Enhancing compliance rate of hand hygiene before and after Covid-19: An interference analysis in Abu Dhabi, UAE hospitals

Hand hygiene (HH) is a crucial factor for reducing Healthcare Associated Infections (HAIs) in the hospital setting. The current analysis was created to create an intervention methodology to enhance hand hygiene compliance among hospital personnel in a healthcare setting. Covid-19 disease epidemic has additional stressed the need for world-wide development in hand hygiene compliance by the healthcare personnel. Healthcare Associated Infections have been a hot issue for several time periods and Healthcare Associated Infections are the most common adverse results due to the delivery of medical care and treatment. There is unanimity that hand hygiene is the extremely successful way to avoid healthcare associated infections. As healthcare systems fluctuate widely, prevention approaches must be designed appropriately. Hand hygiene, however, remains relevant in all settings, and World Health Organization (WHO) is strongly endorsing alcohol-based hand rubs to interrupt transmission. Nevertheless, very minimal compliance rate amongst the healthcare staff have been reported worldwide. Infected surfaces, especially those that are touched repeatedly by the patient's surroundings, act as reservoirs for pathogens and cause towards pathogen transmission. Therefore, healthcare disinfection requires a thorough approach whereby several strategies may be applied together, risk-based methodologies, to decrease the possibility of HAIs for the patients. In this paper more than 200 articles have been studied from 2016 to 2021 time period and various surveys have been conducted to analyze hand hygiene intervention and studied the various factors involving the patient's situation, medication management behavior of several units, and the type of healthcare employees during and before the Covid-19 pandemic. Based on this study, we evaluated overall hand hygiene compliance rate including the intake of hand wash liquid agent, alcohol-based hand rub (ABHR), the paper wipes, medical waste consumption and personal protective equipment's (gloves, masks etc.) before and after Covid-19 intervention to improve the hand hygiene compliance rate in Abu Dhabi hospitals. © 2023 Author(s).

The Impact of COVID-19 on Central Line Bloodstream Infections Standardized Infection Ratio in Intensive Care Units: A 3-year Surveillance Data

Introduction: Healthcare-associated infections have increased during the Coronavirus disease-2019 (COVID-19) pandemic because of inadequate adherence to infection control measures. Central line-associated bloodstream infections (CLBSI) are one of the infections with an increased incidence. In this study, CLBSI standardized infection ratio (SIRs) in three periods were compared, and the effect of the COVID-19 pandemic on CLBSI observed in intensive care units (ICUs) was evaluated. The hand hygiene compliance rates were also examined for the same period.Materials and Methods: The 3-year (2019, 2020, and 2021) SIR, standardized utilization ratio (SUR), and SIR change rates between years in 12 adult ICUs were compared. Calculations were made using the SIR and SUR calculation tool prepared by the General Directorate of Public Health of Turkey. The formula [(SIR/SUR of year Y-SIR/SUR of year X) / SIR/SUR x 100 of year X] was used when calculating the SIR/SUR change rates between periods.Results: In 2019 and 2020, SIR was detected as >1 only in the Burn ICU. Anesthesiology and Reanimation 1 and 2 and Internal Medicine 3 were the ICUs with the highest SIR increase rate in 2020. In 2021, the SIR was <1 in all units. In Anesthesiology and Reanimation 2, Internal Medicine 1 and 3, and Cardiovascular Surgery ICUs, the SUR was >1 in all periods. When the mean SIR values of ICUs between 2019, 2020, and 2021 were compared, the rate was significantly higher in 2020 (p<0.05). A significant increase was found in hand hygiene compliance in 2021 compared with previous years (p<0.05).Conclusion: With the COVID-19 pandemic, an increase in CLBSI-SIR was observed in 2020. In 2021, a decrease in CLBSI-SIR and an increase in hand hygiene compliance were achieved by gaining experience in the follow-up and treatment of patients with COVID-19, implementing infection control programs, and conducting on-site training and inspections.

