New hand washing stations to help fight hygiene-related diseases

The Ministry of Health in partnership with World Vision among other stakeholders have inaugurated 49 modern hand washing facilities set up at different health facilities across the country, which are expected to help prevent Covid-19 and hygiene-related diseases.

The event took place at Masaka Hospital in Kicukiro district on Tuesday, September 1.

According to the ministry, the entire project will involve the establishment of modern hand washing stations in about 300 health facilities across the country.

Speaking at the occasion, the Minister of Health Dr. Daniel Ngamije said that the facilities will help prevent the Covid-19 pandemic and other hygiene-related diseases.

“We thank this partnership with World Vision and other partners who worked hard to avail these facilities. This move comes as an addition effort to the already existing measures to combat the Covid-19 pandemic and other hygiene-related diseases,” he said.

Among primary preventive measures against Covid-19 include regular washing of hands with clean water and soap.

Ngamije also urged people in charge of health facilities where the washing stations have been set up to take care of the established infrastructure and ensure they are always functional.

Sean Kerrigan, National Director of World Vision Rwanda also noted that the Organization is delighted to help the country in the fight against Covid-19.

He said: “We are glad to play a role in the fight against hygiene-related diseases, most especially Covid-19. We know that it is a joint responsibility for us and the government to keep both young children and adults safe. Together we shall win.”

The entire project of setting up these infrastructures, according to World Vision, has cost Rwf290 million.

By Lavie Mutanganshuro
Published 01 September 2020
https://www.newtimes.co.rw/


COVID-19 Hand Hygiene and Dry Skin: 3 Tips for Reducing the Risk of Dry and Cracked Hands

We have been regularly washing our hands for over 20 seconds (while humming the “Happy Birthday” song!) for months now. When there are no handwashing facilities, we have been rubbing our hands with dollops of alcohol-based hand sanitizers to keep them virus-free.

A rather unpleasant complexity of these regular vigorous hand washing and sanitizing is that they tend to make our hands excessively dry and irritated. This is due to the high percentages of alcohol in hand sanitizers and the soaps stripping off the natural oils in our skin. Dry skin in hands should not be ignored since it can lead to irritations and breakage of skin.

This should not mean you should cut back on hand hygiene! One of the easiest ways to prevent dry hands is to use a moisturizer or a hand sanitizer with moisturizing agents. Puracy’s Alcohol-Based Gel Hand Sanitizer keeps your hands germ-free, and its gel consistency with moisturizing agents help keep your skin well hydrated and smooth, preventing dry and cracked hands.
Get Your Puracy’s Citrus and Sea Salt Gel Hand Sanitizer Here!

Important: Even if your hands feel dry, it’s extremely important to keep washing your hands regularly to protect yourself and others against COVID-19. You can regain the skin’s moisture barrier by following the tips below.

1. Use Lukewarm Water To Wash Hands

Washing your hands with lukewarm water is more effective in two ways. The heat helps easily break down any oils and dirt along with any infected respiratory droplets that you may have touched. Lukewarm water helps properly break down the soap for its maximum efficacy, and wash off completely without leaving any traces that can cause dry skin.

2. Use an Occlusive Moisturizer Immediately After Washing Hands

Occlusive agents in moisturizers such as waxes, oils, silicones, and petrolatum increase the overall moisture of your skin by providing a physical barrier to your epidermal water loss. Once you finish washing your hands, pat them dry, and immediately use an occlusive moisturizer to lock in the moisture. Keep a bottle of moisturizer in your bag and nearby your regular sink to help you remember to moisturize each time you wash your hands.

3. Use a Fragrance-Free, Moisturizing Hand Sanitizer

While a whiff of fragrance may be pleasant when you use your hand sanitizer, the aromatic chemicals used to create a fragrance in sanitizing products can further dry and irritate your skin. Especially since you are using sanitizer regularly these days, even the smallest amounts of added chemicals can cause damage eventually.

