Application of PDCA in improving hand hygiene compliance and nosocomial infection quality in orthopedics

Objective:To explore the effect of the Plan-Do-Check-Action(PDCA)cycle on hand hygiene and nosocomial infection quality of or thopedic medical staff.Methods:The whole year of 2021 was selected to monitor the quality of hand hygiene and hospitalization.Follow-up monitoring and real-time recording during the period of morning shift and medical operation concentration time,and compare the compliance of hand hygiene before and after implementation,and evaluate the quality of nosocomial infection.Results:The hand hygiene compliance of doctors and nurses in stage P was 82%.The compliance of medical staff in stage D was 93%.The compliance of stage C was 94%and that of stage A was 95%.The quality score of hospital self-examination nosocomial infection was also significantly increased.Conclusions:The PDCA management cycle can effectively improve the compliance of hand hygiene and the nosocomial infection quality,which is wor thy of circulatory application in or thopedic nosocomial infection quality control,especially improving the quality of hand hygiene.

Analysis of Hand Hygiene Knowledge,Compliance,and Influencing Factors Among Psychiatric Healthcare Workers

Objective:To evaluate the knowledge,compliance,and influencing factors of hand hygiene among psychiatric healthcare workers.Methods:68 healthcare workers who worked in the Department of Psychiatry between September 2023 and May 2024 were selected to assess their knowledge of hand hygiene and compliance by questionnaire as well as to analyze their influencing factors.Results:Knowledge of hand hygiene among healthcare workers was less than 90%,and doctors’knowledge was lower than that of nurses(P<0.05).The healthcare workers’compliance with hand hygiene was lower than 80%,and the adherence of doctors was lower than that of nurses(P<0.05).Analysis of influencing factors reveals that skepticism about the effectiveness of rapid disinfectants/hand washing,skin irritation from disinfectants/cleaning agents,and busy work schedules with time constraints are the main factors affecting healthcare workers’compliance with hand hygiene,with P<0.05 compared with the same group.Conclusion:Psychiatric healthcare workers’knowledge of hand hygiene as well as compliance with it is low,and there are various factors affecting it,so targeted training is required to strengthen their hand hygiene implementation.

Application of PDCA Cycle in Hand Hygiene Management of Psychiatric Medical Staff

Objective:To study the application effect of the plan-do-check-act(PDCA)cycle management in the hand hygiene management of psychiatric medical staff.Methods:One hundred and twenty medical staff from a psychiatric hospital from May 2023 to December 2023 were selected and divided into two groups.The control group(May 2023 to August 2023)applied the conventional management model,and the observation group(September 2023 to December 2023)applied the PDCA cycle management.The hand hygiene compliance,hand hygiene knowledge,and hygiene qualifications were compared,including the amount of hand sanitizer used.Results:The proportion of medical staff’s hand hygiene compliance and hand hygiene knowledge mastery scores in the observation group were higher than those in the control group(P<0.05);the hand hygiene passing rate in the observation group was higher than that of the control group(P<0.05);the daily amount of hand sanitizer per patient bed and the amount of hand sanitizer used was higher than that of the control group(P<0.05).Conclusion:The PDCA cycle management model for psychiatric medical staff promoted the improvement of hand hygiene compliance and increased their hand hygiene qualifications.It is suitable for further popularization and application in future clinical practice.

