Hospital hand hygiene monitoring: internal audits and the role of public health residents

Background Healthcare workers (HCW) adherence to hand hygiene (HH) is the most effective infection prevention and control (IPC) measure to fight healthcare-associated infections (HAI) and is a crucial component for standard precautions, especially in a pandemic context. As suggested by the WHO and Joint Commission Network Project, evaluating adherence to HH is essential to identify deficiencies and promote improvement interventions. Methods San Raffaele Hospital in Milan, Italy, adopted internal audits to measure HCWs' adherence to HH according to WHO Guidelines. Public health (PH) residents were enrolled as auditors. They were trained with WHO technical manual for observers and handovers among residents. WHO observation form was used for collection. Process index was HH adherence, stratified by profession, unit, opportunity and indication. Results 8 PH medical residents carried out observations from January 2018 to December 2019. 434 HCWs were observed in 26 hospital units (191 nurses, 148 physicians, 83 healthcare assistants and 11 other professionals). Global adherence was 53%, calculated on 1,969 opportunities, and 2,221 indications observed, followed by 932 hands rubbing and 110 handwashing. Most observations involved nurses (adherence of 53%) and physicians (54%). Global adherence was generally higher in medicine, specialist surgery and intensive-care units while lower in general surgery and rehabilitation units. Indications with the highest adherence were “after body fluid exposure risk” (69%) and “after touching a patient” (64%). The lowest adherence (44%) was observed for “before clean/aseptic procedure” indication. The belief that gloves use may replace HH might partially explain the data. Conclusions Global HH adherence was in line with significant published data and was far better than 2016 data but slightly lower than observations in 2018 when the program started. We believe 2020 HH compliance could have changed due to HCW involvement in IPC against COVID-19. Key messages Hand hygiene (HH) audits represent a crucial tool of clinical governance and risk management: auditors’ training, monthly and annual reports, and feedbacks allowed to structure a virtuous process. If HH audits aim to improve practice we should understand when HH is most beneficial, assessing quality, improving performances through achievable targets using reproducible methods and technologies.

The efficacy of ultraviolet light-emitting technology against coronaviruses: a systematic review.

The ongoing pandemic of COVID-19 has underlined the importance of adopting effective infection prevention and control (IPC) measures in hospital and community settings. Ultraviolet (UV)-based technologies represent promising IPC tools: their effective application for sanitation has been extensively evaluated in the past but scant, heterogeneous and inconclusive evidence is available on their effect on SARS-CoV-2 transmission. With the aim of pooling the available evidence on the efficacy of UV technologies against coronaviruses, we conducted a systematic review following PRISMA guidelines, searching Medline, Embase and the Cochrane Library, and the main clinical trials' registries (WHO ICTRP, ClinicalTrials.gov, Cochrane and EU Clinical Trial Register). Quantitative data on studies' interventions were summarized in tables, pooled by different coronavirus species and strain, UV source, characteristics of UV light exposure and outcomes. Eighteen papers met our inclusion criteria, published between 1972 and 2020. Six focused on SARS-CoV-2, four on SARS-CoV-1, one on MERS-CoV, three on seasonal coronaviruses, and four on animal coronaviruses. All were experimental studies. Overall, despite wide heterogenicity within included studies, complete inactivation of coronaviruses on surfaces or aerosolized, including SARS-CoV-2, was reported to take a maximum exposure time of 15 min and to need a maximum distance from the UV emitter of up to 1 m. Advances in UV-based technologies in the field of sanitation and their proved high virucidal potential against SARS-CoV-2 support their use for IPC in hospital and community settings and their contribution towards ending the COVID-19 pandemic. National and international guidelines are to be updated and parameters and conditions of use need to be identified to ensure both efficacy and safety of UV technology application for effective infection prevention and control in both healthcare and non-healthcare settings.

Preventive and responsive plans to COVID-19 epidemic in a leading teaching hospital in Milan, Italy

Issue Following the SARS-Cov-2 outbreak in Wuhan, China, the first case of COVID-19 was reported in Codogno, Lombardy, Italy, on 20 February 2020. The ongoing epidemic has exposed the health care system to a severe stress. San Raffaele Hospital (OSR) in Milan, Italy - a leader in the emergency management, may provide a benchmarking experience useful for other countries. Description of the Problem OSR has established a task force including the health care director, the Infections Prevention and Control Committee (IPCC) and the head of ward and outpatients' facilities management area in order to assess the situation and to define a multi-step strategy. The management process has been divided in two steps. Firstly, a preventive phase was devised, in a preparedness perspective, to avoid the spread of the infection to the Healthcare Professionals (HCP). Secondly, a reorganizational phase was implemented to guarantee assistance to infected patients, especially the critical ones. Results Before the outbreak, the IPCC updated OSR's procedures, based on the WHO's, national and regional guidance, planned a lectures series and an online survey to train healthcare professionals and proposed to stack Personal Protective Equipment (PPE) to face the expected shortage. The Head of the facilities management area defined separate pathways in the Emergency Department in order to isolate patients with respiratory symptoms, set up a new ward, with 26 beds and dedicated personnel, as well as two Intensive Care Units, with 13 beds, Some wards were merged and more healthcare workers were moved to the COVID-19 units. Lessons The coordination between task force members has been crucial for translating the multi-step strategy in a quick reorganization of the whole hospital. Despite early preparations, we could not anticipate the evolution of the outbreak and its logistic impact, especially on the PPE procurement. Key messages A major Hospital was proved to be capable to respond to the changing healthcare requests. Organizational flexibility is crucial for proper emergency management.