Hand Hygiene: An Update

Scientific evidence suggest that hand hygiene as one of the most effective measures to control infection. To promote good hand hygiene practices, the World Health Organization introduced May 5 as World Hand Hygiene Day (WHHD), and international stakeholders established Global Handwashing Day (GHD) on October 15. However, its contributions to raising public awareness of hand hygiene is unclear.

This study evaluates the impact of the WHHD and GHD on the public awareness of hand hygiene in Japan, the United Kingdom, the United States, and worldwide from 2016 to 2020, using the relative search volume of “Hand hygiene” in Google Trends as a surrogate. To identify a statistically significant timepoint of a trend change, we performed Joinpoint regression analysis.

Upticks of the relative search volumes as well as joinpoints were noted worldwide around the WHHD and GHD from 2016 to 2019, but no joinpoints were identified around the WHHD and GHD in 2020. No such changes were observed in Japan, the United Kingdom, and the United States during these periods.

While the WHHD was originally established to raise awareness of hand hygiene in healthcare facilities, our result suggests that the WHHD and GHD may not have effectively disseminated the importance of hand hygiene to the general public at a country level. Additional policy measures to advocate hand hygiene to the public are necessary to communicate its benefits.

Hydantoin exhibits tautomerism and the interconversion among the tautomers was studied using theoretical methods in the gas phase and solvents (water or ethanol). The implicit solvation as well as one explicit solvent molecule with water or ethanol were investigated. The functional used was B3LYP-D3(BJ) and the basis set for all atoms was aug-cc-pVTZ. The results indicate that the electronic energy barriers in the gas phase and implicit solvation are in the range 50–90 kcal mol⁻¹. However, explicit water is found to have a catalytic effect as the electronic energy barriers are lowered to 18–30 kcal mol⁻¹. Explicit ethanol lowers the electronic energy barriers further by about 2 kcal mol⁻¹. This study should be beneficial for the rational design and experiments involving hydantoin and water or ethanol as solvents.

Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs).

Since their implementation, quality programs such as “Zero bacteremia” have achieved a reduction in CR-BSI rates, but there is still room for further improvement. New evidence is emerging regarding, e.g., antiseptic-antimicrobial impregnated catheters or the use of passive disinfection of closed connectors. These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.

Hand hygiene is a critical strategy for infection prevention in all healthcare settings. Automated electronic monitoring systems are expected to improve hand hygiene performance.

To investigate the impact of the Internet of Things (IoT) management system on hand hygiene compliance among medical staff in an emergency intensive care unit (EICU).

This retrospective observational study was conducted between July 1^st, 2017 and February 28^th, 2018 in a 19-bed EICU. The changes in hand hygiene compliance among 54 members of medical staff and the incidence of hospital infections were compared, counted, and analysed before and after implementing the IoT management system in the EICU that was initiated on November 1^st, 2017.

After the application of the IoT management system, the hand hygiene compliance rates among the members of the medical staff before (29.5% (3347/11,338) vs 57.9% (4690/8094), P < 0.001) and after (59.9% (9915/16,556) vs 73.8% (17,194/23 286), P < 0.001) the contact with patients and surrounding environment significantly improved. However, hand hygiene compliance among three cleaning staff did not significantly improve after the application. Moreover, there was no significant difference in healthcare-acquired infection rates (2.535% (9/355) vs 2.047% (7/342), P = 0.667) nor in the detection rates of the four major multidrug-resistant bacteria in the EICU before and after the application of the IoT management system (P > 0.05).

The IoT management system significantly improved hand hygiene compliance among medical staff, except cleaners, in the EICU of one provincial hospital; however, the rates of nosocomial infection did not significantly decrease. The quality of hand hygiene implementation needs to be improved.

Chlorhexidine digluconate (CHG) is a cationic bisbiguanide used in the UK as the first-line skin antiseptic prior to surgery in the UK due to its favourable efficacy and safety profile, high affinity for skin binding and minimal reports of resistance. Despite this, bacteria remain within deeper skin layers, furrows and appendages that are considered inaccessible to CHG, due to its poor dermal penetration. In this study a third generation, polyamidoamine dendrimer (G3 PAMAM-NH₂) was utilised to improve dermal penetration of CHG. A topical gel formulation was optimised to maximise CHG delivery (containing 0.5% gelling agent and 4% drug), followed by drug and dendrimer co-formulation into a commercially viable gel. The gel containing 4% CHG and 1 mM PAMAM dendrimer significantly increased the depth permeation of CHG compared to the commercial benchmark (Hibiscrub®, containing 4% w/v CHG) (p < 0.05). The optimised formulation was further characterised using Time-of-Flight Secondary Ion Mass Spectrometry (ToF-SIMS), which indicated that the depth of dermal penetration achieved was sufficient to reach the skin strata that typically harbours pathogenic bacteria, which is currently inaccessible by commercial CHG formulations. This study therefore indicates that a G3 PAMAM-NH₂ dendrimer gel may be viable as a permeation enhancer of CHG, for improved skin antisepsis in those at risk of a skin or soft tissue infection as a result of surgical intervention.

With the beginning of the pandemic of COVID-19 throughout the world, the demand and consumption of hand sanitizers has increased, which had led to a sharp crunch in these products at all levels. This shortage has led to an increase in the prevalence of falsified alcohol-based hand sanitizers, including the illegal addition of methanol to hand sanitizers and the production of hand sanitizers with an alcohol concentration of less than 60%. These findings indicate that regulatory and public health bodies should take an active role in ensuring the safety and quality of antimicrobial products such as alcohol-based hand sanitizers at every stage of the products’ lifecycle, including distribution, manufacture and import.