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Article ; Online: Current issues in hand hygiene.

Boyce, John M

2023 Volume 51, Issue 11S, Page(s) A35–A43

Abstract: Background: Multiple aspects of hand hygiene have changed in recent years.: Methods: A PubMed search was conducted to identify recent articles about hand hygiene.: Results: The COVID-19 pandemic caused temporary changes in hand hygiene compliance ... ...

Abstract	Background: Multiple aspects of hand hygiene have changed in recent years. Methods: A PubMed search was conducted to identify recent articles about hand hygiene. Results: The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. Conclusions: Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
MeSH term(s)	Humans ; Hand Hygiene/methods ; Pandemics/prevention & control ; Hand Sanitizers ; Ethanol ; Hygiene ; Hand Disinfection/methods ; Guideline Adherence
Chemical Substances	Hand Sanitizers ; Ethanol (3K9958V90M)
Language	English
Publishing date	2023-10-26
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2023.02.003
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Article ; Online: Best products for skin antisepsis.

Boyce, John M

American journal of infection control

2023 Volume 51, Issue 11S, Page(s) A58–A63

Abstract: Background: Skin antiseptics are used for several purposes before surgical procedures, for bathing high-risk patients as a means of reducing central line-associated infections and other health care associated infections.: Methods: A PubMed search was ...

Abstract	Background: Skin antiseptics are used for several purposes before surgical procedures, for bathing high-risk patients as a means of reducing central line-associated infections and other health care associated infections. Methods: A PubMed search was performed to update the evidence on skin antiseptic products and practices. Results: Current guidelines for prevention of surgical site infections (SSIs) recommend preoperative baths or showers with a plain or antimicrobial soap prior to surgery, but do not make recommendations on the timing of baths, the total number of baths needed, or about the use of chlorhexidine gluconate (CGH)-impregnated cloths. Randomized controlled trials have demonstrated that pre-operative surgical hand antisepsis using an antimicrobial soap or alcohol-based hand rub yields similar SSI rates. Other studies have reported that using an alcohol-based hand rub caused less skin irritation, was easier to use, and required shorter scrub times than using antimicrobial soap. Current SSI prevention guidelines recommend using an alcohol-containing antiseptic for surgical site infection. Commonly used products contain isopropanol combined with either CHG or with povidone-iodine. Surgical site preparation protocols for shoulder surgery in men may need to include coverage for anaerobes. Several studies suggest the need to monitor and improve surgical site preparation techniques. Daily bathing of intensive care unit (ICU) patients with a CHG-containing soap reduces the incidence of central line-associated bloodstream infections (CLABSIs). Evidence for a similar effect in non-ICU patients is mixed. Despite widespread CHG bathing of ICU patients, numerous barriers to its effective implementation exist. Measuring CHG levels on the skin is useful for identifying gaps in coverage and suboptimal skin concentrations. Using alcohol-based products with at least 2% CHG for skin preparation prior to central line insertion reduces CLABSIs. Conclusions: Progress has been made on skin antisepsis products and protocols, but improvements in technique are still needed.
MeSH term(s)	Male ; Humans ; Soaps ; Anti-Infective Agents, Local ; Chlorhexidine ; Povidone-Iodine ; Antisepsis/methods ; Anti-Infective Agents ; Surgical Wound Infection/prevention & control ; Surgical Wound Infection/epidemiology ; Ethanol ; Skin ; Preoperative Care/methods ; 2-Propanol
Chemical Substances	Soaps ; Anti-Infective Agents, Local ; Chlorhexidine (R4KO0DY52L) ; Povidone-Iodine (85H0HZU99M) ; Anti-Infective Agents ; Ethanol (3K9958V90M) ; 2-Propanol (ND2M416302)
Language	English
Publishing date	2023-10-27
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2023.02.002
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Article ; Online: Quaternary ammonium disinfectants and antiseptics: tolerance, resistance and potential impact on antibiotic resistance.

Boyce, John M

Antimicrobial resistance and infection control

2023 Volume 12, Issue 1, Page(s) 32

Abstract: Background: Due to the substantial increase in the use of disinfectants containing quaternary ammonion compounds (QACs) in healthcare and community settings during the COVID-19 pandemic, there is increased concern that heavy use might cause bacteria to ... ...

