Introduction Infection prevention and speaking up on errors are core qualities of health care providers. Heuristic effects (e.g. overconfidence) may impair behavior in daily routine, while speaking ...up can be inhibited by hierarchical barriers and medical team factors. Aim of this investigation was to determine, how medical students experience these difficulties for hand hygiene in daily routine. Methods On the base of prior investigations we developed a questionnaire with 5-point Likert ordinal scaled items and free text entries. This was tested for validity and reliability (Cronbach's Alpha 0.89). Accredited German, Swiss and Austrian universities were contacted and medical students asked to participated in the anonymous online survey. Quantitative statistics used parametric and non-parametric tests and effect size calculations according to Lakens. Qualitative data was coded according to Janesick. Results 1042 undergraduates of 12 universities participated. All rated their capabilities in hand hygiene and feedback reception higher than those of fellow students, nurses and physicians (p0.001). Half of the participants rating themselves to be best educated, realized that faulty hand hygiene can be of lethal effect. Findings were independent from age, sex, academic course and university. Speaking-up in case of omitted hand hygiene was rated to be done seldomly and most rare on persons of higher hierarchic levels. Qualitative results of 164 entries showed four main themes: 1) Education methods in hand hygiene are insufficient, 2) Hierarchy barriers impair constructive work place culture 3) Hygiene and feedback are linked to medical ethics and 4) There is no consequence for breaking hygiene rules. Discussion Although partially limited by the selection bias, this study confirms the overconfidence-effects demonstrated in post-graduates in other settings and different professions. The independence from study progress suggests, that the effect occurs before start of the academic course with need for educational intervention at the very beginning. Qualitative data showed that used methods are insufficient and contradictory work place behavior in hospitals are frustrating. Even 20 years after "To err is human", work place culture still is far away from the desirable.
Abstract
Introduction
Handwashing is fundamentally an inexpensive means of reducing the spread of communicable diseases. In developing countries, many people die due to infectious diseases that could ...be prevented by proper hand hygiene. The recent coronavirus (COVID-19) pandemic is a threat to people who are living in resource-limited countries including sub-Saharan Africa (SSA). Effective hand hygiene requires sufficient water from reliable sources, preferably accessible on premises, and access to handwashing facility (water and or soap) that enable hygiene behaviors. Therefore, this study aims to determine the prevalence of limited handwashing facility and its associated factors in sub-Saharan Africa.
Methods
Data from the Demographic and Health Surveys (DHS) were used, which have been conducted in 29 sub-Saharan African countries since January 1, 2010. A two-stage stratified random cluster sampling strategy was used to collect the data. This study comprised a total of 237,983 weighted samples. The mixed effect logistic regression model with a cluster-level random intercept was fitted. Meta-analysis and sub-group analysis were performed to establish the pooled prevalence.
Results
The pooled prevalence of limited handwashing facility was found to be 66.16% (95% CI; 59.67%—72.65%). Based on the final model, household head with age group between 35 and 60 AOR = 0.89, 95% CI; 0.86—0.91, households with mobile type of hand washing facility AOR = 1.73, 95% CI; 1.70—1.77, unimproved sanitation facility AOR = 1.58, 95% CI; 1.55—1.62, water access more than 30 min round trip AOR = 1.16, 95% CI; 1.13—1.19, urban residential area AOR = 2.08, 95% CI; 2.04—2.13, low media exposure AOR = 1.47, 95% CI; 1.31—1.66, low educational level AOR = 1.30, 95% CI; 1.14—1.48, low income level AOR = 2.41, 95% CI; 2.33—2.49 as well as lower middle-income level AOR = 2.10, 95% CI; 2.14—2.17 and households who had more than three children AOR = 1.25, 95% CI; 1.20—1.31 were associated with having limited handwashing facility.
Conclusion and recommendation
The pooled coverage of limited handwashing facility was high in sub-Saharan Africa. Raising awareness of the community and promoting access to handwashing materials particularly in poorer and rural areas will reduce its coverage.
