Bakgrund: Vårdrelaterade infektioner är idag ett globalt problem. Trots forskning och evidens som visar att bristfällig handhygien är en bidragande orsak till vårdrelaterade infektioner, förekommer otillräckligt tillämpning av adekvat handhygien inom vården världen över än idag.  Syfte: Syftet med denna studie var att undersöka faktorer som påverkar sjuksköterskans följsamhet till handhygien. Metod: Författarna har gjort en litteraturöversikt med hjälp av kvalitativa och kvantitativa artiklar. Sökningarna har gjorts i databaserna PubMed och Cinahl Complete.   Resultat: Resultatet visade att bristande kunskap, brist på resurser och material, arbetsmiljö samt sjuksköterskans attityd till handhygienprodukter var faktorer som påverkade sjuksköterskans följsamhet till handhygien.   Sammanfattning: Sjuksköterskor i modern tid upplever att det finns ett behov av mer kunskap inom området handhygien. Följsamheten till handhygien ökar med hjälp av utbildning, lättillgänglighet av material, samt goda förebilder. Genom ökad medvetenhet om faktorer som påverkar denna följsamhet kan lidandet lindras hos patienter samt minska kostnaderna för samhället. / Background: Cross infection is a global problem in today’s society. Despite that scientific research and evidence shows inadequate hand hygiene plays a part in the occurrence of cross infections, insufficient enforcement of adequate hand hygiene still exists in healthcare today.  Aim: The aim of this study was to study different factors affecting nurses’ compliance for hand hygiene.  Method: The authors of this literature study used both qualitative and quantitative articles. Searches were made in two different databases, Pubmed and Cinahl Complete.   Results: The results showed lack of knowledge, lack of resources, lack of supplies as well as work environment and the nurses’ attitude were factors affecting nurses’ compliance to hand hygiene.  Conclusion: Nurses in modern time experience the need for more education in regards to hand hygiene. With proper education, accessibility to materials and role models, the adherence to hand hygiene will increase. Through increased awareness of factors affecting compliance, the risks of exposing patients to unnecessary suffering will be reduced. As will costs to society.

Bakgrund: Vårdskador som går att förebygga orsakar dödsfall, funktionsnedsättningar och stora ekonomiska förluster varje år. Vårdrelaterade infektioner är den vanligaste typen av vårdskador i Sverige. Det mest effektiva sättet att förebygga vårdrelaterade infektioner är handdesinfektion av vårdpersonalens händer. Vårdpersonal underlåter i allmänhet att följa riktlinjer för handhygien, trots att de erhåller utbildning och är skyldiga att tillhandahålla säker vård.   Syfte: Att belysa vad som hindrar vårdpersonalens följsamhet till handhygiensriktlinjer. Metod: Deskriptiv studie med litteraturöversikt som metod. Databassökningen utfördes systematiskt på tre databaser. Femton studier analyserades. De identifierade hindren grupperades enligt den Byråkratiska Omvårdnads Teorins faktorer.   Resultat: Det mest framträdande hindret var bristen på resurser, framför allt i bemanningen. Hinder relaterade till ledning och organisation, sociokulturella faktorer och personliga perspektiv var också frekventa. Brist på kunskap identifierades som en återkommande barriär men var inte bland de vanligaste. Viljan att skydda sig själv var ofta en drivkraft för att både följa och bryta mot riktlinjerna. Andra identifierade hinder var relaterade till själva riktlinjerna eller de artiklar som användes under proceduren för handhygien.   Slutsatser: Följsamheten till handhygien påverkas av flera faktorer. Multifaktoriella interventioner som fokuserar på flera faktorer kan ha större sannolikhet att bli framgångsrika. För att uppnå en hög efterlevnad till HH rutiner behöver hela vårdgivarorganisationen involveras, individanpassad utbildning i HH , ökad tillgänglighet för HH artiklar. Den sociala kulturen bör förändras. Mer forskning om de individuella faktorerna krävs för att vägleda effektivare riktlinjer eller interventioner. Byråkratiska Omvårdnads Teorin kan användas som ett verktyg för att implementera kliniska förändringar. / Background: Preventable patient harm causes deaths, disabilities, and big economic losses every year. Healthcare-associated infections are the most common type of preventable harm in Sweden. The most efficient way of preventing healthcare-associated infections is the disinfection of hands by healthcare workers. Healthcare workers generally fail to adhere to hand hygiene protocols, despite receiving training and being legally liable to provide safe care.   Aim: To explore the barriers that prevent healthcare workers from complying with hand hygiene protocols.   Methods: Descriptive review of the qualitative literature, following a systematic search on three databases. 15 studies were analysed. The identified barriers were grouped according to the Bureaucratic Caring Theory's factors.  Results: The most prominent barrier was the lack of resources, particularly human resources. Barriers related to leadership and organisation, socio-cultural factors and personal perspectives were also frequent. Lack of knowledge was identified as a recurrent barrier but was not among the most common ones. Self-protection was often a motivator for both following and breaking against the guidelines. Other identified barriers were related to the actual guidelines, or the materials used during hand hygiene procedures.   Conclusions: Adherence to HH is affected by several factors. To achieve a high level of compliance with HH routines, the entire organization needs to be involved, increased education, the social culture needs to change. More research on the individual factors is needed. Multifactorial interventions that focus on multiple factors may be more likely to be successful. The Theory of Bureaucratic Caring may be useful as a tool to implement or change practice.

