BackgroundHand hygiene compliance is generally assessed by observation of adherence to the “WHO five moments” using numbers of opportunities as the denominator. The quality of the activity is usually not monitored since there is no established methodology for the routine assessment of hand hygiene technique. The aim of this study was to objectively assess hand rub coverage of staff using a novel imaging technology and to look for patterns and trends in missed areas after the use of WHO’s 6 Step technique.MethodsA hand hygiene education and assessment program targeted 5200 clinical staff over 7 days at the National University Hospital, Singapore. Participants in small groups were guided by professional trainers through 5 educational stations, which included technique-training and UV light assessment supported by digital photography of hands. Objective criteria for satisfactory hand hygiene quality were defined a priori. The database of images created during the assessment program was analyzed subsequently. Patterns of poor hand hygiene quality were identified and linked to staff demographic.ResultsDespite the assessment taking place immediately after the training, only 72% of staff achieved satisfactory coverage. Failure to adequately clean the dorsal and palmar aspects of the hand occurred in 24% and 18% of the instances, respectively. Fingertips were missed by 3.5% of subjects. The analysis based on 4642 records showed that nurses performed best (77% pass), and women performed better than men (75% vs. 62%, p<0.001). Further risk indicators have been identified regarding age and occupation.ConclusionOngoing education and training has a vital role in improving hand hygiene compliance and technique of clinical staff. Identification of typical sites of failure can help to develop improved training.

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Abstract. Nosocomial infections are the undesirable result of a treatment in a hospital, or a health care service unit, not related to the patient's original condition. Despite the evolution of medicine, fundamental problems with hand hygiene remain existent, leading to the spread of nosocomial infections. Our group has been working on a generic solution to provide a method and apparatus to teach and verify proper hand disinfection. The general idea is to mark the skin surfaces that were sufficiently treated with alcoholic hand rub. Digital image processing is employed to determine the location of these areas and overlay it on the segmented hand, visualizing the results in an intuitive form. A non-disruptive ultraviolet marker is mixed to a commercially available hand rub, therefore leaving the original hand washing workflow intact. Digital images are taken in an enclosed device we developed for this purpose. First, robust hand contour segmentation is performed, then a histogram-based formulation of the fuzzy c-means algorithm is employed for the classification of clean versus dirty regions, minimizing the processing time of the images. The method and device have been tested in 3 hospitals in Hungary, Romania and Singapore, on surgeons, residents, medical students and nurses. A health care professional verified the results of the segmentation, since no gold standard is available for the recorded human cases. We were able to identify the hand boundaries correctly in 99.2% of the cases. The device can give objective feedback to medical students and staff to develop and maintain proper hand disinfection practice.

Purpose The authors intended to develop a novel procedure and research method that follows the effectiveness of the peer-educational approach in handwashing among school children. Materials and methods To ask the children about their sociodemographic background, health behaviour, hand hygiene knowledge, and health attitudes, and questionnaires were applied. The education on proper handwashing procedures was followed by a test with a mobile UV-light detection system (Semmelweis Scanner, http://www.handinscan.com/), and the scans were evaluated through an intrinsic computer software. Results Our newly developed questionnaire-based research method and the hand-rubbing technique followed by a test with a mobile UV-light detection system may become a reliable and valid scientific measurement of the effectiveness of hand hygiene training programmes. Conclusions The Hand-in-Scan technology and questionnaire-based research method provide proper tools for evaluating the successful peer education method. It can significantly elevate the level of children’s compliance, which leads to a better hygienic consciousness.