Global Hand Hygiene Monitoring System Market is expected to grow at a CAGR of 9.8% over the Forecast Period, Owing to Growing Popularity of Digital Solutions, says Absolute Markets Insights

Hand Hygiene monitoring system market is witnessing lucrative growth opportunities and is driven by the new age technological solutions. The digital age has revolutionized the conventional practices of Hygiene. New age solutions such Internet of Things (IoT), cloud, Artificial Intelligence (AI) and others have facilitated real time monitoring and controlling the Hygiene compliance of healthcare facilities, and other governmental and non-governmental facilities. The automatic and electronically operated hand Hygiene monitoring devices have enabled in overcoming the drawbacks associated with conventional systems such as inaccurate monitoring and wastage of resources in terms of time and labour, and combined the advantages of digital technologies such as IoT and cloud to further enhance the operability of these solutions. Companies including Logi-Tag Systems, manufacturer of IoT based solutions, has introduced RFID based platform for tracking and monitoring assets and ensure staff hand Hygiene. In other such instances, companies such as 9Solutions and AiRISTA Flow have launched SaaS solutions for hand Hygiene monitoring. Owing to the rise in patients with infectious diseases such as COVID-19, these solutions with cutting-edge digital technologies have assisted in complying with Hygiene standards and thus propelling the growth of global hand Hygiene monitoring system market.

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Another such technology which has potential future applications in hand Hygiene monitoring systems is Artificial Intelligence (AI). The AI technology not only has possible implications in enhancing the effectiveness of hand Hygiene compliance systems but also to analyse the data obtained from these systems. Leading global universities, including Stanford University are researching on intelligent hand Hygiene monitoring systems in partnership with healthcare providers. This research focuses on dispenser usage detection, physical space analytics and privacy safe assessment. Under this research, researchers are using information obtained from cameras to build computer algorithms to track hand Hygiene activities. Meanwhile, Wobot Intelligence, an Indian provider of AI powered video analytics, has developed AI based Hygiene tracking solution. The Handwash.ai solution from the company assists hospitals, commercial offices, hospitality providers and others to use their CCTV cameras along with a plug and play software to track hand-wash activity. Introduction of such solutions with a broader scope of end users and ease of use is anticipated to boost the growth of global hand Hygiene monitoring system market exponentially over forecast years.

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In terms of revenue, global hand Hygiene monitoring system market was valued at US$ 3850.6 Mn in 2018 and is anticipated to reach US$ 9701.9 Mn in 2027, growing at a CAGR of 9.8% over the forecast period. The study analyses the market in terms of revenue across all the major regions, which have been bifurcated into countries.

The detailed research study provides qualitative and quantitative analysis of hand Hygiene monitoring system market. The market has been analyzed from demand as well as supply side. The demand side analysis covers market revenue across regions and further across all the major countries. The supply side analysis covers the major market players and their regional and global presence and strategies. The geographical analysis done emphasizes on each of the major countries across North America, Europe, Asia Pacific, Middle East & Africa and Latin America.

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Key Findings of the Report:

The global hand Hygiene monitoring system market was valued at US$ 3850.6 Mn in 2018 and is anticipated to grow at a CAGR of 9.8% over the forecast period owing to digital solutions such as IoT, AI and others.
Hospitals held the maximum share in the global hand Hygiene monitoring system market in 2018 owing to mandatory compliance of regulatory guidelines.

Hardware Devices accounted for largest share in the global hand Hygiene monitoring system market in 2018 owing to rise in demand from hospitals and hospitality providers amongst others.
North America held the highest market share in global hand Hygiene monitoring system market in 2018. Asia Pacific is expected to grow at the highest CAGR over the forecast period owing to the expanding medical infrastructure.
Some of the players operating in the hand Hygiene monitoring system market are CenTrak, Proventix, Ecolab, BioVigil Healthcare Systems, Inc., STANLEY Healthcare, Midmark Corporation, HandGiene Corp, Deb Group and GOJO Industries, Inc. amongst others.

Global Hand Hygiene Monitoring System Market:

By End User
• Hospitals
• Health Clinics
• Ambulatory Surgery Centers
• Dialysis Centers
• Hospitality
• Veterinary
• Others

By Type
• Devices: Portable, Wall Mounted
• Software Solution & Services

By Region
• North America: U.S, Canada, Mexico, Rest of North America
• Europe: France, The UK, Spain, Germany, Italy. Nordic Countries: Denmark, Finland, Iceland, Sweden, Norway. Benelux Union: Belgium, The Netherlands, Luxembourg. Rest of Europe
• Asia Pacific: China, Japan, India, New Zealand, Australia, South Korea. Southeast Asia: Indonesia, Thailand, Malaysia, Singapore, Rest of Southeast Asia.  Rest of Asia Pacific
• Middle East and Africa: Saudi Arabia, UAE, Egypt, Kuwait, South Africa, Rest of Middle East & Africa
• Latin America: Brazil, Argentina, Rest of Latin America

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Published On 25 May 2020 01:03 AM
https://www.industryglobalnews24.com


Don’t Let Hand Hygiene Standards Dip When COVID-19 Ebbs

As communities move into the next phase of COVID-19, healthcare organizations must keep hand hygiene top of mind in all environments to ensure patient and employee safety, and to ultimately reduce the risk of cross-contamination and HAIs.

Keeping healthcare staff informed of the latest protocols and essential hygiene measures will have a profound impact on the post-pandemic world, but driving behavioural change can be extremely challenging. To achieve hand hygiene compliance, healthcare facilities should focus on three areas:

· Hygiene training

· Hygiene tools and dispenser placement

· Signage

With 40% of surveyed healthcare workers saying they would like better training in hand hygiene, healthcare facilities can combine technology with hand hygiene training to help staff easily adapt to the demands of their environment.

Implementing a technology-first approach to training is an engaging and interactive way to reinforce hand-hygiene and sanitization protocols within a facility. According to educational technology pioneer Edgar Dale, learning by doing (direct, purposeful experience) is essential to keeping learners actively engaged as opposed to being passive observers. In fact, the University of Oklahoma created a similar learning hierarchy that emphasizes the usefulness of virtual reality in the learning process today. Virtual reality apps are a readily available and effective means to reinforce the World Health Organization’s “5 Moments of Hand Hygiene.” These apps can serve as an innovative alternative to hand hygiene training.

