Vaccination, time lost from work, and COVID-19 infections: a Canadian healthcare worker retrospective cohort study

The COVID-19 pandemic highlighted hurdles for healthcare delivery and personnel globally. Vaccination has been an important tool for preventing severe illness and death in healthcare workers (HCWs) as well as the public at large. However, vaccination has resulted in some HCWs requiring time off work post-vaccination to recover from adverse events. We aimed to understand which HCWs needed to take time off work post-vaccination, for which vaccine types and sequence, and how post-vaccination absence impacted uptake of booster doses in a cohort of 26,267 Canadian HCWs. By March 31, 2022, more than 98% had received at least two doses of the approved COVID-19 vaccines, following a two-dose mandate. We found that recent vaccination and longer intervals between doses were associated with significantly higher odds of time-loss, whereas being a medical resident and receiving the BNT162b2 vaccine were associated with lower odds. A history of lab-confirmed SARS-CoV-2 infection was associated with lower odds of receiving a booster dose compared with no documented infection, aOR 0.61 (95% CI: 0.55, 0.68). Similarly, taking sick time following the first or second dose was associated with lower odds of receiving a booster dose, aOR 0.83 (95% CI: 0.75, 0.90). As SARS-CoV-2 becomes endemic, the number and timing of additional doses for HCWs requires consideration of prevention of illness as well as service disruption from post-vaccination time-loss. Care should be taken to ensure adequate staffing if many HCWs are being vaccinated, especially for coverage for those who are more likely to need time off to recover

Patient Hand Hygiene Systematic Review

Background: Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HAIs). Aim: To determine the efficacy of patient hand hygiene interventions in reducing HAIs and improving patient hand hygiene rates compared to usual care. Methods: We conducted a systematic review. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Findings: Ten studies were included, most of which were uncontrolled before-after studies (n=8). The majority of interventions (n=7) were multimodal, with components similar to healthcare worker hand hygiene programs, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HAI outcomes and 4 studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. Conclusion: Interventions to improve patient hand hygiene may reduce the incidence of HAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes.Medicine, Faculty ofNon UBCPathology and Laboratory Medicine, Department ofReviewedFacult

Hand hygiene monitoring technology: protocol for a systematic review

Abstract Background Healthcare worker hand hygiene is thought to be one of the most important strategies to prevent healthcare-associated infections, but compliance is generally poor. Hand hygiene improvement interventions must include audits of compliance (almost always with feedback), which are most often done by direct observation - a method that is expensive, subjective, and prone to bias. New technologies, including electronic and video hand hygiene monitoring systems, have the potential to provide continuous and objective monitoring of hand hygiene, regular feedback, and for some systems, real-time reminders. We propose a systematic review of the evidence supporting the effectiveness of these systems. The primary objective is to determine whether hand hygiene monitoring systems yield sustainable improvements in hand hygiene compliance when compared to usual care. Methods/Design MEDLINE, EMBASE, CINAHL, and other relevant databases will be searched for randomized control studies and quasi-experimental studies evaluating a video or electronic hand hygiene monitoring system. A standard data collection form will be used to abstract relevant information from included studies. Bias will be assessed using the Cochrane Effective Practice and Organization of Care Group Risk of Bias Assessment Tool. Studies will be reviewed independently by two reviewers, with disputes resolved by a third reviewer. The primary outcome is directly observed hand hygiene compliance. Secondary outcomes include healthcare-associated infection incidence and improvements in hand hygiene compliance as measured by alternative metrics. Results will be qualitatively summarized with comparisons made between study quality, the measured outcome, and study-specific factors that may be expected to affect outcome (for example, study duration, frequency of feedback, use of real-time reminders). Meta-analysis will be performed if there is more than one study of similar systems with comparable outcome definitions. Discussion Electronic and video monitoring systems have the potential to improve hand hygiene compliance and prevent healthcare-associated infection, but are expensive, difficult to install and maintain, and may not be accepted by all healthcare workers. This review will assess the current evidence of effectiveness of these systems before their widespread adoption. Study registration PROSPERO registration number: CRD4201300451