CDC recommends using hand sanitizers with 60-95% alcohol. While this ensures maximum protection for you, it can also be quite drying. Therefore, look for a hydrating or moisturizing component in your hand sanitizer to reduce dryness. ArtNaturals scent-free hand sanitizer comes with 62.5% alcohol content, and it’s infused with botanical extracts including aloe, jojoba and vitamin E to nourish and protect your skin from damage.

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https://www.newsweek.com


There's Another Benefit to Hand-Washing During Pandemic

Halogenated flame retardants, such as polybrominated diphenyl ethers, are known to be a health risk to children. Previous research has shown that exposure to these chemicals can cause lower IQ and behavioral problems in children.

“It’s well-known that viruses are transferred between surfaces and hands,” said study co-author Miriam Diamond, a professor in the University of Toronto’s department of earth sciences.

“Our study shows that toxic chemicals like flame retardants do the same. That’s another reason we should all wash our hands often and well,” Diamond said in a university news release.

Study co-author Lisa Melymuk, an assistant professor of environmental chemistry at Masaryk University in the Czech Republic, noted that “if a flame retardant is used in the TVs, we then find it throughout the house, including on the hands of the resident.”

And even though regular hand-washing can reduce your exposure to these chemicals, Arlene Blum, executive director of the Green Science Policy Institute in Berkeley, Calif., suggested that “to reduce health harm from flame retardants, the electronics industry should stop their unnecessary use.”

Blum said, “Fire safety can be achieved by innovative product design and materials instead of the use of toxic chemicals that can remain in our homes — and in us — for years to come.”


More information

The U.S. National Institute of Environmental Health Sciences has more on flame retardants.

SOURCE: University of Toronto, news release, June 9, 2020

 

By Robert Preidt
Published: Last Updated:


Experts explain why strict hand hygiene couldn’t be sustained

Kampala, Uganda | THE INDEPENDENT |

With the zeal of hand washing going down months into coronavirus disease transmission in the country, experts have stated that it was inevitable as people were only acting in shock following announcements of a strange killer disease.

Hand hygiene alone is touted as having the ability to keep away many pathogens including the previous coronaviruses that have affected other countries and the COVID-19 pandemic. Even before the the virus was confirmed in the country, many people including politicians and religious leaders came out to demonstrate how proper handwashing is done.

Around that time, the Ministry of Health said that the percentage of those that wash hands that has always staggered around 30 percent had increased to slightly above 50 percent. Now, experts worry that we have gone steps back even as the virus continues to transmit with the country having over 700 infections currently.

Dr Richard Mugambe, a lecturer in Makerere University’s Department of Disease Control and Environmental Health says that sustaining hand hygiene would have been possible if implementer’s of the initiative adopted a behavioral model to strategize on how this behavior that’s not deeply entrenched in the community continues.

Dr Fredrick Oporia, an epidemiologist and currently a disease control research fellow at Makerere University School of Public Health says that observing how people are washing hands, only a few use the recommended quantities and spend the recommended time of 20 seconds washing their hands.

In public places like markets, business centres and other facilities, notes that at the height of the scare, people had put in place facilities which have only remained as a shield to protect them from enforcement officers.

However, David Katwere Ssemwanga, the Technical Assistant of Uganda Sanitation Fund in the Ministry of Health said that the Ministry has made it mandatory for all households and business premises to have wash facilities although they are still challenged with enforcement something they hoped could be made stronger by the COVID-19 pandemic.

Recognizing that people even in crowded city places have gone back to their past, he said they plan to come up with more stringent measures but only after ensuring that there’s considerable access to safe water for all. He says their interventions have started with health facilities where they are now availing them foot-operated handwashing facilities with funding from UNICEF.

Even in these facilities, he acknowledged that not all have water in place but the plan is to avail them water such that individual facilities can provide themselves soap. But as initial focus on sustainable handwashing facilities goes to health facilities, key crowded places like markets and business areas pose a big risk of infection.

