Lesley Price PhD, Lucyna Gozdzielewska PhD, Ayodeji Matuluko MS, Didier Pittet MD, MS, Benedetta Allegranzi MD, Jacqui Reilly PhD

Comparing the effectiveness of hand hygiene techniques in reducing the microbial load and covering hand surfaces in healthcare workers: Updated systematic review.  

American Journal of Infection Control, 50: 1079-1090, 2022

Background: This review, commissioned by the World Health Organization (WHO), examined the effectiveness of the WHO 6-step hand hygiene (HH) technique in reducing microbial load on hands and covering hand surfaces, and compared its effectiveness to other techniques. 

Methods: Medline, CINAHL, ProQuest, Web of Science, Mednar, and Google Scholar were searched for primary studies, published in English (1978-February 2021), evaluating the microbiological effectiveness or hand surface coverage of HH techniques in healthcare workers. Reviewers independently performed quality assessment using Cochrane tools. The protocol for the narrative review was registered (PROSPERO 2021 : CRD42021236138). 

Results : Nine studies were included. Evidence demonstrated that the WHO technique reduced microbial load on hands. One study found the WHO technique more effective than the 3-step technique (P = .02), while another found no difference between these 2 techniques (P = .08). An adapted 3-step technique was more effective than the WHO technique in laboratory settings (P = .021), but not in clinical practice (P = .629). One study demonstrated that an adapted 6-step technique was more effective than the WHO technique (P = .001). Evidence was heterogeneous in application time, product, and volume. All studies were high risk of bias.

Conclusion: Eight studies found that the WHO 6-step technique reduced microbial load on healthcare workers’ hands ; but the studies were heterogeneous and further research is required to identify the most effective, yet feasible technique. 

Afra Calik MSc, RN, Betul Cakmak MSc, RN, Sevgisun Kapucu PhD, RN, Bahar Inkaya PhD, RN

The effectiveness of serious games designed for infection prevention and promotion of safe behaviors of senior nursing students during the COVID19 pandemic.

American Journal of Infection Control, 50: 1360-1367,2022 

Background: Reminding health care workers, especially senior students, of the critical role they play in preventing COVID-19 transmission is more important than ever, therefore it is vital to reinforce graduate students’ intrinsic motivation to implement infection prevention and control guidelines. Serious games are an interesting intervention that could improve adherence to COVID-19 safe behaviors to lower the high prevalence of nosocomial infections. These games, as a type of technology-enhanced simulation, can increase student satisfaction and engagement while still conveying vital ideas. For this reason, this study aimed to develop a serious game and evaluate its effectiveness to prevent the spread of infection and develop safe behaviors during the COVID-19 pandemic. 

Methods: In total, 62 nursing students completed a socio-demographic questionnaire, COVID-19 information form, and game usability form, with the students’ responses analyzed pre-test and post-test. Results: Serious game implementation significantly increased senior students’ knowledge of infection and safe behaviors concerning COVID-19. The students also considered the practice of serious games an effective teaching strategy. Favorite aspects of the serious game according to students’ statements; It was reported as reflecting the real hospital environment, including the nursing care process and roles, being informative, being compatible by phone, and each stage of the game tested a new knowledge. 

Conclusion: Employing serious games for nursing skills development is an appropriate teaching method for infection prevention and promotion of safe behaviors among senior nursing students during the COVID-19 pandemic. This game can be obtained free of charge for research and educational purposes. 

Madison Moon MPH, CIC, Leandro Pecchia PhD, Adriana Velazquez Berumen MSc, April Baller MBBCh, MPH, MBA 

Personal protective equipment research and innovation in the context of the World Health Organization COVID-19 R&D Blueprint program

American Journal of Infection Control, 50 : 839-843,2022   

In February 2020, in response to the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization (WHO) organized a Global Forum on Research and Innovation for COVID-19 (ie, Global Research Forum), which highlighted the importance of fostering research and innovation in the area of infection prevention and control (IPC), including rational and appropriate use of well-designed personal protective equipment (PPE). Despite its utmost importance for global health, PPE had not been prioritized in the research and innovation agendas of funding agencies and research institutions. Thus, at the start of the pandemic, knowledge gaps existed about PPE use by health workers outside the normative use during single encounters as part of infection transmission precautions. This was the case for extended use, to ration availability, and mask use in community settings as a supplementary emergency measure where epidemic containment strategies (testing, isolation, contact tracing, and quarantine) were unable to effectively identify and manage widespread community transmission of severe acute respiratory syndrome coronovirus-2 (SARS-CoV-2). The goals of the Global Research Forum were to accelerate research for containing the spread of SARSCoV-2 and help those affected to receive optimal care.1 This required: identifying and supporting research priorities; creating a global research platform; and strengthening preparedness for prompt information-sharing to bridge gaps in COVID-19 response knowledge and prevent another unforeseen epidemic. This forum was pivotal to encouraging accelerated development of diagnostics, therapeutics and vaccines and ensuring equitable access based on public health needs. One output of the Global Research Forum was the publication of the coordinated global research roadmap.1 This roadmap identified nine priority research priorities, one of which was IPC, including health workers’ protection. This commentary provides an overview of WHO’s activities on IPC/PPE in the context of the R&D Blueprint for COVID-19, introduces nine PPE-focused research projects funded through the WHO R&D Blueprint for COVID-19, and reports on the current research priorities on PPE identified in the last WHO Global Research Forum, held in February 2022.

