Public awareness of hand hygiene as a simple measure in preventing the spread of communicable - PowerPoint Presentation

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Public awareness of hand hygiene as a simple measure in preventing the spread of communicable diseases

World Congress on Infection Prevention and Control 2016

Aaron Lawson, Neale Blair, Marie Vaganay

Presentation Outline

Introduction

Review Methodology

Review of the Literature

Conclusions

Current

Doctoral

Research

References

Questions

Introduction

Communicable Diseases

Communicable diseases are one of the leading causes of death worldwide (

Lozano et al, 2013;

Seimetz

, 2016

)Result of poor hygiene behaviours and sanitation (Banda et al, 2007; Lawrence et al., 2016)Hygiene-related communicable diseases like diarrhoeal disease in particular are a major threat because they target the most vulnerable groups in society like children and the very elderly (Luby et al, 2009; Fisher et al, 2011; Arnold et al, 2013; Freeman et al, 2014). Diarrhoeal disease is one of the largest causes of mortality worldwide (Scott et al, 2007; Biran et al, 2014; Contzen et al, 2015)

Introduction

Role of Good Hand Hygiene

Good hand hygiene is known to reduce the prevalence and spread of communicable diseases

(Scott et al, 2007;

Luby

et al., 2009;

Blencowe et al., 2011; Bolton, 2011; Massey et al, 2011; Hirai et al, 2016)Good hand hygiene compliance is generally poor (Cairncross et al, 2005; Okojie et al, 2005; Scott et al, 2007; Odo et al, 2015; Seimetz et al, 2016)Globally, it is estimated that approximately 19 – 20% of the general public wash their hands with soap after contact with faeces, despite them knowing the benefits of hand hygiene in disease prevention and control (

Biran

et al, 2012; Freeman et al, 2014

)

Review Methodology

An online systematic search of the SCOPUS, Science Direct and PubMed databases took place in April 2016 using key terms related to hand hygiene behaviours and compliance among the general population.

The inclusion criteria keywords were “hand hygiene”, “hand washing”, “public” and “knowledge”,

whereas

the exclusion criteria keywords were “healthcare”, “hospital” and “nursing”.

Review Methodology

31

28

34

There were 99

initial document results ranging from 1987 to 2016 of which 94 were included in the final

review

The majority of these have been published in the last five years (54) demonstrating that most of the knowledge and understanding regarding hand hygiene and its importance in the prevention of the spread of communicable diseases is relatively new in research terms.

Review of the Literature

Behaviours, Knowledge and Practice

Influencing behaviour is not easy, with past efforts based upon health education being met with limited success (

Scott et al., 2007; Arnold et al,

2009

)

Prior studies have exposed gaps in individual knowledge (Biran et al, 2009; McMahon et al, 2011; Tuzun et al., 2015) Other authors have cited a ‘lack of proper hygiene knowledge’ as contributing to poor hand hygiene behaviour and compliance (Contzen et al., 2015; Vujcic et al., 2015)Leads to false perceptions on the causes of common diseases like diarrhoea; shown in previous studies

where mothers who did not perceive babies faeces to be important in causing diarrhoea had a greater risk of getting diarrhoea than those whose mothers recognised the relationship, and the risk with food was found to be even greater (

Al

Khatib

, 2011; Fisher et al, 2011; Greenland et al, 2013

).

Review of the Literature

Behaviours, Knowledge and Practice

H

and

hygiene practice at key times by individuals (before and after food preparation and cooking, before and after cleaning a child who

defecated, before and after toilet use)

was poorly adhered too (Halder et al., 2010; Greenland et al., 2013; Psutka et al., 2013; Phillips et al, 2015)Handwashing with water alone was more common than with soap, and this type of practice was more prevalent in poorer, more rural areas (Biran et al., 2009; Halder et al., 2010; Luby et al, 2011; Phuanukoonnon, et al., 2013; Bruhn, 2014; Phillips et al., 2015)

Review of the Literature

Hand Hygiene Compliance

Compliance differs between males

and females

(

Cairncross

et al, 2005; Garayoa et al, 2005; Tran et al., 2006; Garbutt et al, 2007; Halder et al, 2010; Mariwah et al, 2012)Females typically perform better with regards to hand hygiene compliance compared to their male counterparts (Halder et al, 2010; Mariwah et al, 2012)Individuals from poorer, less well-educated backgrounds complied with good hand hygiene the least (Schmidt et al., 2009; Sibiyia & Gumbo, 2013)

Poor

education leads to poor personal hygiene

practices - need

to

consider the

psycho-social and economic factors when examining potential influences on hygiene behaviour to ensure effective interventions are implemented (

Al-

Khatib

& Al-

Mitwalli

, 2009; Arnold

et al, 2009;

Biran

et al, 2009

).