Hand Hygiene by Ward Staff at Dapaong Regional Hospital in Togo

Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at Dapaong regional hospital (DRH). Methodology: This was a prospective, descriptive cross-sectional study conducted from March to June 2022 in the DRH wards. Data were collected using a questionnaire and observation grid. Results: 90 care providers were surveyed. Males and non-physician personnel predominated with 57.8%, and 94.4% respectively. The survey on staff’s knowledge reported: 31.1% of practitioners did not wash their hands on arrival and departure in services. 24% did not know the difference between simple hand washing (SHW) and hygienic hand washing (HHW). 23.3% did not know the type of soap to use for HHW. The caregivers did not know the type of hand washing (HW) required after a septic and non-septic procedure in respectively 41.6%, and 37.8%. They did not know that there are two types of hand antiseptics (45.4%), nor the amount of antiseptic for HW (78.9%). The survey on staff’s attitude regarding HW found that: 70% did not remove all jewels prior HW, and 51.1% did not know that wearing gloves cannot replace the HW. For HW Staff Practice: 62.2% did not wash their hands before treatment. 91.1% did not spread the soap on their hands and forearms after wetting them. 65.55% did not rinse hands from nails to elbows. Conclusion: The HH was poorly known, the attitude of the staff was dangerous in relation to the HH and the practice of HH was very inadequate at the RHC-Dapaong. As a result, there is a need to retrain staff to increase their capacity to prevent care-related infections and enhance patient safety in the hospital.

Hand Hygiene among Anesthesiologists and Microorganisms Contamination in Anesthesia Environments:A Single-Center Observational Study

Objective To investigate the baseline levels of microorganisms’growth on the hands of anesthesiologists and in the anesthesia environment at a cancer hospital.Methods This study performed in nine operating rooms and among 25 anesthesiologists at a cancer hospital.Sampling of the hands of anesthesiologists and the anesthesia environment was performed at a ready-to-use operating room before patient contact began and after decontamination.Results Microorganisms’growth results showed that 20%(5/25)of anesthesiologists’hands carried microorganisms(>10 CFU/cm^(2))before patient contact began.Female anesthesiologists performed hand hygiene better than did their male counterparts,with fewer CFUs(P=0.0069)and fewer species(P=0.0202).Our study also found that 55.6%(5/9)of ready-to-use operating rooms carried microorganisms(>5 CFU/cm^(2)).Microorganisms regrowth began quickly(1 hour)after disinfection,and increased gradually over time,reaching the threshold at 4 hours after disinfection.Staphylococcus aureus was isolated from the hands of 20%(5/25)of anesthesiologists and 33.3%(3/9)of operating rooms.Conclusion Our study indicates that male anesthesiologists need to pay more attention to the standard operating procedures and effect evaluation of hand hygiene,daily cleaning rate of the operating room may be insufficient,and we would suggest that there should be a repeat cleaning every four hours.

Compliance with Hand Hygiene among Health Professionals in the Medical-Surgical Emergency Department of the Donka National Hospital

Introduction: The transmission of infectious agents through the hands of nursing staff during care is the main cause of nosocomial infections. Hand hygiene has been recognized for over a century as an effective measure to prevent healthcare associated infections in healthcare settings, the objective of this study was to appreciate the practice of hand hygiene during care by health professionals in the medical-surgical emergency department of the Donka National Hospital. Methods: It was a cross-sectional, analytical study. Data collection took place from March 1 to April 30, 2021. The study covered all health professionals, namely doctors, nurses, laboratory technicians, radiography technicians, pharmacists, students, stretcher bearers, surfactants who were present at the time of the study period. Results: During the study period, out of a total of 104 registered health professionals, we surveyed 99, which is a rate of 95%. The most represented age group was [30 - 39 years] with an average of 37.17 ± 10.34 years, and extremes of 22 years to 65 years. The male sex was the most dominant or 59.60% compared to the female sex or 40.40% with a sex ratio of 1.47. The hand hygiene compliance rate was low at 21%. The practice of hand hygiene during care for 100% of health professionals was very low, at 8.08%. No factors influence the observance of the practice of hand hygiene and the socio-professional characteristics of the conditions of provision of care activities. Conclusion: Hand hygiene during care is an essential aspect that must be considered as an essential measure in the prevention of infections in this period of the COVID-19 pandemic.

Does Hospital Ownership Influence Hand Hygiene Compliance?