Abstract	Background: Due to the substantial increase in the use of disinfectants containing quaternary ammonion compounds (QACs) in healthcare and community settings during the COVID-19 pandemic, there is increased concern that heavy use might cause bacteria to develop resistance to QACs or contribute to antibiotic resistance. The purpose of this review is to briefly discuss the mechanisms of QAC tolerance and resistance, laboratory-based evidence of tolerance and resistance, their occurrence in healthcare and other real-world settings, and the possible impact of QAC use on antibiotic resistance. Methods: A literature search was conducted using the PubMed database. The search was limited to English language articles dealing with tolerance or resistance to QACs present in disinfectants or antiseptics, and potential impact on antibiotic resistance. The review covered the period from 2000 to mid-Jan 2023. Results: Mechanisms of QAC tolerance or resistance include innate bacterial cell wall structure, changes in cell membrane structure and function, efflux pumps, biofilm formation, and QAC degradation. In vitro studies have helped elucidate how bacteria can develop tolerance or resistance to QACs and antibiotics. While relatively uncommon, multiple episodes of contaminated in-use disinfectants and antiseptics, which are often due to inappropriate use of products, have caused outbreaks of healthcare-associated infections. Several studies have identified a correlation between benzalkonium chloride (BAC) tolerance and clinically-defined antibiotic resistance. The occurrence of mobile genetic determinants carrying multiple genes that encode for QAC or antibiotic tolerance raises the concern that widespread QAC use might facilitate the emergence of antibiotic resistance. Despite some evidence from laboratory-based studies, there is insufficient evidence in real-world settings to conclude that frequent use of QAC disinfectants and antiseptics has promoted widespread emergence of antibiotic resistance. Conclusions: Laboratory studies have identified multiple mechanisms by which bacteria can develop tolerance or resistance to QACs and antibiotics. De novo development of tolerance or resistance in real-world settings is uncommon. Increased attention to proper use of disinfectants is needed to prevent contamination of QAC disinfectants. Additional research is needed to answer many questions and concerns related to use of QAC disinfectants and their potential impact on antibiotic resistance.
MeSH term(s)	Humans ; Disinfectants/pharmacology ; Disinfectants/chemistry ; Anti-Infective Agents, Local/pharmacology ; Ammonium Compounds ; Quaternary Ammonium Compounds/pharmacology ; Pandemics/prevention & control ; COVID-19 ; Drug Resistance, Microbial ; Bacteria ; Anti-Bacterial Agents/pharmacology
Chemical Substances	Disinfectants ; Anti-Infective Agents, Local ; Ammonium Compounds ; Quaternary Ammonium Compounds ; Anti-Bacterial Agents
Language	English
Publishing date	2023-04-13
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2666706-X
ISSN	2047-2994 ; 2047-2994
ISSN (online)	2047-2994
ISSN	2047-2994
DOI	10.1186/s13756-023-01241-z
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Article: John W. Ferree, M.D., M.P.H. (1904-1975).

Boyce, V S

The Sight-saving review

1975 Volume 45, Issue 3, Page(s) 99–100

MeSH term(s)	Blindness/prevention & control ; History, 20th Century ; Humans ; Preventive Medicine/history ; United States
Language	English
Publishing date	1975
Publishing country	United States
Document type	Biography ; Historical Article ; Journal Article
ZDB-ID	145051-7
ISSN	0037-4822
ISSN	0037-4822
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Article: Obituary. John W. Ferree, MD., M.P.H. 1904-1975.

Boyce, V S

American journal of ophthalmology

1976 Volume 81, Issue 1, Page(s) 111–112

MeSH term(s)	History, 20th Century ; Ophthalmology/history ; Preventive Medicine/history ; United States
Language	English
Publishing date	1976-01
Publishing country	United States
Document type	Biography ; Historical Article ; Journal Article
ZDB-ID	80030-2
ISSN	1879-1891 ; 0002-9394
ISSN (online)	1879-1891
ISSN	0002-9394
DOI	10.1016/0002-9394(76)90207-5
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Ul I Zs.39: Show issues

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Article ; Online: Hand Hygiene, an Update.

Boyce, John M

Infectious disease clinics of North America

2021 Volume 35, Issue 3, Page(s) 553–573

Abstract: Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical ... ...

Abstract	Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.
MeSH term(s)	Cross Infection/prevention & control ; Guideline Adherence/statistics & numerical data ; Hand Disinfection ; Hand Hygiene/trends ; Humans ; Infection Control/methods
Language	English
Publishing date	2021-07-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1077676-x
ISSN	1557-9824 ; 0891-5520
ISSN (online)	1557-9824
ISSN	0891-5520
DOI	10.1016/j.idc.2021.04.003
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Article ; Online: A review of wipes used to disinfect hard surfaces in health care facilities.

Boyce, John M

American journal of infection control

2020 Volume 49, Issue 1, Page(s) 104–114

Abstract: Background: Despite a plethora of wipes available for use in health care facilities, there is a paucity of articles describing wipe composition, potential interactions between wipes and disinfectants, the manner in which wipes are used, and their ... ...