Adequate hand washing with soap at five recommended times is particularly important in urban slums in developing countries, but which of the recommended times are the most important in the prevention ...of diarrhea among children under five years of age living in these areas remains unclear. To address this gap, a community-based cross-sectional study was undertaken in the slums of Addis Ababa, Ethiopia between September and November 2014. Data were collected using a pre-tested structured questionnaire and an observational checklist. Multivariable logistic regression with 95% confidence interval (CI) was used for data analysis. Only 4.4% of the households had hand washing facilities within or near a latrine with soap and water access. The average prevalence of hand washing with soap at the five recommended times was 19.8%. One quarter (24.8%) of caregivers washed their hands with soap before feeding a child, 23.8% before preparing food, and 17.1% after defecation. The most important recommended times in preventing acute diarrhea were before preparing food adjusted odds ratio (AOR) 0.2; 95% CI 0.1–0.7 and after defecation (AOR 0.3; 95% CI 0.1–0.9). Household size of six or more persons (AOR 2.3; 95% CI 1.4–3.9) and low monthly household income (AOR 2.4; 95% CI 1.4–4.0) were significantly associated with acute diarrhea. Promoting hand washing with soap and advocacy programs at the five recommended times, especially before preparing food and after defecation, and implementation of socioeconomic development programs targeting poor households are essential for increasing the prevalence of hand washing with soap and preventing acute diarrhea in the slums of Addis Ababa.
The stratum corneum is the outermost layer of the epidermis. It acts as an interface with the external environment and functions as a barrier that prevents microorganisms and allergens from ...penetrating the skin, while preventing bodily fluids, electrolytes and proteins from being lost in a process aimed at maintaining homeostasis. With the novel coronavirus disease 2019 (COVID-19) outbreak, there has been an increase in hygiene practice, particularly hand washing and the use of hand sanitisers. These practices have undoubtedly assisted a great deal in combatting the rate of transmission and contributed immensely to saving lives. However, repeated hand washing and the use of sanitisers have both been linked with marked skin dryness and contact dermatitis. This especially holds true when the abovementioned practices are carried out in the absence of intermittent hand moisturiser usage.
Handwashing with soap is an important preventive health behavior, and yet promoting this behavior has proven challenging. We report the results of a program that trained teachers to deliver a ...handwashing with soap behavior change program to children in primary schools in Bihar, India. Ten intervention schools selected along with ten nearby control schools, and intervention schools received the "School of Five" program promoting handwashing with soap using interactive stories, games, and songs, behavioral diaries to encourage habit formation, and public commitment. Households with children aged 8-13 attending the nearby school were enrolled in the study. Handwashing with soap was measured using sticker diaries before eating and after defecation 4 weeks after the intervention was completed. Children in the treatment reported 15.1% more handwashing with soap on key occasions (35.2%) than those in the control group (20.1%) (RR: 1.77, CI: (1.22, 2.58), p = .003). There was no evidence that handwashing with soap after defecation was higher in the treatment group than the control group (RR: 1.18, CI: (0.88, 1.57), p = .265), but there was strong evidence that handwashing with soap was greater in the treatment than in the control before eating (RR: 2.68, 95% CI: (1.43, 5.03), p = .002). Rates of handwashing increased both at home (RR: 1.63, CI: 1.14, 2.32), p = .007) and at school (RR: 4.76, 95% CI: (1.65, 17.9), p = .004), though the impact on handwashing with soap at key occasions in schools was much higher than at home. Promoting handwashing with soap through teachers in schools may be an effective way to achieve behavior change at scale.
Hand hygiene practice in hospitals is unfortunately still widely insufficient, even though it is known that transmitting pathogens via hands is the leading cause of healthcare-associated infections. ...Previous research has shown that improving knowledge, providing feedback on past behaviour and targeting social norms are promising approaches to improve hand hygiene practices. The present field experiment was designed to direct people on when to perform hand hygiene and prevent forgetfulness. This intervention is the first to examine the effect of inducing injunctive social norms via an emoticon-based feedback system on hand hygiene behaviour. Electronic monitoring and feedback devices were installed in hospital patient rooms on top of hand-rub dispensers, next to the doorway, for a period of 17 weeks. In the emoticon condition, screens at the devices activated whenever a person entered or exited the room. Before using the alcohol-based hand-rub dispenser, a frowny face was displayed, indicating that hand hygiene should be performed. If the dispenser was subsequently used, this picture changed to a smiley face to positively reinforce the correct behaviour. Hand hygiene behaviour in the emoticon rooms significantly outperformed the behaviour in three other tested conditions. The strong effect in this field experiment indicates that activating injunctive norms may be a promising approach to improve hand hygiene behaviour. Theoretical and practical implications of these findings are discussed.
