<span style="font-family:Verdana;">Dementia needs to be addressed by various researchers to reduce the risk of mor</span><span style="font-family:Verdana;">bidity and progression....<span style="font-family:Verdana;">Dementia needs to be addressed by various researchers to reduce the risk of mor</span><span style="font-family:Verdana;">bidity and progression. And dementia was regarded as one of l</span><span style="font-family:Verdana;">ifestyle-related</span><span> </span><span style="font-family:Verdana;">diseases, and it is estimated that about 10% of MCI (Mild cognitive impairment) progresses t</span><span style="font-family:Verdana;">o dementia in one year.</span><span style="font-family:""> </span><span style="font-family:Verdana;">In this study, we examine</span><span style="font-family:""><span style="font-family:Verdana;">d whether hand care therapy (HCT) as one of passive horticultural therapy was effective in preventing dementia/MCI. In result, the use of HCT was shown to be effective in preventing dementia and MCI illness and slowing progression. The elderly people tended to decrease iADL year by year, but the HCT group did not. In addition, the senile depressive tendency, which is said to be increasing year by year, tended to be reduced in the HCT-treated group. This is thought to be due to not only the healing effect of the massage by HCT treatment and </span><span style="font-family:Verdana;">the effect of transmitting the pleasant stimulus from the tactile sense to the frontal </span><span style="font-family:Verdana;">lobe, but also the true communication effect created by sitting gently and touching the hand. This HCT technique can improve the euphoria of the treated side and the treated side. Therefore, it can be expected that the autoimmunity of all people involved can be improved, and it can be judged to be promising as a preventive technique and non-pharmacotherapy for lifestyle-related diseases and various infectious diseases like COVID-19.</span></span>展开更多
<span style="font-family:Verdana;">The Japan Dementia Prevention Society conducted a questionnaire survey of dementia specialists conducted in August 2020. Regarding the worsening of symptoms in people...<span style="font-family:Verdana;">The Japan Dementia Prevention Society conducted a questionnaire survey of dementia specialists conducted in August 2020. Regarding the worsening of symptoms in people with dementia, 8% answered that they “accept more” and 32% answered that they “recognize a minority”. In the previous research report (Open Journal of Therapy and Rehabilitation Vol.8 No.3), we examined whether hand care therapy (HCT) as one of the passive horticultural therapy was effective in preventing dementia/MCI. Start of the test in August 2018 (I: BL) to February 2020 (VII: 18M) was, the use of HCT was to be effective in preventing dementia and MCI illness and slowing progression. Due to the COVID19 pandemic, VIII (24M) was evaluated in August 2020, and IX (27M) also measured ANS during activity. At that time, they divided into the Group E who had refrained from welfare facilities for the elderly due to the influence of COVID19 and the Group F who HCT continued. In the evaluation of VIII (24M), it was found that the cognitive function of the Group E was significantly reduced compared to VII, and Group F did not show a significant decrease. ADL decreased and depressive symptoms increase by continuing a life with less going out due to the influence of COVID 19 regardless of the use of the facility. It became clear that both Group E and Group F show good changes in ANS balance in the IX. Therefore, by utilizing horticultural therapy that the power of nature and plants in addition to utilizing welfare facilities for the elderly, cognitive impairment in COVID 19</span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> It was expected to lead to prevention and prevention of negative psychology and behavior such as depressive views and depressive tendencies. In the previous research report (Open Journal of Therapy and Rehabilitation Vol.8 No.3), we examined whether hand care therapy (HCT) as one of passive horticultural therapy was effective in preventing dementia/MCI. In the trend from the start of the test in August 2018 (I: BL) to February 2020 (VII: 18M) was, the use of HCT was shown to be effective in preventing dementia and MCI illness and slowing progression. Due to the COVID19 pandemic, various activity restrictions have been implemented in Japan since March 2020, and the number of elderly people who do not receive long-term care or rehabilitation has increased. Therefore, in August and November 2020, when the spread of COVID19 was reduced, cognitive function evaluation was carried out. At that time, they divided into the elderly group (Group E) who had refrained from welfare facilities for the elderly due to the influence of COVID19 and the elderly group (Group F) who HCT continued.</span></span></span></span>展开更多
<span style="font-family:Verdana;">Multi-sensory stimulation is beneficial to a wide variety of conditions typical of geriatric patients. Some therapies for elderly people are based on the philosophy t...<span style="font-family:Verdana;">Multi-sensory stimulation is beneficial to a wide variety of conditions typical of geriatric patients. Some therapies for elderly people are based on the philosophy that the activities to be carried out will also be stimulating to the senses. On the other hand, the dynamics of the senses play</span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> an important role beyond mere reason and sensibility in people’s lives. The hand care therapy that used natural herb oil is the alternative medicine that utilized a plant or its essential oil, which is used in various application scenes. In our past study, the hand care therapy that used natural herb oil demonstrated the effectiveness for elderly people. In this study, we examined influences on psychologi</span><span style="font-family:Verdana;">cal condition of the side to treatment on. On the evaluation with question p</span><span style="font-family:Verdana;">aper, baseline of POMS factor and TMD average were similar to pre-HCT. In post-HCT, T-A, A-H, F and C which were negative factors decreased than pre significantly. The forward factor V did not have significant difference, but the mean increased. Furthermore, the TMD (total mood distance) score generally </span><span style="font-family:Verdana;">decreased and changed in the balance of good feelings. On the objective ev</span><span style="font-family:Verdana;">aluation, temporal change differences in the PNS (Parasympathetic Nervous Sys</span><span style="font-family:Verdana;">tem) during the relaxed state and following the induced stress state were m</span><span style="font-family:Verdana;">onitored using ECG (electrocardiograph). The SNS (Sympathetic Nervous System) of students in HCT has decreased, and the PNS was confirmed to increase. For the tendency in SNS, the changes during the HCT were small. There were no significant changes in rSO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> (regional oxygen saturation) by HCT. BVI (blood volume information) showed significantly big values at left hand treatment and after HCT than BL, indicating that peripheral circulation of the blood flow quantity of the student increased. Generally, it was shown that the subjective emotional evaluation of the hand care treatment side, the objective autonomic nervous system change, and the coronal blood flow were all good. In Japan, the global pandemic of COVID</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">19 disrupts human interaction, and there are concerns about physical, cognitive, and mental deterioration. The use of hand care therapy has been shown to be an effective technique for building quality communication for both recipients and performers.</span>展开更多
