Hospital hand hygiene after COVID-19: has the pandemic heightened healthcare workers’ awareness?

Abstract Background Hand hygiene (HH) is the leading measure for preventing the transmission of healthcare-associated infections (HAI), and a cornerstone to prevent COVID-19 spread. Aim of the research was the assessment of HCWs’ adherence to the application of WHO optimal practices, with the goal to promote a culture of safety and quality infection prevention and control (IPC) activities. Methods Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, implemented a HH monitoring plan in which HCWs’ adherence to HH procedures is evaluated using WHO guidelines, technical manual and observation form. Direct field observations took place in March and April 2022 by trained personnel. Process index was HH adherence, stratified by profession, opportunity and unit, which has been visited at least twice. Results Overall, 302 HCWs were observed from 18 hospital units (105 physicians, 108 nurses, 84 healthcare assistants and 5 students). Out of 1382 opportunities, global adherence was 52% with 190 handwashing and 598 hand rubbing. The indication with the highest adherence was “after body fluid exposure risk” (76%), whereas the lowest were “after touching the patient's setting” (40%) and “before touching a patient” (43%). Adherence was higher in specialistic surgeries and haematology units, while the worst performances were reported in general medicine ward (29%). Physicians’ and nurses’ adherence was respectively 45% and 61%. Audits occasionally revealed non-conformities in glove use (i.e., unnecessary use, not changed between patients, hand rubbing on gloves). Conclusions These preliminary findings could be directly linked to habits acquired during the pandemic, when HW tended to consider COVID-19 patients as a unique block to shield themselves from infections, rather than safeguarding individual patient units. HH awareness could have changed in the wake of COVID-19 pandemic and our study described how HCWs’ adherence to optimal practices needs specific initiatives to promote correct HH. Key messages • The COVID‐19 pandemic reinforced the importance of handwashing and IPC, showing the key role of the HCWs’ adherence to hand hygiene (HH) procedures. • HH audits play a leading part in clinical governance and IPC, aiming at enhancing the quality of care and patient safety, particularly to strengthen health system resilience in post-COVID era.


Background:
Employees in long-term care facilities (LTC) are exposed to physically and mentally demanding workloads. Due to the specific working conditions and processes in LTC, recent literature recommends that care setting-specific health promotion is required. The objective was to systematically review the current evidence of workplace health promotion programs among employees in LTC.

Methods:
A systematic review was conducted in accordance with the PRISMA 2020 Statement. The literature search was applied in the online databases PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and APA PsycArticles (Jan 2000-Feb 2022. Studies were included if (1) participants worked in any occupational setting in LTC, (2) personal health and outcomes related to occupational health were measured as primary outcome, and (3) studies were randomized controlled trials. Methodological quality was assessed using the Cochrane risk of bias assessment tool (RoB 2).

Results:
The literature search yielded 23.007 articles, resulting in 24 included studies and 21 unique interventions with a total of 6.625 participants at baseline. Most participants were female (85.2% to 100%). Interventions were grouped into persondirected (n = 4), person/work interface-directed (n = 10), work-directed (n = 0), and combined approaches (n = 7). Of these studies, two studies (2/4) using a person-directed approach, four studies (4/10) using a person/work interfacedirected approach, and four studies (4/7) using a combined approach demonstrated significant improvements in personal health-related outcomes and occupational health-related outcomes. Methodological quality can be rated as some concerns.

Conclusions:
Interventions that incorporate a combination of intervention approaches appear promising for improving health and workrelated outcomes among employees in LTC. There is a lack of evidence for only work-directed approaches to health promotion in LTC. High-level quality studies are still needed. Key messages: Combined intervention approaches to workplace health promotion in long-term care facility settings appear to be beneficial.
High-level quality studies on workplace health promotion in long-term care facilities are still needed.

