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The World Health Organization 'My five moments for hand hygiene' has been globally adopted and compliance with this practice has been the focus of this thesis. Face touching by healthcare workers may contaminate hands and become a transmission opportunity. The frequency of face touching was examined in medical students as healthcare workers' movements prevent continuous observations. 26 medical students observed over 4 hours demonstrated on average 23 face touches per hour. This frequency is high and healthcare workers should be made aware of this behavior and the need for hand hygiene after face touching to prevent potential transmission of pathogens to vulnerable patients. To improve hand hygiene and the 7 hand hygiene poses an automated training system to improve technique was introduced into a tertiary teaching hospital and used by 789 healthcare worker volunteers (79% of total staff). The highest pass rate, 77%, was with pose-1 (rubbing palm to palm) and the lowest pass rate, 27%, was with pose-6 (cleaning thumbs). The novelty of the training system was short lived with most, 95% to 99.8%, of all failed poses not being reattempted. The training system did not improve the hospitalwide compliance during the implementation period or 8-months post-training; 74% (95%CI 72%-76%) versus 72% (95%CI 71%-74%). To improve hand hygiene compliance by providing daily compliance rates an automated hand hygiene surveillance system was installed in the largest tertiary public hospital while quarterly mandatory human audits continued. The automated system identified compliance for the surgical ward at 49%, 38 percentage points lower than the quarterly audits. The automated system identified compliance on the medical ward compliance at 30%, 55 percentage points lower than the quarterly audits. After 4 months of daily feedback, the compliance improved by 17 percentage points on the surgical ward to 66% while compliance on the medical ward remained at 30%. Qualitative interviews identified the surgical ward culture was one of a strong socially cohesive team compared with the medical ward. Changing hand hygiene behavior and sustaining high compliance is challenging and the findings suggest social cohesiveness on the wards assists the diffusion of a hand hygiene program.

The European Centre for Disease Prevention and Control (ECDC) estimates that 2.5 millioncases of Hospital Acquired Infections (HAIs) occur each year in the European Union. Handhygiene is regarded as one of the most important preventive measures for HAIs. If it is implemented properly, hand hygiene can reduce the risk of cross-transmission of an infection in the healthcare environment. Good hand hygiene is not only important for healthcare settings. Therecent ongoing coronavirus pandemic has highlighted the importance of hand hygiene practices in our daily lives, with governments and health authorities around the world promoting goodhand hygiene practices. The WHO has published guidelines of hand hygiene stages to promotegood hand washing practices. A significant amount of existing research has focused on theproblem of tracking hands to enable hand gesture recognition. In this work, gesture trackingdevices and image processing are explored in the context of the hand washing environment.Hand washing videos of professional healthcare workers were carefully observed and analyzedin order to recognize hand features associated with hand hygiene stages that could be extractedautomatically. Selected hand features such as palm shape (flat or curved); palm orientation(palms facing or not); hand trajectory (linear or circular movement) were then extracted andtracked with the help of a 3D gesture tracking device - the Leap Motion Controller. These fea-tures were further coupled together to detect the execution of a required WHO - hand hygienestage,Rub hands palm to palm, with the help of the Leap sensor in real time. In certain conditions, the Leap Motion Controller enables a clear distinction to be made between the left andright hands. However, whenever the two hands came into contact with each other, sensor data from the Leap, such as palm position and palm orientation was lost for one of the two hands.Hand occlusion was found to be a major drawback with the application of the device to this usecase. Therefore, RGB digital cameras were selected for further processing and tracking of the hands. An image processing technique, using a skin detection algorithm, was applied to extractinstantaneous hand positions for further processing, to enable various hand hygiene poses to be detected. Contour and centroid detection algorithms were further applied to track the handtrajectory in hand hygiene video recordings. In addition, feature detection algorithms wereapplied to a hand hygiene pose to extract the useful hand features. The video recordings did not suffer from occlusion as is the case for the Leap sensor, but the segmentation of one handfrom another was identified as a major challenge with images because the contour detectionresulted in a continuous mass when the two hands were in contact. For future work, the datafrom gesture trackers, such as the Leap Motion Controller and cameras (with image processing)could be combined to make a robust hand hygiene gesture classification system.

Objective: To verify aspects related to the perception of healthcare workers regarding hand hygiene. Methods:
Cross-sectional study in a emergency care unit at a university hospital in Belo Horizonte. A structured
questionnaire was applied to nursing and medical staff. The statistic program SPSS was used, descriptive and
univariate analysis were made. Results: Healthcare workers attributed as high the impact of infections on
clinical evolution of patients and the effectiveness of hand hygiene in controlling those infections. The rate for
self-reported compliance to hand hygiene was 76.0% for the nursing staff and 72.5% for medical staff, but lower
than 60.0% for coworkers. Conclusions: Healthcare workers perceive hand hygiene as an effective measure to
control infection and recognize that compliance rates of hand hygiene among health teams in general are low.