Objectives: To propose the improvements measures by analysing the influencing factors of hand hygiene (HH) compliance by observing the behaviour of health care workers (HCWs). Method: The observational study was condu...Objectives: To propose the improvements measures by analysing the influencing factors of hand hygiene (HH) compliance by observing the behaviour of health care workers (HCWs). Method: The observational study was conducted at a public tertiary hospital in Zhejiang, China, from September 2018 to March 2021. A total of 58 HH observers were trained to conduct a direct observation on the HH behaviors of personnel in the hospital amongst the health care workers. We have observed over 9000 hand hygiene opportunities. The collected data were classified according to time factors, department parameters, and profession conduct of the observed. Hand hygiene (HH) compliance rates were calculated for each category, and a chi-square test was used to analyze differences of the HH compliance rates. Furthermore, binary logistic regression was used for multivariate analysis in each of the hand hygiene moments. Results: The HH compliance rates of HCWs were statistically different before and after the Corona Virus Disease 2019 (COVID-19) pandemic, in the morning and the afternoon, this was observed per parameters stated into objectives on weekdays vs non weekdays. And we found that HH compliance rates drop off a cliff from weekdays to non-weekdays. Conclusions: COVID-19, departments, professions, and weekdays were all factors that influence HH compliance amongst HCWs. However, the influencing factors were not all present in every HH behavior, and had different intensities of influence on HH compliance amongst the HCWs. These findings provide some reference for us to propose improvement measures.展开更多
Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low...Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low in most settings. Objective: The main aim of this paper is to determine findings and start drafting policies in implementing them into practice after finding out nurses’ opinions, beliefs and attitudes toward hand hygiene (HH). Methodology and methods: A cross sectional descriptive and observational study during November 2009. Results: From the total number of 175 health care workers employed in this unit, 67 (38.3%) were observed regarding adherence to hand hygiene. Regarding the knowledge, practices and attitudes of the nurses, data were collected from 54 (50.0%) among 108 nurses in four intensive care units within the University Clinical Centre of Kosovo (UCCK). From research findings, it was concluded that hand hygiene compliance in the intensive care units was low (51.3%). Conclusion: Research results show the necessity of organizing multimodal programs with intensive care units of University Clinical Centre of Kosovo (UCCK) on increase of knowledge level on health-care associated infections (HAI).展开更多
<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"> Hands...<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"> Hands of health care workers play an important part in infection transmission in a healthcare setting infections. Even though it is a simple and effective procedure, it is many times ignored by the health care workers (HCWs) due to lack of knowledge and interest, time constraints, skin irritation, understaffing, etc. There are no specific drugs and vaccines available for COVID-19 pandemic management, so as control measures, hand hygiene is an essential measure. It will be helpful even for the second wave preparedness. So this study was planned for analysis of barriers and practices of hand hygiene among health care workers which determine the adherence of hand hygiene in medical practice. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This was a cross-sectional study designed during COVID-19 pandemic management to analyze the barriers and knowledge, attitude and practices in health care workers for hand hygiene. Semi-structured questionnaires based study based on previous experience of seasonal flu outbreak was make to know barriers as well as to analyze the knowledge, attitude and practices of Health care workers. 215 participants were enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The “Barriers” related questions’ analysis showed that hand hygiene facilities, with the supply of soap, hand rub, basins with adequate as well as clean water, are available at various places in the Hospital. In knowledge related questions, major gaps are found in 5 moments of hand hygiene and regarding aspects of alcohol-based hand-rub. Majority HCWs show a good attitude towards questions that hand hygiene is an important thing to do along with other works</span></span><span style="font-family:Verdana;"> and</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> they feel frustrated when others or they themselves omit hand hygiene. But the attitude toward hand hygiene when hands are not visibly soiled and when working with gloved hand showed a wrong attitude. There is a major gap in practices of hand hygiene. The majority feel hand hygiene is difficult due to work pressure, sometimes they forgot, they feel it difficult to adhere due to more steps during an emergency. </span><b><span style="font-family:Verdana;">Discussion:</span></b><span style="font-family:Verdana;"> Hand hygiene is an essential part of COVID-19 pandemic management. Less compliance was observed due to a lack of knowledge and awareness. Such ignorance leads to an increase in Hospital-acquired infection. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;"><strong>:</strong> Good preparedness by Government and Institute for supplying adequate hand hygiene facilities in the work area for health care workers. But there were few gaps found in knowledge and attitude-related questionnaires and major gaps in practices were found which should be corrected by repeated training, awareness programs, demonstrations for hand hygiene and hands-on training. Conducting Periodic Webinar can be the most useful, convenient and safe method to provide training during the COVID-19 pandemic.</span></span>展开更多
Purpose: The purpose of this study was to describe adherence to self-care for hand-foot syndrome (HFS) and the relationship between self-care and health-related quality of life (QOL). Methods: A cross-sectional study ...Purpose: The purpose of this study was to describe adherence to self-care for hand-foot syndrome (HFS) and the relationship between self-care and health-related quality of life (QOL). Methods: A cross-sectional study was conducted on 105 consecutive outpatients with HFS. To assess self-care for HFS and QOL, the participants were asked to complete self-care and HFS-14 (hand-foot syndrome specific QOL) questionnaires, respectively. Multiple regression models were used to identify the relationship between self-care and QOL. Results: Adherence to self-care for HFS was low, less than 50% for most of the items. Multivariate analysis revealed that poorer self-care (βs = -0.19;P = 0.03), depressive symptoms (βs = 0.43;P βs = 0.20;P = 0.04) were independent predictors of poorer QOL scores. Conclusions: We have identified a need for further research to develop effective programs of self-care in HFS.展开更多
