"Water or not water: That is the question." Analysis of costs and consumption of the operating theaters in a greener perspective.

OBJECTIVE: To compare the amounts of water and plastic used in surgical hand washing with medicated soaps and with alcohol-based products and to compare costs and consumption in a year, based on scheduled surgical activity. METHOD: This retrospective study was carried out at Udine's Gynecology Operating Block from October to November 2022. We estimated the average amount of water with a graduated cylinder and the total cost of water usage based on euros/m3 indicated by the supplier; for each antiseptic agent we collected the data relevant to wash time, amount of water and product used per scrub, number of handscrubs made with every 500 mL bottle and cost of a single bottle. We put data into two hypothetical contexts, namely WHO guidelines and manufacturers' recommendations. Data were subjected to statistical analysis. RESULTS: The daily amount of water using povidone-iodine, chlorhexidine-gluconate and alcohol-based antiseptic agents was 187.6, 140.7 and 0 L/day (P value = 0.001), respectively; A total of 69 000 L/year of water would be saved if alcohol-based products were routinely used. A single unit of an alcohol-based product allows three times as many handscrubs as any other product (P value = 0.001) with consequent reduction in plastic packaging. CONCLUSION: Despite the cost saving being negligible, choosing alcohol-based handrub over medicated soap handrub - on equal antiseptic efficacy grounds - could lead to a significant saving of water and plastic, thus making our operating theaters more environmentally friendly.

Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi.

Despite being preventable, foodborne diseases remain a global health challenge. Poor food hygiene practices such as improper handling of kitchen utensils are among the major causes of diarrhea transmission. A formative study was conducted in Malawi to inform an intervention design to promote complementary food hygiene practices. An assessment of contextual and psychosocial factors for behavior change was conducted using Risk, Attitude, Norms, Ability, and Self-regulation model. We conducted 323 household surveys with caregivers of children aged 6 to 24 months. Analysis of variance was used to estimate difference between doers and non-doers of three targeted behaviors: washing utensils with soap, keeping utensils on a raised place, and handwashing with soap. Analysis of variance analyses revealed that literacy level, ownership of animals, and presence of handwashing facility and dish racks were contextual factors predicting storage of utensils on an elevated place and handwashing frequencies. Psychosocial factors, such as time spent to wash utensils with soap, distance to the handwashing facility, and cost for soap, had an influence on washing utensils and handwashing practices. Perceived vulnerability determined effective handwashing and storage of utensils. Perceived social norms and ability estimates were favorable for the three targeted behaviors. Promotion of already existing targeted beneficial behaviors should be encouraged among caregivers. Risk perceptions on storage of utensils and handwashing practices should be increased with motivational exercises such as paint games. Caregivers' technical know-how of local dish rack and tippy tap construction is essential.

Prevalence of Contact Allergens in Personal Care Products for Babies and Children.

BACKGROUND: Personal care products marketed for babies and children are often regarded as "safe" or "gentle." However, little is known about the prevalence of contact allergens in these types of products. OBJECTIVE: This study assessed the prevalence of important sensitizers in personal care products marketed for babies and children. A secondary objective of this study was to determine whether a product's cost correlates with content of sensitizing ingredients. METHODS: The ingredient lists of 533 unique personal care products were analyzed for presence of fragrance, betaines, propylene glycol, methylchloroisothiazolinone, methylisothiazolinone, formaldehyde, lanolin, and neomycin. Price per ounce was determined for each product as well. CONCLUSIONS: Most personal care products for babies and children contain 1 or more sensitizers. Products containing more sensitizers tend to cost less than those without any sensitizing ingredients.

Hygiene Practices During Food Preparation in Rural Bangladesh: Opportunities to Improve the Impact of Handwashing Interventions.