Abstract	Background: Despite a plethora of wipes available for use in health care facilities, there is a paucity of articles describing wipe composition, potential interactions between wipes and disinfectants, the manner in which wipes are used, and their relative efficacy. The purpose of this article is to provide an in-depth review of wipes used for disinfection of hard surfaces in health care settings. Methods: Comprehensive searches of the Pubmed database and Internet were conducted, and articles published from 1953 through September 2019 and pertinent on-line documents were reviewed. Bibliographies of relevant articles were reviewed. Results: Wipes vary considerably in their composition, and the disinfectants with which they are used. With reusable dry wipes, the ratio of wipe material to disinfectant and the amount of disinfectant absorbed by the wipe and delivered to surfaces is difficult to standardize, which may affect their efficacy. The manner in which wipes are used by health care personnel is highly variable, due in part to insufficient instructions for use and inadequate education of relevant personnel. Conclusions: Additional research is needed regarding the best practices for using different types of wipes, improved methods for educating staff, and establishing the relative efficacy of wipes in reducing environmental contamination and health care-associated infections.
MeSH term(s)	Cross Infection/prevention & control ; Delivery of Health Care ; Disinfectants ; Disinfection ; Health Facilities ; Humans
Chemical Substances	Disinfectants
Language	English
Publishing date	2020-06-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2020.06.183
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Article ; Online: Alcohol-Based Handrubs and Influenza A.

Boyce, John M

mSphere

2019 Volume 4, Issue 6

MeSH term(s)	Hand Hygiene ; Humans ; Influenza, Human ; Mucus ; Orthomyxoviridae
Language	English
Publishing date	2019-11-27
Publishing country	United States
Document type	Letter ; Comment
ISSN	2379-5042
ISSN (online)	2379-5042
DOI	10.1128/mSphere.00787-19
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Article ; Online: In-use contamination of a hospital-grade disinfectant.

Boyce, John M / Havill, Nancy L

American journal of infection control

2022 Volume 50, Issue 12, Page(s) 1296–1301

Abstract: Background: Microbiological monitoring of disinfection of high-touch surfaces identified heavy growth of Serratia marcescens and Achromobacter xylosoxidans not present on surfaces before disinfection, suggesting contamination of the disinfectant used.!## ...

Abstract	Background: Microbiological monitoring of disinfection of high-touch surfaces identified heavy growth of Serratia marcescens and Achromobacter xylosoxidans not present on surfaces before disinfection, suggesting contamination of the disinfectant used. Methods: An investigation included interview of the housekeeper involved, level of bacterial contamination of the in-use quaternary ammonium (Quat) disinfectant, bactericidal activity of the contaminated disinfectant, pulsed field gel electrophoresis of S.marcescens and Achromobacter isolates, survival of S. marcescens on dry surfaces, and genome sequencing to identify possible Quat resistance genes. Results: The housekeeper, who seldom cleaned patient rooms, had used the disinfectant for months without emptying and drying the bucket between uses. The contaminated disinfectant contained 9.3 × 10 Conclusions: Failure to follow existing guidelines and manufacturer's instructions for use resulted in contamination by A. xylosoxidans and by S. marcescens that possessed multiple genes associated with Quat resistance.
MeSH term(s)	Humans ; Disinfectants/pharmacology ; Serratia marcescens/genetics ; Disinfection ; Drug Contamination ; Hospitals
Chemical Substances	Disinfectants
Language	English
Publishing date	2022-03-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2022.03.008
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Article ; Online: Pilot study of using thermal imaging to assess hand hygiene technique.

Boyce, John M / Martinello, Richard A

American journal of infection control

2022 Volume 50, Issue 11, Page(s) 1208–1211

Abstract: Background: Currently, there is no standard method for assessing hand hygiene (HH) technique. We explored the use of thermal imaging to determine if alcohol-based sanitizer (ABHS) has been applied to fingertips and thumbs, areas often missed by ... ...

Abstract	Background: Currently, there is no standard method for assessing hand hygiene (HH) technique. We explored the use of thermal imaging to determine if alcohol-based sanitizer (ABHS) has been applied to fingertips and thumbs, areas often missed by healthcare personnel. Methods: A FLIR thermal camera attached to an iPhone with FLIR app was used to obtain thermal images of volunteers' dominant hand before and after performing HH with an ABHS. Temperature readings of the mid-palm area, and tips of 3 Results: In 11 of 12 volunteers, thermal images revealed significant decreases in mid-palm, finger and thumb temperatures after performing HH (P < .01 for all sites), confirming visual assessment of coverage. When HH was performed without including the thumb, a lack of colorimetric change in the thumb was visible. For persons with "cold" fingers at baseline, assessing ABHS coverage of the fingers was more difficult. Conclusions: Thermal imaging of HH performance shows promise for assessing HH technique. Additional studies involving a larger number of persons under varying conditions are needed to establish if thermal imaging can be a practical modality for teaching or monitoring HH technique.
MeSH term(s)	Humans ; Hand Hygiene/methods ; Pilot Projects ; Hand Disinfection/methods ; Hand ; Ethanol ; Guideline Adherence ; Cross Infection
Chemical Substances	Ethanol (3K9958V90M)
Language	English
Publishing date	2022-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	392362-9
ISSN	1527-3296 ; 0196-6553
ISSN (online)	1527-3296
ISSN	0196-6553
DOI	10.1016/j.ajic.2022.07.015
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