Assessing the accuracy of a new hand hygiene monitoring device (SmartRub®): from the laboratory to clinical practice

Abstract Background We developed SmartRub® powered by iQati®, an electronic device composed of a wristband and an alcohol-based handrub pocket-sized dispenser that measures and provides feedback on the duration of hand friction and the volume poured during each hand hygiene action. We aimed to assess the accuracy of SmartRub®. Methods The specificity, sensitivity, positive and negative predictive values (PPV and NPV) of SmartRub® were assessed in a 3-phased experiment: (1) laboratory-controlled conditions with volunteers; (2) pre-planned clinical path with volunteers and (3) real clinical conditions with healthcare workers. The accuracy of SmartRub® was evaluated by quantifying its ability to correctly capture true hand hygiene actions and to not record other actions performed while wearing the device. Results In the laboratory, 7 volunteers performed 816 actions. Overall sensitivity was 94.1% (95% CI 91.4–96.2%) with a PPV of 99.0% (95% CI 97.3–99.6%) and specificity was 99.0% (95% CI 97.5–99.7%) with a NPV of 94.4% (95% CI 91.9–96.1%). During the pre-planned clinical path phase, 13 volunteers performed 98 planned paths and a total of 967 actions were performed. Overall sensitivity was 94.6% (95% CI 92.2–96.5%) with a PPV of 84.3% (95% CI 81.6–86.7%) and specificity was 82.4% (95% CI 78.7–85.7%) with a NPV of 93.9% (95% CI 91.3–95.7%). During the real clinical conditions phase, 17 healthcare workers were observed for a total of 15 h and 3 min while they performed 485 actions. Sensitivity was 96.8% (95% CI 93.8–98.6%) with a PPV of 98.3% (95% CI 95.6–99.3%) and specificity was 98.3% (95% CI 95.7–99.5%) with a NPV of 96.8% (95% CI 93.9–98.4%). Conclusions Smartrub® is a highly reliable device for capturing hand hygiene actions under a range of conditions, from the laboratory to clinical care activities.

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Knowledge, Perception, and Performance of Hand Hygiene and Their Correlation among Nursing Students in Republic of Korea

Healthcare ◽

10.3390/healthcare9070913 ◽

2021 ◽

Vol 9 (7) ◽

pp. 913

Author(s):

Hyang Soon Oh

Keyword(s):

Nursing Education ◽

Clinical Practice ◽

Nursing Students ◽

Hand Hygiene ◽

Healthcare Workers ◽

Final Analysis ◽

World Health ◽

Cross Sectional ◽

And Performance ◽

Health Organization

Recently, various outbreaks of newly emerging or reemerging diseases are expected more frequently and regularly. The importance of hand hygiene (HH) competency of nursing students (NS) is further required as a crucial learning objective of nursing education in universities. Purpose: This study aimed to investigate knowledge, perception, and performance of HH among NS and analyze their correlation. Methods: A cross-sectional questionnaire (modified from a World Health Organization questionnaire) was conducted from 23 November to 22 December 2019; 233 responses were used for the final analysis. Results: The average scores (mean ± standard deviation (range)) for knowledge, perception, and performance of HH were 17.82 ± 2.15 (0–25), 77.24 ± 10.78 (15–96), and 67.42 ± 23.10 (0–100), respectively. No significant variables were discovered to the knowledge of HH. Grade, university-affiliated hospitals, and the most recent healthcare institute of clinical practice nursing course significantly affected perceptions of HH (p < 0.039, p = 044, p < 0.001). Knowledge of HH was positively correlated with performance of HH (p = 0.002). The perception and the performance of HH of NS were positively correlated with HH performance of healthcare workers (HCWs); p < 0.001, p = 0.002. Conclusion: HH education for NS is crucial for improving the performance and the knowledge of HH. Good HH performance of healthcare workers (HCWs) can contribute to increased perception and performance of HH among NS. The cooperation of nursing education in a university and clinical practice with competent HCWs in healthcare institutions may create an effective education program for good HH performance of NS, who will be nurses during unpredictable pandemics.

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1838. Bare Below the Elbows vs. Sleeved Attire: A Pilot Study Comparing Microbial Flora of Healthcare Workers

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.100 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S45-S46

Author(s):

Mariam Assi ◽

Yvette Major ◽

Olivia Hess ◽

Emily Styslinger ◽

Tara Srivastava ◽

...