Background: Previous studies have shown that Hand Care Treatment, a form of passive horticultural therapy, is effective in preventing dementia and MCI and reducing the rate of progression. Due to the Covid-19 pandemic...Background: Previous studies have shown that Hand Care Treatment, a form of passive horticultural therapy, is effective in preventing dementia and MCI and reducing the rate of progression. Due to the Covid-19 pandemic, various activity restrictions were implemented in Japan from March 2020, and the number of elderly people without care and rehabilitation will the number of elderly people without care and rehabilitation has been increasing. Purpose: Progression of cognitive, physical, and mental disability was examined for long-term horticultural therapy study subjects by level of care required. Methods: One subject who had been diagnosed with dementia and was residing in an elderly care facility and consented to a long-term study was selected. In addition to assessments using various evaluation forms, data recorded from time to time, including changes in care plans, were analyzed using text mining methods. Results: This subject tended to progress slowly from 1 to 2 care needs, but progressed from 3 to 5 care needs over a 2-year period. The results of the assessment chart test showed that cognitive impairment and IADL decreased with each increase in the level of care required, but DBD remained the same at the time of admission, even at 5 years of care required. A comparison of HCT and aroma intervention with and without aroma intervention during the nursing care level 1 showed that the improvement in physical, mental, and cognitive function was expected to be higher at the time of intervention. Text-mining inspections have revealed that during the period of nursing care level 1 - 5, active horticultural therapy techniques, and passive horticultural therapy techniques such as HCT and brain rejuvenation aromatherapy were found to betweenness centrality with each other. Conclusion: From the results of mean score of DBD, although the nursing care level has progressed from 1 to a maximum of 5, it can be concluded that the burden of care has not become heavier. There was no tendency for the progression of cognitive impairment in this subject to be faster than in the general AD population, despite the influences of Covid-19. The results indicated that caregiving techniques and active and passive horticultural therapy techniques in Japanese welfare facilities for the elderly are expected to be effective in preventing the progression of cognitive impairment.展开更多
Background: In Japan, due to the COVID-19 pandemic, various behavioral restrictions were implemented from March 2020, resulting in an increased number of elderly people with reduced participation in care and rehabilit...Background: In Japan, due to the COVID-19 pandemic, various behavioral restrictions were implemented from March 2020, resulting in an increased number of elderly people with reduced participation in care and rehabilitation. As a result, the decline in motor and cognitive functions became more pronounced. Purpose: The study examined how activities combining passive horticultural therapy, which is always introduced, with active functional recovery training, which is used in the functional recovery training of patients with hemiplegia, influence the behavior of elder people using the facility. Methods: 36 elder people with care need 1 or 2 who regularly used the day-care facilities after the pandemic ended and who agreed to participate in the study was included. The assessment data were every three months from December 2021 to December 2023 after the COVID-19 pandemic, the MMSE and Moca-J, TMIG-Index, and GDS15. AI-based text mining was used to compare changes in visit reports before and after the introduction of the Posture Chart and Red Code, and the relationship between the language used. Results: The results of MMSE and Moca-J were both significantly higher in Group B and C than in Group A. TIMG assessment, was significantly higher in Group B and C than in Group A, and Group C was significantly higher than Group B. The GDS, an assessment of depression in old age, tended to be significantly higher in Group A than in Groups B and C. In the “Co-Occurrence Network Analysis” shown after the introduction of the latest functional recovery training equipment such as the Red Cord, its results showed a high association between the words Bathing and CARE and words such as POSTURE, Red-Code, and AI, App, which are used in functional training and rehabilitation, and their analysis. Conclusion: At day-care facilities specializing in functional recovery training and rehabilitation, a combination of horticultural therapy and the latest functional training equipment found to help maintain the physical and mental health of elderly people certified as requiring nursing care. Since this is a short-term study following behavioral restrictions, long-term research should continue to study the effects of adding functional training, handled by rehabilitation professionals, to horticultural therapy.展开更多
Hairdressers are exposed to numerous skin-damaging factors, such as wet work, skin irritants, and thermal changes. Skin protection is a very important factor for the prevention of occupational skin disorders. Therefor...Hairdressers are exposed to numerous skin-damaging factors, such as wet work, skin irritants, and thermal changes. Skin protection is a very important factor for the prevention of occupational skin disorders. Therefore, we evaluated a hand cream that was specially formulated for highly stressed skin with regard to its capability to reduce dry, rough, and scaly skin. The objective of this study was to conduct a controlled use test of a barrier repair cream containing pseudo-ceramide and demonstrate its efficacy for hairdressers with dry, sensitive hands and/or occupational skin disorders. A total of 30 hairdressers (29 females and 1 male, aged 20 - 67) participated in the study. All subjects suffered from dry hands. Subjects applied the test cream on their hands for 28 days (four weeks). For each subject, the skin surface topography of the hands was measured by the Surface Evaluation of Living Skin (SELS) system at day 14 (week 2) and day 28 (week 4). Dryness, scaling, cracking, redness, and itchiness were evaluated and graded by experts at week 2 and week 4, and then compared to baselines. All 30 subjects completed the study. A comparison of the changes from baseline to endpoint revealed a statistically significant reduction in skin roughness, scaling, and volume measured according to SELS. These data were confirmed by photographic documentation. The results were further supported by the expert evaluation. For the symptoms dryness and scaling, improvement could be observed in almost all regions of the hands. In addition, according to subjective assessments of overall hand skin condition and the hand cream, subjects reported clear improvement over time (p value below 0.001) and good efficacy of the product. In this study, the test hand cream showed excellent skin compatibility. Therefore, the hand cream may be effective for hairdressers with dry, sensitive hands and/or occupational skin disorders.展开更多
Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at ...Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at Dapaong regional hospital (DRH). Methodology: This was a prospective, descriptive cross-sectional study conducted from March to June 2022 in the DRH wards. Data were collected using a questionnaire and observation grid. Results: 90 care providers were surveyed. Males and non-physician personnel predominated with 57.8%, and 94.4% respectively. The survey on staff’s knowledge reported: 31.1% of practitioners did not wash their hands on arrival and departure in services. 24% did not know the difference between simple hand washing (SHW) and hygienic hand washing (HHW). 23.3% did not know the type of soap to use for HHW. The caregivers did not know the type of hand washing (HW) required after a septic and non-septic procedure in respectively 41.6%, and 37.8%. They did not know that there are two types of hand antiseptics (45.4%), nor the amount of antiseptic for HW (78.9%). The survey on staff’s attitude regarding HW found that: 70% did not remove all jewels prior HW, and 51.1% did not know that wearing gloves cannot replace the HW. For HW Staff Practice: 62.2% did not wash their hands before treatment. 91.1% did not spread the soap on their hands and forearms after wetting them. 65.55% did not rinse hands from nails to elbows. Conclusion: The HH was poorly known, the attitude of the staff was dangerous in relation to the HH and the practice of HH was very inadequate at the RHC-Dapaong. As a result, there is a need to retrain staff to increase their capacity to prevent care-related infections and enhance patient safety in the hospital.展开更多
Background: 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 chai...Background: 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. Aims: The aim is to assess the knowledge, practice and attitude of Palestinian physicians and nurses regarding hand hygiene in hospitals. Methods: 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. Data was collected using Hand Hygiene Questionnaire. Results: 200 nurses and physicians participated in this study. 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). Conclusion: 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.展开更多
Background: A proper hand washing of community health care worker (CHCW) is universally accepted as an important factor in reducing Heath Care Associated Infections (HCAIs). This cross sectional study was done to asse...Background: A proper hand washing of community health care worker (CHCW) is universally accepted as an important factor in reducing Heath Care Associated Infections (HCAIs). This cross sectional study was done to assess the knowledge, the attitude and practice on hand hygiene among health science students in Aden University. Method: 329 participants from medical, dental and nursing schools completed the questionnaire (43.8% female and 56.2% males). 1<sup>st</sup>, 2<sup>nd</sup> and internship years were excluded from the study. The questionnaire is adapted from World Health Organization (WHO) tools for hand hygiene surveys. Epi info., an epidemiological software from the Centre of Disease Control (CDC), was used for data analysis. Results: Responses of the participants in the study indicated that the majority of the students were aware of Hand hygiene (>90%) and 60% have had some sort of training. There is an obvious lack of knowledge on hand movement i.e. my five moments of hand hygiene, particularly on the main source and route of cross contamination with pathogens in hospital setting. In hand hygiene practice, 95% of participants wash their hands before and after food intake, 85% of participants use soap and water, but 8% of participants use only water and very few use alcohol base cleansing agent. 84% of participants wash their hands after handling patient. There was no significant difference between males and females in hand hygiene practice. Conclusion: The study on assessment of knowledge, attitude & practice of students of medical sciences revealed that almost all participants were aware of hand hygiene. However, at this stage of assessment, knowledge and practice are below 100% score for the correct response in particular knowledge and practice.展开更多
Acinetobacter baumanii is an opportunistic pathogen known to cause hospital acquired infection presenting with varying clinical feature from simply to much more severe manifestation. More importantly, widely improper ...Acinetobacter baumanii is an opportunistic pathogen known to cause hospital acquired infection presenting with varying clinical feature from simply to much more severe manifestation. More importantly, widely improper and overuse of antibiotics consumption have caused an endemic of multidrug-resistant-Acinetobacter baumanii leading to prolonged hospital stay and poorer prognosis for intensive care patients. A descriptive study of pre- and post-education was conducted at an intensive care setting in Indonesia. The microbiology data were collected to evaluate the benefit of education on hand hygiene and management of antibiotic use to reduce the number of MDR-Acinetobacter baumanii infection. Based on the result of previous local susceptibility patterns, Cefoperazone/Sulbactam and Amikacin are favored as the empirical therapy. Chi-square analysis shows the significant reduction of Acinetobacter baumanii cases from 70.8% (17/24) to 38% (3/8) with P-value 0.006. Similarly, the susceptibility rate significantly increased, from 21% to 100% to Amikacin;from 5% to 89% to Piperacillin/Tazobactam, and from 42% to 89% to Meropenem. Education improving around hand hygiene, appropriate antibiotic prescribing following local hospital guidelines and the result of antibiotic susceptibility has been shown to reduce the transmission of MDR-Acinetobacter baumanii in the intensive care in our unit within this Indonesian hospital.展开更多
Aim It is our opinion that the CDC and the WHO have underestimated cross-contamination under examination gloves in dental clinics while wearing jewelry, such as finger rings. These agencies only ＂recommend＂ removing...Aim It is our opinion that the CDC and the WHO have underestimated cross-contamination under examination gloves in dental clinics while wearing jewelry, such as finger rings. These agencies only ＂recommend＂ removing jewelry, and only washing hands for 15 seconds with soap and warm water before donning gloves. This study examined several washing procedures and finger rings using simulated microbes. Methodology A gloved robber hand manikin was made and fitted with a flesh disposable vinyl glove. Four fingers were fitted with rings or no ring, dusted with simulated microbes, and washed with a scrub brush for 5, 15, and 25 seconds under 20℃ and 40℃ water alone, or with liquid hand soap. Light levels （in lux） of fluorescent powder before and after washing were measured and delta scores calculated for changes in light levels, equivalent to effectiveness of hand washing procedures. A full-factorial, 3-factor analysis of variance （ANOVA） was used to test for differences among levels of the three study factors-time, temperature, and soap use. Tukey＇s post hoc honestly significant difference （HSD） test was applied to significant factors to examine pair-wise differences between factor levels. Results It was found that the longer the hands with rings were washed with a scrub brush under flowing water, the more simulated microbes were removed. By 25 seconds, all methods were essentially the same. Simulated microbes were more difficult to remove from the palm compared to the back of the hand. The liquid hand soap used in this study was more effective with warm water than cold. When given a choice of washing with cold water up to 15 seconds, it would be preferable not to use soap to remove simulated microbes. Qualitatively, the outer surface of finger rings were more effectively cleaned than the crevice below the ring, and the ring with a stone setting appeared to accumulate and retain simulated microbes more than other rings. Conclusion The most effective treatment was washing with warm water and liquid soap. Longer times were more effective. Rings should not be worn under examination gloves due to difficulty cleaning in the crevice under the ring, and the well-known consequences of cross-contamination between the patient and the health care worker.展开更多