Background:
Hand hygiene (HH) is the leading measure for preventing the transmission of healthcare-associated infections (HAI), and a cornerstone to prevent COVID-19 spread. Aim of the research was the assessment of HCWs' adherence to the application of WHO optimal practices, with the goal to promote a culture of safety and quality infection prevention and control (IPC) activities.

Methods:
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy, implemented a HH monitoring plan in which HCWs' adherence to HH procedures is evaluated using WHO guidelines, technical manual and observation form. Direct field observations took place in March and April 2022 by trained personnel. Process index was HH adherence, stratified by profession, opportunity and unit, which has been visited at least twice.

Results:
Overall, 302 HCWs were observed from 18 hospital units (105 physicians, 108 nurses, 84 healthcare assistants and 5 students). Out of 1382 opportunities, global adherence was 52% with 190 handwashing and 598 hand rubbing. The indication with the highest adherence was ''after body fluid exposure risk'' (76%), whereas the lowest were ''after touching the patient's setting'' (40%) and ''before touching a patient'' (43%). Adherence was higher in specialistic surgeries and haematology units, while the worst performances were reported in general medicine ward (29%). Physicians' and nurses' adherence was respectively 45% and 61%. Audits occasionally revealed nonconformities in glove use (i.e., unnecessary use, not changed between patients, hand rubbing on gloves).

Conclusions:
These preliminary findings could be directly linked to habits acquired during the pandemic, when HW tended to consider COVID-19 patients as a unique block to shield themselves from infections, rather than safeguarding individual patient units. HH awareness could have changed in the wake of COVID-19 pandemic and our study described how HCWs' The literature highlights low vaccination coverage among most minority or ethnic pediatric communities in EU, including migrants. In addition to being less likely to get a vaccine, such communities may be vulnerable to developing certain infectious diseases. It is particularly important in the context of the current humanitarian crisis connected with Russia's aggression towards Ukraine. Identification of potential barriers to vaccination and system gaps is crucial to further ensure that underserved pediatric communities benefit from the same level of protection as the general population in terms of disease prevention and control, including those diseases which can be prevented by routine vaccinations. The proposed workshop moderated by well-known experts of the subject (Bernardette Kumar and Maria Ganczak) will be based on the results from qualitative data collected as a part of the 5-year RIVER-EU (Reducing Inequalities in Vaccine uptake in the European region -Engaging Underserved communities) project which tackles health system barriers among selected underserved communities living in four countries: Ukrainian migrants in Poland, females with a Turkish and Moroccan migration background in the Netherlands, marginalized Roma communities in Slovakia and migrants/refugees in Greece. This interactive workshop will provide short (5 minutes per country) comparisons of the health system barriers to vaccination against MMR (measles, mumps, rubella) and Human Papillomavirus (HPV) in children living in different underserved communities, and contrast barriers to vaccination experienced by the community members with barriers perceived by the health care professionals. International comparisons of in-depth information collected during qualitative studies (interviews and focus groups) will help to provide an increased understanding of the health system determinants of low vaccine uptake in their specific multifactorial contexts that will vary in terms of geography, size, wealth, health sector structures, culture and vaccination law. Such qualitative research is particularly valuable regarding its potential for producing comprehensive and refinement analyses adjusted for understanding the voices of underserved communities. The session will go beyond describing those. Based on the presentations the participants will be divided into 4 groups to discuss (15 minutes) the Key Barriers; Key Facilitators to vaccination; Main lessons Learnt; Ways forward for the future to increase vaccine uptake among underserved pediatric communities to reduce the burden of vaccine preventable diseases. These 4 groups of workshop participants will be led by experts from the MEMH and IDC sections. Then, concluding remarks will be presented by each group (5 minutes per group). The final resume delivered by session chairs will end the workshop. Key messages: The health system barriers to child vaccination among underserved communities vary among European countries, and the optimal way to adequately address them is likely to be context specific.
The RIVER-EU project gives an opportunity to discuss lessons already learnt around the different components of the vaccination process and to pinpoint ways forward for the future to reduce the VPD.