Keyword(s):

Hand Hygiene ◽

Healthcare Workers ◽

Clinical Care ◽

Numerical Data ◽

Latex Agglutination ◽

Patient Contact ◽

Limited Evidence ◽

Skin Flora ◽

Potential Impact ◽

Staphylococcus Spp

Abstract Background Bare Below the Elbows (BBE) is an approach to healthcare worker (HCW) attire that limits patient contact with contaminated HCW clothing. While supported by biological plausibility, the practice is controversial. Critics cite limited evidence that bare skin is less contaminated in comparison to sleeved garments such as white coats. This study is a comparison of the flora and bioburden between BBE and sleeved HCW. Methods HCW on 2 progressive care units were asked to allow swab sampling of their dominant wrist/forearm (Figure 1). Non-clinicians were excluded. Hand hygiene was not performed prior to sampling. HCW agreeing to participate completed informed consent, and a survey regarding bathing and laundering. Swabs were inoculated into TSA broths, and incubated for 24 hours at 37°C. Bioburden was estimated using McFarland standard optical densities by 2 independent blinded evaluators. The broth was streaked on blood agar and MacConkey plates. Colonies consistent with possible Staphylococcus spp. were tested with latex agglutination, and positive isolates were plated on CHROMagar™ MSSA/MRSA. Fisher’s exact/Wilcoxon rank-sum tests were used to compare the categorical/numerical data between BBE and sleeved providers using SAS version 9.4. Results Sixty-three HCW participated; 30 were BBE and 33 sleeved. A comparison of the 2 groups is shown in Table 1. The majority of bacterial growth was morphologically consistent with skin flora; no Gram-negative rods grew. The bioburden estimates and presence of Staphylococcus aureus were not different between the groups (P = 0.099 and 0.325, respectively). Surveys indicated that BBE providers were more likely to be working in freshly laundered garments (P < 0.0001); this was true for all BBE providers except 2 HCW on shift >24 hours. Three sleeved individuals could not remember when they last laundered the garment in which they were providing clinical care. Conclusion HCW laundering practices remain suboptimal, particularly among sleeved HCW. The potential impact of hand hygiene on comparative bioburden between sleeved and BBE HCWs remains unknown and is the focus of future investigations. Disclosures All Authors: No reported Disclosures.

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An Electronic Hand Hygiene Surveillance Device: A Pilot Study Exploring Surrogate Markers for Hand Hygiene Compliance

Infection Control and Hospital Epidemiology ◽

10.1086/652527 ◽

2010 ◽

Vol 31 (6) ◽

pp. 634-639 ◽

Cited By ~ 35

Author(s):

Andrew G. Sahud ◽

Nitin Bhanot ◽

Anita Radhakrishnan ◽

Rajinder Bajwa ◽

Harish Manyam ◽

...

Keyword(s):

Pilot Study ◽

Hand Hygiene ◽

Phase I ◽

Phase Ii ◽

Healthcare Workers ◽

Hand Hygiene Compliance ◽

Electronic Device ◽

Compliance Rate ◽

Patient Room ◽

Hygiene Compliance

Objective.To evaluate the feasibility of using an electronic hand hygiene surveillance and feedback monitoring device.Design.A 2-phase pilot study included initial direct observation of hand hygiene practices as part of routine hospital quality assurance (phase I) and subsequent monitoring using an electronic hand hygiene surveillance device (phase II).Setting.A 700-bed tertiary care teaching hospital.Participants.Phase I included a convenience sample of healthcare workers. Phase II included 7 medical interns and 7 registered nurses recruited through email and at work-related meetings.Methods.During phase I, healthcare workers were directly observed at patient room entry and exit during the period April through November 2008. During phase II, hand hygiene data were gathered through indirect observation using the electronic device during a 4-week period in August 2009. Twenty patient rooms were fitted with electronic trigger devices that signaled a reader unit worn by participants when they entered the room, and 70 dispensers for liquid soap or hand sanitizer were fitted with triggers that signaled the reader unit when the dispenser was used. The accuracy of the devices was checked by the principal investigator, who manually recorded his room entries and exits and dispenser use while wearing a reader unit.Results.During phase I, hand hygiene occurred before room entry for 95 (25.1%) and after room exit for 149 (39.4%) of 378 directly observed patient room visits, for a cumulative composite compliance rate of 32.3%. Among the 378 room visits, 347 (91.8%) involved contact with the patient and/or environment. During phase II, electronic monitoring revealed a cumulative composite compliance rate of 25.5%. The electronic device captured 61 (98%) of 62 manually recorded room entries and 133 (95%) of 140 manually recorded dispensing events.Conclusions.The electronic hand hygiene surveillance device seems to be a practical method for routinely monitoring hand hygiene compliance in healthcare workers.

