COVID-19 infections in day care centres in Germany: social and organisational determinants of infections in children and staff in the second and third wave of the pandemic.

BACKGROUND: During the SARS-CoV-2 pandemic, German early childhood education and care (ECEC) centres organised children's attendance in different ways, they reduced opening hours, provided emergency support for a few children, or closed completely. Further, protection and hygiene measures like fixed children-staff groups, ventilation and surface disinfection were introduced in ECEC centres. To inform or modify public health measures in ECEC, we investigate the occurrence of SARS-CoV-2 infections among children and staff in ECEC centres in light of social determinants (i.e. the socioeconomic status of the children) and recommended structural and hygiene measures. We focus on the question if the relevant factors differ between the 2nd (when no variant of concern (VOC) circulated) and the 3rd wave (when VOC B.1.1.7 (Alpha) predominated). METHODS: Based on panel data from a weekly online survey of ECEC centre managers (calendar week 36/2020 to 22/2021, ongoing) including approx. 8500 centres, we estimate the number of SARS-CoV-2 infections in children and staff using random-effect-within-between (REWB) panel models for count data in the 2nd and 3rd wave. RESULTS: ECEC centres with a high proportion of children with low socioeconomic status (SES) have a higher risk of infections in staff and children. Strict contact restrictions between groups like fixed group assignments for children and fixed staff assignments to groups prevent infections. Both effects tend to be stronger in the 3rd wave. CONCLUSION: ECEC centres with a large proportion of children with a low SES background and lack of using fixed child/staff cohorts experience higher COVID-19 rates. Over the long run, centres should be supported in maintaining recommended measures. Preventive measures such as the vaccination of staff should be prioritised in centres with large proportions of low SES children.

Evaluating healthcare workers' hand hygiene performance using first-person view video observation in a standardized patient-care scenario.

BACKGROUND: Monitoring healthcare workers' (HCWs) hand hygiene (HH) performance is recommended for improving compliance. Observer biases challenge data validity, thus supplemental approaches such as video observation are needed to complement monitoring. METHODS: We investigate first-person view (FPV) video observation during simulated standardized patient care handling a catheter in a study with 71 HCWs. HH performance was evaluated for (1) all HH opportunities and (2) a subset of opportunities required in an ideal work sequence, hereafter core opportunities. HCWs' acceptance of FPV video observation and usability judgments were assessed. RESULTS: Compliance level for core HH opportunities (M = 43.5%) was significantly higher than compliance considering all opportunities (M = 30.4%, t(70) = 8.493, P < .001). Reducing HH opportunities to core opportunities would significantly increase compliance levels from the observed average of 30.4% to 44.9% (t(70) = 12.822, P < .001). Overall, both usability ratings and acceptance of the body camera were promising. DISCUSSION: FPV video observation in simulated standardized patient care provides new instruments to evaluate HH performance beyond mere compliance rates. Our results emphasize the role of optimizing workflow in order to improve HCW's HH compliance. CONCLUSIONS: FPV video observation in a standardized patient care simulation is feasible and offers information for HH interventions that target actual deficiencies.

On the Role of Habit in Self-Reported and Observed Hand Hygiene Behavior.

BACKGROUND: The present contribution tests the main ideas that (a) hand hygiene behavior is associated with habit, and (b) this association is robust when deliberative constructs (i.e. knowledge and intention) are controlled for, indicating an automatic component in hand hygiene behavior. METHODS: Two correlational studies using different operationalisations of hand hygiene behavior are reported. In Study 1, hand hygiene was assessed in the context of food preparation; data were measured using the Day Reconstruction Method in a sample of the general population. Study 2 considered hand hygiene compliance of healthcare workers applying video observation by body cameras and additionally self-reported behavior. In both studies, habit was assessed using the Self-Report Behavioral Automaticity Index. RESULTS: Both studies found the expected positive association between habit and hand hygiene (0.271 < r < 0.570). Habit was further analyzed in combination with knowledge and intention (Study 2), and emerged as a significant predictor of observed hand hygiene, while knowledge and intention were marginally significant. No significant interactions were found. CONCLUSIONS: The present work provides evidence that hand hygiene behavior is reliably related to habit. The findings speak to the notion that addressing the automatic route to hand hygiene behavior when designing interventions can be fruitful.

A person-oriented approach to hand hygiene behaviour: Emotional empathy fosters hand hygiene practice.

OBJECTIVES: Adopting a social-psychological approach, this research examines whether emotional empathy, an affective reaction regarding another's well-being, fosters hand hygiene as this affects other's health-related well-being extensively. DESIGN: Three studies tested this notion: (a) a cross-sectional study involving a sample of health care workers at a German hospital, (b) an experiment testing the causal effect of empathy on hand hygiene behaviour and (c) an 11-week prospective study testing whether an empathy induction affected disinfectant usage frequency in two different wards of a hospital. MAIN OUTCOME MEASURES: Self-reported hand hygiene behaviour based on day reconstruction method was measured in Study 1, actual hand sanitation behaviour was observed in Study 2 and disinfectant usage frequency in two different hospital wards was assessed in Study 3. RESULTS: Study 1 reveals an association of empathy with hand hygiene cross-sectionally, Study 2 documents the causal effect of empathy on increased hand sanitation. Study 3 shows an empathy induction increases hand sanitiser usage in the hospital. CONCLUSIONS: Increasing emotional empathy promotes hand hygiene behaviour, also in hospitals. Besides providing new impulses for the design of effective interventions, these findings bear theoretical significance as they document the explanatory power of empathy regarding a distal explanandum (hand hygiene).