The issue as to whether hospital ownership has an impact on the quality of care has long been a serious concern. Hand hygiene（HH） compliance is regarded as an important indicator of the quality of care in the control of hospital-acquired infections. However, little information is available on whether hospital ownership influences HH compliance. In this study, of 229 hospitals selected from Hubei province in China, 152 were public and 77 were private hospitals. A total of 23 652 healthcare workers（HCWs） were surveyed, using a convenience sampling. HH compliance, the WHO＇s ＂My Five Moments for hand hygiene＂（5 MHH）, among HCWs, together with the factors of hospital ownership, training frequency, bed occupancy rates, etc. were collected. Univariate analysis and ordinal logistic regression analysis were used to analyze factors affecting HH compliance. Overall, HH compliance rates were 67% and 79% for public and private hospitals, respectively. The HH compliance rates of HCWs and 5 MHH were between 55% and 95%, and influenced by hospital ownership（P〈0.05）, excluding compliance rate at the moment after body fluid exposure, and other influence factors included training frequency and bed occupancy rate（P〈0.05）. HH compliance is better in private than in public hospitals. Hospital ownership is a significant factor affecting HH compliance, in addition to training frequency and bed occupancy rate.

Enhanced Sporicidal Activity of Alcohol and Epigallocatechin-Palmitate-Based Hand Hygiene Formulations Comprised of Plant-Derived Compounds

Pathogenic spore-forming bacteria pose high risks to healthcare settings, as well as in the food and beverage industries. We reported recently that novel alcohol-based formulations containing plant-derived compounds, including epigallocatechin-3-gallate-palmitate (EGCG-P), a green tea polyphenol ester, provide > 99.99% inactivation of bacterial spores within 60 sec. Based on recently published data from our group and others, we hypothesize that a combination of EGCG-P and alcohol formulated with other plant-derived ingredients would achieve high sporicidal efficacy against a wide spectrum of bacterial spores and can provide novel hand hygiene methods against bacterial spores without toxicity. The objectives of the current study were to optimize two novel formulations with combinations of glycerol, citric acid, and EGCG-P to increase sporicidal activity and explore the rapid inactivation mechanisms and suitability for sporicidal products with broad-spectrum activities against aerobic and anaerobic bacterial spores. Methods included suspension testing of two formulations against spores from Bacillus cereus and Clostridium sporogenes, quantification of spore germination, and scanning electron microscopy. The results demonstrated that these novel formulations were able to reduce spore germination by >99.999% after 30 sec exposure in suspension tests, and rapidly caused physical damage to the spores. Additional studies are warranted to determine the suitability of the novel formulations for future hand hygiene use.

Hand Hygiene Knowledge, Practices and Attitudes among Nurses and Physicians

Background: Hand hygiene is one of the most effective ways to control health care related infection. Nurses and physicians are the main health care workers contacting with patients, representing the vector in the chain of infection. Thus, assessing their knowledge, practice and attitudes regarding hand hygiene is very important to decrease the incidence of health care related infection and to improve quality of care. Aims: The aim is to assess the knowledge, practice and attitude of Palestinian physicians and nurses regarding hand hygiene in hospitals. Methods: The study adopted a cross-sectional, quantitative design. Nurses and doctors who worked in the major governmental and private hospitals in the West Bank (Palestine) were targeted. Data was collected using Hand Hygiene Questionnaire. Results: 200 nurses and physicians participated in this study. The results showed that the participants had a moderate knowledge regarding the hand hygiene (m = 6, SD = 1.7). They had a better attitude score than practice with a mean of 82.5 ± 8.8. There was a significant difference between male and female only in practice score (p = 0.015). Older participants had better attitudes, and private hospitals had significantly higher scores for compliance, importance of hand hygiene and practice than governmental hospitals (p < 0.05). Conclusion: The results of the current study showed that there was a further need to focus on the practices of hand hygiene by continuous education for both Palestinian nurses and physicians.