It is equally important to consider the critical factors of hygiene access in a facility, such as location of hygiene tools and hand-washing stations. Dispenser placement is key to promoting hand hygiene compliance within a healthcare environment.

It is imperative that dispensers are placed throughout walking routes and corridors to ensure accessibility for nurses and other staff on-the-go. Increasing the accessibility and visibility of hand hygiene stations throughout a facility can have a significant impact on hand hygiene practices without adding an extra burden to your environmental services staff (EVS).

Most healthcare staff understand the importance of hand washing, but visual cues for staff and patients are essential in the ongoing education of hand hygiene best practices and are especially helpful for nurses working long shifts.

Hand hygiene focused signage is an effective way to further hygiene and sanitization communication with staff, on an everyday basis. In addition to improving health standards, hand hygiene posters can also have a positive effect on a facility’s image. In fact, more than 8 in 10 patients indicate that the presence of hand hygiene signage makes them feel more confident about a facility’s cleanliness and its quality of care.

These simple steps can have a far-reaching impact on the success of hygiene compliance within a healthcare facility and takes hand hygiene from an afterthought to a long-lasting habit and routine—as it should be.

Deborah Chung is the regional marketing manager for Essity Professional Hygiene, North America.

 
By Deborah Chung
May 8, 2020

Published at: https://www.infectioncontroltoday.com

Deborah Chung is the regional marketing manager for Essity Professional Hygiene, North America.


Hand hygiene a key defence in Europe’s fight against antibiotic resistance

Antimicrobial resistance (AMR), and resistance to antibiotics in particular, continues to grow in the WHO European Region and hundreds of thousands of patients die or are considerably affected each year by health care-associated infections (HAI) and diseases caused by germs that are resistant to antimicrobial medicines.

This year’s SAVE LIVES: Clean Your Hands campaign on 5 May uses the slogan “Fight antibiotic resistance – it’s in your hands” to highlight the fact that health-care workers and the public have a responsibility to prevent and control AMR and HAI, in turn helping to prevent related complications and deaths.

It is estimated that 7–10% of patients will acquire at least one HAI at any given time under treatment. A large percentage of these are preventable by improving hand hygiene practices and other infection prevention and control measures.

Taking action from many sides

HAI, including those resistant to antibiotics, are among the most common adverse events in health care delivery. Such infections can impact quality of life and lead to serious disease or even death. Action across all sectors of society is required to effectively prevent AMR. The following key recommendations will help prevent the spread of AMR and protect people in the Region from HAI:

• Health workers must clean their hands at the right times (see below).
• Chief executive officers and managers of health facilities need to support hand hygiene campaigning and infection prevention and control (IPC) programmes.
• IPC leaders should champion hand hygiene campaigns and comply with WHO’s “core components” for IPC.
• Policy-makers should stop the spread of AMR by demonstrating national support for and commitment to infection prevention programmes.

Cleaning hands at the right times

Protecting patients against HAI can be achieved by improving hand hygiene at five key moments, preferably by using an alcohol-based rub or by hand washing with soap and water if hands are visibly dirty. The “five moments” for hand hygiene comprise:

• before patient contact
• before preparing and administering injections
• after contact with body fluids
• after patient contact
• after touching patient surroundings.

Reinforcing the importance of hand hygiene through policy-making

Making infection prevention and hand hygiene a national policy priority by aligning and strengthening existing programmes will go far in combating AMR and protecting patients from resistant infections.

National authorities should implement or reinvigorate any or all of the following options according to the new WHO recommendations on core components for IPC programmes:

• establish a national IPC programme linked with other relevant national programmes and professional organizations;
• ensure that any national IPC programme supports the education and training of the health workforce as one of its core functions;
• establish an HAI surveillance programme and networks that include mechanisms for timely data feedback;
• consider hand hygiene as a key national performance indicator providing vital feedback data on health-care practices;
• have a system in place to ensure patient care activities are undertaken in a clean and/or hygienic, well-equipped environment to prevent and control HAI.

 

Building momentum in the fight against antibiotic resistance

This year’s campaign builds important momentum ahead of World Antibiotic Awareness Week (WAAW), which takes place on 13–19 November 2017. WAAW encourages all countries, health partners and the public to help raise awareness of AMR and to emphasize that we all have a part to play in preserving the effectiveness of antimicrobial medicines.

 

By WHO Europe
Publihed May 4th 2017
http://www.euro.who.int


Hand Hygiene Day: It’s in your hands – prevent sepsis in health care

Sepsis is a life-threatening complication from infection that arises when an infection alters the body’s normal response, causing injury to tissues and organs. Each year, sepsis can cause up to 6 million deaths globally – most of which are preventable.

Sepsis is the most preventable cause of death and disability in Europe. According to the Global Sepsis Alliance, more than 3.4 million individuals develop sepsis every year in the WHO European Region, and 700 000 of these patients do not survive. An additional one third of survivors die within the following year, and many face lifelong consequences, such as physical, psychological and cognitive challenges.

The financial burden due to sepsis has been calculated to be more than US$ 24 billion, representing 6.2% of total hospital costs in 2013. Studies in Europe and Canada estimated the daily costs of hospital care of a septic patient to be between €710 and €1033 in 2000 (equivalent to about US$ 645 and US$ 939, respectively).

On Hand Hygiene Day, observed annually on 5 May, WHO calls on health facilities to prevent health care-associated sepsis through hand hygiene and infection prevention and control (IPC) action. By working together to each play our part, we can prevent sepsis and save millions of lives every year.

To stop sepsis, prevent infection

The first step to stopping sepsis is implementing measures that prevent infections from occurring. The second is preventing infections from evolving into sepsis. In both communities and health-care facilities, this requires early detection of sepsis signs and symptoms and appropriate antibiotic treatment.

In health-care settings, sepsis may result from health care-associated infections. This makes it all the more important for health workers to practise good IPC measures, including effective hand hygiene. Washing hands properly prevents infections and, in turn, reduces the risk of sepsis in health-care facilities.