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Healthcare workers' attitudes towards hand-hygiene monitoring technology

Journal of Hospital Infection ◽

10.1016/j.jhin.2019.02.017 ◽

2019 ◽

Vol 102 (4) ◽

pp. 413-418 ◽

Cited By ~ 1

Author(s):

C. Tarantini ◽

P. Brouqui ◽

R. Wilson ◽

K. Griffiths ◽

P. Patouraux ◽

...

Keyword(s):

Hand Hygiene ◽

Healthcare Workers ◽

Monitoring Technology

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Hand Hygiene Compliance Study at a Large Central Hospital in Vietnam

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16040607 ◽

2019 ◽

Vol 16 (4) ◽

pp. 607 ◽

Cited By ~ 6

Author(s):

Cam Le ◽

Erik Lehman ◽

Thanh Nguyen ◽

Timothy Craig

Keyword(s):

Quality Assurance ◽

Hand Hygiene ◽

Healthcare Workers ◽

Medical Center ◽

Compliance Rate ◽

World Health ◽

Limiting Factors ◽

Cultural Attitudes ◽

Knowledge And Attitude ◽

Hygiene Compliance

Lack of proper hand hygiene among healthcare workers has been identified as a core facilitator of hospital-acquired infections. Although the concept of hand hygiene quality assurance was introduced to Vietnam relatively recently, it has now become a national focus in an effort to improve the quality of care. Nonetheless, barriers such as resources, lack of education, and cultural norms may be limiting factors for this concept to be properly practiced. Our study aimed to assess the knowledge and attitude of healthcare workers toward hand hygiene and to identify barriers to compliance, as per the World Health Organization’s guidelines, through surveys at a large medical center in Vietnam. In addition, we aimed to evaluate the compliance rate across different hospital departments and the roles of healthcare workers through direct observation. Results showed that, in general, healthcare workers had good knowledge of hand hygiene guidelines, but not all believed in receiving reminders from patients. The barriers to compliance were identified as: limited resources, patient overcrowding, shortage of staff, allergic reactions to hand sanitizers, and lack of awareness. The overall compliance was 31%; physicians had the lowest rate of compliance at 15%, while nurses had the highest rate at 39%; internal medicine had the lowest rate at 16%, while the intensive care unit had the highest rate at 40%. In summary, it appears that addressing cultural attitudes in addition to enforcing repetitive quality assurance and assessment programs are needed to ensure adherence to safe hand washing.

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Edoxaban treatment of elderly patients with atrial fibrillation in routine clinical practice: 1-year results of the non-interventional Global ETNA-AF program

European Heart Journal ◽

10.1093/ehjci/ehaa946.0663 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Yamashita ◽

C.C Wang ◽

Y.-H Kim ◽

R De Caterina ◽

P Kirchhof ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Major Bleeding ◽

Intracranial Haemorrhage ◽

Clinical Care ◽

Oral Anticoagulants ◽

Clinical Event ◽

Funding Source ◽

Private Company ◽

All Cause Mortality

Abstract Background The prevalence of atrial fibrillation (AF) and the need for appropriate anticoagulation increase with age. The benefit/risk profile of direct oral anticoagulants such as edoxaban in elderly population with AF in regular clinical practice is therefore of particular interest. Purpose Analyses of Global ETNA-AF data were performed to report patient characteristics, edoxaban treatment, and 1-year clinical events by age subgroups. Methods Global ETNA-AF is a multicentre, prospective, noninterventional program conducted in Europe, Japan, Korea, Taiwan, and other Asian countries. Demographics, baseline characteristics, and 1-year clinical event data were analysed in four age subgroups. Results Of 26,823 patients included in this analysis, 50.4% were ≥75 years old and 11.6% were ≥85 years. Increase in age was generally associated with lower body weight, lower creatinine clearance, higher CHA2DS2-VASc and HAS-BLED scores, and a higher percentage of patients receiving the reduced dose of 30 mg daily edoxaban. At 1-year, rates of ISTH major bleeding and ischaemic stroke were generally low across all age subgroups. The proportion of intracranial haemorrhage within major bleeding events was similar across age groups. All-cause mortality increased with age more than cardiovascular mortality. Conclusion Data from Global ETNA-AF support the safety and effectiveness of edoxaban in elderly AF patients (including ≥85 years) in routine clinical care with only a small increase in intracranial haemorrhage. The higher all-cause mortality with increasing age is not driven by cardiovascular causes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Daiichi Sankyo