文摘<span style="font-family:Verdana;">Dementia needs to be addressed by various researchers to reduce the risk of mor</span><span style="font-family:Verdana;">bidity and progression. And dementia was regarded as one of l</span><span style="font-family:Verdana;">ifestyle-related</span><span> </span><span style="font-family:Verdana;">diseases, and it is estimated that about 10% of MCI (Mild cognitive impairment) progresses t</span><span style="font-family:Verdana;">o dementia in one year.</span><span style="font-family:""> </span><span style="font-family:Verdana;">In this study, we examine</span><span style="font-family:""><span style="font-family:Verdana;">d whether hand care therapy (HCT) as one of passive horticultural therapy was effective in preventing dementia/MCI. In result, the use of HCT was shown to be effective in preventing dementia and MCI illness and slowing progression. The elderly people tended to decrease iADL year by year, but the HCT group did not. In addition, the senile depressive tendency, which is said to be increasing year by year, tended to be reduced in the HCT-treated group. This is thought to be due to not only the healing effect of the massage by HCT treatment and </span><span style="font-family:Verdana;">the effect of transmitting the pleasant stimulus from the tactile sense to the frontal </span><span style="font-family:Verdana;">lobe, but also the true communication effect created by sitting gently and touching the hand. This HCT technique can improve the euphoria of the treated side and the treated side. Therefore, it can be expected that the autoimmunity of all people involved can be improved, and it can be judged to be promising as a preventive technique and non-pharmacotherapy for lifestyle-related diseases and various infectious diseases like COVID-19.</span></span>
文摘<span style="font-family:Verdana;">The Japan Dementia Prevention Society conducted a questionnaire survey of dementia specialists conducted in August 2020. Regarding the worsening of symptoms in people with dementia, 8% answered that they “accept more” and 32% answered that they “recognize a minority”. In the previous research report (Open Journal of Therapy and Rehabilitation Vol.8 No.3), we examined whether hand care therapy (HCT) as one of the passive horticultural therapy was effective in preventing dementia/MCI. Start of the test in August 2018 (I: BL) to February 2020 (VII: 18M) was, the use of HCT was to be effective in preventing dementia and MCI illness and slowing progression. Due to the COVID19 pandemic, VIII (24M) was evaluated in August 2020, and IX (27M) also measured ANS during activity. At that time, they divided into the Group E who had refrained from welfare facilities for the elderly due to the influence of COVID19 and the Group F who HCT continued. In the evaluation of VIII (24M), it was found that the cognitive function of the Group E was significantly reduced compared to VII, and Group F did not show a significant decrease. ADL decreased and depressive symptoms increase by continuing a life with less going out due to the influence of COVID 19 regardless of the use of the facility. It became clear that both Group E and Group F show good changes in ANS balance in the IX. Therefore, by utilizing horticultural therapy that the power of nature and plants in addition to utilizing welfare facilities for the elderly, cognitive impairment in COVID 19</span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> It was expected to lead to prevention and prevention of negative psychology and behavior such as depressive views and depressive tendencies. In the previous research report (Open Journal of Therapy and Rehabilitation Vol.8 No.3), we examined whether hand care therapy (HCT) as one of passive horticultural therapy was effective in preventing dementia/MCI. In the trend from the start of the test in August 2018 (I: BL) to February 2020 (VII: 18M) was, the use of HCT was shown to be effective in preventing dementia and MCI illness and slowing progression. Due to the COVID19 pandemic, various activity restrictions have been implemented in Japan since March 2020, and the number of elderly people who do not receive long-term care or rehabilitation has increased. Therefore, in August and November 2020, when the spread of COVID19 was reduced, cognitive function evaluation was carried out. At that time, they divided into the elderly group (Group E) who had refrained from welfare facilities for the elderly due to the influence of COVID19 and the elderly group (Group F) who HCT continued.</span></span></span></span>
文摘<span style="font-family:Verdana;">Multi-sensory stimulation is beneficial to a wide variety of conditions typical of geriatric patients. Some therapies for elderly people are based on the philosophy that the activities to be carried out will also be stimulating to the senses. On the other hand, the dynamics of the senses play</span><span style="font-family:Verdana;">s</span><span style="font-family:""><span style="font-family:Verdana;"> an important role beyond mere reason and sensibility in people’s lives. The hand care therapy that used natural herb oil is the alternative medicine that utilized a plant or its essential oil, which is used in various application scenes. In our past study, the hand care therapy that used natural herb oil demonstrated the effectiveness for elderly people. In this study, we examined influences on psychologi</span><span style="font-family:Verdana;">cal condition of the side to treatment on. On the evaluation with question p</span><span style="font-family:Verdana;">aper, baseline of POMS factor and TMD average were similar to pre-HCT. In post-HCT, T-A, A-H, F and C which were negative factors decreased than pre significantly. The forward factor V did not have significant difference, but the mean increased. Furthermore, the TMD (total mood distance) score generally </span><span style="font-family:Verdana;">decreased and changed in the balance of good feelings. On the objective ev</span><span style="font-family:Verdana;">aluation, temporal change differences in the PNS (Parasympathetic Nervous Sys</span><span style="font-family:Verdana;">tem) during the relaxed state and following the induced stress state were m</span><span style="font-family:Verdana;">onitored using ECG (electrocardiograph). The SNS (Sympathetic Nervous System) of students in HCT has decreased, and the PNS was confirmed to increase. For the tendency in SNS, the changes during the HCT were small. There were no significant changes in rSO</span><sub><span style="font-family:Verdana;">2</span></sub><span style="font-family:Verdana;"> (regional oxygen saturation) by HCT. BVI (blood volume information) showed significantly big values at left hand treatment and after HCT than BL, indicating that peripheral circulation of the blood flow quantity of the student increased. Generally, it was shown that the subjective emotional evaluation of the hand care treatment side, the objective autonomic nervous system change, and the coronal blood flow were all good. In Japan, the global pandemic of COVID</span></span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;">19 disrupts human interaction, and there are concerns about physical, cognitive, and mental deterioration. The use of hand care therapy has been shown to be an effective technique for building quality communication for both recipients and performers.</span>