Measuring the Effect of Sousveillance in Increasing Socially Desirable Behaviour

Abstract—Hospital acquired infections (HAIs) occur frequently in hospitalized patients. Staff compliance with hand hygiene (HH) policy during patient care has been shown to reduce HAIs. Currently, hospitals evaluate adherence to HH policies through direct observation by human auditors. The auditors do not have authority over staff members; thus, this process is more akin to sousveillance (watching from below) than surveillance (watching from above). When behaviour change occurs due to awareness of being observed, it is referred to as the “Hawthorne effect”. We quantified the effect of sousveillance by comparing the frequency of HH events with an auditor present to when no auditor was present. The data analysed in the present work is from an ongoing study on hand hygiene compliance monitoring. A monitoring network recorded 290,000 hand hygiene events over 6 months; auditors were present on five occasions for about an hour each visit. When using an exponential underlying distribution we found that the change in the HH event rate was significant (p <0.01) in 4 of the 5 auditor visits. Finally, with a hyper-exponential underlying distribution, 5 of 5 were significant (p <0.01). There was no significant change in the HH event rate among dispensers located within patient rooms (not visible to the auditor), irrespective of auditor’s presence. I

Use of copper formulations in hospitals

Objective: To evaluate three formulations of copper (Cu) based self-sanitizing surfaces for antimicrobial efficacy and durability over one year in inpatient clinical areas and laboratories. Design: Randomized control trial. Setting: Three Cu formulations were assessed a) solid alloy 80% Cu 20% Ni (integral copper), b) spray–on 80% Cu 20% Ni (spray-on) and c) 16% composite Cu-impregnated surface. Coupons (1cm2 ) of the three products and control surgical grade (AISI 316) stainless steel (SS) were inserted into gaskets and adhered onto clinical carts used in patient care areas (including Emergency and Maternity units) (n=480) and on microbiology laboratory bench workspaces (n=240). The microbial burden and assessment of resistance to wear, corrosion, and material compatibility were determined every three months. Three tertiary care Canadian adult and one paediatric/maternity hospital participated. Results: Cu formulations used on inpatient units statistically significantly reduced bacterial bioburden compared to SS at months 3 and 6. Only the integral product had significantly less bacteria compared to SS at month 12. There were no statistically significant differences in microbial burden between Cu formulations and SS coupons on microbiology laboratory benches where bacterial counts were low overall. All mass changes and corrosion rates of the formulations were acceptable by engineering standards. Conclusions: Cu surfaces vary in their antimicrobial efficacy after one year in-hospital use. Frequency of cleaning and disinfection influences the impact of copper with the greatest reduction in microbial bioburden seen in clinical areas compared to the microbiology laboratory where cleaning/disinfection occurred multiple times daily.Applied Science, Faculty ofMedicine, Faculty ofNon UBCMaterials Engineering, Department ofPathology and Laboratory Medicine, Department ofReviewedFacultyResearcherPostdoctoralGraduat

Herd effect from influenza vaccination in non-healthcare settings: a systematic review of randomised controlled trials and observational studies

Influenza vaccination programmes are assumed to have a herd effect and protect contacts of vaccinated persons from influenza virus infection. We searched MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Global Health and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to March 2014 for studies assessing the protective effect of influenza vaccination vs no vaccination on influenza virus infections in contacts. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using a random-effects model. Of 43,082 screened articles, nine randomised controlled trials (RCTs) and four observational studies were eligible. Among the RCTs, no statistically significant herd effect on the occurrence of influenza in contacts could be found (OR: 0.62; 95% CI: 0.34-1.12). The one RCT conducted in a community setting, however, showed a significant effect (OR: 0.39; 95% CI: 0.26-0.57), as did the observational studies (OR: 0.57; 95% CI: 0.43-0.77). We found only a few studies that quantified the herd effect of vaccination, all studies except one were conducted in children, and the overall evidence was graded as low. The evidence is too limited to conclude in what setting(s) a herd effect may or may not be achieved