This study explored the steps of food preparation, related handwashing opportunities, current practices, and community perceptions regarding foods at high-risk of contamination such as mashed foods and salads. In three rural Bangladeshi villages, we collected qualitative and observational data. Food preparation was a complex and multistep process. Food preparation was interrupted by tasks that could contaminate the preparers' hands, after which they continued food preparation without washing hands. Community members typically ate hand-mixed, uncooked mashed food and salad as accompaniments to curry and rice at meals. Hand-mixed dried foods were mostly consumed as a snack. Observers recorded handwashing during preparation of these foods. Among 24 observed caregivers, of 85 opportunities to wash hands with soap during food preparation, washing hands with soap occurred twice, both times after cutting fish, whereas washing hands with water alone was common. A simple and feasible approach is promotion of handwashing with soap upon entering and re-entering the food preparation area, and ensuring that everything needed for handwashing should be within easy reach.

An Economic Analysis of Strategies to Control Clostridium Difficile Transmission and Infection Using an Agent-Based Simulation Model.

BACKGROUND: A number of strategies exist to reduce Clostridium difficile (C. difficile) transmission. We conducted an economic evaluation of "bundling" these strategies together. METHODS: We constructed an agent-based computer simulation of nosocomial C. difficile transmission and infection in a hospital setting. This model included the following components: interactions between patients and health care workers; room contamination via C. difficile shedding; C. difficile hand carriage and removal via hand hygiene; patient acquisition of C. difficile via contact with contaminated rooms or health care workers; and patient antimicrobial use. Six interventions were introduced alone and "bundled" together: (a) aggressive C. difficile testing; (b) empiric isolation and treatment of symptomatic patients; (c) improved adherence to hand hygiene and (d) contact precautions; (e) improved use of soap and water for hand hygiene; and (f) improved environmental cleaning. Our analysis compared these interventions using values representing 3 different scenarios: (1) base-case (BASE) values that reflect typical hospital practice, (2) intervention (INT) values that represent implementation of hospital-wide efforts to reduce C. diff transmission, and (3) optimal (OPT) values representing the highest expected results from strong adherence to the interventions. Cost parameters for each intervention were obtained from published literature. We performed our analyses assuming low, normal, and high C. difficile importation prevalence and transmissibility of C. difficile. RESULTS: INT levels of the "bundled" intervention were cost-effective at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in all importation prevalence and transmissibility scenarios. OPT levels of intervention were cost-effective for normal and high importation prevalence and transmissibility scenarios. When analyzed separately, hand hygiene compliance, environmental decontamination, and empiric isolation and treatment were the interventions that had the greatest impact on both cost and effectiveness. CONCLUSIONS: A combination of available interventions to prevent CDI is likely to be cost-effective but the cost-effectiveness varies for different levels of intensity of the interventions depending on epidemiological conditions such as C. difficile importation prevalence and transmissibility.

Aggregate exposure modelling of zinc pyrithione in rinse-off personal cleansing products using a person-orientated approach with market share refinement.

Realistic estimates of chemical aggregate exposure are needed to ensure consumer safety. As exposure estimates are a critical part of the equation used to calculate acceptable "safe levels" and conduct quantitative risk assessments, methods are needed to produce realistic exposure estimations. To this end, a probabilistic aggregate exposure model was developed to estimate consumer exposure from several rinse off personal cleansing products containing the anti-dandruff preservative zinc pyrithione. The model incorporates large habits and practices surveys, containing data on frequency of use, amount applied, co-use along with market share, and combines these data at the level of the individual based on subject demographics to better estimate exposure. The daily-applied exposure (i.e., amount applied to the skin) was 3.79 mg/kg/day for the 95th percentile consumer. The estimated internal dose for the 95th percentile exposure ranged from 0.01-1.29 µg/kg/day after accounting for retention following rinsing and dermal penetration of ZnPt. This probabilistic aggregate exposure model can be used in the human safety assessment of ingredients in multiple rinse-off technologies (e.g., shampoo, bar soap, body wash, and liquid hand soap). In addition, this model may be used in other situations where refined exposure assessment is required to support a chemical risk assessment.

Three kinds of psychological determinants for hand-washing behaviour in Kenya.