The Influence of Emotions and Behavioral Theories behind Hand Hygiene in COVID-19 Pandemic

Background: Hand hygiene (HH) is essential in preventing healthcare-associated infections, especially during the COVID-19 pandemic, where SARS-CoV2 has shown the ability to survive on surfaces for days. In this study, we explore HH compliance rate and the factors associated with its increase during COVID-19 pandemic. Methods: HH compliance was assessed amongst doctors in Anesthesia and Surgical Intensive Care Unit by direct observation between 2018 and 2021. An anonymous survey was then sent to the doctors to understand factors influencing the observed improvement in HH compliance during the pandemic. Results: Compliance towards the five moments of HH has shown a statistically significant rising trend from a median HH compliance of 60% in 2018, to 70% in 2019 to 94% in 2020. However, HH compliance subsequently declined in the first quarter of 2021 to median of 87%. The follow-up survey had a response rate of 96% (n = 53). 90% of survey participants responded that their HH frequency had increased during the COVID-19 pandemic with 47% stating they were performing HH 11 - 20 times/day. 64% responded that this increased frequency had affected their skin condition. 62% responded that this increased frequency was sustainable even after the pandemic ends. Participants ranked considerations influencing HH compliance. “Prevent transmitting the infection to vulnerable patients” was ranked highest followed by “High infection rate”, “Fear of contracting COVID-19” and lastly, “Public health guidelines”. Conclusions: Despite the absence of new campaigns, HH compliance reached an all-time high. The pandemic has provided opportunity for behavioral change through “reflective” drivers of behavior such as emotions (“Fear”) and knowledge (“High infection rate”). Understanding the motivations behind current increased HH compliance and riding on the increased initial uptake of behavior may help convert HH into a habitual action and not just a reaction to the pandemic.

Analysis of Compliance and Barriers for Hand Hygiene Practices among Health Care Workers during COVID-19 Pandemic Management in Tertiary Care Hospital of India—An Important Step for Second Wave Preparedness

Introduction: Hands of health care workers play an important part in infection transmission in a healthcare setting infections. Even though it is a simple and effective procedure, it is many times ignored by the health care workers (HCWs) due to lack of knowledge and interest, time constraints, skin irritation, understaffing, etc. There are no specific drugs and vaccines available for COVID-19 pandemic management, so as control measures, hand hygiene is an essential measure. It will be helpful even for the second wave preparedness. So this study was planned for analysis of barriers and practices of hand hygiene among health care workers which determine the adherence of hand hygiene in medical practice. Methods: This was a cross-sectional study designed during COVID-19 pandemic management to analyze the barriers and knowledge, attitude and practices in health care workers for hand hygiene. Semi-structured questionnaires based study based on previous experience of seasonal flu outbreak was make to know barriers as well as to analyze the knowledge, attitude and practices of Health care workers. 215 participants were enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. Results: The “Barriers” related questions’ analysis showed that hand hygiene facilities, with the supply of soap, hand rub, basins with adequate as well as clean water, are available at various places in the Hospital. In knowledge related questions, major gaps are found in 5 moments of hand hygiene and regarding aspects of alcohol-based hand-rub. Majority HCWs show a good attitude towards questions that hand hygiene is an important thing to do along with other works and they feel frustrated when others or they themselves omit hand hygiene. But the attitude toward hand hygiene when hands are not visibly soiled and when working with gloved hand showed a wrong attitude. There is a major gap in practices of hand hygiene. The majority feel hand hygiene is difficult due to work pressure, sometimes they forgot, they feel it difficult to adhere due to more steps during an emergency. Discussion: Hand hygiene is an essential part of COVID-19 pandemic management. Less compliance was observed due to a lack of knowledge and awareness. Such ignorance leads to an increase in Hospital-acquired infection. Conclusion: Good preparedness by Government and Institute for supplying adequate hand hygiene facilities in the work area for health care workers. But there were few gaps found in knowledge and attitude-related questionnaires and major gaps in practices were found which should be corrected by repeated training, awareness programs, demonstrations for hand hygiene and hands-on training. Conducting Periodic Webinar can be the most useful, convenient and safe method to provide training during the COVID-19 pandemic.