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COVID-19 Seroprevalence among Healthcare Workers of a Large COVID-19 Hospital in Rome Reveals Strengths and Limits of Two Different Serological Tests

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052650 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2650

Author(s):

Giuseppe Vetrugno ◽

Daniele Ignazio La Milia ◽

Floriana D’Ambrosio ◽

Marcello Di Pumpo ◽

Roberta Pastorino ◽

...

Keyword(s):

Blood Test ◽

Healthcare Workers ◽

Point Of Care ◽

Venous Blood ◽

Administrative Staff ◽

Serological Tests ◽

Predictive Values ◽

Work From Home ◽

Significant Difference ◽

Sensitivity Specificity

Healthcare workers are at the forefront against COVID-19, worldwide. Since Fondazione Policlinico Universitario A. Gemelli (FPG) IRCCS was enlisted as a COVID-19 hospital, the healthcare workers deployed to COVID-19 wards were separated from those with limited/no exposure, whereas the administrative staff were designated to work from home. Between 4 June and 3 July 2020, an investigation was conducted to evaluate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin (IgG) antibodies among the employees of the FPG using point-of-care (POC) and venous blood tests. Sensitivity, specificity, and predictive values were determined with reverse-transcription polymerase chain reaction on nasal/oropharyngeal swabs as the diagnostic gold standard. The participants enrolled amounted to 4777. Seroprevalence was 3.66% using the POC test and 1.19% using the venous blood test, with a significant difference (p < 0.05). The POC test sensitivity and specificity were, respectively, 63.64% (95% confidence interval (CI): 62.20% to 65.04%) and 96.64% (95% CI: 96.05% to 97.13%), while those of the venous blood test were, respectively, 78.79% (95% CI: 77.58% to 79.94%) and 99.36% (95% CI: 99.07% to 99.55%). Among the low-risk populations, the POC test’s predictive values were 58.33% (positive) and 98.23% (negative), whereas those of the venous blood test were 92.86% (positive) and 98.53% (negative). According to our study, these serological tests cannot be a valid alternative to diagnose COVID-19 infection in progress.

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Comparison of saliva with healthcare workers- and patient-collected swabs in the diagnosis of COVID-19 in a large cohort

BMC Infectious Diseases ◽

10.1186/s12879-021-06343-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mitnala Sasikala ◽

Yelamanchili Sadhana ◽

Ketavarapu Vijayasarathy ◽

Anand Gupta ◽

Sarala Kumari Daram ◽

...

Keyword(s):

