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      Quantification of diurnal variation in “glove hygiene” compliance in COVID ICUs: an exploratory study

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          Abstract

          Background

          Hand hygiene compliance (HHC) monitoring is almost always done in daytime. Documentation of HHC in healthcare workers (HCWs) is limited during odd hours and nighttime.

          Aim

          The objective of the study was to determine diurnal variation in HHC in different categories of health care workers in tertiary care hospital in North India.

          Methods

          A prospective, observational study was conducted in three COVID-19 intensive care units (ICUs) with closed-circuit television (CCTV) cameras. Dedicated infection control nurses monitored HHC among various HCWs (doctors, nursing staff, technicians, hospital and sanitary attendants) during day and nighttime, in 20- minute durations. The difference in HHC by-professional category and for each WHO moment was assessed using chi-square test and p value.

          Findings

          A total of 705 opportunities were observed over a period of seven days, with overall compliance of 53%. Day and nighttime compliance was recorded to be 60.7% and 42.1%, respectively ( p<0.001). HCC was highest amongst resident doctors with little diurnal variation. However, nurses and housekeeping staff exhibited significant diurnal variation. The compliance at “after” moments was much higher than “before” moments in all professional categories.

          Conclusion

          There was a significant decrease in compliance during nighttime, amongst all HCWs, with maximum variation exhibited by nursing staff. The present study underlines the importance of monitoring HHC at odd hours, to elicit a more accurate picture round the clock. Healthcare facilities monitoring compliance only during the daytime may substantially overestimate HHC.

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          Most cited references26

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          Compliance with handwashing in a teaching hospital. Infection Control Program.

          T Perneger, P Mourouga, Didier Pittet (1999)
          Transmission of microorganisms from the hands of health care workers is the main source of cross-infection in hospitals and can be prevented by handwashing. To identify predictors of noncompliance with handwashing during routine patient care. Observational study. Teaching hospital in Geneva, Switzerland. Nurses (66%), physicians (10%), nursing assistants (13%), and other health care workers (11%). Compliance with handwashing. In 2834 observed opportunities for handwashing, average compliance was 48%. In multivariate analysis, noncompliance was higher among physicians (odds ratio [OR], 2.8 [95% CI, 1.9 to 4.1]), nursing assistants (OR, 1.3 [CI, 1.0 to 1.6]), and other health care workers (OR, 2.1 [CI, 1.4 to 3.2]) than among nurses and was lowest on weekends (OR, 0.6 [CI, 0.4 to 0.8]). Noncompliance was higher in intensive care than in internal medicine units (OR, 2.0 [CI, 1.3 to 3.1]), during procedures that carry a high risk for contamination (OR, 1.8 [CI, 1.4 to 2.4]), and when intensity of patient care was high (compared with 60 opportunities: OR, 2.1 [CI, 1.3 to 3.5]). Compliance with handwashing was moderate. Variation across hospital ward and type of health care worker suggests that targeted educational programs may be useful. Even though observational data cannot prove causality, the association between noncompliance and intensity of care suggests that understaffing may decrease quality of patient care.
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            Why healthcare workers don't wash their hands: a behavioral explanation.

            Alexander Ross, Michael Whitby, Mary-Louise McLaws (2006)
            To elucidate behavioral determinants of handwashing among nurses. Statistical modeling using the Theory of Planned Behavior and relevant components to handwashing behavior by nurses that were derived from focus-group discussions and literature review. The community and 3 tertiary care hospitals. Children aged 9-10 years, mothers, and nurses. Responses from 754 nurses were analyzed using backward linear regression for handwashing intention. We reasoned that handwashing results in 2 distinct behavioral practices--inherent handwashing and elective handwashing--with our model explaining 64% and 76%, respectively, of the variance in behavioral intention. Translation of community handwashing behavior to healthcare settings is the predominant driver of all handwashing, both inherent (weighted beta =2.92) and elective (weighted beta =4.1). Intended elective in-hospital handwashing behavior is further significantly predicted by nurses' beliefs in the benefits of the activity (weighted beta =3.12), peer pressure of senior physicians (weighted beta =3.0) and administrators (weighted beta =2.2), and role modeling (weighted beta =3.0) but only to a minimal extent by reduction in effort (weighted beta =1.13). Inherent community behavior (weighted beta =2.92), attitudes (weighted beta =0.84), and peer behavior (weighted beta =1.08) were strongly predictive of inherent handwashing intent. A small increase in handwashing adherence may be seen after implementing the use of alcoholic hand rubs, to decrease the effort required to wash hands. However, the facilitation of compliance is not simply related to effort but is highly dependent on altering behavioral perceptions. Thus, introduction of hand rub alone without an associated behavioral modification program is unlikely to induce a sustained increase in hand hygiene compliance.
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              COVID-19 vaccine efficacy in patients with chronic lymphocytic leukemia

              Lindsey Roeker, David Knorr, Meghan Thompson … (2021)
              Article 0 comments Cited 74 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Dr. Parakriti Gupta: Role: Senior Resident
                Dr. Manisha Biswal: Role: Professor
                Rupinder Kaur: Role: Infection Control Nurse
                Kulbeer Kaur: Role: Infection Control Nurse
                Harinder Kaur: Role: Infection Control Nurse
                Manjinder Kaur: Role: Infection Control Nurse
                Dr. Varun Mahajan: Role: Professor and Head Dean (Academic)
                Dr. GD Puri: Role: Professor and Head Dean (Academic)
                Dr. Vipin Kaushal: Role: Professor
                Journal
                Journal ID (nlm-ta): Am J Infect Control
                Journal ID (iso-abbrev): Am J Infect Control
                Title: American Journal of Infection Control
                Publisher: Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
                ISSN (Print): 0196-6553
                ISSN (Electronic): 1527-3296
                Publication date PMC-release: 29 July 2022
                Publication date (Electronic): 29 July 2022
                Affiliations
                [1 ]Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [2 ]Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [3 ]Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [4 ]Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [5 ]Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [6 ]Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [7 ]Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [8 ]Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [9 ]Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [10 ]Department of Hospital Administration, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                Author notes
                [* ]Corresponding author: Manisha Biswal, Professor, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, INDIA, Phone no.:91-172-2755151;7087008164
                Article
                Publisher Item ID: S0196-6553(22)00574-0
                DOI: 10.1016/j.ajic.2022.07.018
                PMC ID: 9334865
                SO-VID: e081d783-307f-41b9-80d9-ed93b7aa66ef
                Copyright © © 2022 Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Categories
                Subject: Major Article

                Keywords: glove hygiene compliance,covid-19,diurnal variation,india
                Data availability:
                Keywords: glove hygiene compliance, covid-19, diurnal variation, india

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