ABSTRACT BACKGROUND. There have been few studies conducted in hospitalized patients in Viet nam on the epidemiology of surgical site infections (SSIs) and the impact of hand hygiene practices. This study aimed to assess the impact of a bedside hand sanitizer program on SSIs in orthopaedic and neurosurgical patients. DESIGN. A prospective quasi-experimental study was conducted with an untreated control group design in neurosurgical patients and before-after design in orthopaedic patients. A cost analysis based on data derived from the results of this study was also performed. SETTING. Cho Ray Hospital, a tertiary university hospital in Ho Chi Minh City, Viet nam. PATIENTS. All patients admitted for operation between 11 July and 15 August 2000 (Before), and 14 July and 18 August 2001 (After) were included, except those who had undergone another operation within one month prior to admission or were admitted because of SSIs. INTERVENTION. Bedside hand sanitizers were introduced into the Orthopaedic ward and one Neurosurgical ward (Ward A) from September 2000. Training on proper use was also provided to ward staff. Another Neurosurgical ward (Ward B) was used as a control group with no intervention conducted. RESULTS. A total of 1368 patients were recruited into the study. After intervention, in Ward A of the neurosurgical department, the SSI rate between the two periods was reduced by 54% (8.3% to 3.8%; p=0.09). Superficial SSIs were eliminated after the intervention (p=0.007). Comparison between Ward A (intervention) and Ward B (control) showed that, before the intervention, there was no difference in incidence of SSI between the two wards (Ward A: 8.3%, Ward B: 7.2%, p=0.7); however, after intervention, the incidence of SSI in Ward A was significantly lower than Ward B (3.8% and 9.2%, p=0.04). For orthopaedic patients, the SSI rate between the two periods was reduced by 34% (14.8% to 9.8%; p=0.07). SSI patients had a median post-operative length of stay of 19 days longer than patients without SSI (p&lt0.001). Costs were 2.5 times higher in patients with in-hospital SSI compared to uninfected patients (p&lt0.001). Mean SSI-attributable costs were conservatively estimated at US$368 in neurosurgical patients and US$207 in the orthopaedic patients in the before period. SSIs were responsible for at least 14 percent of the annual budget before intervention. The savings per SSI prevented were estimated at US$332 in neurosurgical patients and US$157 in orthopaedic patients. Annual cost savings arising from the intervention were estimated at US$11,112 in orthopaedic patients and US$19,320 in neurosurgical patients. CONCLUSIONS. The incidence of SSI in the hospital was high. The use of hand sanitizers reduced SSI rates, particularly impacting on the incidence of superficial SSIs. The hand sanitization program was found to be a dominant intervention being both more effective and cost saving as compared with no intervention in both study departments. The use of bedside hand sanitizers should be encouraged in the hospitals in Viet nam, where there often is a lack of other hand-washing facilities. / PhD Doctorate

Bakgrund: Vårdrelaterade infektioner är ett problem som tar upp resurser och vårdplatser. Ett av huvudproblemen är brister i handhygienen. Handhygienen ska utföras korrekt för att bedriva en god och säker vård. Det sistnämnda är en kärnkompetens hos den utbildade sjuksköterskor. Händerna utgör en smittväg mellan vårdpersonal och patienter. För att förhindra detta används skyddsutrustning men även handtvätt och handdesinfektion. Trots kunskap om handhygienens betydelse ses bristande tillämpning bland vårdpersonal.Syfte: Syftet är att identifiera faktorer som kan associeras med följsamheten till handhygien hos vårdpersonal inom somatisk slutenvård.Metod: I detta arbete har en litteraturstudie gjorts. Metoden som valts för att svara på syftet  är en kvantitativ metod. Observationsstudier (7) samt kombinerad observation och enkätstudier (3). Databaserna som användes var PubMed och Cinahl för att få fram relevanta artiklar.Resultat: Tio artiklar har sammanställts för att besvara syftet. Resultatet visade att handtvätt görs för sällan och ersätts med desinfektionsmedel. Arbetsbelastning och utbrändhet leder till sämre följsamhet till handhygien. Att handhygien spelar roll beroende av vilket typ av moment som ska genomföras. Följsamheten till handhygien var sämre innan kontakt med patientkontakt än efter. Slutsats: Dålig handhygien har setts på grund av olika faktorer, detta minskar patientsäkerheten genom risken för eventuell vårdrelaterade infektioner (VRI). Genom god handhygien minskar risken för smittbara ämnen vilket främjar både samhället och patienten. / Background: Healthcare related infections are a big problem in our society. This takes up unnecessary resources and hospital beds. One of the main problems is deficiencies in hand hygiene. Hand hygiene has to be performed correctly to provide good and safe care. Safe care is one of the nurses core competencies. Our hands transmit bacteria and viruses infections between the patient and healthcare professionals. To prevent this use protective equipment but also hand washing and hand disinfection. Aim: the purpose is to identify factors that can be associated with compliance with hand hygiene among care staff in somatic inpatient care.Method: In this work a literature study has been used. Observation studies (7) but also combined observation and questionnaire studies (3) was applied. Cinahl and PubMed were used as databases.Result: A total of ten articles were included in the result. The result showed that handwashing is not done as often as it should, and getting replaced with hand disinfection, workload and burnout leads to less compliance with hand hygiene. Hand hygiene plays a role depending on the type of procedures that are going to be performed. Adherens to hand hygiene were worse before patient contact than after. Conclusion: Poor hand hygiene has been due to various factors. This reduces patient safety through the risk of possible healthcare related infections (HRI). Good hand hygiene reduces the risk of infectious substances, which promotes both society and the patient.