Hand Hygiene in Pediatric Emergency Care Unit in a Teaching Hospital in Benin

Introduction: Appropriate hand hygiene reduces healthcare associated infections (HCAI). The present study was an attempt to determine the real knowledge and practices of healthcare professionals of pediatric emergency care unit in Benin. Methods: This was a three-month observational study. First a trained interviewer observed both the premises and the healthcare professionals during their administering treatment, without their knowledge. Second, their level of knowledge about HCAI was examined using a self-administered questionnaire. Finally, bacteria were cultured/measured from their hands before and after hand-washing through swab samples. Outcome: The modes of microorganism transmission were poorly known (21.6%), but knowledge about the 5 moments for hand hygiene was satisfactory (84.1%). Hand hygiene adherence rate was 6.9% in the study population. Simple hand-washing was prevalent (82%). The healthcare professionals did not adhere to the recommended duration for hand-washing. The required hand-washing equipment was inadequate, and alcohol-based handrub dispenser was unavailable. Microorganism isolated from healthcare professionals before hand-washing included Klebsiella pneumonia and Enterobacter Cloacae. After hand-washing, the transient flora decreased. Conclusion: Hand hygiene adherence rate is low in the study population. An immediate action is required to improve observance of hand-washing. This may include: training healthcare professionals, displaying visual behavior reminder posters, providing alcohol-based handrub.

Assessment of Hand Hygiene Attitude, Knowledge and Practice among Health Science Students in Aden University

Background: A proper hand washing of community health care worker (CHCW) is universally accepted as an important factor in reducing Heath Care Associated Infections (HCAIs). This cross sectional study was done to assess the knowledge, the attitude and practice on hand hygiene among health science students in Aden University. Method: 329 participants from medical, dental and nursing schools completed the questionnaire (43.8% female and 56.2% males). 1st, 2nd and internship years were excluded from the study. The questionnaire is adapted from World Health Organization (WHO) tools for hand hygiene surveys. Epi info., an epidemiological software from the Centre of Disease Control (CDC), was used for data analysis. Results: Responses of the participants in the study indicated that the majority of the students were aware of Hand hygiene (>90%) and 60% have had some sort of training. There is an obvious lack of knowledge on hand movement i.e. my five moments of hand hygiene, particularly on the main source and route of cross contamination with pathogens in hospital setting. In hand hygiene practice, 95% of participants wash their hands before and after food intake, 85% of participants use soap and water, but 8% of participants use only water and very few use alcohol base cleansing agent. 84% of participants wash their hands after handling patient. There was no significant difference between males and females in hand hygiene practice. Conclusion: The study on assessment of knowledge, attitude & practice of students of medical sciences revealed that almost all participants were aware of hand hygiene. However, at this stage of assessment, knowledge and practice are below 100% score for the correct response in particular knowledge and practice.

Health Care Personnel’s Attitude toward Hand Hygiene in Regard to the Prevention of Health-Care Associated Infections: A Cross Sectional Study at the University Hospital Pristine

Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low in most settings. Objective: The main aim of this paper is to determine findings and start drafting policies in implementing them into practice after finding out nurses’ opinions, beliefs and attitudes toward hand hygiene (HH). Methodology and methods: A cross sectional descriptive and observational study during November 2009. Results: From the total number of 175 health care workers employed in this unit, 67 (38.3%) were observed regarding adherence to hand hygiene. Regarding the knowledge, practices and attitudes of the nurses, data were collected from 54 (50.0%) among 108 nurses in four intensive care units within the University Clinical Centre of Kosovo (UCCK). From research findings, it was concluded that hand hygiene compliance in the intensive care units was low (51.3%). Conclusion: Research results show the necessity of organizing multimodal programs with intensive care units of University Clinical Centre of Kosovo (UCCK) on increase of knowledge level on health-care associated infections (HAI).