M.D. van Dijk, C.M., Waltmans-den Breejen, J.M.J.J. Vermeeren, S. van den Berg, E.F. van Beeck, M.C. Vos, on behalf of the Cooperating Rijnmond Hospitals 

Compliance with a novel hand hygiene protocol tailored to non-sterile healthcare workers in the operating theatre.. 

Journal of Hospital Infection 113 (2021) 85e95

Background: Observing hand hygiene compliance (HHC) among non-sterile healthcare workers (HCWs) in the operating theatre (OT) is challenging as there are no tailored protocols or observation tools. Aim: To develop and test a hand hygiene protocol tailored to non-sterile HCWs in the OT. 

Methods: In this prospective observational study, nine hospitals in the RotterdamRijnmond region provided input on a draft protocol on hand hygiene in the OT, resulting in a new consensus protocol for the region. An observation tool based on the protocol was developed and tested. HHC rates with 95% confidence intervals (CI) were calculated by type of hospital and type of HCW. 

Findings: The protocol has three sections: (1) written general hand hygiene rules; (2) written hand hygiene rules specific for anaesthesia and surgery; and (3) visual representation of the OT, divided into four hand hygiene areas. Hand hygiene should be applied when changing area. Average HHC of 48.0% (95% CI 45.2e61.2%) was observed in OTs across all hospitals. HHC was highest in the two specialized hospitals (64.0%, 95% CI 30.6e89.8%; 76.7%, 95% CI 62.8e84.5%) and lowest in the academic teaching hospital (23.1%, 95% CI 0.0 e45.8%). In terms of type of HCW, HHC was lowest among anaesthesiologists (31.6%, 95% CI 19.2e62.4%) and highest among OT assistants (57.4%, 95% CI 50.1e78.2%). 

Conclusion: This uniform way of observing HHC in the OT enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, HHC in the OT was below 50%; this needs to be addressed, particularly in teaching hospitals and among physicians. 

M.O.P. Alvarenga, J.M.M. Dias, B.J.L.A. Lima, A.S.L. Gomes , G.Q.M. Monteiro

The implementation of portable air-cleaning technologies in healthcare settings – a scoping review 

Journal of Hospital Infection, 132 : 93-103, 2023

SUMMARY The COVID-19 pandemic revealed opportunities to improve prevention practices in healthcare settings, mainly related to the spread of airborne microbes (also known as bioaerosols). This scoping review aimed to map methodologies used to assess the implementation of portable air cleaners in healthcare settings, identify gaps, and propose recommendations for future research. The protocol was registered in the Open Science Framework and reported following the checklist provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis e an extension for Scoping Reviews (PRISMAScR) statement. The search strategy was performed in five databases and one grey literature source. At the last selection phase, 24 articles that fulfilled our inclusion criteria were summarized and disseminated. Of these, 17 studies were conducted between 2020 and 2022; one of them was a protocol of a multicentre randomized controlled trial. The outcomes measured among the studies include airborne microbe counts, airborne particle concentrations, and rate of infections/interventions. The leading healthcare settings assessed were dental clinics (28%), patient’s wards (16%), operating rooms (16%), and intensive care units (12%). Most of the devices demonstrated a significant potential to mitigate the impact of bioaerosols. Although some indoor air quality parameters can influence the mechanics of aerosols, only a few studies controlled these parameters in their analyses. Future clinical research should assess the rate of infections through randomized controlled trials with long-term follow-up and large sample sizes to determine the clinical importance of the findings.

S. Gaube, S. Da¨umling, I. Biebl, A. Rath, A. Caplunik-Pratsch, W. Schneider-Brachert   

(Mis-)Judgment of infection risks is associated with additional workload among healthcare workers when treating isolated patients. 