For instance, in Kikuubo, Kampala’s major business hub, one of the administrators Sam Bafirawala Muyomba tells URN that to be able to do some bit of handwashing at the all-time crowded centre, they buy about 60 jerry cans of water at a fee of 500 Shillings each.

He admits they are conducting their handwashing on the principle of something is better than nothing, not as WHO recommends.

By The Independent
Published June 17, 2020
https://www.independent.co.ug


Water & Sanitation This WHO-UNICEF Initiative Is Fighting so Everyone Can Wash Their Hands Against COVID-19

Nearly half of the world population can’t wash their hands at home.

Why Global Citizens Should Care

COVID-19 has been called an equaliser, because it doesn’t discriminate based on race, gender, geography, sexuality or religion. Yet, in the months since the World Health Organisation declared coronavirus a pandemic, it’s become increasingly evident that people from marginalised communities and poor countries bear the brunt of the virus due to lack of access to resources, like water and sanitation. You can join us here to take actions to help mitigate the impact of COVID-19 on the world’s most vulnerable communities.

It’s often been said that changing personal behaviour is vital in containing COVID-19: wearing a mask in public, maintaining social distance, and frequently washing hands with soap and clean water.

Yet for 3 billion people globally, access to hygiene is not as simple as turning on a tap, according to the United Nations Children’s Fund (UNICEF).

That’s 40% of the world population who cannot wash their hands with soap and water in their homes.

The majority are in sub-Saharan Africa, while children and people who live in informal settlements, refugee camps, or conflict areas are most affected by the continent’s lack of clean water and sanitation facilities.

The World Health Organisation (WHO) and UNICEF have recently launched a hand-washing initiative aimed at bringing attention to the plight of people who don’t have access to clean water and are, therefore, unable to protect themselves effectively from COVID-19.

“Hand hygiene has never been more critical, not only to combat COVID-19, but to prevent a range of other infections. Yet, nearly six months since the onset of the pandemic, the most vulnerable communities around the world continue to lack access to basic hand hygiene,” said the executive directors of UNICEF and WHO, Henrietta Fore and Dr. Tedros Adhanom Ghebreyesus, in a joint statement.

The statement added: “According to our [UNICEF and WHO] latest data, the majority of people in the least developed countries are at immediate risk of COVID-19 infection due to a lack of hand hygiene facilities.”

The statement said one billion people are at direct risk of contracting COVID-19 as a result of not having water and soap in their homes, and that almost half of then are children.

However, it’s not only homes that lack access to clean water, the statement added. “All too often, schools, clinics, hospitals and other public spaces also lack hand hygiene facilities, putting children, teachers, patients and health workers at risk. Globally, two in five in health care facilities do not have hand hygiene at points of care,” said the statement.

A report by World Vision revealed that nine out of 10 countries in the world with the worst access to water are African.

These include: Eritrea, where 81% of the population do not have clean drinking water. In Uganda, 61% of the population doesn’t have basic water services. The figures are 61% in Ethiopia, 60% in Somalia, 59% in Angola, 58% in the Democratic Republic of the Congo, 58% in Chad, 54% in Niger, and 53% in Mozambique.

“The COVID-19 pandemic has exposed an uncomfortable truth: too many people around the world simply cannot clean their hands,” said the statement.

UNICEF and WHO said they will be working through the initiative with other international partners, national governments, the public and private sectors, and community organisations to ensure that products and services are available and affordable, and to enable a culture of hygiene. This includes ensuring that handwashing stations are accessible, especially in disadvantaged areas and among marginalised communities.

“We must also ramp up investment in hygiene, water and sanitation, and in infection prevention and control,” said the statement. “We urge countries to scale up, systemise, and institutionalise hand hygiene and commit to strengthening the enabling environment, supply vital products and services, and to actively promote hygiene practices as part of a package of actions that save lives.”