This year’s Hand Hygiene Day campaign follows a resolution, adopted in May 2017 by the Seventieth World Health Assembly, recognizing sepsis as a global health priority and calling for improved prevention, diagnosis and clinical management of sepsis. It emphasizes 5 calls to action for 5 target audiences:

• health workers: “Take 5 moments to clean your hands to prevent sepsis in health care”;
• IPC leaders: “Be a champion in promoting hand hygiene to prevent sepsis in health care”;
• health facility leaders: “Prevent sepsis in health care, make hand hygiene a quality indicator in your hospital”;
• ministries of health: “Implement the 2017 WHA sepsis resolution. Make hand hygiene a national marker of health care quality”; and
• patient advocacy groups: “Ask for 5 moments of clean hands to prevent sepsis in health care”.

It is also vital to ensure that health workers can recognize, diagnose and rapidly treat sepsis. Despite its tragic impact, sepsis is frequently underdiagnosed at an early stage when it is still potentially reversible.

The evolution of an infection to sepsis can be prevented through early detection of the signs and symptoms, followed by prompt medical care and especially treatment with appropriate antimicrobials. This is crucial to increasing the chances of surviving sepsis. In the case of antimicrobial-resistant infections, which are becoming increasingly common, a patient’s condition can deteriorate rapidly, further underscoring the need for early diagnosis.

Working towards a sepsis-free world

It is possible to envision a world free from sepsis, but this vision will only become a reality through concerted action taken by a range of actors. On Hand Hygiene Day, it is time to collectively commit to raising awareness about the proven approaches to preventing infection, and to encourage everyone – particularly health workers – to recognize that stopping sepsis is in their hands.

WHO/Europe


Patient safety: too little, but not too late

The first-ever World Patient Safety Day is taking place on Sept 17, 2019. Every day, countless patients worldwide are put at risk by unsafe care and end up requiring treatment for ailments caused by the very system that was supposed to help them get better. Protecting patients from errors, injuries, accidents, and infections is an essential goal for every health system, but no health system has so far successfully addressed patient safety.

Some of the statistics proffered by WHO to high-light patient safety are striking. In low-income and middle-income countries (LMICs), 134 million adverse events per year are directly attributable to unsafe care. These adverse events—including misdiagnosis, hospital-acquired infections, and medical errors—lead to 2·6 million unnecessary deaths. Worldwide, the risk of patient death because of a preventable medical accident is one in 300. One in ten patients suffer injury while receiving health care, and 15% of all hospital expenses are incurred as a result of treating failures in patient safety.

Patient safety hinges on quality of care. The Lancet Global Health’s 2018 Commission highlighted the need for “high-quality health systems that optimise health care in each context by consistently delivering care that improves or maintains health”. It feels obvious to state that a health-care system should aim to improve the health of those accessing it. Similarly, all health professionals expect that patients will have their condition improved by health care. However, the data compiled by WHO should be a wake-up call as they would be in any other industry. So what can be done?

First, do no harm. The safety of patients must be the paramount concern of professionals and the systems they work in. Rather than a platitude, this ask is an exhortation to strengthen systems, build better infrastructure, and value strong leadership. Reporting in US hospitals shows some health-care-associated infections can be reduced by as much as 70% with proper patient safety interventions that include stan-dardised clinician education, proper notification processes, and strict hand hygiene procedures. However, the WHO hand hygiene guidelines sug-gest compliance with proper hygiene can be as low s 40%. Hence, a greater effort needs to be made in monitoring and ensuring that basic practices of patient safety are strong and robust across all institutions, no matter how obvious the need for such procedures.

Second, health professionals must recognise that patient safety is a two-way partnership. Patients must be involved—indeed be central—in their own care. The myriad ways inadvertent harm can be done to patients indicate that everyone, from policy maker and health advocate to caregiver and health worker, holds a vital stake in patient safety. Indeed, evidence suggests that involving patients, service users, and carers in important decisions relating to care and treatment strengthens patient safety and is the best way for patients to achieve a positive outcome. As WHO comments, “safe health care starts with good communication”.

Finally, awareness of the burden that patient safety requirements place on LMICs is needed: addressing all improvements necessary for increased patient safety require resources. Two-thirds of all adverse events resulting from unsafe care occur in LMICs. Health professionals in high-income countries must ask themselves what they can do, not just to promote patient safety in their own system but also to offer outreach, support, resources, and expertise to LMICs bearing the burden of raised patient safety standards, rapidly changing disease patterns, and expectations of achieving the same development goals.

Recognising the importance of patient safety world wide is something that strikes right at the philosophical heart of health care. A Comment in this issue highlights how patient safety is now a core part of the move towards universal health coverage and states, importantly, that “addressing systemic, organisational, cultural and behavioural drivers of patient harm remains extremely challenging and a lot of known problems remain unsolved”. World Patient Safety Day is a prompt to everyone involved in care to examine their role in contributing to these drivers. In the treatment of immediate illness, health-care systems must offer best practice and consistent treatment for all patients, and at all levels, to ensure further damage is prevented.

The Lancet
www.thelancet.com Vol 394 September 14, 2019


Effect of gloved hand disinfection on hand hygiene before infection- prone procedures on a stem cell ward

From February 2017 to April 2018, a tri-phase study was performed with the intervention ‘gloved hand disinfection’ at the stem cell unit of the University Medical Center, Goettingen, a tertiary care centre.

The stem cell ward comprises 16 beds in 10 patient rooms. The staff consisted of eight physicians and 18 female/male nurses, of whom five physicians and nine nurses were present each day. The ward had already been sufficiently equipped with alcohol-based hand rub (ABHR) dispensers; only alcoholic disinfectants were used.

During phase I (February to August 2017) baseline observation was performed to determine baseline hand hygiene compliance. During phase II (September 2017 to January 2018) gloved hand disinfection was strongly advised for predefined situations, but not enforced. Because gloved hand disinfection makes work easier, HCWs were keen to try this tool. If the HCW preferred regloving with proper hand rub instead of disinfecting gloves, the infection control professional (ICP) documented correct behaviour. During phase III (February to May 2018) gloved hand disinfection was restricted to discriminate intervention effects from time trends and learning effects. The gloved hand disinfection was restricted to workflows including at least one infection-prone procedure only within one patient. Examples were (not restricted to):

– preparing and handling with intravenous medication and/or blood products;

– manipulations at central or peripheral lines including blood sampling procedure.