文摘Objectives: To propose the improvements measures by analysing the influencing factors of hand hygiene (HH) compliance by observing the behaviour of health care workers (HCWs). Method: The observational study was conducted at a public tertiary hospital in Zhejiang, China, from September 2018 to March 2021. A total of 58 HH observers were trained to conduct a direct observation on the HH behaviors of personnel in the hospital amongst the health care workers. We have observed over 9000 hand hygiene opportunities. The collected data were classified according to time factors, department parameters, and profession conduct of the observed. Hand hygiene (HH) compliance rates were calculated for each category, and a chi-square test was used to analyze differences of the HH compliance rates. Furthermore, binary logistic regression was used for multivariate analysis in each of the hand hygiene moments. Results: The HH compliance rates of HCWs were statistically different before and after the Corona Virus Disease 2019 (COVID-19) pandemic, in the morning and the afternoon, this was observed per parameters stated into objectives on weekdays vs non weekdays. And we found that HH compliance rates drop off a cliff from weekdays to non-weekdays. Conclusions: COVID-19, departments, professions, and weekdays were all factors that influence HH compliance amongst HCWs. However, the influencing factors were not all present in every HH behavior, and had different intensities of influence on HH compliance amongst the HCWs. These findings provide some reference for us to propose improvement measures.
文摘Background: Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections, but health care worker compliance with optimal practices remains low in most settings. Objective: The main aim of this paper is to determine findings and start drafting policies in implementing them into practice after finding out nurses’ opinions, beliefs and attitudes toward hand hygiene (HH). Methodology and methods: A cross sectional descriptive and observational study during November 2009. Results: From the total number of 175 health care workers employed in this unit, 67 (38.3%) were observed regarding adherence to hand hygiene. Regarding the knowledge, practices and attitudes of the nurses, data were collected from 54 (50.0%) among 108 nurses in four intensive care units within the University Clinical Centre of Kosovo (UCCK). From research findings, it was concluded that hand hygiene compliance in the intensive care units was low (51.3%). Conclusion: Research results show the necessity of organizing multimodal programs with intensive care units of University Clinical Centre of Kosovo (UCCK) on increase of knowledge level on health-care associated infections (HAI).
文摘<b><span style="font-family:Verdana;">Introduction:</span></b><span style="font-family:;" "=""><span style="font-family:Verdana;"> Hands of health care workers play an important part in infection transmission in a healthcare setting infections. Even though it is a simple and effective procedure, it is many times ignored by the health care workers (HCWs) due to lack of knowledge and interest, time constraints, skin irritation, understaffing, etc. There are no specific drugs and vaccines available for COVID-19 pandemic management, so as control measures, hand hygiene is an essential measure. It will be helpful even for the second wave preparedness. So this study was planned for analysis of barriers and practices of hand hygiene among health care workers which determine the adherence of hand hygiene in medical practice. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This was a cross-sectional study designed during COVID-19 pandemic management to analyze the barriers and knowledge, attitude and practices in health care workers for hand hygiene. Semi-structured questionnaires based study based on previous experience of seasonal flu outbreak was make to know barriers as well as to analyze the knowledge, attitude and practices of Health care workers. 215 participants were enrolled who were doctors, resident doctors, nurses, lab technicians, ward boys and food distributors. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The “Barriers” related questions’ analysis showed that hand hygiene facilities, with the supply of soap, hand rub, basins with adequate as well as clean water, are available at various places in the Hospital. In knowledge related questions, major gaps are found in 5 moments of hand hygiene and regarding aspects of alcohol-based hand-rub. Majority HCWs show a good attitude towards questions that hand hygiene is an important thing to do along with other works</span></span><span style="font-family:Verdana;"> and</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> they feel frustrated when others or they themselves omit hand hygiene. But the attitude toward hand hygiene when hands are not visibly soiled and when working with gloved hand showed a wrong attitude. There is a major gap in practices of hand hygiene. The majority feel hand hygiene is difficult due to work pressure, sometimes they forgot, they feel it difficult to adhere due to more steps during an emergency. </span><b><span style="font-family:Verdana;">Discussion:</span></b><span style="font-family:Verdana;"> Hand hygiene is an essential part of COVID-19 pandemic management. Less compliance was observed due to a lack of knowledge and awareness. Such ignorance leads to an increase in Hospital-acquired infection. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;"><strong>:</strong> Good preparedness by Government and Institute for supplying adequate hand hygiene facilities in the work area for health care workers. But there were few gaps found in knowledge and attitude-related questionnaires and major gaps in practices were found which should be corrected by repeated training, awareness programs, demonstrations for hand hygiene and hands-on training. Conducting Periodic Webinar can be the most useful, convenient and safe method to provide training during the COVID-19 pandemic.</span></span>
文摘Purpose: The purpose of this study was to describe adherence to self-care for hand-foot syndrome (HFS) and the relationship between self-care and health-related quality of life (QOL). Methods: A cross-sectional study was conducted on 105 consecutive outpatients with HFS. To assess self-care for HFS and QOL, the participants were asked to complete self-care and HFS-14 (hand-foot syndrome specific QOL) questionnaires, respectively. Multiple regression models were used to identify the relationship between self-care and QOL. Results: Adherence to self-care for HFS was low, less than 50% for most of the items. Multivariate analysis revealed that poorer self-care (βs = -0.19;P = 0.03), depressive symptoms (βs = 0.43;P βs = 0.20;P = 0.04) were independent predictors of poorer QOL scores. Conclusions: We have identified a need for further research to develop effective programs of self-care in HFS.