Background Healthcare-associated infections constitute a threat to patient safety and an economic burden on health systems worldwide. The most effective way to prevent healthcare-associated infections is through proper hand hygiene practice, but studies show that compliance is low. In 2009, the World Health Organization released hand hygiene guidelines and tools to address the issue.  Aim The aim of the study was to measure the compliance to the WHO Guidelines on Hand Hygiene in Health Care among nursing staff in a private hospital in the Philippines using the evaluation framework of the World Health Organization. Method The method used to assess compliance was structured direct observations using the World Health Organization’s observation form. Data was collected in 15 days, during full shifts, and analyzed quantitatively based on overall compliance, according to indication, ward, week day/weekend and shift. Results A total of 1920 opportunities were recorded, of which 336 were hand rub performances, 168 hand wash and 1416 missed opportunities, giving an overall compliance of 26.25 percent. The ward with the highest compliance rate was the Neonatal Intensive Care Unit (45.40 percent) and the lowest was Nursing Station 1 (22.26 percent). Conclusion The overall compliance rate of 26.25 percent is lower compared to most published studies and healthcare workers were more compliant to indications that protect themselves than to indications that protect patients. The results can be useful in improving quality of care and patient safety.

Background: Hand hygiene is an essential practice in preventing sickness and damageupon patients and the nursing care environment. Despite this there is a lack of handhygiene adherence in the healthcare systems. Hand hygiene routines in Swedishhealthcare systems are regulated by law and to be applied in all healthcare activities.Nurses core expertise is to practise evidence based, assess risks, provide safe care and tofollow established guidelines. Objective: The aim of this literature review was to describe the perceived barriers ofnurses for hand hygiene adherence. Method: Descriptive literature review using Popenoe et al. (2021) data analysis guide toidentify, summarise and condense data from selected articles for thematicallycategorising a nurse's perceived barriers for hand hygiene adherence. Results: The results showed a lack of knowledge, heavy workload, inadequateinfrastructure and materials, social barriers and skin irritation were the most perceivedbarriers to hand hygiene adherence according to participating nurses. Conclusion: Nurses from different parts of the world perceive similar barriers to handhygiene adherence. The perceived barriers are several and impact nurses differentlydepending on the location. The lack of hand hygiene can have a widespread damage onthe wellbeing of healthcare users. Nurses have an important role to provide theirpatients with evidence based nursing care by adhering to established hand hygieneguidelines. The motivation behind the making of this literature review is to raiseawareness of nurses' perceived barriers to hand hygiene adherence which can facilitatethe process of resolving the perceived barriers.

