Disinfection of gloved hands has been demonstrated as efficient and feasible during patient care for multiple activities , and a recent study shows that alcohol-based solution did not affect elongation at breakage of the nitrile gloves .
• rate on room entry decreased over time ; on room exit , it increased by 13.73 percent during the first wave of COVID-19 , decreased by 9.87 percent during the post-lockdown period , then rebounded by 2.82 percent during the second wave of the epidemic . Hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic ; conversely , hand hygiene on room entry did not depend on the trend of the epidemic , nor on nursing of COVID-19 patients , and it decreased over time .
As Huang , et al . ( 2021 ) observe , “ Healthcare workers modified their behaviors to face the risk propensity of the pandemic . However , to improve the poor compliance at room entry , reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary ; disinfection of gloving hands might solve this issue .”
Huang , et al . ( 2021 ) acknowledge the paradigm shift : “ Healthcare workers worldwide – who have been regularly trained to avoid hospital-acquired infection by following guidelines , particularly hand hygiene – are currently facing another objective to reduce cross-transmission and protect their patients : to protect themselves from SARS-CoV-2 infection using prevention protocols to which they are less commonly accustomed ( self-protection ). These new sanitary guidelines directed toward healthcare worker protection rather than toward patient protection constitute a new challenge for this community . With personal protective equipment ( PPE ), hand hygiene has been shown to be the cornerstone of protection from respiratory viruses , and hand hygiene remains a major way to limit cross-transmission , as recommended by WHO .”
They note , “ The changing paradigm of hand hygiene practice imposed by this new ongoing epidemic seemed interesting to monitor with our system , to evaluate whether healthcare workers had easily adjusted to this new approach of infection prevention and changed their behavior . Since two epidemic waves have been observed , the intention was to monitor healthcare workers in between the two waves to determine whether their hand hygiene behavior correlated with the outbreak amplitude and with the type of patient being cared for . This study aimed to observe whether hand hygiene practices on entry and exit of the patient ’ s room and during patient care were correlated with the dynamic of the epidemic , and with the type of patient being cared for ( COVID-19 cases or not ) throughout the two waves of the COVID-19 pandemic .”
Huang , et al . ( 2021 ) explain that during the COVID-19 pandemic , healthcare workers were trained and encouraged to adhere to the principles of WHO evidence-based guidelines for PPE use and hand hygiene practice : “ They were requested to wear PPE ( gown , FFP2 mask , and gloves ) before entering patient rooms . Hand sanitizers containing alcohol ( 75 percent to 85 percent v / v ) effectively reduce the infectivity of coronaviruses in vitro . Disinfection of gloved hands has been demonstrated as efficient and feasible during patient care for multiple activities , and a recent study shows that alcohol-based solution did not affect elongation at breakage of the nitrile gloves . Thus , we promoted the use of gloved AHR upon entry to the room , upon exit of the room , and as often as necessary during patient care .”
In their study , the researchers computed daily hand hygiene compliance rate on room entry and exit by using the daily number of AHR utilizations on entry and exit , divided by the total daily number of entries and exits . AHRs during care were computed by the number of AHRs recorded by the researchers ’ system after 18 seconds ( grace delay period ) from entering divided by the total daily number of room entries . AHR consumption was computed by the total volume ( one application of AHR : 3 mL ) of AHR by each healthcare worker each day . Over 15 months of real-time observation , a total of 162,334 entries and exits were recorded by the researchers ’ automatic monitoring system . The average of compliance with AHR use on entry to a patient ’ s room within this period of observation was 21.02 percent and on exit from a patient ’ s room was 55.03 percent . During care , the average incidence of AHR use by healthcare workers was 4.32 percent . The average AHR consumption was 61.63 mL per healthcare worker per day .
According to the researchers , compliance with AHR use on room exit had a positive correlation with the number of patients screened , the number of patients diagnosed , and the total number of bed-days of COVID-19 patients . Use of AHR during care had a strong positive correlation with the number of patients screened , the number of patients diagnosed , the number of bed-days of COVID-19 patients , and the moderately positive correlation with total number of bed-days of care . AHR consumption had a positive correlation with the number of bed-days of COVID-19 patients and total bed-days of care . Compliance with AHR use on room exit and AHR use during patient care increased as the epidemic of COVID-19 increased or the nursing of COVID-19 in the unit increased , and vice versa . AHR consumption increased when the total number of bed-days or the nursing of COVID-19 patients increased . However , compliance with AHR use on room entry was not associated with the COVID-19 epidemic or the nursing of COVID-19 in the unit .
The average of compliance with AHR use on room entry was 23.88 percent during the pre-COVID-19 period . For the first wave of COVID-19 this was 27.31 percent , for the post-lockdown period 17.3 percent , and for the second wave was 13.3 percent . The researchers say this low compliance rate on room entry could be explained by the fact that healthcare workers were gloved before entering the room and staff were not used to disinfecting gloved hands . The average rate of AHR use during patient care was 3.21 percent at the pre-COVID-19 period ; for the first wave of COVID-19 this was 5.37 percent , for the post-lockdown period 4.41 percent , and for the second wave 5.17 percent . The average of compliance with AHR use on room exit was 50.63 percent for the pre-COVID-19 period ; for the first wave of COVID-19 this was 64.37 percent , for the post-lockdown period 54.5 percent , and for the second wave 57.32 percent . Average AHR consumption was 60.28 mL per healthcare worker per day for the pre-COVID-19 period ; for the first wave of COVID-19 this was 69.42 mL per healthcare worker per day , for the post-lockdown period 54.94 mL per healthcare worker per day , and for the second wave was 66.98 mL per healthcare worker per day .
The researchers report that the average rate of AHR use on room entry increased by 3.43 percent during the first wave of COVID-19 but became lower over time . The average rate of AHR use during patient care increased by 2.15 percent during the first wave of COVID-19 , decreased by 0.95 percent during the post-lockdown period , and then rebounded by 0.76 percent during the second