SARS-CoV-2 is the virus responsible for the current global pandemic, COVID-19. Because this virus is novel, little is known about its sensitivity to disinfection. In this study, we performed suspension tests against SARS-CoV-2 using three commercially available quaternary ammonium compound (Quat) disinfectants and one laboratory-made 0.2% benzalkonium chloride solution. Three of the four formulations completely inactivated the virus within 15 seconds of contact, even in the presence of a soil load or when diluted in hard water. We conclude that Quats rapidly inactivate SARS-CoV-2, making them potentially useful for controlling SARS-CoV-2 spread in hospitals and the community. In addition to disinfection, little is known about the sensitivity of SARS-CoV-2 to wastewater. A number of researchers have tracked the spread of COVID-19 by using qPCR to look for SARS-CoV-2 RNA in wastewater, but it is unclear how long that RNA lasts or whether that RNA is from intact or inactivated virus. In this study, we added laboratory-grown SARS-CoV-2 to various samples of wastewater and measured its persistence using both qPCR, which detects all viral RNA, and a plaque assay, which detects only infectious virus. The level of infectious virus declined sharply by over 4 log reductions during an 8 day time period, while the level of measurable RNA did not decline significantly. Autoclaving or filtering the wastewater before adding virus attenuated this effect, producing declines of only around 1-3 logs for the infectious virus over 8 days and no significant decline for the RNA.

Background SARS-CoV-2 is the virus responsible for the current global pandemic, COVID-19. Because this virus is novel, little is known about its sensitivity to disinfection. Methods We performed suspension tests against SARS-CoV-2 using three commercially available quaternary ammonium compound (Quat) disinfectants and one laboratory-made 0.2% benzalkonium chloride solution. Findings Three of the four formulations completely inactivated the virus within 15 s of contact, even in the presence of a soil load or when diluted in hard water. Conclusion Quats rapidly inactivate SARS-CoV-2, making them potentially useful for controlling SARS-CoV-2 spread in hospitals and the community.

Background: Hand hygiene is now, more than ever, one of the most important factors to minimize spread of infection. In low income countries like Lesotho between 6% - 19% of patients contract at least one healthcare associated infection. Compared to between 3% - 10% in high income countries. Objective: The aim was to describe how healthcare professionals experience and conduct basic hand hygiene procedures at a hospital in Lesotho. Method: The study was conducted using a qualitative content analysis with a manifest level of abstraction and an inductive approach. Result: The results showed in our final categories; Healthcare professionals perceive different views on the risk for contamination, Healthcare professionals described hand hygiene as important although there are hindrances, and Healthcare professionals stated that basic hand hygiene need support from management for good compliance. That healthcare professionals did not always perform basic hand hygiene the way it was supposed as low budget or lack of knowledge was an obstacle. Conclusions: There are many problem areas, such as cost, availability and knowledge although the personnel are interested, resourceful and willing to make the best of any situation they come across.