Introdução: A utilização de métodos simples e de baixo custo para se medir a adesão à higienização das mãos em serviços de saúde torna-se cada vez mais necessária, a fim de permitir a avaliação da qualidade da assistência prestada, dos investimentos realizados e da eficácia das intervenções objetivando o aumento da adesão à prática. Objetivo: Correlacionar o método indireto de medir a adesão à higienização das mãos com o método direto em uma unidade de terapia intensiva neonatal de um hospital público universitário em Belo Horizonte, Minas Gerais. Método: Estudo analítico de observação direta da higienização de mãos de profissionais e visitantes. Paralelamente, o número de higienizações de mãos obtido por meio de contadores eletrônicos instalados no interior dos dosadores de sabão neutro e gel alcoólico. A correlação entre os métodos foi analisada pelo diagrama de dispersão e pela regressão. Resultados: Foram observadas 7.324 oportunidades de higienização de mãos em 255 períodos de uma hora cada. Foi identificada uma correlação positiva moderada quando a variável resposta foi a porcentagem de adesão e uma correlação positiva forte quando a variável resposta foi o número de higienizações de mãos. Conclusões: A existência de uma concordância e uma correlação positiva entre os dois métodos significa a possibilidade da utilização de métodos indiretos para monitorar o aumento ou a diminuição da adesão à higienização das mãos. O monitoramento dessa importante prática de prevenção de infecções permite aos serviços de saúde aprimorar a qualidade do cuidado assistido, incentivo para a realização de melhorias, investigação de surtos e infra-estrutura física adequada / Introduction: The use of a simple and low cost method to measure hand hygiene compliance in health care services becomes more and more necessary to allow assessment of the quality of care, investments done and interventions effectiveness aiming to increase compliance. Objective: To correlate the indirect method of measuring hand hygiene compliance with the direct method in a neonate intensive care unit at a university public hospital in Belo Horizonte, Minas Gerais. Method: Analytical study of hand hygiene direct observation of health care workers and visitors. At the same time, the number of hand hygiene was obtained through the electronic counters device installed inside the alcohol and blend soap dispensers was obtained. Correlation between methods was analyzed using dispersion diagram and regression. Results: 7.324 hand hygiene opportunities were observed during 255 periods of one hour each one. Moderate positive correlation was identified when the dependent variable was percentage of compliance and a strong positive correlation when the dependent variable was the number of hand hygiene. Conclusions: The existence of the concordance and the positive correlation between the two methods means the possibility to use indirect methods to monitor hand hygiene compliance increase or decrease. The monitoring of this important practice of infection prevention allow the health care services to improve quality of care assessment, incentive for performance improvement, outbreak investigation, and infrastructure design

Introdução: A utilização de métodos simples e de baixo custo para se medir a adesão à higienização das mãos em serviços de saúde torna-se cada vez mais necessária, a fim de permitir a avaliação da qualidade da assistência prestada, dos investimentos realizados e da eficácia das intervenções objetivando o aumento da adesão à prática. Objetivo: Correlacionar o método indireto de medir a adesão à higienização das mãos com o método direto em uma unidade de terapia intensiva neonatal de um hospital público universitário em Belo Horizonte, Minas Gerais. Método: Estudo analítico de observação direta da higienização de mãos de profissionais e visitantes. Paralelamente, o número de higienizações de mãos obtido por meio de contadores eletrônicos instalados no interior dos dosadores de sabão neutro e gel alcoólico. A correlação entre os métodos foi analisada pelo diagrama de dispersão e pela regressão. Resultados: Foram observadas 7.324 oportunidades de higienização de mãos em 255 períodos de uma hora cada. Foi identificada uma correlação positiva moderada quando a variável resposta foi a porcentagem de adesão e uma correlação positiva forte quando a variável resposta foi o número de higienizações de mãos. Conclusões: A existência de uma concordância e uma correlação positiva entre os dois métodos significa a possibilidade da utilização de métodos indiretos para monitorar o aumento ou a diminuição da adesão à higienização das mãos. O monitoramento dessa importante prática de prevenção de infecções permite aos serviços de saúde aprimorar a qualidade do cuidado assistido, incentivo para a realização de melhorias, investigação de surtos e infra-estrutura física adequada / Introduction: The use of a simple and low cost method to measure hand hygiene compliance in health care services becomes more and more necessary to allow assessment of the quality of care, investments done and interventions effectiveness aiming to increase compliance. Objective: To correlate the indirect method of measuring hand hygiene compliance with the direct method in a neonate intensive care unit at a university public hospital in Belo Horizonte, Minas Gerais. Method: Analytical study of hand hygiene direct observation of health care workers and visitors. At the same time, the number of hand hygiene was obtained through the electronic counters device installed inside the alcohol and blend soap dispensers was obtained. Correlation between methods was analyzed using dispersion diagram and regression. Results: 7.324 hand hygiene opportunities were observed during 255 periods of one hour each one. Moderate positive correlation was identified when the dependent variable was percentage of compliance and a strong positive correlation when the dependent variable was the number of hand hygiene. Conclusions: The existence of the concordance and the positive correlation between the two methods means the possibility to use indirect methods to monitor hand hygiene compliance increase or decrease. The monitoring of this important practice of infection prevention allow the health care services to improve quality of care assessment, incentive for performance improvement, outbreak investigation, and infrastructure design