The primary endpoint, on which the power analysis was based, was full hand hygiene compliance determined by direct observation (reference standard) according to the WHO protocol [18]. Hand hygiene compliance was defined by the number of performed hand rubs divided by the number of observed hand hygiene opportunities. Observation was performed by three ICPs. Inter-observer agreement was ≥90% after a six-week training period. The secondary endpoints were: (i) WHO indication-specific hand hygiene compliance, notably compliance ‘before aseptic tasks’, defined by the number of hand rubs performed divided by the number of observed indications for specific opportunities [18, 19]; (ii) incidence density of severe infection (defined by healthcare-associated primary bloodstream infection (HABSI; no. per 1000 patient days (PD)) and healthcare-associated pneumonia (HAP; no. per 1000 patient-days);(iii) incidence density (occurrence) of healthcare-acquired multidrug-resistant (micro-)organism (HA MDRO; no. per 1000 patient-days).

Severe infections (HABSI and HAP) were determined according national reference protocol designed for allogeneic stem cell transplant patients and adjusted at 1000 patient-days [20]. This protocol addressed patients undergoing allogeneic stem cell transplants and evaluated sepsis and pneumonia. HA MDROs were defined as meticillin-resistant Staphylococcus aureus (MRSA), extended spectrum β-lactamase (ESBL) r carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci. HA MDROs were defined according to the US Centers for Disease Control and Prevention guidelines for MDRO management [21, 22]. Specimens from outpatients and inpatients of less than four days were excluded. Patient specimens included samples taken routinely for screening and for investigation of possible infection. All data, obtained from the laboratory information system, were analysed and assessed daily by ICPs. Length of stay (patient-days) was determined using the patient management system. Hand hygiene observations were made during day shifts; one observation period lasted 30–90 min and a range of five to 25 opportunities was observed in each. An additional secondary endpoint, HCWs acceptance of gloved hand disinfection, was assessed using a standardized questionnaire, using an ordinal scale, applied to 10 selected HCWs (Appendix A, including Supplementary Figure S1).

The investigation was approved by the local ethics committee (Reference No. COMTRA-12/12/16).

For the study, nitrile-polymer gloves were used [17]. These were Purple-nitrile-xtra® (Halyard Health, Inc., Alpharetta, GA, USA; manufacturer’s specifications: ISO 374-1/5 2016 Type C, ISO 10993-1/2/5/10/12; EN 16523-1, EN 455, 420, 374-2/4) and Nitrile LG PF® (Maimed GmbH, Neuenkirchen, Germany; manufacturer’s specifications: EN420, 374, 455, ASTM 6319, CAT III) [17]. Hand rubs were performed using standard hand rub solutions used at each hospital: Desderman pure® (Schülke & Mayr GmbH, Nordstedt, Germany; pharmaceutical ingredients 78.2 g ethanol 96%, 0.1 g biphenyl-2-ol, povidone 30, isopropylmyristate, 2-ethylhexanoate, sorbitol, 2-propanol, purified water) and Softa-Man® (B. Braun Melsungen AG, Melsungen, Germany; pharmaceutical ingredients: 45% ethanol, 18% 1-propanol, purified water, diisopropyladipate, macrogol-6-glycerolcaprylocaprate, dexpathenol, bisabolol, lemon- and linalool-flavour, allantoin).

Gloved hand disinfection may have risks (e.g. skin damage, transmission of microbes), if HCWs perform gloving inappropriately, e.g. changing between patients with gloved hands, wearing gloves for too long, and inappropriate glove–ABHR combinations. However, disinfectability and stability of medical examination gloves has been recently demonstrated in vitro [17, 23]. Moreover, gloved hand disinfection is in line with the national guidelines and recommendations of the Clean Hands campaign (ASH) which was founded initially by the German Coalition for Patient Safety (APS) and the German National Reference Center for Surveillance of Nosocomial Infections (NRZ Surveillance).

To minimize the remaining risks, we defined the following rules before starting the study:

– All HCWs were informed individually and in detail about the design, timeline and aim of the study, and were given appropriate training on gloved hand disinfection.

– HCWs were warned about the risk of premature loss of integrity of gloves and were asked to report any event of suspicious alteration, e.g. stickiness, fragility, sacculation, or colour change of gloves when disinfected. Pretesting of several glove and ABHR combinations was used to determine the best combinations for the study.

– The number of consecutive gloved hand disinfections was restricted to a maximum of five.
The duration of glove usage was shortened to 20 min (in contrast to the ASH statement).

– Gloves had to be changed immediately whenever dirty or damaged.

– The same gloves could only be worn for contact with an individual patient.

– The study was supported by the occupational health service.

– The trial was overseen by ICPs, who were empowered to interrupt the study if any rules were broken.

Statistical analysis

Power calculation and expected increase in hand hygiene compliance of 40% were applied according to previous intervention strategies supposing 80% power with a given two-sided α error level of 5% [14, 24]. Computation of odds ratio (OR); 95% confidence interval (CI); P-values and χ2-statistics were performed using PSPP® 1.0.1 (GNU General Public License version 2), R 3.5.1 (GNU General Public License version 2) with Yates’ correction and Medcalc® 18.6 (MedCalc Software bvba) [25, 26, 27, 28, 29, 30]. To avoid errors by zero values of the odds ratios, values were slightly modified by adding 0.5 to all contingency cells [31, 32]. Statistics were supported by the Department of Medical Statistics.

Our hypothesis of an improvement in hand hygiene compliance by ntroducing gloved hand disinfection was confirmed, with a significant increase from 31% (baseline) to 65% (post-interventional) before infection-prone procedures. This is especially impressive because we offered no training on general infection control or hand hygiene either before or during the study. Thus, gloved hand disinfection may be an effective single strategy for improving hand hygiene compliance before infection-prone procedures.

According to WHO’s requirements a hand rub must be performed before gloving and after removing gloves, e.g. when moving from dirty to clean tasks or when aseptic activities are interrupted and continued afterwards. This scenario is complex, time-consuming, and in a real-life setting not always realized [23, 33].
Achieved compliance of 31% (indication 2; phase 1) in our study seems to be low compared to hand hygiene compliance with other indications, e.g. 81% (indication 4), 56% (indication 3). Compared to other studies aiming at hand hygiene compliance, the improvement in our study represents a major improvement without increasing the workforce or costs. This is of great importance, since the most often self-reported and currently proven reason for HCWs’ non-compliance is lack of time and a forced workload, and this is in line with previous results for another strategy, namely process optimization [12, 13, 14, 15, 16]. Indication 2 is regarded as the most important for patients, is associated with the lowest compliance rates in most studies, and is least improved by most hand hygiene improvement strategies. Thus, gloved hand disinfection could help to improve patient safety in a resource-neutral, easy implementable way.