You can join us to help mitigate the impact of COVID-19 on the world’s most vulnerable and marginalised communities by taking action here.

By Lerato Mogoatlhe
Published July 2, 2020
https://www.globalcitizen.org


In a pandemic, hospital staffers need to get better at hand-washing

After visiting Ellis Island in 1906, President Theodore Roosevelt noted the lack of hand-washing by doctors and wrote the Public Health Service that he was “struck by the way doctors made the examinations with dirty hands,” turning the examinations themselves into “a fruitful source of carrying infection.”

Fast forward 114 years: Today’s hospitals aren’t doing much better at hand-washing. That’s a serious problem in ordinary times; during the Covid-19 national emergency it could become extraordinarily dangerous. One way the government can protect public safety is by immediately setting specific hand hygiene standards for doctors, nurses, and hospital staff.

There’s not even monitoring of a national compliance rate, although hand-washing remains “the most important intervention” to reduce the “staggering mortality” associated with hospital infections, according to an article in an infection control journal.

The most recent hand hygiene data — an 18-year-old study from the Centers for Disease Control and Prevention — is discouraging. It concluded that adherence “has remained low.”

How low is “low”? According to the CDC, health care providers in U.S. hospitals clean their hands less than half the time they should. In comparison, people using bathrooms in New York train stations washed their hands afterward 80% of the time.

The medical literature doesn’t show much systemic improvement in hand-washing since the CDC last looked at the issue or, for that matter, since the Public Health Service issued an educational video showing hospital staff how to wash their hands back in 1961!

Hospitals with hand hygiene compliance in the 50% to 60% range include the kind of large, urban medical centers designated by the CDC as “first tier” treatment centers during the 2014-16 Ebola outbreak. After reviewing hundreds of inspection reports, ProPublica recently reported that “infection control has been a recurring problem at some of the very hospitals that would likely be called upon to treat Covid-19 patients.”

Better hand-washing won’t solve all infection control issues, of course, but it would significantly improve safety. The first step to achieving it is valid measurement.

A new standard from the Leapfrog Group, a nonprofit focused on improving patient safety where one of us (L.B.) works, encourages hospitals to measure hand hygiene using electronic monitoring of clinician compliance. This kind of technology is commonplace in retail and other industries.
Related:
‘We didn’t follow through’: He wrote the Ebola ‘lessons learned’ report for Obama. Now he weighs in on coronavirus response

Hospitals traditionally measure hand hygiene by having someone spot violations and report them, a technique with questionable reliability. Monitoring hand hygiene in a way that yields accurate data is vital. The Leapfrog standard is evidence-based; the government should adopt it.

The next step, getting to universal compliance with hand hygiene best practices, is even more crucial.

Based on what hospitals have already shown they can achieve, the secretary of Health and Human Services should call on all hospitals to meet an 85% hand hygiene goal within 90 days. While President Trump’s well-known use of hand sanitizer even before the Covid-19 crisis should make this an easy step for the administration to take, its obvious importance should also draw support from both parties in Congress.

Meanwhile, the Centers for Medicare and Medicaid Services should start the process of issuing formal regulations that would include an aggressive time frame for 100% hand hygiene compliance by any health care facility receiving Medicare payments — which is virtually all of them.

It took 98 years from the time President Roosevelt pointed out the hand-washing problem at Ellis Island until U.S. hospitals were required to institute a hand hygiene program that followed the CDC’s recommendations. If a deadly pandemic doesn’t justify urgently demanding accountability for making patients safer by the simple act of clinicians washing their hands, it’s hard to imagine what will.

Leah Binder is CEO of the Leapfrog Group. Michael L. Millenson is a patient safety activist, researcher, consultant, and author of “Demanding Medical Excellence: Doctors and Accountability in the Information Age” (University of Chicago Press).

 

 

By Leah Binder and Michael L. Millenson

Published March 25, 2020
https://www.statnews.com


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


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