Healthcare associated infections cause 75,000 to 80,000 deaths a year. Many are preventable with proper hand hygiene adherence (HHA). Worldwide, HHA range is between 40-60%, far below the 100% recommended. The purpose of this quantitative, cross-sectional, prospective study was to investigate any association between 15 demographic variables and HHA of ICU nurses. A convenience sample of 613 hand hygiene opportunities was collected by direct observation at each of 5ICUs (4 hospitals) in Texas for 8 consecutive hours each day for 3-5 days. The theoretical foundation guiding this study was the healthcare environment theory. The Statistical Package for Social Sciences software was used for descriptive and inferential analysis of data. An aggregated overall HHA rate of 64.09% was identified among all nurses, 66.88% among male nurses and 62.27% among female nurses. Number of children, age of the nurse, number of years of living in the U.S., and the number of years of active nursing practice were significantly associated with HHA (p = .000) using paired sample t-test. The potential social change impact of this study is identifying variables associated with HHA, identification and measurement of 4 barriers to HHA, measuring the Hawthorne Effect, identification of Low Gelers, High Gelers, and Super Gelers, average rate may not be indicative of what is happening in hospital, and call for standardization of surveillance methodology. Findings may lead to specific interventions to increase HHA among nurses with certain demographic characteristics.

As infecções relacionadas à assistência à saúde (IRAS) são consideradas um grande problema para a segurança do paciente e sua vigilância e prevenção devem ser prioridade. A higiene de mãos é a medida mais importante para prevenção de IRAS. O uso do álcool gel é o método mais simples e mais eficaz para se evitar IRAS apesar de muitas vezes ocasionar perda da integridade da pele. Neste estudo composto por profissionais de uma Unidade de Terapia Intensiva (UTI) adulto, os participantes foram convidados a utilizar 4 formulações alcoólicas (A, B, C e D) com diferentes concentrações de glicerol para a higiene de mãos durante os turnos de trabalho. A formulação A continha etanol a 80% (vol / vol) e glicerol 1,45% (V / V), a solução B etanol a 80% (vol / vol) e glicerol 0,75% (V/V), a formulação C etanol a 80% (vol / vol) e glicerol 0,50% (V / V) e a formulação D apenas etanol a 80% (vol / vol), todas preparadas pelo departamento de farmácia do hospital, único a saber o conteúdo de cada um dos frascos entregues em cada fase do estudo. Para a avaliação da tolerância da pele, realizou-se uma avaliação visual e objetiva da integridade da pele das mãos dos participantes, que efetuaram também uma auto avaliação dessa condição após pelo menos sete dias de uso de cada uma das formulações testadas. Para mensuração da adesão à prática de higiene de mãos observou-se em todas às fases do estudo por observação direta a realização desta prática. Dos 45 participantes potencialmente elegíveis, cinco não completaram todas as fases do estudo devido à interrupção do trabalho na UTI. Quanto à avaliação da pele as variáveis fissura e escamosidade foram mais frequentes quando os participantes usaram a formulação sem glicerol, mas não variaram entre as outras três formulações. A média das diferenças de adesão entre as fases 1,45% versus 0,75%; 1,45% versus 0,50% e 1,45% versus 0, foram respectivamente 9,71%; 5,86% e 6,82%. Esses dados sugerem que a adesão à higiene de mãos foi superior na fase glicerol 1,45% comparada com as demais fases, sem, entretanto, nenhuma média ter sido superior a 10%. A fase glicerol 0,50% obteve a menor diferença em relação à concentração padrão. Considerando estes achados, concluímos que a formulação alcoólica com glicerol a 0,50% poderia ser passível de utilização na prática clínica, podendo a mesma ser testada em diferentes instituições de saúde / Healthcare-associated infections (HAI) are a major problem for patient health and safety, and their prevention must be a high priority. Hand hygiene is the most important preventive measure against HAI. The use of alcohol gel is the simplest and most effective method to avoid HAI although it often causes loss of skin integrity. In this study, the participants were assigned to use one of four formulations of an alcohol gel (A, B, C and D with different concentrations of glycerol) for hand hygiene during work shifts. The study was carried out in four phases, in each one the alcoholic formulation with a specific concentration of glycerol was used. The formulations were tested sequentially, in random order. Formulation A contained 80% (vol / vol) ethanol and 1.45% (V / V) glycerol, formulation B ethanol 80% (vol / vol) and glycerol 0.75% (V / V), formulation C ethanol at 80% (vol / vol) and glycerol 0.50% (V / V) and formulation D was made up of just 80% ethanol (vol / vol). All the gels were prepared by the hospital\'s pharmacists, who were the only ones to know the contents of the gel-containing bottles. To assess skin tolerance, a visual and objective assessment of the skin integrity of the participants\' hands was performed, which also performed a self-assessment of this condition after at least seven days of use of each of the formulations tested. Compliance with hand-hygiene practices was monitored and measured throughout the study by the direct observation of the researcher. There were 45 participants eligible for the study. Five, however, were not able to complete all phases of the study due to the discontinuation of their working in the ICU. Regarding skin evaluation, the variables fissure and scaliness were more frequent when the participants used the formulation without glycerol but their frequency did not vary with the other three formulations. The mean of compliance differences between the phases was 1.45% versus 0.75%; 1.45% versus 0.50% and 1.45% versus 0, were respectively 9.71%; 5.86% and 6.82%. These data suggest that compliance to hand hygiene was superior in the glycerol phase, 1.45% compared to the other phases, but no average was greater than 10%. The 0.50% glycerol phase had the smallest difference from the standard. According to these findings, we concluded that the alcoholic formulation with 0.50% glycerol might be used in clinical practice and could be tested in other hospitals