An investigation on hand hygiene cognition status and influencing factors of nursing workers in a third - grade a hospital during COVID - 19 epidemic

Objective:During the COVID-19 epidemic,the hand hygiene of nursing workers in a third-grade a traditional Chinese medicine hospital was in vestigated to find out existing problems and put forward management countermeasures.Methods:A cross-sectional questionnaire survey was conducted to investigate the hand hygiene cognitive status and influencing factors of 78 nurses in the hospital.Result s:Through the early training,the nursing workers had a good grasp of the hand hygiene signs and related knowledge.Among the factors affecting hand hygiene,there are some problems in facilities and management factors.The cognitive factors of different categories of nursing workers have different influences on hand hygiene,especially the influence of length of service on hand hygiene is significantly different(P<0.05);Nursing workers should be trained on how to use hand washing.Conclusion:Hand hyg iene of nursing workers is of great significance for the prevention and control of hospital infection.Medical institutions at all levels and of various types should,in light of their own actual conditions,formulate operational and feasible hand hygiene management systems for various groups of people in hospitals,strengthen training and supervision,and improve compliance with hand hygiene,so as to prevent hospital infections and fight the battle against COVID-19.

Effect of hand hygiene intervention on the absenteeism of pre-school children in Klang Valley,Malaysia:a quasi-experimental study

Background Absenteeism amongst pre-school children is often due to illnesses such as hand,foot,and mouth disease,acute gastroenteritis,cold and flu,which are easily spread amongst them.This is because of weak immunity and lack of knowledge on proper hand hygiene.This quasi-experimental study assessed the efficacy of an intervention consisting of a hand hygiene education programme,along with digital tools in bringing about a change in behaviour and health conditions amongst pre-school children in Klang Valley,Malaysia.Methods A total of 377 school children,male and female,aged 5–6 years old,participated and were assigned to either the intervention or a control group.During the 2 months intervention period,children in the test group were trained on proper hand hygiene practices and techniques with the aid of the interactive android-based tablets.The numbers of absent days of all the children were recorded for 2 months before the intervention and during the intervention.Results In the test group,there was a 25%increase in the total number of absent days from the pre-intervention period to the intervention period,a much lesser increment observed as compared to that of control group in which the increase was much higher at 89%.Results showed a significant difference(P<0·05)between the absenteeism rates for the test and control group during the intervention period.Conclusion These results suggest that proper education and intervention increase hand hygiene compliance,which may help decrease school absenteeism due to illness;however,a longer study duration may be necessary to evaluate the benefit further.

The role of isolation rooms, facemasks and intensified hand hygiene in the prevention of nosocomial COVID-19 transmission in a pulmonary clinical setting

From December 25,2019 to January 31,2020,33 cases of the coronavirus disease 2019(COVID-19)were identified in the Department of Respiratory and Critical Care Medicine of Zhongnan Hospital of Wuhan University,China,yet none of the affiliated HCWs was infected.Here we analyzed the infection control measures used in three different departments in the Zhongnan Hospital of Wuhan University and correlated the measures with the corresponding infection data of HCWs affiliated with these departments.We found that three infection control measures,namely the isolation of the presumed positive patients,the use of facemasks and intensified hand hygiene play important roles in preventing nosocomial transmission of COVID-19.

Assessing School-Based Water, Sanitation and Hygiene (WASH) Facilities in Peri-Urban Settings of Kinshasa, DR Congo

Background: Kinshasa’s peri-urban settings have a low rate of water access, which has significant consequences for the WASH infrastructures in schools and preventative measures against the spread of waterborne diseases and pathogens. This study aimed to assess the availability, functionality, and gender sensitivity of WASH infrastructures of Kinshasa’s peri-urban schools. Methods: A cross-sectional study was performed in three of the four educational provinces of Kinshasa, targeting 165 peri-urban schools. Data were collected using a questionnaire and an observation grid. Results: An overall proportion of 10.9% of schools possessed a water point, and therefore time-consuming water chores are a necessity in 89.1% of schools. Girl students provided 30% of the labor collecting water during punishments. A total of 98.2% of schools had functional latrines of which 3.6% were found hygienic, associated with water reserve next to the latrines (P = 0.040). Only 2.4% of schools displayed posters raising awareness of latrine hygiene, and 3.6% displayed posters on hand hygiene. The ratios of latrines units for girls were 58:1 for toilets and 115:1 for urinals, justifying open defecation and urination reported in 62.4% of schools. Also, 43% of schools had hand-washing facilities whose functionality was significantly associated with the presence of water points in the school’s inner courtyard (P = 0.032), with water (P P Conclusion: The majority of schools had limited drinking water services, which negatively impact the functionality and gender sensitivity of other WASH provisions. The current evidence as a public health concern would raise government and school authorities’ attention to address these environmental threats.