During the study the incidence density of severe infections decreased
(6.0 per 1000 vs 2.5 per 1000 patient-days) by trend. This is in line with the improvement for hand hygiene especially before infection-prone procedures. However, this is no definite proof of reduction of infections.

Notably, power calculation did not primarily address this secondary endpoint. Investigation of severe infections during gloved hand disinfection in a roll-out setting is warranted.

Hand hygiene compliance with indications 3 and 4 (after contact with body fluid or patient) were not expected to improve by gloved hand disinfection in this setting. This hypothesis was proven by our study, since hand hygiene compliance improvement in this case was not driven by the intervention itself. Interestingly, our study showed an increase in hand hygiene compliance after contact with patients’ surroundings. HA MDRO remained constant during all study phases independently from outpatients’ incidence. Thus, we infer that gloved hand disinfection did not represent a patient risk when safety rules were followed. On the contrary, gloved hand disinfection improved hygiene in those situations most relevant for patients.

Different strategies may influence hand hygiene compliance. System-related (e.g. ABHR dispenser availability and localization, implementation of standardized procedures, process simplification and optimizing or automated monitoring) and individual patient-related (individual training, feedback audits) strategies differ in implementation workforce and probability of sustained effectiveness [2, 15, 34, 35, 36, 37, 38]. Thus, as a system-related strategy, disinfection of gloves is probably a sustainable component of a multi-faceted infection control strategy.

Support by the staff is a basic requirement of implementation. HCWs rated the release of the gloved hand disinfection as an improvement or alleviation of personal working conditions. In fact, gloved hand disinfection was not perceived as a burden, but as a tool that made work easier.

There were limitations to this study. It was a single-centre study only on one stem cell ward. The data shown cannot easily be extrapolated to other settings. However, the study was initiated as a proof-of-principle study. At baseline, hand hygiene compliance was only at a moderate level, thus the effect could be overestimated with regard to settings starting at higher baseline levels. The study was designed to correct potential time and training effects from the ‘glove effect’. However, the significant ‘glove effect’ shown in phase 2 is no definite proof. The direct observation was intended to be performed in a completely anonymous manner without HCW anonymization. ICPs were asked to rotate HCW sequence when observing. Thus, observation bias cannot be excluded completely. Although direct observation is widely accepted as a reference standard to calculate hand hygiene compliance, there is no method to ensure compliance with gloved hand disinfection beyond the observation period.
Every entity of infection belongs to different transmission events and those that are related to hand hygiene compliance according to the WHO indications have not been investigated in detail. However, according to the national surveillance programmes we used the combined infection parameter as secondary endpoint. It may be useful to distinguish different entities in further studies to compare their responses to the hand hygiene compliance.

In conclusion, this study is the first to investigate gloved hand disinfection in real-work scenarios, demonstrating an improvement in hand hygiene compliance. Hand hygiene compliance was even improved before infection-prone pro-cedures, the situations with the highest impact on infections, and thus infection control. Notably, severe infections decreased by trend.
Taken together, gloved hand disinfection could be an easy implementable, resource-neutral tool as a new component within the infection control bundles. Settings with a high number of aseptic procedures and unsatisfactory baseline levels would benefit most, especially in times of HCW shortage.

Read the full article:  https://www.journalofhospitalinfection.com/article/S0195-6701(19)30258-0/fulltext?dgcid=raven_jbs_etoc_email

© 2019    P. Fehlinga,∗,’Correspondence information about the author P. FehlingEmail the author P. Fehling, J. Hasenkampb, S. Unkelc, I. Thalmanna, S. Horniga, L. Trümperb, S. Scheithauera


Epidemiology and impact of norovirus outbreaks in Norwegian healthcare institutions, 2005–2018

Outbreaks in healthcare settings affect vulnerable populations, disrupt normal routines and may spread to other healthcare institutions (HCIs). Outbreaks can be limited in extent by good routines for detection, management of cases and other infection-control measures [1]. Norovirus infection is most often seen in the winter months and is a common cause of outbreaks in HCIs [2] as it has a low infectious dose, short incubation period, and symptoms such as diarrhoea and vomiting which facilitate spread. Symptoms normally lasts around one to three days, but can be longer in hospital patients [3]; and in this type of setting, infection can lead to slower recovery from other illness and even death [4]. Norovirus can be divided into several genogroups and genotypes [5]. Genogroup II genotype 4 is the most prevalent genotype globally [6] as well as in the Nordic countries [6]. There is no vaccine and immunity is not well understood; at best it is strain-specific but probably only partial and shortlived as the virus readily undergoes mutation [7, 8]. Humans are the only reservoir of the virus and spread of the infection in outbreaks is particularly difficult to control because of the low infectious dose, its stability in the environment and efficient transmission by person-to-person contact and exposure through contaminated surfaces [9]. Norway has national recommendations on norovirus infection in long-term-care facilities (LTCFs) in which the most important measure is isolation or cohort nursing of sick residents. Exclusion of sick staff until 48 h after they are symptom free is also recommended [10]. In a hospital setting, the infection-prevention-control unit will have local procedures. There are around 60 hospitals and 950 LTCFs in Norway [11]. The responsibility for management of local outbreaks lies within the hospital or with the community medical officer (one in each of the 422 municipalities) for outbreaks in LTCFs. All suspected outbreaks in Norwegian HCIs, regardless of the causative pathogen, should be alerted by law to relevant actors, including the Norwegian Insititute of Public Health (NIPH), to facilitate communication and response [12, 13]. The aim of this study was to describe, for the first time, the epidemiology and impact of these outbreaks in order to identify areas which may improve outbreak response.

This study shows that norovirus outbreaks pose an important burden for HCIs all over Norway, especially in the winter months. In addition to affecting an already vulnerable population, this study shows that these outbreaks indeed also impact on the internal workflow and resources, with a conservative estimate of around 1800 days of absenteeism per year due to these outbreaks, during which staff would have to be covered for by other internal or external healthcare staff.