Master of Public Health / Public Health Interdepartmental Program / Kate KuKanich / The College of Veterinary Medicine (CVM) environment is a place where veterinarians, veterinary staff, and veterinary students may have increased risk of exposure to zoonotic pathogens. This exposure may occur in classrooms or laboratories where pre-clinical veterinary students and non-clinical staff frequent. Exposure may also occur in the veterinary teaching hospital (VTH) and may impact veterinary patients, clinicians, interns, residents, veterinary technicians, veterinary students, animal caretakers, and others. This thesis is divided into 3 chapters. The first chapter describes a current review of the literature involving risk of zoonotic pathogen exposure at VTHs including descriptions of the most commonly documented zoonotic pathogens and their transmission, environmental sources of zoonotic pathogens at VTHs, and ways to prevent zoonotic pathogen exposure at individual and institutional levels. The second chapter describes an original research study of hand hygiene behavior among pre-clinical veterinary students at a CVM. The purpose of this study was to determine if a campaign could improve hand hygiene among veterinary students at extracurricular meetings serving meals. Campaign interventions included a 3.5 minute educational video and a novel motivational poster. The video was presented to all 1st, 2nd, and 3rd year veterinary students. Posters encouraging hand sanitization were displayed on doors and tables alongside sanitizers at each meeting. Observational hand hygiene data were collected immediately after introduction of interventions and again 3 months later. Environmental sampling for presence of bacteria in and around meeting locations was also performed. Observed hand hygiene was lowest during baseline (11.0% +/- 1.7), improved significantly post-intervention (48.8% +/- 3.2), and remained improved at 3-month follow-up (33.5% +/-4.0). Females had higher probability of hand- sanitizing (35.9% ± 2.2) than males (21.4% ± 2.4) (p<0.01). Clostridium perfringens was isolated from 2/42 samples, and Salmonella spp. were isolated from 4/42 samples. This study documented that a short-term public health campaign targeting veterinary students successfully improved hand hygiene before meals. The final chapter discusses future areas of research in the realm of risk of zoonotic pathogen exposure and risk mitigation at CVMs.

Thesis (MPH.) -- University of Limpopo, 2016 / Background: The purpose of the study was to find out if hand hygiene was being done according to World Health Organization hand hygiene Guideline. It was hoped that the study would benefit all health care workers through making recommendations aimed at improving hand hygiene compliance. Purpose: The aim of the study was to assess hand hygiene practices among healthcare workers in Nyangabgwe Hospital, Francistown, Botswana Methods: Quantitative, Cross-sectional study, using a self-administered Questionnaire to collect data on 280 participants. The questionnaire consisted of three (3) sections: socio-demographic profile; attitudes of HCWs and practice of healthcare on hand hygiene. For attitude questions Three (3) point Likert scale was used. The sampled Healthcare workers were stratified. The results were analysed using SPSS version 24.0. The descriptive statistical method was used to analyse frequencies, correlations and means. The chi-squared was used to analyse cross tabulation between variables and association with significance level at (p < = 0.05). Results: The results shows that 260 participants aged between 20- 60years responded to the questionnaire. The majority of participants had good knowledge of hand hygiene and younger participants practiced hand hygiene more than older ones (p<.05). Barriers to hand hygiene were significant and included lack of time, negative attitude, but not lack of knowledge. Conclusion: The study highlighted the practices of hand hygiene among health care workers and the status of hand hygiene resources in the hospital which have a negative impact on hand hygiene practices demonstrated that compliance with hand hygiene compliance among health care workers remains unacceptably low, despite xiv the irrefutable scientific evidence that hands are the most common vehicle for transmission of pathogens Keywords: Hand hygiene, Health care workers, Hand hygiene practices, Health care associated infection, Resources.