文摘Background: Previous studies have shown that Hand Care Treatment, a form of passive horticultural therapy, is effective in preventing dementia and MCI and reducing the rate of progression. Due to the Covid-19 pandemic, various activity restrictions were implemented in Japan from March 2020, and the number of elderly people without care and rehabilitation will the number of elderly people without care and rehabilitation has been increasing. Purpose: Progression of cognitive, physical, and mental disability was examined for long-term horticultural therapy study subjects by level of care required. Methods: One subject who had been diagnosed with dementia and was residing in an elderly care facility and consented to a long-term study was selected. In addition to assessments using various evaluation forms, data recorded from time to time, including changes in care plans, were analyzed using text mining methods. Results: This subject tended to progress slowly from 1 to 2 care needs, but progressed from 3 to 5 care needs over a 2-year period. The results of the assessment chart test showed that cognitive impairment and IADL decreased with each increase in the level of care required, but DBD remained the same at the time of admission, even at 5 years of care required. A comparison of HCT and aroma intervention with and without aroma intervention during the nursing care level 1 showed that the improvement in physical, mental, and cognitive function was expected to be higher at the time of intervention. Text-mining inspections have revealed that during the period of nursing care level 1 - 5, active horticultural therapy techniques, and passive horticultural therapy techniques such as HCT and brain rejuvenation aromatherapy were found to betweenness centrality with each other. Conclusion: From the results of mean score of DBD, although the nursing care level has progressed from 1 to a maximum of 5, it can be concluded that the burden of care has not become heavier. There was no tendency for the progression of cognitive impairment in this subject to be faster than in the general AD population, despite the influences of Covid-19. The results indicated that caregiving techniques and active and passive horticultural therapy techniques in Japanese welfare facilities for the elderly are expected to be effective in preventing the progression of cognitive impairment.
文摘Background: In Japan, due to the COVID-19 pandemic, various behavioral restrictions were implemented from March 2020, resulting in an increased number of elderly people with reduced participation in care and rehabilitation. As a result, the decline in motor and cognitive functions became more pronounced. Purpose: The study examined how activities combining passive horticultural therapy, which is always introduced, with active functional recovery training, which is used in the functional recovery training of patients with hemiplegia, influence the behavior of elder people using the facility. Methods: 36 elder people with care need 1 or 2 who regularly used the day-care facilities after the pandemic ended and who agreed to participate in the study was included. The assessment data were every three months from December 2021 to December 2023 after the COVID-19 pandemic, the MMSE and Moca-J, TMIG-Index, and GDS15. AI-based text mining was used to compare changes in visit reports before and after the introduction of the Posture Chart and Red Code, and the relationship between the language used. Results: The results of MMSE and Moca-J were both significantly higher in Group B and C than in Group A. TIMG assessment, was significantly higher in Group B and C than in Group A, and Group C was significantly higher than Group B. The GDS, an assessment of depression in old age, tended to be significantly higher in Group A than in Groups B and C. In the “Co-Occurrence Network Analysis” shown after the introduction of the latest functional recovery training equipment such as the Red Cord, its results showed a high association between the words Bathing and CARE and words such as POSTURE, Red-Code, and AI, App, which are used in functional training and rehabilitation, and their analysis. Conclusion: At day-care facilities specializing in functional recovery training and rehabilitation, a combination of horticultural therapy and the latest functional training equipment found to help maintain the physical and mental health of elderly people certified as requiring nursing care. Since this is a short-term study following behavioral restrictions, long-term research should continue to study the effects of adding functional training, handled by rehabilitation professionals, to horticultural therapy.
文摘Hairdressers are exposed to numerous skin-damaging factors, such as wet work, skin irritants, and thermal changes. Skin protection is a very important factor for the prevention of occupational skin disorders. Therefore, we evaluated a hand cream that was specially formulated for highly stressed skin with regard to its capability to reduce dry, rough, and scaly skin. The objective of this study was to conduct a controlled use test of a barrier repair cream containing pseudo-ceramide and demonstrate its efficacy for hairdressers with dry, sensitive hands and/or occupational skin disorders. A total of 30 hairdressers (29 females and 1 male, aged 20 - 67) participated in the study. All subjects suffered from dry hands. Subjects applied the test cream on their hands for 28 days (four weeks). For each subject, the skin surface topography of the hands was measured by the Surface Evaluation of Living Skin (SELS) system at day 14 (week 2) and day 28 (week 4). Dryness, scaling, cracking, redness, and itchiness were evaluated and graded by experts at week 2 and week 4, and then compared to baselines. All 30 subjects completed the study. A comparison of the changes from baseline to endpoint revealed a statistically significant reduction in skin roughness, scaling, and volume measured according to SELS. These data were confirmed by photographic documentation. The results were further supported by the expert evaluation. For the symptoms dryness and scaling, improvement could be observed in almost all regions of the hands. In addition, according to subjective assessments of overall hand skin condition and the hand cream, subjects reported clear improvement over time (p value below 0.001) and good efficacy of the product. In this study, the test hand cream showed excellent skin compatibility. Therefore, the hand cream may be effective for hairdressers with dry, sensitive hands and/or occupational skin disorders.