Washing hands with soap at the right times - primarily after contact with faeces, but also before handling food or feeding an infant - can significantly reduce the incidence of childhood infectious disease. Here, we present empirical results which substantiate a recent claim that washing hands can be the consequence of different kinds of psychological causes. Such causes can be divided into three kinds of control over behaviour: automatic or habitual responses, motivated or goal-driven behaviour to satisfy needs, and cognitive causes which reflect conscious concerns. Empirical results are based on 3-h-long structured observations of hand-washing behaviour in 802 nationally representative Kenyan households with children under five, and structured interviews with the primary female caretaker in these households, collected in March 2007. Factor analysis of questionnaire responses identified three psychological factors which are also significant predictors of observed hand-washing behaviour: having the habit of hand-washing at particular junctures during the day, the motivated need for personal or household cleanliness, and a lack of cognitive concern about the cost of soap use. These factors each represent a different kind of psychological cause. A perceived link between clean hands and sexual attractiveness also appeared in the factor analysis, but was not a determinant of actual behaviour. We also report evidence that those who express concern about the cost of soap use are those with relatively few economic resources. We suggest that those developing hygiene promotion programmes should consider the possible existence of multiple types of strategies for increasing hand-washing behaviour.

A randomized controlled trial of tea tree oil (5%) body wash versus standard body wash to prevent colonization with methicillin-resistant Staphylococcus aureus (MRSA) in critically ill adults: research protocol.

BACKGROUND: Over the past ten years MRSA has become endemic in hospitals and is associated with increased healthcare costs. Critically ill patients are most at risk, in part because of the number of invasive therapies that they require in the intensive care unit (ICU). Washing with 5% tea tree oil (TTO) has been shown to be effective in removing MRSA on the skin. However, to date, no trials have evaluated the potential of TTO body wash to prevent MRSA colonization or infection. In addition, detecting MRSA by usual culture methods is slow. A faster method using a PCR assay has been developed in the laboratory, but requires evaluation in a large number of patients. METHODS/DESIGN: This study protocol describes the design of a multicentre, phase II/III prospective open-label randomized controlled clinical trial to evaluate whether a concentration of 5% TTO is effective in preventing MRSA colonization in comparison with a standard body wash (Johnsons Baby Softwash) in the ICU. In addition we will evaluate the cost-effectiveness of TTO body wash and assess the effectiveness of the PCR assay in detecting MRSA in critically ill patients. On admission to intensive care, swabs from the nose and groin will be taken to screen for MRSA as per current practice. Patients will be randomly assigned to be washed with the standard body wash or TTO body wash. On discharge from the unit, swabs will be taken again to identify whether there is a difference in MRSA colonization between the two groups. DISCUSSION: If TTO body wash is found to be effective, widespread implementation of such a simple colonization prevention tool has the potential to impact on patient outcomes, healthcare resource use and patient confidence both nationally and internationally.

Effect of guideline implementation on costs of hand hygiene.

Hands of health care personnel frequently serve as vectors for the transmission of organisms between patients and are also a major reservoir for pathogens with antimicrobial resistance. Hand hygiene is one effective strategy to reduce health care associated infections. The purposes of this study were to (a) compare the costs of hand hygiene in hospitals with high and low hand hygiene compliance as well as high and low frequency of alcohol hand rub use; and (b) examine associations between hospital characteristics and hand hygiene compliance as well as frequency of alcohol hand rub use. Nursing and health care policy leaders should look for ways to promote sustained adherence to hand hygiene recommendations.

Comparison of sampling methods for urine cultures.

PURPOSE: To compare efficacy and cost of conventional and alternative sampling methods concerning urine cultures. DESIGN AND METHODS: An experimental study with two replications was carried out in a 900-bed university hospital in Ankara, Turkey. The sample was 160 hospitalized female patients, who were asked to give urine specimens, September 10,2000 and September 1,2001. They were patients on urology and obstetrics and gynaecology wards. The authors informed the patients about the study first and then obtained two samples from each patient under their observation. The number of specimens was 320. Statistical methods were descriptive. FINDINGS: The rates of contamination and significant growth, respectively, were 4.4% and 7.5% for the conventional method and 5.6% and 10% for the alternative method. The cost per culture was 2.588.257 TL (2.10 USD) for the conventional method and 57.021 TL (0.05 USD) for the alternative method. The cost difference was statistically significant. CONCLUSIONS: The two methods yielded similar results but the alternative method was less expensive.

