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Mindful hand hygiene and self-guided training using a Mobile Phone App
Event Type
Poster Presentation
TimeThursday, April 152:00pm - 3:00pm EDT
LocationEducation and Simulation
Description1. Application
• Diverse healthcare contexts (i.e., acute, post-acute care, care in the community, primary care, informal care, voluntary/charities).
• All healthcare workers (i.e., clinical, and non-clinical roles at different seniority levels).

2. Background
COVID-19 infection in HCWs is a critical risk factor in the healthcare system’s ability to manage the COVID- 19 pandemic. Appropriate hand hygiene practices are critical to protect HCW from acquisition of COVID-19 in the workplace. The use of alcohol-based hand rub (ABHR) or handwashing, is a simple yet effective way to prevent the spread of pathogens and infections.
Both WHO and the CDC have provided guidance on the correct hygiene technique. Further, WHO provide guidance on the key moments when health-care workers should perform hand hygiene (‘5 Moments for Hand Hygiene’). Hand hygiene is a key part of PPE donning/doffing. HCW wash their hands before commencing the task, and at the end. Further, if an error is made, the practice of HH restores the HCW to a safe state. A 2019 CDC study found that 90% of PPE practices by HCW were incorrect, resulting in an increased risk of infection.
Studies of the Ebola outbreak identified that, in addition to sufficient PPE training, achieving a reduction in HCW infections requires a multidisciplinary response that addresses HCW fears, stresses, and the risk of burnout. (Li, Y., Wang, H., Jin, X. et al., 2018).
The recruitment and training of HCW into frontline work during the current COVID-19 pandemic has given rise to the need to provide rapid training for HCW in the correct techniques for putting on and removing PPE (‘donning’ and ‘doffing’). As with any physical learning process it takes multiple repetitions to learn and memorise the protocol with feedback from a “spotter” to catch potential errors.
Currently, training for HCW typically involves a mix of theoretical training (accessible via hospital virtual learning environments) and practice-based classroom lessons. In addition, formal and ad hoc training is also provided on the ward. This is usually led by the hospital’s infection management team. Some hospitals are providing access to basic training materials using bespoke mobile phone Apps.
Staying in good physical and mental health, is essential to the response and management of COVID-19 (Smith, 2020). The COVID-19 pandemic is having profound impacts on the health and wellbeing of healthcare workers (Sim, 2020). Based on previous outbreaks, such as SARS, it is expected that health-care workers will be one of the occupational groups at highest risk of disease transmission (Yeung, 2004; Hsin & Macer, 2004). This increased risk along with the attendant increases in workload and fear of infecting family and household members, is likely to be associated with poorer mental health (Smith, 2020; Smith, Oudyk, Potter, Mustard, C., 2020).
As part of the response to the COVID pandemic, resources have been put in place throughout many countries to support HCW well-being and mental health, however, many of these are still in their infancy and not all HCW will have access to confidential listening, referral, and counselling services.
Mindfulness techniques are being used to manage stress pertaining to the impact of work stressors on wellbeing, performance, and safety, along with the management of the home/work interface (Mulcahy, 2019).
Given the high reported COVID-19 infection rate among HCW there is a significant potential for a technological support that will assist tired HCW be diligent in following the infection prevention and control protocols for hand hygiene and safe donning and doffing PPE. Augmented reality phone Apps are being introduced to support training in the WHO HH technique.
As defined in behaviour change literature, the least burdensome way to introduce a new behaviour is to attach it to another behaviour (Wood, W., & Neal, D. T. (2016). In relation to the hand hygiene and PPE donning/doffing task, mindfulness practices might be built into existing protocols. Further, potentially, new HH training technologies might also incorporate mindfulness, to address concomitant issues pertaining to HCW fears, stresses, and the risk of burnout.
Recent studies have found that strengthening employer-based infection control strategies is likely to have important implications for mental health symptoms among health-care workers (Smith, Oudyk, Potter, Mustard, C., 2020).
Given the high reported COVID-19 infection rate among HCW there is a significant potential for providing technological support to assist HCW in relation to training in the infection prevention and control protocols for hand hygiene and safe donning and doffing of PPE. Further, augmented reality mobile phone Apps are now being introduced to provide training in the WHO hand hygiene technique. Potentially, these technologies might also incorporate mindfulness, to address concomitant issues pertaining to HCW fears, stresses, and the risk of burnout.

3. Overview of the Presentation.
• Project background and rationale
• Technology opportunity and research objectives
• Rationale and background to selfcare approach and mindfulness approach
• Objective of technique
• Overview of stakeholder evaluation methods
• Results
o Learner journey
o Mindfulness approach
o Training for technique on mobile phone application
o Implementation
• Conclusions

4. Relevant Track.
Education and Simulation

5. Importance of the message and take away points.
Hand hygiene training plays a fundamental role in ensuring both staff and patient safety.
Wellness as a protective factor for effective and safe performance. Given the relationship between wellbeing, performance, and safety - healthcare organisations need to investigate how best to integrate existing health promotion and health protection (i.e., occupational health and safety) functions and activities.
Mindfulness is increasingly important in COVID context - providing an opportunity for self-care and protection (staff and patient safety).Mindfulness is an inexpensive strategy to reduce stress and improve the quality of the working lives of healthcare workers. However, it is not a substitute for professional counselling services.
As part of the response to the COVID pandemic, resources have been put in place throughout many countries to support HCW well-being and mental health, however, many of these are still in their infancy and not all HCW will have access to confidential listening, referral, and counselling services. This approach provides an opportunity for HCW to take time out to pause and prepare self for the next task ahead, to bolster resilience in the face of great trauma, promote well-being and self-compassion. This is not intended to be a substitute for professional counselling services.
This research has demonstrated the potential efficacy of both (1) integrating mindfulness in the HH task to address HCW stress, burnout, and trauma), and (2) the benefits of using a mobile phone APP for this purpose.
Mindfulness complements the hand hygiene task. Mindfulness can be used in combination with the WHO HH technique to bring attention to the moment. Mindfulness enables HCW to focus on the correct procedure for hand hygiene along with addressing the need for self-care.
The proposed mobile phone App concept can enable effective training in the mindful HH technique from home.
Mindful HH training form parts of a wider learner journey which includes addressing self-care and training in PPE donning and doffing. Overall, feedback for this approach has been positive. Further research will address the detailed specification of the mobile phone App. Further, it will investigate how mindful HH can be integrated with training in the wider PPE donning/doffing task, and the user of other technologies such as augmented reality kiosks.