Power of Handwashing in the era of COVID 19 pandemic – Innovative visual tool of instant feed-back to improve hand hygiene compliance
At a time of national lockdown, ruthless containment, aggressive suppression of social contact and large scale, active screening programs, effective hand-washing still remains to be the most powerful weapon against COVID-19 infection. Advisories published by international and national health agencies have identified 20 second hand-washing exercise as one of the simplest and cheapest means to break the cycle of COVID-19 spread. Thanks to the various awareness campaigns initiated by Government of India, popularity of hand hygiene practices has improved considerably. However, is it accompanied by improvement in the quality?
A panel of India researchers from Indian Institute of Public Health – Gandhinagar (IIPHG) had evaluated currently available evidences that advocated use of a novel technology – Ultraviolet (UV) light based visual imaging for improvement of hand-hygiene compliance in health care workers. The team comprised of Dr. Komal Shah, Dr. Somen Saha and Dr. Priya Kotwani used statistical approach to validate and substantiate the findings of 10 internationally published studies assessing impact of instant feedback on hand washing quality provided by visual images of hands in improving the hand hygiene compliance.
Pooled results from 7,896 health care workers who were asked to perform the recommended WHO steps using alcohol-based rub tagged with UV light sensitive fluorescent marker. After that they were immediately told to observe their hands under UV lamp, where they could easily identify the contaminated area through naked eyes. This exercise discriminated contaminated areas of hands through fluorescence where the areas with proper distribution of alcohol-based hand rub can be seen white under the UV lamp while the unrubbed areas or the contaminated ones appears dark.
Use of this technology has resulted in drastically increased hand hygiene compliance rate in health care professionals working in different settings. The average non-compliance rate was reduced to 14.8% from 40% with the usage of this innovative device in the health system. Though the study participants were majorly from non-Indian origin, keeping in mind the predicted burden of corona pandemic in India, public health impact of this innovation can be huge, says the Principle Investigator Dr. Komal Shah.
With India directing all its efforts in preventing spread of COVID-19, and specifically strengthening infection control and prevention strategies, optimum utilization of known interventions such as effective hand-hygiene may act as a game changer, says the Senior Scientist Dr. Somen Saha. In addition to secondary and tertiary care healthcare facilities – both in public and private sector, India has a wide network of 1.4 million Anganwadi centres which provides a package of six services for under 6 years children, adolescent and for pregnant and lactating women. In addition, 150,000 sub health centres, primary health centers and urban primary health centres are being transformed as Health & Wellness centres. These posts form the backbone of India’s primary response for health and nutrition services. It is high time that India adapts adherence to standard protocols of hand hygiene and induced behavioral changes which primarily worked on the principle of “Seeing is believing”.
Effective training and surveillance system especially when India have reached to a stage where its hospitals are also getting converted into containment zone. We need to protect our doctors, nurses and other frontline health care works from this deadly disease. Fortunately, COVID 19 originated outside India and due to aggressive containment measures, the disease has not achieved wide scale community transmission.
The promising results found on health care workers must be quickly adapted among primary, secondary and tertiary healthcare facilities for effective hand hygiene. This can be a sustainable solution especially during the phase when India will come out of the lockdown period where the risk of communication will be greater. Portable hand held instruments can be installed at various public places, primary health care facilities, anganwadi centres to generate awareness in common public and to use the power of hand hygiene to the fullest for fight against this deadly COVID 19 pandemic.
COVID 19 pandemic curve will eventually flatten, however, compliance and quality of hand hygiene practices should not flatten with it. The virus will pass, however, the opportunity should not. With only 36% of the Indians washing the hands with soap before meals and 26% after defecation, effective hand-hygiene practices are still a dream to chase. During this difficult time, we need to re-affirm our commitment to make our frontline health workers as change agents for improved hand hygiene compliance in the community. The following visual add two additional steps using UV light-based technique to the existing WHO steps of hand washing.
Komal Shah, Somen Saha, Priya Kotwani