Cost analysis of hand hygiene using antimicrobial soap and water versus an alcohol-based hand rub.

Proper hand hygiene is acknowledged as the most critical element of an adequate infection control program in the oral healthcare setting. However, adherence to proper hand hygiene protocols is often lacking. Poor compliance with hand hygiene protocols has been attributed to such factors as lack of time, hand irritation, hand dryness, forgetfulness, skepticism over importance, understaffing, perceived low risk of cross-infection, inconvenience, and the belief gloves alone offer protection. In the medical environment the use of alcohol-based hand rubs now represent the preferred method of performing hand hygiene when delivering non-surgical care. In this study we compared the costs associated with traditional hand washing against an alcohol-based hand rub protocol in the dental setting. The results indicate an alcohol-based hand rub protocol is less costly and less time consuming when compared to traditional handwashing in the dental setting, creating a new paradigm for hand hygiene in the dental office.

[Consumption of hand-hygiene products in health establishments in the west of France]. / La consommation de produits d'hygiène des mains dans les établissements de soins dans l'interrégion Ouest.

OBJECTIVES: The study had for aim to investigate hand hygiene product use in French hospitals between 2000 and 2003. DESIGN: A questionnaire was sent in 2002 and 2 more in 2003 and 2004 (for 2000 to 2003) requiring data on type of hospital, number of beds, staff members, admissions and patient-day, litres of mild soap, antiseptic soap and alcohol-based rub used and price per litre. Indices were calculated accordingly. RESULTS: 574 hospitals answered over the 4 year period (average 143 per year) representing an average of 50 000 beds/year, 80 000 full-time staff positions, 1.2 million admissions and 16 millions patient-days. The median consumption of mild soap was 3.8 l per bed, 2.7 l per staff member, 2.4 l per 100 admissions, and 10.6 ml per patient-day. The median consumption of antiseptic soap was 1 l per bed, 0.8 l per staff member, 4.8 l per 100 admissions, and 3.2 ml per patient-day. The median consumption of alcohol-based rub (HAS) was 0.3 l per bed, 0.3 l per staff-member, 1.5 l per admission, and 0.9 l per patient-day. Between 2000 and 2003, HAS use significantly increased from 69 to 88% (a relative increase of 31%) and the median consumption increased from 0.5 ml to 1.5 ml per patient-day. 370 fully completed grids gave a number of 7 opportunities per patient-day with less than 1 for HAS. CONCLUSION: The best indicator for an infection control practitioners is the quantity of alcohol-based solution in ml/patient-day and HAS per patient-day is the reference.

A cost comparison of hand hygiene regimens.

The cost and quality of two hand hygiene regimens were compared. A waterless alcohol-based rub was significantly less costly than traditional handwashing because of reduced time required, and was associated with significantly better quality.

Comparison of two skin care regimes for incontinence.

It is estimated that 30% of nursing home residents may be faecally incontinent, with those figures rising to 60% for patients in long-stay hospitals (Royal College of Physicians, 1995). Maintaining skin integrity for these patients can be complex. With little clinical information to support carers, choosing a skin care regime that maintains skin integrity for this high-risk group can be difficult. This study aims to compare two recognized skin care regimes, used in the cleansing of patients' skin following an episode of incontinence, and their impact on patients' skin integrity. A total of 93 patients were recruited to the trial from five care of the elderly or dependent service providers. The subjects were randomly allocated to either group A (soap and water; n = 49), or group B (Clinisan (Vernacare); n = 44). Initially, 33 patients in both groups started with healthy skin. However, the results of the final assessment identified only 17 subjects in group A remaining healthy, compared with 27 in group B.