Observational Study of Hand Hygiene Compliance at a Trauma Hospital in Iraqi Kurdistan

Healthcare-associated infections, commonly caused by poor hand hygiene, represent a significant source of disease and economic burden for healthcare systems, especially those in resource-limited settings. The few existing studies on hand hygiene compliance in resource-limited hospital settings suggest that compliance is insufficient. The difference in compliance rates between units in resource-limited trauma hospitals is largely unknown. We aimed to assess hand hygiene compliance rates among healthcare workers at a trauma hospital in Iraqi Kurdistan and compare the levels of compliance between the emergency room (ER), the intensive care unit (ICU), and the acute care ward (ACW). We carried out overt observations in 2018 using the validated World Health Organization ‘five moments for hand hygiene’ observational tool. We observed a total of 622 hand hygiene opportunities performed by 149 healthcare workers. Hand hygiene compliance was defined as handwashing with soap and water or the use of alcohol-based hand rub, in accordance with the ‘five moments for hand hygiene’ concept. Overall, the hand hygiene compliance rate was found to be 6.8% (95% confidence interval 5.0–9.1). Compliance was significantly lower in the ER (1.0%), compared with the ICU (8.1%) (p = 0.0012), and the ACW (11.1%) (p < 0.0001). In all three units, the availability of alcohol-based hand rub and handwashing sinks was insufficient in relation to the number of patient beds. We conclude that the overall level of hand hygiene compliance was low, with the lowest level of compliance in the ER. Our findings call for improved resource allocation and strengthened hand hygiene routines. These relatively simple measures could potentially lower the incidence of healthcare-associated infections and improve the mortality and morbidity of patients in already overburdened healthcare systems.

Compared hand hygiene compliance among healthcare providers before and after the COVID-19 pandemic: A rapid review and meta-analysis.

BACKGROUND: Hand hygiene (HH) is a cost-effective measure to reduce health care-associated infections. The overall characteristics and changes of hand hygiene compliance (HHC) among health care providers during the COVID-19 pandemic provided evidence for targeted HH intervention measures. AIM: To systematically review the literature and conduct a meta-analysis of studies investigating the rate of HHC and the characteristics of HH during the COVID-19 pandemic. METHODS: The PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were searched. All the original articles with valid HHC data among health care providers during the COVID-19 pandemic (from January 1, 2020 to October 1, 2021) were included. Meta-analysis was performed using a DerSimonian and Laird model to yield a point estimate and a 95% CI for the HHC rate. The heterogeneity of the studies was evaluated using the Cochrane Q test and I2 statistics and a random-effects model was used to contrast between different occupations, the WHO 5-moments of HH and different observation methods. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. FINDINGS: Seven studies with 2,377 health care providers reporting HHC were identified. The estimated overall HHC was 74%, which was higher than that reported in previous studies (5%-89%). Fever clinic has become a new key place for HHC observation. Nurses had the highest HHC (80%; 95% CI:74%-87%) while auxiliary workers (70%; 95%CI:62%-77%) had the lowest. For the WHO 5-moments, the health care providers had the highest HHC after contact with the body fluids of the patients (91%; 95% CI:88%-94%), while before contact with patient's health care providers had the lowest HHC (68%; 95% CI:62%-74%) which was consistent with before the pandemic. There existed great HHC differences among different monitoring methods (automatic monitoring system:53%; 95% CI:44%-63% versus openly and secretly observation: 91%; 95% CI: 90%-91%). CONCLUSIONS: During the COVID-19 pandemic, the compliance of health care providers' HH showed a great improvement. The fever clinics have become the focused departments for HH monitoring. The HHC of auxiliary workers and the HH opportunity for "before contact with patients" should be strengthened. In the future, it will be necessary to develop standardized HH monitoring tools for practical work.

Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review.

BACKGROUND: The hands of healthcare workers (HCWs) are known to be a primary source of transmission of hospital-acquired infections (HAIs). Thus, both practising hand hygiene (HH) and adhering to HH guidelines are expected to decrease the risk of transmission. However, there is no consensus on the optimal hand hygiene compliance (HHC) rate for HCWs. AIM: To systematically review the published literature to determine an optimal threshold for the HCW HHC rate associated with the lowest HAI incidence rate. METHODS: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Online databases were searched using comprehensive search criteria for randomized controlled trials and non-randomized controlled studies, investigating the impact of the HCW HHC rate on HAI incidence rates in patients of all ages within healthcare facilities in high-income countries. FINDINGS: Of the 8093 article titles and abstracts screened, 35 articles were included in the review. Most studies reported overall HAIs per 1000 patient-days and device-associated HAIs per 1000 device-days. Most studies reported HHC rates between 60% and 70%. Lower HAI incidence rates seemed to be achieved with HHC rates of approximately 60%. The studies included in this review were not originally designed to assess the impact of HHC on HAI incidence rates, but risk of bias was assessed in accordance with the predetermined exposure and outcome criteria. Eleven (31%) studies were deemed to have low risk of bias. CONCLUSIONS: Although HHC is part of the HCW code of conduct, very high HHC rates are difficult to reach. In observational studies, HHC and HAIs had a negative relationship up to approximately 60% HHC. Due to flaws in the study design, causality could not be inferred; only general trends could be discussed. Given the limitations, there is a need for high-quality evidence to support the implementation of specified targets for HHC rates.

