wave of the epidemic . The average rate of AHR use on room exit 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 . AHR consumption increased by 9.14 mL per healthcare per day during the first wave of COVID-19 , decreased by 14.48 mL per healthcare per day post lockdown , and then rebounded by 12.05 mL per healthcare per day during the second wave of the epidemic . Time-series analysis confirmed that there was a decrease in compliance with AHR use on room entry over time and an increase in compliance with AHR use on room exit over time .
Huang , et al . ( 2021 ) report that automated monitoring revealed the different evolution of four hand hygiene indicators : compliance with AHR use on room entry , AHR use during patient care , AHR use on room exit and total AHR consumption : “ AHR use on room entry and during patient care are mainly related to patient protection whereas AHR use on room exit is related to self-protection of healthcare workers . At the beginning of the epidemic , the improvement of self-protection and of patient-protection measures could be explained by HCW fear of the crisis , to avoid transmitting the virus to their family , to themselves or to their patients . A recent psychology study showed that fear of pandemic encouraged recommended public health behaviors due to the negative emotions that reduce motivation for risky behaviors . It could also be explained by reference to the protocol . Among all required PPE within the COVID-19 protocol , our observations show a correlation between AHR use and the hospitalization of COVID-19 patients in the unit , with hand hygiene being performed frequently as recommended by WHO .”
A second observation by Huang , et al . ( 2021 ) was the different evolution of compliance with AHR use at room entry and room exit : “ It seems that the COVID-19 outbreak had more impact on compliance with AHR use on room exit and during care , and on total AHR consumption . Healthcare workers were asked to wear PPE before entering a patient ’ s room and then to remove gloves and apply AHR before leaving a patient ’ s room ; this protocol was respected . Thus , even with the fall in compliance during the post-lockdown period , the AHR use on room exit and during patient care remained higher during the second wave of the epidemic than during the pre-COVID-19 period . Under those circumstances , it seems that gloving hands causes the reduction of compliance at entry . After the first wave of the epidemic , healthcare workers disinfected their hands less and less on room entry . The low compliance rates on entry could be explained by the gloved hands , which have been reported to reduce hand hygiene rates . Moreover , one may imagine that healthcare workers better perceived the risk of being exposed to the virus themselves rather than the risk to the patients . However , several recent studies showed the benefit of disinfection of gloved hands ; alcohol-based disinfectants may slightly affect the breaking load of nitrile gloves , but it does not affect its extensibility . It seems that our healthcare workers were not aware of such evidence on room entry . As noticed by Allegranzi , et al ., hand hygiene appears neglected when the emergent virus seems to disappear with compliance rates becoming lower , which ties in with our observations .”
One key take-away from the study by Huang , et al . ( 2021 ) is that even though healthcare workers respected the protocol and modified their behaviors during the outbreak , improvements in their compliance with AHR on room entry and on exit were not sustained throughout the epidemic , especially for entry . As the
researchers conclude , “ This pandemic has led healthcare workers to adapt their hand hygiene behavior to the visible risk ( the epidemic ’ s curve ) to protect themselves ; according to our findings , we emphasize the importance of hand hygiene monitoring even during the pandemic , especially before patient contact . To reduce potential confusion between the hand hygiene recommendation and the glove recommendation , disinfection of gloved hands might improve poor compliance at entry .”
References :
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Chang NC , Jones M , et al . Hand hygiene and the sequence of patient care . Infect Control Hosp Epidemiol . Apr 6 , 2021 ; 1-6 . doi : 10.1017 / ice . 2021.82
Chang NC , Reisinger HS , Schweizer ML , Jones M , Chrischilles E , Chorazy M , Huskins C and Herwaldt L . Hand Hygiene Compliance at Critical Points of Care . Clin Infect Dis . Vol . 72 , Issue 5 . Pages 814-820 . March 1 , 2021 . https :// doi . org / 10.1093 / cid / ciaa130
Huang F , Armando M , et al . Covid-19 outbreak and healthcare worker behavioral change toward hand hygiene practices . J Hosp Infect , 111 ( 2021 ), pp . 27-34 .
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Kirk J , Kendall A , Marx JF , Pincock T , Young E , Hughes JM and Landers T . Point of care hand hygiene — where ’ s the rub ? A survey of US and Canadian health care workers ’ knowledge , attitudes , and practices . Am J Infect Control . Vol . 44 , Issue 10 . Pages 1095-1101 . Oct . 1 , 2016 . https :// doi . org / 10.1016 / j . ajic . 2016.03.005
Prescott K , Mahida N , Wilkinson M and Gray J . Editorial : Hand hygiene : a COVID beneficiary ? J Hosp Infect . March 22 , 2021 . https :// doi . org / 10.1016 / j . jhin . 2021.03.017
World Health Organization ( WHO ). Minimum requirements for infection prevention and control programs . 2019 . https :// apps . who . int / iris / handle / 10665 / 330080
World Health Organization ( WHO ). Global progress report on WASH in healthcare facilities : fundamentals first . 2020 . https :// www . who . int / publications / i / item / 9789240017542
Sue Barnes , RN , CIC , FAPIC ,
is an independent clinical consultant , boardcertified in infection prevention and control ( CIC ), a fellow of APIC ( FAPIC ) and co-founder of the National Corporate IP Director Network . She currently provides marketing and clinical consultation to select industry partners who seek to support infection prevention with innovative products .
Learn more about her services at : www . zeroinfections . org www . healthcarehygienemagazine . com • may 2021
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