Prevention and Control Program (PPI) including hospital accreditation assessment. One of the standard phase is hand hygiene. The hands of health care are often contact with the patient and his environment, thus becoming the most common transmission of HAIs. Hand hygiene can reduce HAIs if done with appropriate recommendation. This study was conducted to determine the relationship between the level of knowledge of hand hygiene and hand hygiene compliance implementation. This study was observational analytic with cross sectional approach. Subjects were participants of educational programs in the medical profession with a total sampling technique. Instrument research using questionnaires and observation sheet. Analyzed with descriptive statistics, the average level of knowledge and implementation of hand hygiene compliance in respondents is less. Analysis distribution of respondents by sex, male totaled 17 people and female totaled 14 people, distribution of respondents according to the level of knowledge, less value totaled 29 people (93.5%) and enough value totaled 2 people (6.5%), distribution of respondents according to the level of compliance, less value totaled 26 people (83.9%) and good value totaled 5 people (16.1%). Analysis using a correlation test, 0.599 correlation value, where p<0.005, positively related. This study shows that there is a positive relationship between the level of knowledge of hand hygiene and hand hygiene compliance implementation. The average level of knowledge has less value. The average rate of hand hygiene compliance implementation has less value.Keywords: Knowledge level of hand hygiene-Implementation of hand hygiene compliance

BACKGROUND: Hand hygiene compliance scores in the anaesthetic department of an acute NHS hospital were persistently low. AIMS: To determine the feasibility and validity of regular accurate measurement of HHC in anaesthetics and understand the context of care delivery, barriers and opportunities to improve compliance. METHODS: The hand hygiene compliance of one anaesthetist was observed and noted by a senior infection control practitioner (ICP). This was compared to the World Health Organization five moments of hand hygiene and the organisation hand hygiene tool. FINDINGS: In one sequence of 55 min, there were approximately 58 hand hygiene opportunities. The hand hygiene compliance rate was 16%. The frequency and speed of actions in certain periods of care delivery made compliance measurement difficult and potentially unreliable. During several activities, taking time to apply alcohol gel or wash hands would have put the patients at significant risk. DISCUSSION: We concluded that hand hygiene compliance monitoring by direct observation was invalid and unreliable in this specialty. It is important that hand hygiene compliance is optimal in anaesthetics particularly before patient contact. Interventions which reduce environmental and patient contamination, such as cleaning the patient and environment, could ensure anaesthetists encounter fewer micro-organisms in this specialty.

BACKGROUND: Monitoring results showing poor hand hygiene compliance in a major, busy emergency department prompted a quality improvement initiative to improve hand hygiene compliance. PURPOSE: To identify, remove, and reduce barriers to hand hygiene compliance in an emergency department. METHODS: A barrier identification tool was used to identify key barriers and opportunities associated with hand hygiene compliance. Hand hygiene imperatives were developed and agreed on with clinicians, and a framework for monitoring and improving hand hygiene compliance was developed. RESULTS: Barriers to compliance were ambiguity about when to clean hands, the pace and urgency of work in some areas of the department, which left little time for hand hygiene and environmental and operational issues. Sore hands were a problem for some staff. Expectations of compliance were agreed on with staff, and changes were made to remove barriers. A monitoring tool was designed to monitor progress. Gradual improvement occurred in all areas, except in emergency situations, which require further improvement work. CONCLUSIONS: The context of care and barriers to compliance should be reflected in hand hygiene expectations and monitoring. In the emergency department, the requirement to deliver urgent live-saving care can supersede conventional hand hygiene expectations.

It has been widely recognized that adequate hand hygiene behaviour is a simple and cost-effective measure for moderating the spread of covid-19. Hence, this study focused on hand hygiene behavioural change amid the COVID-19 pandemic in Yenagoa. The study adopted the cross-sectional survey design, which involved the administration of a set of questionnaires to 400 randomly selected respondents using the multi-stage sampling technique, and physical inspection of household's hygiene facilities. The findings revealed that amid the COVID-19, there was a marginal increase in the status of water supply and hygiene services from the initial levels before the pandemic. The t-test statistic revealed that there was a significant difference in the frequency of hand washing before and amid the COVID-19 pandemic. This means that the level of hand hygiene behaviour among the people increased significantly during the pandemic. However, much still need to be done as a reasonable proportion of the population in Yenagoa do not practice regular hand hygiene due to some identified constraints. It is therefore recommended, that government should provide water and hygiene services for the people and carry out mass education and aggressive campaigns on the need for regular hand hygiene by all.