Surveillance of norovirus outbreaks exists in Germany and Scotland. In Germany, reporting of norovirus outbreaks in HCIs has been mandatory since 2001. In contrast to what is seen in Norway, outbreaks were smaller (median nine cases vs 15 in this study) and around 80% of norovirus outbreaks were reported from hospitals (vs 23% in this study) during the first 12 months after introduction of the system [15]. Varying ways of counting interdepartmental outbreaks, better collaboration with the local level or under-reporting from hospitals may explain this. In Scotland, surveillance of ward closures due to norovirus infection has been in place since October 2017. From then until week 26, 2018, 219 wards or bays have been closed due to confirmed or suspected norovirus [16]. This is markedly more than the 16 reported outbreaks in hospitals in Norway 2017/18, in a population of similar size. The occurrence of norovirus outbreaks has also been studied prospectively; Curran et al. [17] aimed to identify the index cases of norovirus outbreaks in the UK and Ireland in 54 acute and non-acute healthcare centres; only five out of the 54 included centres did not experience any outbreak during one winter. Also, Lopman et al. found that 171 inpatients units, had on average 1.3 gastroenteritis outbreaks in the 1-year follow-up period. Of these, 63%were caused by norovirus [2].

It was seen that a small proportion of residents at LTCFs were admitted to hospital during norovirus outbreaks. This may be necessary in severe cases despite the risk of spread from one institution to the next. Our results suggest that hospitals are affected by norovirus outbreaks earlier in the epidemiological year than LTCFs. Potentially because there is a greater influx of patients from the community, where norovirus circulates, to and from hospital than between the community and LTCFs as also suggested by Sadique et al. [18]. This finding, however, could only be evaluated on the national level, as the number of reported outbreaks is low. That the start of the outbreak season seemed to start earlier in hospitals than in LTCFs, at least at the national level, suggests an opportunity that with improved communication, hospitals could alert LTCFs within the same area in order to prepare for the outbreak season and limit the extent of further outbreaks.

Slightly more cases were seen amongst healthcare staff in hospitals compared to LTCFs, though no information about the number of healthcare staff at risk during the outbreaks is available. The patient or resident:healthcare-staff ratio varies with the level of care needed and type of department and will most often be higher in hospitals. Whether this explains the slightly higher proportion of staff affected in hospital outbreaks is unknown. Nevertheless, healthcare staff do represent a big proportion of cases in the reported outbreaks, indicating a need for improved compliance with infection prevention and control measures. Outbreaks are an economic burden for HCIs, both as infected staff need to be covered for during illness and ‘quarantine’ and cohort nursing may require extra staff.

The relatively high number of people infected during an outbreak underscores the infectiousness of norovirus and norovirus can serve as a worst-case scenario for introduction of other, more virulent, person-to-person transmitted pathogens into HCIs. With the current information captured in the alert system, it was not possible to assess the extent to which national recommendations were followed and/or which infection prevention control procedures are in place locally. But the high number of people infected do suggest a potential for limiting spread, for example by having systems and routines in place before outbreaks happen, as advised in the national recommendations.

Even though NIPH routinely promotes the web-based outbreak alert system and teaches outbreak management, both at the regional and national level, in order to strengthen local capacity and encourage the use of the alert system, under-reporting is still apparent. If the under-reporting of outbreaks reflects a lack of awareness concerning outbreak management, or a lack of communication between the LTCF and the municipal doctors about ongoing outbreaks, it is worrying. The alert system serves to alert relevant stakeholders so that outbreak support and advice can be given in an early phase. The alert system can also be used for statistical purposes to get a national overview of outbreaks which will facilitate targeted capacity building, guideline development and communication messages in order to increase awareness and investigate whether there are any changes in trends.

Limitations
This study has three main limitations: the sensitivity of the norovirus outbreak definition and under-reporting of number of outbreaks and number of cases in each outbreak. Classification as a norovirus outbreak is dependent on local definitions. The infection prevention measures for diarrhoea and vomiting are the same for all the common pathogens in this setting. Samples were submitted for testing in two thirds of the outbreaks and most were confirmed as norovirus at the time of reporting or updating. Information about the genotypes of the isolated strains from each outbreak or of dominant strain of the season was not available. For this reason, it was not possible to evaluate the effect of the genotype.

Concerning under-reporting, the number of outbreaks notified through the outbreak alert system and reported here, most likely represent only a proportion of all norovirus outbreaks occurring in Norwegian HCIs. Although outbreaks were reported from all parts of Norway, some areas had not reported any outbreaks of any kind during the 13-year study-period.

The alert system is used for the mandatory alerting of suspected outbreaks. Reporting should happen as soon as the outbreak is suspected and before the full extent of the outbreak is known. Even though the system sends a reminder to update the details about the outbreak, including the case numbers, three weeks after the initial alert, some under-reporting of the extent of each outbreak is expected.

This is the first comprehensive description of norovirus outbreaks in HCIs in Norway. Even though the analyses revealed under-reporting that is unlikely to reflect the real epidemiology, this study clearly shows that these outbreaks affect both hospital and LTCFs all over Norway. Norovirus infection may delay medically important procedures and recovery, but also presents a major challenge to the functional ability of an HCI and its resources as up to one-half of cases were healthcare personnel.

It is recommended that NIPH promotes the outbreak alert system to increase reporting and improve the quality of the data and strengthen local capacity for outbreak management and general infection control. It is also recommended to investigate possibilities for improving communication between hospitals and LTCFs regarding when the norovirus season starts and progresses, for hospitals and LTCFs to be prepared and to take early action to prevent and limit further spread.

Read full article: https://www.journalofhospitalinfection.com/article/S0195-6701(19)30268-3/fulltext?dgcid=raven_jbs_etoc_email

© 2019 The Authors. Published by Elsevier Ltd on behalf of The Healthcare Infection Society.


Enterococcus hirae, Enterococcus faecium and Enterococcus faecalis show different sensitivities to typical biocidal agents used for disinfection

– Ethanol and other alcohols such as iso-propanol or n-propanol are typically used for hand disinfection or surface disinfection. An ethanol concentration of 40% will not be found in alcohol-based hand rubs because the bactericidal efficacy will be too low to fulfill European efficacy standards such as EN 1500. Even hand rubs based on 60% or 70% often fail to meet the EN 1500 efficacy requirements although the alcohols are effective against E. faecium and E. faecalis [11, 14, 15, 16]. In that respect it is of concern that the use of E. hirae may yield a sufficient efficacy against enterococci although E. faecium and E. faecalis are less susceptible.

