Efficacy of chlorine solutions used for hand hygiene and gloves disinfection in Ebola settings: a systematic review

Hopman, Joost; Kubilay, Zeynep; Allen, Tomas; Edrees, Hadeel Y.; Pittet, Didier; Allegranzi, Benedetta

doi:10.1186/2047-2994-4-s1-o13

Cited by 5 publications

(3 citation statements)

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“…However, WHO does not recommend glove decontamination [ 6 ] because of material damage, which can endanger the protective function of gloves. Similar problems were encountered by the WHO in Ebola-affected countries, where gloves were frequently disinfected with chlorine solutions [ 23 ].…”

Section: Discussionmentioning

confidence: 74%

Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study

Santosaningsih

Erikawati

Santoso

et al. 2017

Antimicrob Resist Infect Control

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BackgroundHand hygiene is recognized as an important measure to prevent healthcare-associated infections. Hand hygiene adherence among healthcare workers is associated with their knowledge and perception. This study aimed to evaluate the effect of three different educational programs on improving hand hygiene compliance, knowledge, and perception among healthcare workers in a tertiary care hospital in Indonesia.MethodsThe study was performed from May to October 2014 and divided into a pre-intervention, intervention, and post-intervention phase. This cluster randomized controlled trial allocated the implementation of three interventions to the departments, including role model training-pediatrics, active presentation-surgery, a combination of role model training and active presentation-internal medicine, and a control group-obstetrics-gynecology. Both direct observation and knowledge-perception survey of hand hygiene were performed using WHO tools.ResultsHand hygiene compliance was observed during 2,766 hand hygiene opportunities, and knowledge-perception was assessed among 196 participants in the pre-intervention and 88 in the post-intervention period. After intervention, the hand hygiene compliance rate improved significantly in pediatrics (24.1% to 43.7%; P < 0.001), internal medicine (5.2% to 18.5%; P < 0.001), and obstetrics-gynecology (10.1% to 20.5%; P < 0.001). The nurses’ incorrect use of hand rub while wearing gloves increased as well (P < 0.001). The average knowledge score improved from 5.6 (SD = 2.1) to 6.2 (SD = 1.9) (P < 0.05). In the perception survey, “strong smell of hand alcohol” as a reason for non-compliance increased significantly in the departments with intervention (10.1% to 22.9%; P = 0.021).ConclusionThe educational programs improved the hand hygiene compliance and knowledge among healthcare workers in two out of three intervention departments in a limited-resource hospital in Indonesia. Role model training had the most impact in this setting. However, adjustments to the strategy are necessary to further improve hand hygiene.

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Section: Discussionmentioning

confidence: 74%

Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study

Santosaningsih

Erikawati

Santoso

et al. 2017

Antimicrob Resist Infect Control

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“…In such situations, the timeliness is of essence at both stages of evidence synthesis and development of recommendations. Recent work to support the management of the Ebola outbreak in West Africa offers an extreme example where the need for evidence to guide hand hygiene measures was achieved by accelerated SRs [ 7 ] while in other areas requiring an evidence base expert opinion was used without any dedicated form of a SR [ 8 ]. Likewise, for academically based hospitals producing hospital-based health technology assessments (HTAs) of new or emerging technologies, both timeliness and costs of producing reviews may be critical, in particular when deadlines for the conduct and delivery of HTAs are driven by the interests of manufacturers, physicians and/or patients [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

How to conduct systematic reviews more expeditiously?

