Interventions to improve hand hygiene compliance in patient care

Background Health care‐associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. This is an update of a previously published review. Objectives To assess the short‐ and long‐term success of strategies to improve compliance to recommendations for hand hygiene, and to determine whether an increase in hand hygiene compliance can reduce rates of health care‐associated infection. Search methods We conducted electronic searches of the Cochrane Register of Controlled Trials, PubMed, Embase, and CINAHL. We conducted the searches from November 2009 to October 2016. Selection criteria We included randomised trials, non‐randomised trials, controlled before‐after studies, and interrupted time series analyses (ITS) that evaluated any intervention to improve compliance with hand hygiene using soap and water or alcohol‐based hand rub (ABHR), or both. Data collection and analysis Two review authors independently screened citations for inclusion, extracted data, and assessed risks of bias for each included study. Meta‐analysis was not possible, as there was substantial heterogeneity across studies. We assessed the certainty of evidence using the GRADE approach and present the results narratively in a 'Summary of findings' table. Main results This review includes 26 studies: 14 randomised trials, two non‐randomised trials and 10 ITS studies. Most studies were conducted in hospitals or long‐term care facilities in different countries, and collected data from a variety of healthcare workers. Fourteen studies assessed the success of different combinations of strategies recommended by the World Health Organization (WHO) to improve hand hygiene compliance. Strategies consisted of the following: increasing the availability of ABHR, different types of education for staff, reminders (written and verbal), different types of performance feedback, administrative support, and staff involvement. Six studies assessed different types of performance feedback, two studies evaluated education, three studies evaluated cues such as signs or scent, and one study assessed placement of ABHR. Observed hand hygiene compliance was measured in all but three studies which reported product usage. Eight studies also reported either infection or colonisation rates. All studies had two or more sources of high or unclear risks of bias, most often associated with blinding or independence of the intervention. Multimodal interventions that include some but not all strategies recommended in the WHO guidelines may slightly improve hand hygiene compliance (five studies; 56 centres) and may slightly reduce infection rates (three studies; 34 centres), low certainty of evidence for both outcomes. Multimodal interventions that include all strategies recommended in the WHO guidelines may slightly reduce colonisation rates (one study; 167 centres; low certainty of evidence). It is unclear whether the intervention improves hand hygiene compliance (five studies; 184 centres) or reduces infection (two studies; 16 centres) because the certainty of this evidence is very low. Multimodal interventions that contain all strategies recommended in the WHO guidelines plus additional strategies may slightly improve hand hygiene compliance (six studies; 15 centres; low certainty of evidence). It is unclear whether this intervention reduces infection rates (one study; one centre; very low certainty of evidence). Performance feedback may improve hand hygiene compliance (six studies; 21 centres; low certainty of evidence). This intervention probably slightly reduces infection (one study; one centre) and colonisation rates (one study; one centre) based on moderate certainty of evidence. Education may improve hand hygiene compliance (two studies; two centres), low certainty of evidence. Cues such as signs or scent may slightly improve hand hygiene compliance (three studies; three centres), low certainty of evidence. Placement of ABHR close to point of use probably slightly improves hand hygiene compliance (one study; one centre), moderate certainty of evidence. Authors' conclusions With the identified variability in certainty of evidence, interventions, and methods, there remains an urgent need to undertake methodologically robust research to explore the effectiveness of multimodal versus simpler interventions to increase hand hygiene compliance, and to identify which components of multimodal interventions or combinations of strategies are most effective in a particular context

Development of Protective Clothing against Nanoparticle Based on Electrospun Nanofibers

In this paper, the development of efficient protective clothing against nanoparticulate aerosols is presented. Nanofibrous mats of polyamide 6 (PA6) were deposited onto a nonwoven viscose substrate by electrospinning technique. The influence of electrospinning parameters, including solution concentration, viscosity, and conductivity, was studied for the production of nonwovens with controlled fiber diameter showing a size distribution ranging from 66 to 195 nm. By varying several process parameters, textiles with different thickness of the nanofiber layer and thus air permeability were obtained. A hot-press lamination process using a thermoplastic resin as glue was applied to improve the adhesion of the nanofiber layer onto the textile support. After 1500 cycles of repeated compression and torsion, the nanofiber layer was still firmly attached to the support, while mechanical damage is visible in some areas. The penetration of NaCl particles with diameter ranging from 15 to 300 nm through the electrospun textiles was found to be strongly dependent on nanofiber layer thickness. A really thin nanofiber coating provides up to 80% retention of 20 nm size particles and over 50% retention of 200 nm size nanoparticles. Increasing the thickness of the nanofiber mat, the filtration efficiency was increased to over 99% along the whole nanoparticle range. The results obtained highlight the potential of nanofibers in the development of efficient personal protective equipments against nanoparticles.The financial support of this work was provided by MICINN (Spanish Ministry of Science and Innovation) and ERDF (European Regional Development Fund) (ref.: PSE-420000-2008–003), and ACC1´O (Catalan Business Competitiveness Support Agency

Study of the performance and capability of the new ultra-fast 2 GSample/s FADC data acquisition system of the MAGIC telescope

In February 2007 the MAGIC Air Cherenkov Telescope for gamma-ray astronomy was fully upgraded with an ultra fast 2 GSamples/s digitization system. Since the Cherenkov light flashes are very short, a fast readout can minimize the influence of the background from the light of the night sky. Also, the time structure of the event is an additional parameter to reduce the background from unwanted hadronic showers. An overview of the performance of the new system and its impact on the sensitivity of the MAGIC instrument will be presented.Comment: Contribution to the 30th ICRC, Merida Mexico, July 2007 on behalf of the MAGIC Collaboratio

Long term monitoring of bright TeV Blazars with the MAGIC telescope

The MAGIC telescope has performed long term monitoring observations of the bright TeV Blazars Mrk421, Mrk501 and 1ES1959+650. Up to 40 observations, 30 to 60 minutes each have been performed for each source evenly distributed over the observable period of the year. The sensitivity of MAGIC is sufficient to establish a flux level of 25% of the Crab flux for each measurement. These observations are well suited to trigger multiwavelength ToO observations and the overall collected data allow an unbiased study of the flaring statistics of the observed AGNs.Comment: 4 pages, 4 figures, to appear in the proceedings of the 30th International Cosmic Ray Conference, Merida, July 200

Second large-scale Monte Carlo study for the Cherenkov Telescope Array

The Cherenkov Telescope Array (CTA) represents the next generation of ground based instruments for Very High Energy gamma-ray astronomy. It is expected to improve on the sensitivity of current instruments by an order of magnitude and provide energy coverage from 20 GeV to more than 200 TeV. In order to achieve these ambitious goals Monte Carlo (MC) simulations play a crucial role, guiding the design of CTA. Here, results of the second large-scale MC production are reported, providing a realistic estimation of feasible array candidates for both Northern and Sourthern Hemisphere sites performance, placing CTA capabilities into the context of the current generation of High Energy $\gamma$-ray detectors.Comment: In Proceedings of the 34th International Cosmic Ray Conference (ICRC2015), The Hague, The Netherlands. All CTA contributions at arXiv:1508.0589