Nosocomial infections or hospital-acquired infections (HAIs) are a major patient safety issue in hospitals.

The most frequent nosocomial infections are pneumonia (usually ventilator-associated), urinary tract infection (usually catheter-associated) and primary bloodstream infection (usually associated with the use of an intravascular device) [1]. Virtually every pathogen has the potential to cause infection in patients but only a limited number of bacterial species is responsible for the majority of HAIs. Among them Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and enterococci are the most common [2]. Enterococci account for about 10% of hospital-acquired bacteremia cases and are a major cause of sepsis worldwide [3]. HAIs caused by enterococci are difficult to treat due to acquired resistance to many classes of antibiotics [4]. Considering the severity of the consequences of nosocomial infections, such as morbidity, mortality, prolonged stay, costs, and treatment problems, it is all the more important that preventive measures in hospitals and other health facilities are fully effective [5]. Targeted disinfection, with species that are considered to be the most resistant representatives of a whole range of human pathogenic microorganisms and, due to their role in nosocomial infections, also include enterococci. As part of the standardization efforts to determine the efficacy of disinfectants at European level, the enterococcal strain Enterococcus (E.) faecium, formerly used for chemical and chemo-thermal disinfection processes, was replaced by E. hirae. E. faecium is currently only used for testing thermal disinfection processes, such as for instance for testing laundry disinfection processes at temperatures above 60 °C [6]. The differences in heat tolerance between the enterococcal species is already well described resulting in the use of E.hirae for testing chemical disinfectants and E. faecium for chemo-thermal and thermal processes [7, 8]. Pidot et al. have shown in 2018 that some multidrug-resistant E. faecium isolates isolated recently are more tolerant to 23% iso-propanol than older isolates suggesting an adaptive cellular response [9]. Overall, the chemical susceptibility of two common clinical species (E. faecalis and E. faecium) and the commonly used test species (E. hirae) has not yet been sufficiently investigated [10, 11, 12]. The aim of this study was therefore to find out whether E. hirae is a suitable species to evaluate the efficacy of biocidal agents against the clinically relevant species E. faecalis and E. faecium. Therefore, we determined the in vitro bactericidal efficacy of five substances from commonly used groups of biocidal agents (aldehydes, alcohols, surfactants, oxidizing agents and halogens) on E. hirae, E. faecium and E. faecalis according to the European Norm EN 13727 [13].effective procedures and correctly performed, is one of the most important measures to interrupt the transmission of pathogens in hospitals. In Europe, the microbicidal effectivity of any disinfection procedure must be evaluated and confirmed in accordance with national or international standards and norms in vitro and under practical conditions before it can be used in hospitals [6]. These efficacy tests are performed with defined test

Our data show that the testing of disinfectants based upon a culture collection E. hirae strain alone may not represent the sensitivity of other collection Enterococcus spp. with more clinical relevance. At a 5 min exposure time the current EN 13727 test species E. hirae was found to be more tolerant to 0.2% glutaraldehyde and 0.0125% peracetic acid compared to E. faecium and E. faecalis whereas it was more susceptible to 40% ethanol and 3% sodium hypochlorite. Only with 0.00125% benzalkoniumchloride (15 min) the susceptibility of E. hirae was between E. faecium and E. faecalis. Based on these data E. hirae is a suitable species when bactericidal activity needs to be determined against enterococci with the biocidal agents glutaraldehyde and peracetic acid. It may, however, not be a suitable species for ethanol at 40% or sodium hypochlorite at 3% if the bactericidal activity shall include the clinical pathogens E. faecium and E. faecalis.

Ethanol and other alcohols such as iso-propanol or n-propanol are typically used for hand disinfection or surface disinfection. An ethanol concentration of 40% will not be found in alcohol-based hand rubs because the bactericidal efficacy will be too low to fulfill European efficacy standards such as EN 1500. Even hand rubs based on 60% or 70% often fail to meet the EN 1500 efficacy requirements although the alcohols are effective against E. faecium and E. faecalis [11, 14, 15, 16]. In that respect it is of concern that the use of E. hirae may yield a sufficient efficacy against enterococci although E. faecium and E. faecalis are less susceptible.

The situation is different in surface disinfection. Many low alcohol products are available for immediate use in the patient environment, often as presoaked tissues [17]. Low alcohol concentration has the advantage of a better compatibility with plastic surfaces which are now commonly found in healthcare such as mobile phones or tablet computers [18]. Based on our data obtained with suspension tests it seems to be possible that low alcohol surface disinfectants which are effective against E. hirae do not provide the same level of bacterial killing against E. faecium or E. faecalis. In 2014 a dramatic increase of infections caused by vancomycin-resistant enterococci has been described [19]. The reasons for the increase are still unknown. But it is known that Enterococcus spp. can survive on inanimate surfaces between 4 days and 4 months [20]. It is therefore important to ensure a sufficient bactericidal efficacy of alcohol-based surface disinfectant against Enterococcus spp. However even with higher concentrations of alcohol it is essential to apply a sufficient volume. Approximately 10% of the solution is released during wiping when a soaked tissue is used [16, 21]. It has been shown previously that the application of a low volume of an effective alcohol results in failure to meet the efficacy requirements [16].

Sodium hypochlorite at 3% was also more effective in 5 min against E. hirae and less effective against E. faecalis and E. faecium. It is a biocidal agent commonly used in many countries for surface disinfection [22]. Our findings with E. faecalis appear plausible because sodium hypochlorite at 2.5% has been described to achieve at least 5 log10 against ATCC 35550 (10 min) and ATCC 29212 (20 min) [23, 24]. The very low effect of 3% sodium hypochlorite even in 15 min against E. faecium is of concern and should be followed up with more research on the possible implications for its use in healthcare.

In this study we have only used culture collection strains from each of the three Enterococcus spp. in order to compare the susceptibility of potential test strains for disinfectant efficacy testing. We have not used any Enterococcus spp. clinical isolates. That is why we cannot evaluate whether the different biocidal agents would reveal a similar bactericidal activity against clinical isolates of each of the three Enterococcus species.