et al. 2015

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Healthcare consumers, researchers, patients and policy makers increasingly use systematic reviews (SRs) to aid their decision-making process. However, the conduct of SRs can be a time-consuming and resource-intensive task. Often, clinical practice guideline developers or other decision-makers need to make informed decisions in a timely fashion (e.g. outbreaks of infection, hospital-based health technology assessments). Possible approaches to address the issue of timeliness in the production of SRs are to (a) implement process parallelisation, (b) adapt and apply innovative technologies, and/or (c) modify SR processes (e.g. study eligibility criteria, search sources, data extraction or quality assessment). Highly parallelised systematic reviewing requires substantial resources to support a team of experienced information specialists, reviewers and methodologists working alongside with clinical content experts to minimise the time for completing individual review steps while maximising the parallel progression of multiple steps. Effective coordination and management within the team and across external stakeholders are essential elements of this process. Emerging innovative technologies have a great potential for reducing workload and improving efficiency of SR production. The most promising areas of application would be to allow automation of specific SR tasks, in particular if these tasks are time consuming and resource intensive (e.g. language translation, study selection, data extraction). Modification of SR processes involves restricting, truncating and/or bypassing one or more SR steps, which may risk introducing bias to the review findings. Although the growing experiences in producing various types of rapid reviews (RR) and the accumulation of empirical studies exploring potential bias associated with specific SR tasks have contributed to the methodological development for expediting SR production, there is still a dearth of research examining the actual impact of methodological modifications and comparing the findings between RRs and SRs. This evidence would help to inform as to which SR tasks can be accelerated or truncated and to what degree, while maintaining the validity of review findings. Timely delivered SRs can be of value in informing healthcare decisions and recommendations, especially when there is practical urgency and there is no other relevant synthesised evidence.

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“…Inconsistencies between guidelines are due, in part, to the lack of evidence to inform disinfection protocols in response to outbreaks, as highlighted during the 2014 Ebola virus disease outbreak. 27,28 Conducting research in humanitarian settings is challenging, and a recent systematic review found no rigorous evaluation of the field effectiveness or health impacts of surface disinfection in response to outbreaks. 29 However, there is a large body of literature on the laboratory-based efficacy of surface disinfection − including studies from different research fields such as hospital infection control, food science, or bioterrorism prevention − that has the potential to inform disinfection interventions in response to outbreaks.…”

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confidence: 99%

A systematic review of chlorine-based surface disinfection efficacy to inform recommendations for low-resource outbreak settings

Gallandat¹,

Kolus²,

Julian³

et al. 2021

American Journal of Infection Control

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Background: Infectious diseases can be transmitted via fomites (contaminated surfaces/objects); disinfection can interrupt this transmission route. However, disinfection guidelines for low-resource outbreak settings are inconsistent and not evidence-based. Methods: A systematic review of surface disinfection efficacy studies was conducted to inform low-resource outbreak guideline development. Due to variation in experimental procedures, outcomes were synthesized in a narrative summary focusing on chlorine-based disinfection against 7 pathogens with potential to produce outbreaks in low-resource settings (Mycobacterium tuberculosis, Vibrio cholerae, Salmonella spp., hepatitis A virus, rotavirus, norovirus, and Ebola virus). Results: Data were extracted from 89 laboratory studies and made available, including 20 studies on relevant pathogens used in combination with surrogate data to determine minimum target concentration £ time ("CT") factors. Stainless steel (68%) and chlorine-based disinfectants (56%) were most commonly tested. No consistent trend was seen in the influence of chlorine concentration and exposure time on disinfection efficacy. Disinfectant application mode; soil load; and surface type were frequently identified as influential factors in included studies. Conclusions: This review highlights that surface disinfection efficacy estimates are strongly influenced by each study's experimental conditions. We therefore recommend laboratory testing to be followed by fieldbased testing/monitoring to ensure effectiveness is achieved in situ.

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Efficacy of chlorine solutions used for hand hygiene and gloves disinfection in Ebola settings: a systematic review

Cited by 5 publications

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Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study

Intervening with healthcare workers’ hand hygiene compliance, knowledge, and perception in a limited-resource hospital in Indonesia: a randomized controlled trial study

How to conduct systematic reviews more expeditiously?

A systematic review of chlorine-based surface disinfection efficacy to inform recommendations for low-resource outbreak settings

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