 91.1% of isolates were sensitive to fluconazole and voriconazole, respectively. 11.4% and 6.3% were resistant to fluconazole and voriconazole. The results of this study demonstrate the importance of the carriage of yeasts in the hands of health personnel; therefore it is essential to educate them about proper hand washing, use of gloves and antiseptic products to prevent or minimize the transmission of these agents.

Hand Hygiene Compliance of Healthcare Workers in a Pediatric Intensive Care Unit.

We conducted an observational study over 11 months to assess the hand-hygiene compliance of health-care workers in a Pediatric intensive care unit. The overall compliance was 80.9%, which decreased with increase in workload (79.2% vs. 82.9%). Assessment of hand hygiene compliance helps understand the gaps in practices followed by healthcare workers, and plan effective protocols.

Atuação da equipe multidisciplinar no combate à infecções hospitalares / Role of the multidisciplinary team in fighting hospital infections

Objetivo ­ Avaliar a equipe multidisciplinar e sua funcionalidade, assim como os conceitos de biossegurança adotados por seus profissionais colaborando com a comissão de controle de infecção hospitalar Métodos ­ Para o desenvolvimento deste estudo foi aplicado um questionário de 19 questões objetivas com respostas pré-determinadas a 30 profissionais divididos em 3 grupos. Resultados ­ Observou-se que 13.3% dos profissionais fazem parte da comissão de controle de infecção. A questão da água corrente e limpa deixa no ar a qualidade da higienização, uma vez que a cidade enfrenta problemas sérios quanto à escassez e qualidade da água. Os pontos mais críticos foram encontrados na não higienização das mãos ao se mover de um sitio anatômico contaminado para outro com dados de 20%, contato com áreas próximas a paciente, objetos inanimados com não adesão de 34%. A taxa de profissionais sem conhecimento de realização de culturas foi de 24%. Falta de procedimentos escritos sobre exposição a material perfuro cortante foi de 24%. Conclusão ­ A equipe multidisciplinar não está seguindo corretamente o ideal preconizado pelo Ministério da Saúde, este trabalho evidenciou várias falhas em seus procedimentos quanto á higienização das mãos.

Objective ­ Evaluate the multidisciplinary team and its functionality, as well as the concepts of biosafety adopted by practitioners working with the commission of hospital infection control Methods ­ To develop a questionnaire study of 19 objective questions with predetermined answers to 30 professionals divided into 3 groups was applied. Results ­ It was observed that 13.3% of professionals are part of the infection control committee. The issue of clean running water makes the air quality of hygiene, since the city faces serious problems regarding the scarcity and quality of water. The most critical points were found in not washing hands when moving from one anatomical site to another with tainted data of 20%, close contact with the patient, inanimate objects with non-adherence of 34% areas. The rate without professional knowledge to conduct crop was 24%. Lack of written procedures overexposure cut and puncture wounds material was 24%. Conclusion ­ The multidisciplinary team is not properly following the ideal advocated by the Ministry of Health, this study revealed several flaws in their procedures regarding hand hygiene

Handwashing with soap and national handwashing projects in Korea: focus on the National Handwashing Survey, 2006-2014 / 한국역학회지

OBJECTIVES: Handwashing is the most fundamental way to prevent the spread of infectious diseases. Correct handwashing can prevent 50 to 70% of water-infections and foodborne-infections. We report the results of a fact-finding study on general handwashing attitude and practice in the Republic of Korea by analyzing habits and awareness among adults and students (grades 4 to 12) based on the 2006 to 2014 National Handwashing Surveys and observational surveys. METHODS: The awareness survey was performed by telephone interviews with adults and students in 16 municipalities and provinces sampled by quota for region, sex and age. The observational survey was performed in subway, railway, and other public restrooms in seven municipalities selected through systematic sampling. RESULTS: Adults and students washed their hands with soap/sanitizer an average of 6.6 and 5.2 times daily, respectively, in 2014, an increase and decrease compared to 2006 (4.8) and 2013 (6.8). Their average daily handwashing frequency in 2014, 9.8 and 8.3, was higher than in 2006 (7.6), but lower than in 2013 (10.3).The percentage of participants handwashing with soap after using the restroom (29.5%) has been increasing since 2009, but remain slower than in other countries (42% to 49%). The percentages of participants handwashing with water in 2014, 2013, and 2011 were 57.5%, 72.6%, and 71.4%, respectively. CONCLUSIONS: Handwashing with soap is an important national public health issue, and national projects promoting it should be given high priority. Research support is necessary to provide scientific evidence of the importance of handwashing with soap and to develop and implement evidence-based policies.