Epidemiology and Clonal Spread Evidence of Carbapenem-Resistant Organisms in the Center of Care and Protection of Orphaned Children, Vietnam

Objective: To determine the prevalence of colonization and transmission of carbapenem-resistant Gram-negative organisms in order to develop of an effective infection prevention program. Design: Cross-sectional study with carbapenem-resistant organisms (CRO) colonization detection from the fecal specimens of 20 Health Care Workers (HCWs) and 67 residents and 175 random environment specimens from September 2022 to September 2023. Setting: A Care and Protection Centre of Orphaned Children in South of HCM City. Participants: It included 20 HCWs, 67 residents, and 175 randomly collected environmental specimens. Method: Rectal and environmental swabs were collected from 20 HCWs, 67 residents (most of them were children), and 175 environmental specimens. MELAB Chromogenic CARBA agar plates, Card NID, and NMIC-500 CPO of the BD Phoenix TM Automated Microbiology System and whole genome sequencing (WGS) were the tests to screen, confirm CROs, respectively and determine CRO colonization and transmission between HCWs, residents, and the environment. Result: We detected 36 CRO isolates, including 6, 11 and 19 CROs found in 6 HCWs, 10 residents and 19 environments. The prevalence of detectable CRO was 30% (6/20) in HCWs, 14.92% (10/67) in residents, and 10.86% (19/175) in environmental swabs in our study. WGS demonstrated CRO colonization and transmission with the clonal spread of E. coli and A. nosocomialis, among HCWs and residents (children). Conclusion: Significant CRO colonization and transmission was evident in HCWs, residents, and the center environment. Cleaning and disinfection of the environment and performing regular hand hygiene are priorities to reduce the risk of CRO colonization and transmission.

Simulated Microbe Removal around Finger Rings Using Different Hand Sanitation Methods

Aim It is our opinion that the CDC and the WHO have underestimated cross-contamination under examination gloves in dental clinics while wearing jewelry, such as finger rings. These agencies only ＂recommend＂ removing jewelry, and only washing hands for 15 seconds with soap and warm water before donning gloves. This study examined several washing procedures and finger rings using simulated microbes. Methodology A gloved robber hand manikin was made and fitted with a flesh disposable vinyl glove. Four fingers were fitted with rings or no ring, dusted with simulated microbes, and washed with a scrub brush for 5, 15, and 25 seconds under 20℃ and 40℃ water alone, or with liquid hand soap. Light levels （in lux） of fluorescent powder before and after washing were measured and delta scores calculated for changes in light levels, equivalent to effectiveness of hand washing procedures. A full-factorial, 3-factor analysis of variance （ANOVA） was used to test for differences among levels of the three study factors-time, temperature, and soap use. Tukey＇s post hoc honestly significant difference （HSD） test was applied to significant factors to examine pair-wise differences between factor levels. Results It was found that the longer the hands with rings were washed with a scrub brush under flowing water, the more simulated microbes were removed. By 25 seconds, all methods were essentially the same. Simulated microbes were more difficult to remove from the palm compared to the back of the hand. The liquid hand soap used in this study was more effective with warm water than cold. When given a choice of washing with cold water up to 15 seconds, it would be preferable not to use soap to remove simulated microbes. Qualitatively, the outer surface of finger rings were more effectively cleaned than the crevice below the ring, and the ring with a stone setting appeared to accumulate and retain simulated microbes more than other rings. Conclusion The most effective treatment was washing with warm water and liquid soap. Longer times were more effective. Rings should not be worn under examination gloves due to difficulty cleaning in the crevice under the ring, and the well-known consequences of cross-contamination between the patient and the health care worker.