文摘Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at Dapaong regional hospital (DRH). Methodology: This was a prospective, descriptive cross-sectional study conducted from March to June 2022 in the DRH wards. Data were collected using a questionnaire and observation grid. Results: 90 care providers were surveyed. Males and non-physician personnel predominated with 57.8%, and 94.4% respectively. The survey on staff’s knowledge reported: 31.1% of practitioners did not wash their hands on arrival and departure in services. 24% did not know the difference between simple hand washing (SHW) and hygienic hand washing (HHW). 23.3% did not know the type of soap to use for HHW. The caregivers did not know the type of hand washing (HW) required after a septic and non-septic procedure in respectively 41.6%, and 37.8%. They did not know that there are two types of hand antiseptics (45.4%), nor the amount of antiseptic for HW (78.9%). The survey on staff’s attitude regarding HW found that: 70% did not remove all jewels prior HW, and 51.1% did not know that wearing gloves cannot replace the HW. For HW Staff Practice: 62.2% did not wash their hands before treatment. 91.1% did not spread the soap on their hands and forearms after wetting them. 65.55% did not rinse hands from nails to elbows. Conclusion: The HH was poorly known, the attitude of the staff was dangerous in relation to the HH and the practice of HH was very inadequate at the RHC-Dapaong. As a result, there is a need to retrain staff to increase their capacity to prevent care-related infections and enhance patient safety in the hospital.
文摘Background: 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. Aims: The aim is to assess the knowledge, practice and attitude of Palestinian physicians and nurses regarding hand hygiene in hospitals. Methods: 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. Data was collected using Hand Hygiene Questionnaire. Results: 200 nurses and physicians participated in this study. 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). Conclusion: 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.
文摘Background: A proper hand washing of community health care worker (CHCW) is universally accepted as an important factor in reducing Heath Care Associated Infections (HCAIs). This cross sectional study was done to assess the knowledge, the attitude and practice on hand hygiene among health science students in Aden University. Method: 329 participants from medical, dental and nursing schools completed the questionnaire (43.8% female and 56.2% males). 1<sup>st</sup>, 2<sup>nd</sup> and internship years were excluded from the study. The questionnaire is adapted from World Health Organization (WHO) tools for hand hygiene surveys. Epi info., an epidemiological software from the Centre of Disease Control (CDC), was used for data analysis. Results: Responses of the participants in the study indicated that the majority of the students were aware of Hand hygiene (>90%) and 60% have had some sort of training. There is an obvious lack of knowledge on hand movement i.e. my five moments of hand hygiene, particularly on the main source and route of cross contamination with pathogens in hospital setting. In hand hygiene practice, 95% of participants wash their hands before and after food intake, 85% of participants use soap and water, but 8% of participants use only water and very few use alcohol base cleansing agent. 84% of participants wash their hands after handling patient. There was no significant difference between males and females in hand hygiene practice. Conclusion: The study on assessment of knowledge, attitude & practice of students of medical sciences revealed that almost all participants were aware of hand hygiene. However, at this stage of assessment, knowledge and practice are below 100% score for the correct response in particular knowledge and practice.
文摘Acinetobacter baumanii is an opportunistic pathogen known to cause hospital acquired infection presenting with varying clinical feature from simply to much more severe manifestation. More importantly, widely improper and overuse of antibiotics consumption have caused an endemic of multidrug-resistant-Acinetobacter baumanii leading to prolonged hospital stay and poorer prognosis for intensive care patients. A descriptive study of pre- and post-education was conducted at an intensive care setting in Indonesia. The microbiology data were collected to evaluate the benefit of education on hand hygiene and management of antibiotic use to reduce the number of MDR-Acinetobacter baumanii infection. Based on the result of previous local susceptibility patterns, Cefoperazone/Sulbactam and Amikacin are favored as the empirical therapy. Chi-square analysis shows the significant reduction of Acinetobacter baumanii cases from 70.8% (17/24) to 38% (3/8) with P-value 0.006. Similarly, the susceptibility rate significantly increased, from 21% to 100% to Amikacin;from 5% to 89% to Piperacillin/Tazobactam, and from 42% to 89% to Meropenem. Education improving around hand hygiene, appropriate antibiotic prescribing following local hospital guidelines and the result of antibiotic susceptibility has been shown to reduce the transmission of MDR-Acinetobacter baumanii in the intensive care in our unit within this Indonesian hospital.
文摘Aim It is our opinion that the CDC and the WHO have underestimated cross-contamination under examination gloves in dental clinics while wearing jewelry, such as finger rings. These agencies only ＂recommend＂ removing jewelry, and only washing hands for 15 seconds with soap and warm water before donning gloves. This study examined several washing procedures and finger rings using simulated microbes. Methodology A gloved robber hand manikin was made and fitted with a flesh disposable vinyl glove. Four fingers were fitted with rings or no ring, dusted with simulated microbes, and washed with a scrub brush for 5, 15, and 25 seconds under 20℃ and 40℃ water alone, or with liquid hand soap. Light levels （in lux） of fluorescent powder before and after washing were measured and delta scores calculated for changes in light levels, equivalent to effectiveness of hand washing procedures. A full-factorial, 3-factor analysis of variance （ANOVA） was used to test for differences among levels of the three study factors-time, temperature, and soap use. Tukey＇s post hoc honestly significant difference （HSD） test was applied to significant factors to examine pair-wise differences between factor levels. Results It was found that the longer the hands with rings were washed with a scrub brush under flowing water, the more simulated microbes were removed. By 25 seconds, all methods were essentially the same. Simulated microbes were more difficult to remove from the palm compared to the back of the hand. The liquid hand soap used in this study was more effective with warm water than cold. When given a choice of washing with cold water up to 15 seconds, it would be preferable not to use soap to remove simulated microbes. Qualitatively, the outer surface of finger rings were more effectively cleaned than the crevice below the ring, and the ring with a stone setting appeared to accumulate and retain simulated microbes more than other rings. Conclusion The most effective treatment was washing with warm water and liquid soap. Longer times were more effective. Rings should not be worn under examination gloves due to difficulty cleaning in the crevice under the ring, and the well-known consequences of cross-contamination between the patient and the health care worker.