Hand hygiene is one of the most effective ways to control health care related infection. Nurses and physicians are the main health care workers contacting with patients, representing the vector in the chain of infection. Thus, assessing their knowledge, practice and attitudes regarding hand hygiene is very important to decrease the incidence of health care related infection and to improve quality of care. The study adopted a cross-sectional, quantitative design. Nurses and doctors who worked in the major governmental and private hospitals in the West Bank (Palestine) were targeted. The results showed that the participants had a moderate knowledge regarding the hand hygiene (m = 6, SD = 1.7). They had a better attitude score than practice with a mean of 82.5 ± 8.8. There was a significant difference between male and female only in practice score (p = 0.015). Older participants had better attitudes, and private hospitals had significantly higher scores for compliance, importance of hand hygiene and practice than governmental hospitals (p < 0.05). The results of the current study showed that there was a further need to focus on the practices of hand hygiene by continuous education for both Palestinian nurses and physicians.

Hand hygiene is the most effective way to stop the spread of microorganisms and to prevent healthcare-associated infections (HAI). The World Health Organization launched the First Global Patient Safety Challenge - Clean Care is Safer Care - in 2005 with the goal to prevent HAI globally. This year, on 5 May, the WHO's initiative SAVE LIVES: Clean Your Hands, which focuses on increasing awareness of and improving compliance with hand hygiene practices, celebrated its second global day. In this article, four Member States of the European Union describe strategies that were implemented as part of their national hand hygiene campaigns and were found to be noteworthy. The strategies were: governmental support, the use of indicators for hand hygiene benchmarking, developing national surveillance systems for auditing alcohol-based hand rub consumption, ensuring seamless coordination of processes between health regions in countries with regionalised healthcare systems, implementing the WHO's My Five Moments for Hand Hygiene, and auditing of hand hygiene compliance.

Hand hygiene is the most effective way to stop the spread of microorganisms and to prevent healthcare-associated infections (HAI). The World Health Organization launched the First Global Patient Safety Challenge - Clean Care is Safer Care - in 2005 with the goal to prevent HAI globally. This year, on 5 May, the WHO's initiative SAVE LIVES: Clean Your Hands, which focuses on increasing awareness of and improving compliance with hand hygiene practices, celebrated its second global day. In this article, four Member States of the European Union describe strategies that were implemented as part of their national hand hygiene campaigns and were found to be noteworthy. The strategies were: governmental support, the use of indicators for hand hygiene benchmarking, developing national surveillance systems for auditing alcohol-based hand rub consumption, ensuring seamless coordination of processes between health regions in countries with regionalised healthcare systems, implementing the WHO's My Five Moments for Hand Hygiene, and auditing of hand hygiene compliance.

Cover -- Half Title -- Title Page -- Copyright Page -- Dedication -- Table of Contents -- List of figures -- List of tables -- List of contributors -- Foreword -- Preface -- Acknowledgements -- List of abbreviations -- 1 Overview of hand hygiene -- 2 The encyclopaedia of hand hygiene - what it is all about? -- 3 Status of hand hygiene practices among schoolchildren in developing countries -- 4 Factors influencing hand hygiene practices among schoolchildren in developing countries -- 5 Opportunities to embrace hand hygiene practices among schoolchildren -- 6 Lessons derived from developed countries -- 7 Recommended strategies to improve hand hygiene compliance among schoolchildren in developing countries -- 8 Way forward -- Appendix 1 -- Appendix 2 -- Index.

ABSTRACTObjective: To evaluate doctors' compliance to five recommended moments of hand hygiene in a tertiary care hospital in a developing country and to identify doctors' opinion regarding various obstacles in adherence to hand hygiene.Method: A cross-sectional analytical study was conducted among trainee doctors -called House Officers - of a tertiary care teaching hospital in a resource-limited country (Pakistan). Subjects were consented and selected through non-probability convenient sampling. A self-administered questionnaire, based on five moments of hand hygiene recommended by WHO and factors affecting compliance was used.Results: Out of total 125 respondents, majority of the trainee doctors (63.2%) reported non-compliance to hand hygiene before contact with the patients. This non-compliance reduces to 46% among those who carry their own soap/sanitizer. After risk of exposure to body fluids and after direct contact with patient 9% and 22% doctors reported non-compliance respectively. Most common reasons/ excuses given for non-compliance were lack of facilities (65.6%) and overcrowding (68.8%). Only 10% doctors reported lack of knowledge as a major factor effecting compliance.Conclusions: Doctors compliance to hand hygiene for indications specifically protecting the patients was not in line with the recommendations by W.H.O. Along with improving facilities for hand hygiene, there is a need to motivate and continuously educate about patient safety.Keywords: Hand hygiene, healthcare-associated infections, trainee doctors, hand sanitizer, five moments of hand hygiene.