Las Infecciones Asociadas a Atención en Salud (IAAS), las Enfermedades Transmitidas por Alimentos (ETAS) y las zoonosis generan altos costos a la salud pública. Una medida sencilla y económica, y con ...evidencia de su efectividad para prevenirlas es el lavado de manos, protocolo establecido por la Organización Mundial de la Salud (OMS), práctica que se enseña en los programas de formación profesional a estudiantes de la salud humana y animal, así como a quienes procesan alimentos. El objetivo de este estudio descriptivo y transversal fue evaluar el lavado de manos mediante bioluminiscencia en estudiantes durante su desempeño en los centros de práctica, así como su conocimiento y actitud hacia el lavado de mano, mediante una encuesta a 45 estudiantes de las carreras de Gastronomía, Enfermería y Medicina Veterinaria en su último ciclo de formación académica de una institución de Educación Superior Privada (Concepción, Chile). Los estudiantes presentan un adecuado conocimiento sobre el lavado de mano (90%), pero una mala actitud frente a este (70% de respuestas favorables). Los estudiantes le dan mayor relevancia al lavado de mano cuando son observados, evaluados o cuando sus compañeros lo realizan, mostrando una falta de conciencia respecto a la importancia de realizarlo. La prueba de bioluminiscencia indicó una reducción significativa entre antes y después del lavado de mano, de 2951±40 URL vs. 400.7±73 URL, respectivamente (p<0.0001), sin diferencias significativas entre las carreras. La medición de ATP mediante bioluminiscencia es un método sencillo y rápido para evaluar la eficacia del lavado de mano, siendo una herramienta que puede incorporarse dentro de la formación disciplinar en carreras directamente relacionadas con la salud humana-animal.
Handwashing with soap is a cost-effective, efficient health behavior to prevent various diseases. Despite its immense health benefits, the lowest prevalence of handwashing is found in low-income ...countries. Here, its practice is not only determined by individual behavior, but also heavily shaped by deprivations in the social and structural ecology. Moreover, handwashing barriers are not equally experienced as overlapping social identities (e.g., age and gender) intersect and create inequities between members of different social groups. To embrace the complexities of handwashing beyond individual-level behavior and singular social identities, a combined socioecological and intersectional perspective is employed. This multi-level approach with regards to intersecting privileges and disadvantages serves as a basis to promote this highly important health behavior.
This study used a qualitative, theory-based approach and combined data from two samples: experts in health promotion (n = 22) and local citizens stratified by gender and rural/urban location (n = 56). Data was collected in face-to-face interviews in Sierra Leone between November 2018 and January 2019 and analyzed using thematic analysis and typology of the qualitative data.
The conceptualization of multi-level determinants of handwashing within a socioecological model showed the high relevance of inhibiting social and structural factors for handwashing practice. By establishing seven distinguishing social identity dimensions, data demonstrates that individuals within the same social setting yet with distinct social identities experience strikingly differing degrees of power and privileges to enact handwashing. While a local leader is influential and may also change structural-level determinants, a young, rural wife experiences multiple social and structural constraints to perform handwashing with soap, even if she has high handwashing intentions.
This study provides a holistic analytical framework for the identification of determinants on multiple levels and accumulating intersections of socially produced inequalities for handwashing and is applicable to other health topics. As the exploration of handwashing was approached from a solution-focused instead of a problem-focused perspective, the analysis can guide multi-level intervention approaches (e.g., using low-cost, participatory activities at the community level to make use of the available social capital).
We present a passive and non-intrusive sensing system for monitoring hand washing activity using structural vibration sensing. Proper hand washing is one of the most effective ways to limit the ...spread and transmission of disease, and has been especially critical during the COVID-19 pandemic. Prior approaches include direct observation and sensing-based approaches, but are limited in non-clinical settings due to operational restrictions and privacy concerns in sensitive areas such as restrooms. Our work introduces a new sensing modality for hand washing monitoring, which measures hand washing activity-induced vibration responses of sink structures, and uses those responses to monitor the presence and duration of hand washing. Primary research challenges are that vibration responses are similar for different activities, occur on different surfaces/structures, and tend to overlap/coincide. We overcome these challenges by extracting information about signal periodicity for similar activities through cepstrum-based features, leveraging hierarchical learning to differentiate activities on different surfaces, and denoting “primary/secondary” activities based on their relative frequency and importance. We evaluate our approach using real-world hand washing data across four different sink structures/locations, and achieve an average F1-score for hand washing activities of 0.95, which represents an 8.8X and 10.2X reduction in error over two different baseline approaches.
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