The effect of the SARS-CoV-2 pandemic in the compliance of hand hygiene in ICU in a tertiary hospital

Abstract Background Hand hygiene (HH) is one of the main preventive methods for healthcare-associated infections. Our aim is to compare the level of HH compliance in 2021, SARS-CoV-2 pandemic period, with the previous 2019 period. Methods Descriptive cross-sectional study of direct observation on compliance of HH in adult intensive care unit (AICU) and neonatal intensive care unit (NICU) in a third-level hospital in Madrid during the years 2019 and 2021. Trained healthcare workers observed and recorded hand hygiene opportunities (HHO) among staff (nurse, nurses’ aide, physicians and orderly) using the World Health Organization's “My Five Moments for Hand Hygiene” tool. All observations of professional that attended patients in SARS-CoV-2 isolation units were excluded. Results Overall, there was a total of 1199 HHO, 961 in AICU (2019:466; 2021:495) and 238 in NICU (2019:122; 2021:116). HH compliance in AICU improved from 57.5% in 2019 to 65.9% in 2021 (p = 0.008) and remained unchanged in NICU (2019:90.2% vs 2021:88.8%; p = 0.730). In AICU all professional categories, except nurse’s aide, improved HH compliance being statistically significant in physicians (2019:33.8% vs 2021:50.0%; p = 0.009). In relation to the 5 moments, an increase in HH compliance was observed in: before and after touching a patient/after touching patient surroundings, being only statistically significant in moment after touching a patient (2019:69.4% vs 2021:83.7%; p = 0.001). In NICU there were no significant changes between the two periods regarding to the professional category or the five moments of HH. In NICU there were no significant changes between the two periods regarding to the professional category or the five moments of HH. Conclusions The increase in compliance of HH within the adult ICUs demonstrates this adaptation, stating a behavioural change in the habits of professionals. This increase was no observed in the NICU since their compliance was already extremely high. Key messages • There has been an increase in HH compliance in the AICU. • The HH method has varied, becoming COVID-19 specific.


Background:
Hand hygiene (HH) is one of the main preventive methods for healthcare-associated infections. Our aim is to compare the level of HH compliance in 2021, SARS-CoV-2 pandemic period, with the previous 2019 period.

Methods:
Descriptive cross-sectional study of direct observation on compliance of HH in adult intensive care unit (AICU) and neonatal intensive care unit (NICU) in a third-level hospital in Madrid during the years 2019 and 2021. Trained healthcare workers observed and recorded hand hygiene opportunities (HHO) among staff (nurse, nurses' aide, physicians and orderly) using the World Health Organization's ''My Five Moments for Hand Hygiene'' tool. All observations of professional that attended patients in SARS-CoV-2 isolation units were excluded.

Results:
Overall, there was a total of 1199 HHO, 961 in AICU (2019:466; 2021:495) and 238 in NICU (2019:122;2021:116). HH compliance in AICU improved from 57.5% in 2019 to 65.9% in 2021 (p = 0.008) and remained unchanged in NICU (2019:90.2% vs 2021:88.8%; p = 0.730). In AICU all professional categories, except nurse's aide, improved HH compliance being statistically significant in physicians (2019:33.8% vs 2021:50.0%; p = 0.009). In relation to the 5 moments, an increase in HH compliance was observed in: before and after touching a patient/after touching patient surroundings, being only statistically significant in moment after touching a patient (2019:69.4% vs 2021:83.7%; p = 0.001). In NICU there were no significant changes between the two periods regarding to the professional category or the five moments of HH. In NICU there were no significant changes between the two periods regarding to the professional category or the five moments of HH.

Background:
Highlighting the intersectionalities between different markers of diversity and health inequities encourages the reconsideration of normativities in public health (PH). We developed an open access collection of syllabi on the relevance of intersectionality and diversity in PH together with the Association of Schools of Public Health in the European Region (ASPHER).

Objectives:
We developed the syllabi in a participatory, iterative process guided by transformative teaching pedagogy. We reflect on this process and how this can inform the enhancement of the syllabi themselves, as well as future curriculum development.

Results:
We recruited a core group of 9 PH researchers, teachers and professionals from all career levels from participants of introductory session presentations in different settings (e.g., 14th EPHC, ASPHER Retreat). The core group met once a month for one year online, and each meeting took the form of co-working sessions in breakout rooms to develop the syllabi based on interest and expertise. We designed a qualitative online survey to evaluate and ensure the scientific rigor and pedagogical value of the syllabi. We invited critical and constructive input from ASPHER member school professionals with expertise in intersectionality, diversity or curriculum development in PH in terms of content and pedagogy.

Conclusions:
Drawing from the expertise of the PH community we combined diverse professional and cultural backgrounds, experiences from different career levels and PH education systems, as well as specialisation in the PH field. The transformative pedagogical approach was considered particularly valuable in strengthening competences such as reflexive strategies and self-, social-and global awareness which are key to teaching on diversity and intersectionality issues. The peerreview structure supports the uptake in PH education and a sustainable implementation. The collection will also allow PH faculty to diversify their pedagogical approaches.

Key messages:
Inclusion of health inequities, diversity and social injustice issues is crucial in public health curricula, since an intersectional perspective is increasingly acknowledged in public health research. The syllabi collection will equip public health teachers of all career levels to develop their own course material on social identities and their significance for public health.