Healthcare Workers ◽

Early Stage ◽

Cost Effective ◽

Hospitalized Patients ◽

Detection Sensitivity ◽

Nasopharyngeal Swab ◽

Predictive Values ◽

Qrt Pcr ◽

Asymptomatic Patients ◽

Sensitivity Specificity

Abstract Background A considerable amount of evidence demonstrates the potential of saliva in the diagnosis of COVID-19. Our aim was to determine the sensitivity of saliva versus swabs collected by healthcare workers (HCWs) and patients themselves to assess whether saliva detection can be offered as a cost-effective, risk-free method of SARS-CoV-2 detection. Methods This study was conducted in a hospital involving outpatients and hospitalized patients. A total of 3018 outpatients were tested. Of these, 200 qRT-PCR-confirmed SARS-CoV-2-positive patients were recruited for further study. In addition, 101 SARS-CoV-2-positive hospitalized patients with symptoms were also enrolled in the study. From outpatients, HCWs collected nasopharyngeal swabs (NPS), saliva were obtained. From inpatients, HCWs collected swabs, patient-collected swabs, and saliva were obtained. qRT-PCR was performed to detect SARS-CoV-2 by TAQPATH assay to determine the sensitivity of saliva detection. Sensitivity, specificity and positive/negative predictive values (PPV, NPV) of detecting SARS-CoV-2 were calculated using MedCalc. Results Of 3018 outpatients (asymptomatic: 2683, symptomatic: 335) tested by qRT-PCR, 200 were positive (males: 140, females: 60; aged 37.9 ± 12.8 years; (81 asymptomatic, 119 symptomatic). Of these, saliva was positive in 128 (64%); 39 of 81 asymptomatic (47%),89 of 119 symptomatic patients (74.8%). Sensitivity of detection was 60.9% (55.4–66.3%, CI 95%), with a negative predictive value of 36%(32.9–39.2%, CI 95%).Among 101 hospitalized patients (males:65, females: 36; aged 53.48 ± 15.6 years), with HCW collected NPS as comparator, sensitivity of saliva was 56.1% (47.5–64.5, CI 95%), specificity 63.5%(50.4–75.3, CI95%) with PPV of 77.2% and NPV of 39.6% and that of self-swab was 52.3%(44–60.5%, CI95%), specificity 56.6% (42.3–70.2%, CI95%) with PPV 77.2% and NPV29.7%. Comparison of positivity with the onset of symptoms revealed highest detection in saliva on day 3 after onset of symptoms. Additionally, only saliva was positive in 13 (12.8%) hospitalized patients. Conclusion Saliva which is easier to collect than nasopharyngeal swab is a viable alternate to detect SARS-COV-2 in symptomatic patients in the early stage of onset of symptoms. Although saliva is currently not recommended for screening asymptomatic patients, optimization of collection and uniform timing of sampling might improve the sensitivity enabling its use as a screening tool at community level.

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Hand hygiene and the sequence of patient care

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.82 ◽

2021 ◽

pp. 1-6

Author(s):

Nai-Chung Chang ◽

Michael Jones ◽

Heather Schacht Reisinger ◽

Marin L. Schweizer ◽

Elizabeth Chrischilles ◽

...

Keyword(s):

Intensive Care ◽

Hand Hygiene ◽

Patient Care ◽

Intensive Care Units ◽

Healthcare Workers ◽

Hand Hygiene Compliance ◽

Resistant Bacteria ◽

Surgical Intensive Care ◽

Hygiene Compliance ◽

Hand Hygiene Opportunity

Abstract Objective: To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. Design: For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. Setting: The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. Participants: HCWs in the STAR*ICU study units. Results: HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). Conclusions: HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.

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Discontinuation and relapse with paliperidone palmitate three-monthly for maintenance of schizophrenia: Two year follow-up of use in clinical practice

Journal of Psychopharmacology ◽

10.1177/02698811211009794 ◽

2021 ◽

pp. 026988112110097

Author(s):

Phoebe Wallman ◽

Ivana Clark ◽

David Taylor

Keyword(s):

Clinical Practice ◽

Treatment Duration ◽

Maintenance Treatment ◽

Clinical Care ◽

Paliperidone Palmitate ◽

Reduce Risk ◽

Patient Refusal ◽

Long Acting ◽

Post Hoc

Background: The use of antipsychotic long-acting injections (LAI) aims to reduce risk of relapse and hospitalisation in patients with schizophrenia compared with oral medication. Paliperidone palmitate is currently the only LAI that can be administered at three-monthly intervals for maintenance treatment of schizophrenia. Aim: This prospective study aimed to evaluate relapse and continuation in licensed use of paliperidone palmitate three-monthly (PP3M) over a 2-year follow-up in clinical practice. Method: Non-interventional, observational study of patients treated in the South London and The Maudsley NHS Foundation Trust. Results: A total of 166 patients initiated on PP3M, 55 were excluded from the study (non-F20 diagnosis ( n = 43); F20 >65 years old ( n = 12)). Of the 111 patients included, 67 (60%) continued PP3M for 2 years. Overall 102 patients received more than one dose of PP3M and 92 (90%) remained on the same dose of PP3M for the whole of their treatment duration. Relapse (defined as a step-up in clinical care) occurred in eight patients (7%) while on PP3M. The most common reason for discontinuation was patient refusal and the most frequent medication prescribed after discontinuation was paliperidone palmitate one-monthly (PP1M). Post hoc, we analysed outcome in those continuing any form of PPLAI (those continuing with PP3M and those switching back to PP1M). Continuation over 2 years with any PPLAI formulation was 73% (81/111) and relapse was recorded in 9% (10/111). Conclusion: Overall, PP3M was an effective maintenance treatment for schizophrenia after stabilisation on PP1M in a clinical setting.

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