Three-year hand hygiene monitoring and impact of real-time reminders on compliance.

BACKGROUND: Hand hygiene remains both the major strategy and an ongoing challenge for infection control. The main issues in the sustainability of hand hygiene automatic monitoring are healthcare worker (HCW) turnover rates and declining participation. AIM: To assess hand hygiene compliance and the impact of real-time reminders over three years. METHODS: HCW compliance was observed for the use of alcohol-based hand rubs (AHR) on room entry and exit. Linear multi-level mixed models with time autocorrelations were performed to analyse the repeated measurements of daily room compliance and the effect of reminders over eight quarters (24 months). FINDINGS: In all, 111 HCWs were observed and 525,576 activities were identified in the database. There was an improvement in compliance both on room entry and exit over two years, and the rooms which had activated reminders had better performance than the rooms which did not have activated reminders. CONCLUSIONS: This study showed the benefit of using real-time reminders; even 20% of rooms with an activated reminder improved overall hand hygiene compliance. A randomized real-time reminder setting may be a potential solution in reducing user fatigue and enhancing HCW self-awareness.

The Covid-19 pandemic and its concomitant benefits: improved hygiene habits.

In an editorial, the editor has explored how state response to the pandemic has collateral damages not only in the public health in general but also in economy and education. Ironically, it also shows that the adjustments and adaptations in peoples' behavior have resulted in improved habits in personal hygiene and self-care. Not all is bad though as people have (re)learned the basic value of handwashing and preventive measures to avoid any diseases and spread of germs. In the long run, this is going to be beneficial to prevent any repeat of the pandemic of this magnitude.

The impact of COVID-19 pandemic on hand hygiene performance in hospitals.

BACKGROUND: Achieving high levels of hand hygiene compliance of health care personnel has been an ongoing challenge. The objective of this study was to examine the impact of the COVID-19 pandemic on hand hygiene performance (HHP) rates in acute care hospitals. METHODS: HHP rates were estimated using an automated hand hygiene monitoring system installed in 74 adult inpatient units in 7 hospitals and 10 pediatric inpatient units in 2 children's hospitals. A segmented regression model was used to estimate the trajectory of HHP rates in the 10 weeks leading up to a COVID-19-related milestone event (eg, school closures) and for 10 weeks after. RESULTS: Three effects emerged, all of which were significant at P < .01. Average HHP rates increased from 46% to 56% in the months preceding pandemic-related school closures. This was followed by a 6% upward shift at the time school closures occurred. HHP rates remained over 60% for 4 weeks before declining to 54% at the end of the study period. CONCLUSIONS: Data from an automated hand hygiene monitoring system indicated that HHP shifted in multiple directions during the early stages of the pandemic. We discuss possible reasons why HHP first increased as the pandemic began and then decreased as it progressed.

Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During the COVID-19 Pandemic.

The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is "Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?" What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of HAIs during COVID-19 pandemic. Given the seriousness of this outbreak, it was observed that the hand hygiene has occupied a new place of importance in the minds of HCWs. We observed 4 times increase in the consumption of hand sanitizers after COVID-19 outbreak. The increased consumption of hand sanitizers was reflected in improved hand hygiene practices. A reduction was observed in the number of HAIs after the COVID-19 outbreak, and we assume that the dip in HAIs is associated with the improvement in hand hygiene practices in the recent months. In the wake of COVID-19 pandemic, these trends reassure us that hand hygiene compliance by HCWs alone can be effective in reducing HAIs in a hospital setting.