Another limitation of our study is that all experiments were carried out using a low organic load described as clean conditions. That is why we are unable to describe if similar or other results would be obtained under dirty conditions. Clean conditions were chosen because they reflect the majority of applications of these agents. Alcohol-based hand rubs are applied to clean hands, ethanol is a typical biocidal agent used for hand disinfection. Instrument disinfectant should be used on cleaned instruments, glutaraldehyde, benzalkonium chloride and peracetic acid are typical agents used for instrument disinfection. Surface disinfection is often performed without prior cleaning, benzalkonium chloride and sodium hypochlorite are typical agents used for surface disinfection. With sodium hypochlorite it has been described before that the bactericidal efficacy will be impaired in the presence of organic load [25].

E. hirae is a suitable species when a bactericidal activity should be determined against enterococci with glutaraldehyde and peracetic acid. E. hirae may not be a suitable species for ethanol at 40% or sodium hypochlorite at 3% if the bactericidal activity shall include the clinical pathogens E. faecium and E. faecalis.

By Miranda Suchomel, Anita Lenhardt, Günter Kampf, Andrea Grisold

https://www.journalofhospitalinfection.com
https://www.journalofhospitalinfection.com/article/S0195-6701(19)30345-7/fulltext

For references: https://www.journalofhospitalinfection.com/article/S0195-6701(19)30345-7/references


Hand hygiene helps reduce HCAIs (healthcare-associated infection)

Chris Wakefield, Vice President at GOJO Industries-Europe Ltd, highlights how hand hygiene systems reduce the spread of healthcare-associated infection (HCAI)

It is estimated that 300,000 patients a year in England acquire a healthcare associated infection (HCAI) as a result of care within the NHS. Such infections draw large attention from patients, regulatory bodies and the media. Not only because of the magnitude of the problem – after all, they are associated with morbidity, mortality and the financial cost of treatment – but, also, because most are preventable.

Despite being avoidable, HCAIs continue to present a major threat to our public health. They are particularly difficult to eliminate due to the speed and ease that they can be transmitted – and because of their long-life span. Did you know, for example, that MRSA can live up to nine weeks, whilst C.Diff spores can live up to five months? Or that they can be spread through both direct and indirect contact?

Studies have shown that contaminated hands can sequentially transfer some viruses to up to seven surfaces, and that fourteen people can be contaminated by touching the same object one after the other. Perhaps itʼs not surprising then, that research indicates that you have a 50/50 chance of picking up a dangerous pathogen anytime you touch anything or anyone in a hospital.

Such outbreaks can have serious repercussions; including the increased risk to the lives of vulnerable patients, disruption of services and reduced clinical activity, such as the enforced closure of hospital wards, cancelled admissions and delayed discharges. There is also the cost of treatment to factor.
Indeed, a report by the National Audit Office estimated that a reduction in the rates of MRSA bloodstream infections saved the NHS in England between £45 million-£59 million in treatment costs between 2003/4 and 2008/9. It also identified that by reducing the rate of C. difficile infections, between £97 million-£204 million was saved in treatment costs between 2006/7 and 2007/8.

Going back to basics

A great deal of scientific research has shown that, if properly implemented, hand hygiene is the single most important, easiest and cost-effective means of reducing the prevalence of HCAIs and the spread of antimicrobial resistance. In fact, research shows it can cut the number of HCAI cases by up to 50%. Several other studies have also demonstrated that handwashing virtually eradicates the carriage of MRSA which invariably occurs on the hands of healthcare professionals working in intensive care units. An increase in handwashing adherence has also been found to be accompanied by a fall in MRSA rates.
In order to reduce the spread of illness, everyone has to engage with hand hygiene practices – not only healthcare workers, who already make this a part of their daily lives, but visitors and patients too. As a founder member of the World Health Organization (WHO) Private Organizations for Patient Safety group, GOJO is a strong advocate of the ‘total solutionʼ approach to making hand hygiene second nature to everyone in a healthcare setting. We believe that, to successfully change behaviour, a triple-pronged approach is required.

Firstly, handwashing facilities must be accessible and dispensers easy to use. The WHO recommends that an adequate number of appropriately positioned hand hygiene facilities should be readily available at the point of care.

Secondly, the high frequency with which healthcare workers clean their hands means that the formulations must be gentle yet effective against germs, complying with key hospital norms EN 1500, EN 14476 and EN 12791. Studies have also shown that using an alcohol-based handsanitising rub can improve hand hygiene practice, since it is quicker, is microbiologically more effective and is less irritating to skin than traditional hand washing with soap and water.
Finally, eye-catching signage is very effective as a prompt, especially at key germ hot-spots such as washrooms and waiting areas. Hand hygiene facilities must remain well-stocked and maintained at all times too.

Getting smart

Although evidence supports a ‘back to basicsʼ approach, digital innovation also has a role to play. GOJO has spent many years developing advanced formulations and high-tech dispensers, and has recently harnessed revolutionary smart technology to create its SMARTLINK™ Electronic Monitoring Solutions. These two mobile apps are a smarter way to help reduce the maintenance time spent on dispensers, and measure hand hygiene performance – ultimately helping to prevent the spread of germs.
Combining the latest technology with the simple act of hand hygiene, and working together to put effective systems in place, we can reduce the spread of HCAIs. GOJO, the leading global producer of skin health and hygiene solutions for away-from-home settings, is your specialist partner in healthcare hygiene.

For a tailored, effective, total solution for your setting, or for more information, please call +44 (0)1908 588444,
email infouk@GOJO.com or visit www.GOJO.com

 

By Kerrie Doughty
Trade Marketing & Communications Manager GOJO Industries-Europe
Tel: +44 (0)1908588457
infouk@gojo.com
www.GOJO.com
www.twitter.com/GOJO_Hcare
www.twitter.com/GOJO_Europe

 

 

References
1. https://www.nice.org.uk/guidance/qs61/chapter/introduction
2. Hata B et al. Clin Infect Dis 2004; 39k1182 | Kramer A et al. BMC Infect Dis 2006; 6k130 | Havill NL. et al. Infect Control Hosp Epidemiol 2014; 35k445 | Weber DJ et al. Infect Control Hosp Epidermiol 2015.
3. Barker J, Vipond IB, Bloomfield SF. J Hosp Infect 2004,58k42-494 Stiefel U et al. Infect Control Hosp Edipdemiol 2011; 32k185.
4. 2008 SDA Clean Hands Report Card® sponsored by the Soap and Detergent Association.
5. 24 &25 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1
6. 26 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1
7. 2,3 & 35
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3249958/#ref1