Review of the Literature

Built Environment

The provision

and usage of hygiene facilities (such as restrooms) play a key role in

influencing hand

hygiene behaviours and compliance (

Lang, 2012; Miller et al, 2012; Jenkins et al., 2013).Poor sanitation, and a lack of proper hygiene facilities lead to a low compliance rate and poor hand hygiene practices (Okojie et al, 2005; Blanton et al., 2010; Contzen et al., 2013; Sibiya & Gumbo, 2013; Alexander et al, 2014; Pfadenhauer, 2015; Phillips et al, 2015; Lawrence et al, 2016)Lack of amenities (availability of water, soap, drying) essential for handwashing have shown to result in low hand hygiene compliance (

Gilman et al, 1993;

Luby

et al., 2009; Greenland et al., 2013; Hirai et al,

2016

)

Review of the Literature

Hand Hygiene Interventions

Multimodal approach is the most effective method when designing a successful hand hygiene intervention

(

York et al, 2009; Ram et al, 2011;

Pincock

et al, 2012; Seimetz et al., 2016)Proper hygiene education reinforced from an early age is strongly associated with good behaviour and compliance in later life (Kaltenthaler & Drašar, 1996; Wyler et al, 2012; Phuanukoonnon, et al., 2013; Chaifetz et al., 2015; Contzen et al, 2015). Role models such as parents, teachers and work colleagues are influential when determining hand hygiene behaviour and compliance (Pinfold, 1999; Green et al, 2005; Eves et al, 2010; Patel et al., 2012; Greenland et al,

2013

)

Review of the Literature

Conclusions

There is a general lack of knowledge and understanding of the benefit of good hand hygiene behaviour in preventing the spread of communicable

diseases

D

ifferences

in self-reported behaviour and actual behaviour meaning the extent of the problem has not been explored in detailLack of compliance and subsequent spread of disease particularly amongst the most vulnerable in the population. There is also evidence of mal-practice through the likes of not washing hands before and after the preparation of food or after handling a child who had defecatedSocial-demographic factors show that level of education and societal class influence hand hygiene behaviours; with those from a lower-class, less-educated background being more likely to have poor knowledge and compliance with hand hygiene. This is compounded by the fact that those from a poorer background repeat bad practice such as open defecation which leads to the further spread of diseases such as diarrhoea

Review of the Literature

Conclusions

Built environment plays a major role in influencing hand hygiene behaviour and compliance; with the provision of clean, accessible restrooms along with the provision of amenities like warm water, soap and a means for drying essential when practicing proper hand

hygiene

Various intervention strategies are discussed and we can conclude that the most effective approach is a multimodal one which is tailored to the specific audience and

setting

Hygiene education from a young age, reinforced by role models such as parents, teachers and work colleagues is recommended throughout a number of the studies as promoting positive changeHowever, as overall public awareness of good hand hygiene as a simple, effective measure in preventing the spread of communicable diseases remains low, more research is needed into the behavioural, cultural and social drivers that influence the public’s knowledge and perceptions of hand hygiene, as well as further examining the effectiveness of specific hygiene interventions in improving behaviour and compliance

Current Doctoral Research

“An investigation of the hand hygiene behaviours of the general population when using public restrooms”

No

study to date has comprehensively looked at the general population’s usage of public restrooms using an unobtrusive, observational monitoring method, how human factors (personal, behavioural, environmental, social) affect hand hygiene behaviours and compliance while using public restrooms the barriers to hand hygiene compliance nor the effectiveness of simple intervention strategies for improving hand hygiene

compliance

This research therefore will examine how human behaviour and attitudes towards hand hygiene affects their usage of public restrooms and their amenities. It will also look at how built environment factors (design and layout of public restrooms) influence hand hygiene amongst the general population, and which interventions would be most

effective in improving hand hygiene compliance

Current Doctoral Research

Aims

Current Doctoral Research

“An investigation of the hand hygiene behaviours of the general population when using public restrooms”

Twin studies being carried out – survey vs observational

Various locations

Observational study – use of thermal imaging cameras

Survey study – sample the general population on their hand hygiene attitudes, behaviour, compliance and knowledge

Use feedback to compare and contrast views and help inform the design of an effective hand hygiene intervention

Current Doctoral Research

“An investigation of the hand hygiene behaviours of the general population when using public restrooms”

Findings from this research

will have

relevance in public health and the understanding of the spread of

hygiene-related communicable diseases

Used to inform government and key public policy-makers by highlighting the importance of good hand hygiene as a simple, unobtrusive method in the control of hygiene-related communicable diseases. The findings hope to inform how government policy could achieve better hand-hygiene standard through either changes in the built environment (design and layout of public restrooms), changes in education intervention to the public on hand hygiene, or influencing a cultural shift.Findings could also influence other sectors such as within the business community, the manufacturing and food industry to improve the health of the general population and reduce economic downturn (days lost at work due to illness; skill loss) by reducing hygiene-related communicable diseases.While the scope of the problem is vast, new improvements in public health can be achieved through new understandings of hand hygiene and the transmission pathways of communicable disease via our hands. This research will hopefully advance that goal.

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QUESTIONS?