An increase in outbreaks caused by zoonotic agents has brought about intensified efforts to address the transmission of infectious organisms in animal settings. In October 2002, the CDC released recommendations for the use of waterless hand sanitizer (WHS) in human healthcare settings. The question arises whether WHS may be as effective in veterinary and animal agricultural settings given some of the dissimilarities in conditions. To address this question, three studies were conducted. The first was a retrospective analysis of a Samonella agona outbreak which occurred in 2001 at the Large Animal Teaching Hospital of the Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM). The second evaluated the pattern of use and efficacy of hand hygiene products in the VMRCVM Large Animal Hospital. The third study assessed the efficacy of WHS among visitors to a children's petting zoo at the 2002 Virginia State Fair. Regarding the Salmonella outbreak, it is thought that a calf from the university owned dairy herd was the index case. A total of 16 equine patients acquired S. agona while hospitalized. The nosocomial disease incidence risk for in-house patients was estimated to be 33% (16/49). The LAH was closed for 7 months for cleaning, disinfection and renovation. The total cost of the outbreak was estimated to be at least $755,000. Waterless hand sanitizer proved useful in the veterinary hospital setting. When measured immediately after use, WHS reduced bacterial loads on the hands of 20 LAH personnel (P < 0.001). Before WHS use, HBC ranged from less than to 20 to 48,800 CFU/ml with a geometric mean of 6,926 CFU/ml. Counts after WHS use ranged from less than 20 to 23,400 with a geometric mean of 1,152 CFU/ml. Differences in before and after ranged from -4,000 to 48,200 CFU/ml with a median of 9,700 CFU/ml. The logarithmic reduction in bacterial load before and after WHS use was 0.78 (79.7%). In the petting zoo study, bacterial counts on the fingers of the children sampled before use of WHS ranged from 40 to 75,200 CFU/ml with a geometric mean of 8,653 CFU/ml. After WHS use, bacterial growth ranged from 19 to 58,400 CFU/ml with a geometric mean of 1,727 CFU/ml. Differences in before and after ranged from -35,600 to 59,400 CFU/ml with a median of 8,190 CFU/ml. The logarithmic reduction in bacterial load before and after WHS use was 0.70 (82.2%; P< 0.001). These data suggest that WHS may be of benefit in veterinary medicine and animal agriculture as a means to reduce nosocomial and zoonotic infections. / Master of Science

The goal of this project is to demonstrate a new hand sanitizer stand. A project template is selected to carry out tasks in six different phases. A preliminary study was carried out aims to gather background information of the thesis topic. The market research was conducted by searching for existing products on the Internet. A set of Design for Environment guidelines have been established aids to develop concepts. The collected information become the basis for subsequent decisions. Three potential concepts are generated. Two concepts are chosen for further development. A number of design techniques such as CAD, FEM analysis and 3D printing are applied in detailed design. Final design solution where all the geometric, functional details of the hand sanitizer stand are developed. Due to the time limitation, costs associated with the design is not estimated. Detail drawings of hand sanitizer stand are provided in the report to describe its dimensions and shape. / Den här rapporten beskriver formgivningsprocessen och konstruktionsarbetet av ett nytt golvstativ för handsprit. En projektmall tillämpas för att skapa en struktur och vägledning i sex olika faser. En förstudie har genomförts för att få förståelse för ämnet. För att samla information gjordes en marknadsundersökning. Design for Environment riktlinjer har skapats för att utveckla koncept. Den valda informationen användes sedan för att ta beslut. Utifrån de tre framställda koncepten valdes två att vidare utveckla. Tekniker såsom CAD-mjukvara, FEM-beräkningar och 3D teknik användas för att lösa problem och sedan uppnå målet. En slutprodukt uppfyllde de definierade produktkraven vad gäller funktionalitet och prestanda. Vi tog inte hänsyn till den ekonomiska kostnaden på grund av tidbegränsningar. Ritningar med måttsättningar finns i rapporten.

Master of Science / Hospitality Management and Dietetics / Kevin R. Roberts / Many pathogenic microorganisms are spread by contaminated hands and may lead to foodborne illness. The use of hand sanitizers can significantly reduce bacterial contamination and is an efficient and inexpensive method to prevent infections and sickness. Previous researchers have found that the routine use of hand sanitizers allowed the U.S. Army to significantly reduce illness. However, few studies have been conducted within a U.S. Army dining facility, which is considered to be one of the primary sources of foodborne illness within the U.S. Army. Therefore, using the Theory of Planned Behavior, the purpose of this study was to identify the behavioral intention, attitudes, subjective norms, and perceptions of control of using hand sanitizer among military personnel. The study targeted soldiers using a written survey during their lunch hour on the U.S. Army base at Fort Riley, KS. A total of 201 surveys were collected. All data were screened and entered into IBM SPSS for analysis. Results indicated that attitudes, subjective norms, and perceived behavioral control explained 64% of the variance in behavioral intention. Attitude and subjective norms were found to be significant predictors of behavioral intention, with attitude being the strongest predictor. In general, behavioral beliefs were positive among soldiers. Related to normative beliefs, soldiers did perceive negative social pressure from other soldiers not to use hand sanitizers. Analysis of control beliefs found soldiers perceived hand sanitizers were readily available, but disliked their smell and feel after application. Food production managers and Army commanders can use these results to implement hand sanitation behavioral interventions within military dining environments. Practical implications will likely translate to reduced healthcare costs, decreased absenteeism rates, and improved mission readiness. Some of the limitations include commonly perceived social psychology bias. Further, clustered samples were collected within one military installation in a relatively short amount of time.