Journal of Hospital infection, 133: 95-97, 2023

The COVID-19 pandemic has an immense negative impact on healthcare workers’ (HCWs’) mental health leading to more burnout, depression, anxiety, and insomnia [1,2]. According to a meta-analysis, high workloads, elevated infection risk perception, and lacking specialized training are especially detrimental [1]. However, COVID-19 is not the only infectious disease that HCWs face. Multi-drug-resistant organisms (MDROs) are ubiquitous in hospitals and lead to increased patient mortality [3,4]. To prevent their transmission, similar protective measures to those for COVID-19 are taken, such as contact isolation and wearing personal protective equipment (PPE) [5]. Therefore, caring for patients with MDROs might likewise cause higher workloads and perception of infection risk. The present study is the first to compare HCWs’ selfreported workload and task-related colonisation risk perception after performing care tasks on isolated and nonisolated patients. Moreover, we investigated whether the perception of task-related and task-independent colonisation risks, as well as knowledge about appropriate infection prevention behaviour were associated with experiencing additional workload when caring for isolated patients. We conducted a repeated-measures study with N ¼ 45 HCWs (71.1% female, 95.6% nurses) at a tertiary care hospital. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) was used to measure self-reported workload [6,7]. HCWs rated all NASA-TLX dimensions twice, directly after a care task on an isolated patient and after the same task on a non-isolated patient. Participants evaluated their task-related risk of becoming colonised while performing the task both times. Moreover, HCWs rated their task-independent risk once for the following pathogens: vancomycin-resistant enterococci (VRE), meticillin-resistant Staphylococcus aureus (MRSA), multi-drug-resistant Gram-negative bacteria (3 MRGN, 4 MRGN according to the German classification [8]), and COVID-19. Finally, we assessed participants’ perception of additional workload and their self-reported knowledge about appropriate infection prevention behaviour when caring for isolated patients. Data were collected between October 2021 and February 2022. 

M. Fennelly, S. Hellebust, J. Wenger, D. O’Connor, G.W. Griffith, B.J. Plantf, M.B. Prentice   

Portable HEPA filtration successfully augments natural-ventilation-mediated airborne particle clearance in a legacy design hospital ward

Journal of Hospital Infection, 131: 54-57, 2023

SUMMARY As the severe acute respiratory syndrome coronavirus-2 pandemic has proceeded, ventilation has been recognized increasingly as an important tool in infection control. Many hospitals in Ireland and the UK do not have mechanical ventilation and depend on natural ventilation. The effectiveness of natural ventilation varies with atmospheric conditions and building design. In a challenge test of a legacy design ward, this study showed that portable air filtration significantly increased the clearance of pollutant aerosols of respirable size compared with natural ventilation, and reduced spatial variation in particle persistence. A combination of natural ventilation and portable air filtration is significantly more effective for particle clearance than either intervention alone. 

Simon Simonet MS, Jonas Marschall MD, Rolf Kuhn PD, Matthias Schlegel MD, Christian R. Kahlert    

Implementation of an electronic, secure, web-based application to support routine hand hygiene observation with immediate direct feedback and anonymized benchmarking

American Journal of Infection Control, 50 :1263-1265, 2022

ABSTRACT A secure web-based electronic tool was developed and implemented to record adherence to hand hygiene during routine care and to provide direct feedback including anonymized benchmarking. It was found suitable for documenting hand hygiene improvements in a local campaign and ollowing rollout to other institutions in 2013, the tool is currently used in >100 hospitals in Switzerland and will play a major part in upcoming national hand hygiene campaigns. 

Li-hao Peng MD, Ya-juan Chen RN, Shi-yi Yang RN, Guo-jiang Wang MD, Yan-hua Gu RN, Bao-liang Shen MD, Li-zhen Liu MD, Rui-xing Xian MD, Xian-hua Li RN, Shu-yun Li RN , Zhen-ni Dai RN, Fei-peng Xu MD, Jian-rong Hu MD, Fei Wang MD  

Viral contamination on the surfaces of the personal protective equipment among health care professionals working in COVID-19 wards: A single center prospective, observational study 

American Journal of Infection Control, 51 : 276 281 2023

Objective: To evaluate potential viral contamination on the surfaces of personal protective equipment (PPE) in COVID-19 wards. 

Methods: Face shields, gloves, the chest area of PPE and shoe soles were sampled at different time points. The samples were tested for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by PCR, and the cycle threshold (CT) values were recorded. Results: The positive rate was 74.7% (239/320) for all PPE specimens. The CT values of the samples were ranked in the following order: face shields > chests > gloves > shoe soles (37.08§1.38, 35.48§2.02, 34.17§1.91 and 33.52§ 3.16, respectively; P for trend < .001). After disinfection, the CT values of shoe soles decreased compared with before disinfection (32.78§3.47 vs. 34.3§2.61, P = .037), whereas no significant effect of disinfection on the CT values of face shields, chests and gloves was observed. After disinfection, the CT values of specimens collected from shoe soles gradually increased; before disinfection, the CT values of shoe sole specimens were all less than 35. 

Conclusions: SARS-CoV-2 can attach to the surfaces of the PPE of healthcare professionals in COVID-19 wards, especially the shoe soles and undisinfected gloves. Shoe soles had the highest SARS-CoV-2 loads among all tested PPE items.