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      Umsetzung des Arbeitsschutzes während der SARS-CoV-2-Pandemie in Friseursalons Translated title: Implementation of occupational health and safety during the SARS-CoV-2 pandemic in hairdressers’ salons

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          Abstract

          Hintergrund

          Zur Einhaltung (Adhärenz) von Arbeitsschutzvorgaben bestehen in Deutschland wenig empirische Erkenntnisse. Empfehlungen zur Prävention von SARS-CoV-2-Infektionen im Friseurhandwerk wurden im Frühjahr 2020 von der Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW) in einem Arbeitsschutzstandard bereitgestellt.

          Fragestellung

          Inwieweit werden die Inhalte der Empfehlungen in dieser Branche aus Sicht von Friseurkund:innen umgesetzt und eingehalten?

          Material und Methoden

          Die Erhebung erfolgte als verdeckte teilnehmende Beobachtungsstudie zwischen Anfang Oktober und Mitte Dezember 2020 als nichtsystematische Gelegenheitsstichprobe in 3 Städten. Das standardisierte Erhebungsinstrument umfasste 3 Bereiche: a) Maßnahmen allgemeiner Art, vorwiegend technischer Art, b) im Kontakt mit der Kundin/dem Kunden und c) auf individueller Ebene zur Infektionsprävention. Die Ergebnisse auf Einzel- und Gesamtebene wurden in einem standardisierten Summenindex (0–1) zur SARS-CoV-2-Arbeitsschutzstandard-Adhärenz zusammengefasst. Mittels nonparametrischem Wilcoxon-Test wurden mögliche Unterschiede zwischen den 3 Subindizes geprüft.

          Ergebnisse

          Der Gesamtindex zur Adhärenz von 162 Beobachtungen beträgt 0,75 (SD: 0,14). Die Werte der beiden Subindizes zur Infektionsprävention im Kontakt mit dem/der Kund:in (z. B. Hinweis auf Verhaltensregeln) und auf individueller Schutzebene (Tragen einer Mund-Nasen-Bedeckung) sind signifikant besser als der zu allgemeinen Maßnahmen (z. B. Händereinigungsmöglichkeit für Kund:innen).

          Diskussion

          Die beobachtete Adhärenz zur Vermeidung von SARS-CoV-2-Infektionen in Friseurbetrieben ist höher, als dies subjektive Erfahrungen der BGW zur Arbeitsschutzadhärenz nahelegen. Dies könnte auch mit der in der Öffentlichkeit diskutierten Infektionsgefährdung erklärt werden. Die Ergebnisse weisen eine leicht niedrigere Adhärenz im Vergleich mit Erkenntnissen auf, die in rund 400 standardisierten Befragungen durch die BGW-Präventionsdienste gewonnen wurden.

          Limitationen

          Angesichts der nichtsystematischen Gelegenheitsstichprobe kann eine (positive) Verzerrung der Ergebnisse nicht ausgeschlossen werden.

          Translated abstract

          Background

          There is little empirical evidence with respect to the implementation (adherence) of occupational health and safety guidelines in Germany. Recommendations for the prevention of SARS-CoV‑2 infections in hairdressing services were provided by the German Statutory Accident Insurance for the Health and Welfare Services (BGW) in an occupational health and safety (OHS) standard in spring 2020.

          Research question

          To what extent are the recommendations adhered to in this service profession as judged by hairdresser’s customers after their visits?

          Material and methods

          The survey was conducted as a covert participant observational study between the beginning of October and the middle of December 2020 as a non-systematic opportunistic sample in three cities. The standardized checklist included three domains: a) measures of general, mainly technical nature, b) in contact with the customer and c) on an individual level for infection prevention.

          The results on domain and overall level were summarized in a standardized sum index (0–1) of SARS-CoV‑2 OHS standard adherence. Nonparametric Wilcoxon tests were used to examine possible differences among the three subindices.

          Results

          The overall adherence index of 162 observations was 0.75 (SD 0.14). The two subindices on infection prevention in contact with the customer (e.g. indications for behavior rules) and on the individual level (e.g. wearing a mouth-nose covering) were significantly better than the one on general measures (e.g., hand cleaning possibility for customers).

          Discussion

          The observed adherence for prevention of SARS-CoV-2-infections in hairdresser salons was higher than experiences of the BGW on OHS adherence suggest. This might be explained by the general public awareness of risks of infection. The results on the adherence are only slightly lower than those resulting from around 400 standardized personal surveys of the BGW prevention services.

          Limitations

          Given the non-systematic opportunistic sample, a (positive) bias in the adherence results cannot be excluded.

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          Most cited references 13

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          Systematic review of studies on compliance with hand hygiene guidelines in hospital care.

          To assess the prevalence and correlates of compliance and noncompliance with hand hygiene guidelines in hospital care. A systematic review of studies published before January 1, 2009, on observed or self-reported compliance rates. Articles on empirical studies written in English and conducted on general patient populations in industrialized countries were included. The results were grouped by type of healthcare worker before and after patient contact. Correlates contributing to compliance were grouped and listed. We included 96 empirical studies, the majority (n = 65) in intensive care units. In general, the study methods were not very robust and often ill reported. We found an overall median compliance rate of 40%. Unadjusted compliance rates were lower in intensive care units (30%-40%) than in other settings (50%-60%), lower among physicians (32%) than among nurses (48%), and before (21%) rather than after (47%) patient contact. The majority of the time, the situations that were associated with a lower compliance rate were those with a high activity level and/or those in which a physician was involved. The majority of the time, the situations that were associated with a higher compliance rate were those having to do with dirty tasks, the introduction of alcohol-based hand rub or gel, performance feedback, and accessibility of materials. A minority of studies (n = 12) have investigated the behavioral determinants of hand hygiene, of which only 7 report the use of a theoretical framework with inconclusive results. Noncompliance with hand hygiene guidelines is a universal problem, which calls for standardized measures for research and monitoring. Theoretical models from the behavioral sciences should be used internationally and should be adapted to better explain the complexities of hand hygiene.
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            Absence of Apparent Transmission of SARS-CoV-2 from Two Stylists After Exposure at a Hair Salon with a Universal Face Covering Policy — Springfield, Missouri, May 2020

            On May 12, 2020 (day 0), a hair stylist at salon A in Springfield, Missouri (stylist A), developed respiratory symptoms and continued working with clients until day 8, when the stylist received a positive test result for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). A second hair stylist (stylist B), who had been exposed to stylist A, developed respiratory symptoms on May 15, 2020 (day 3), and worked with clients at salon A until day 8 before seeking testing for SARS-CoV-2, which returned a positive result on day 10. A total of 139 clients were directly serviced by stylists A and B from the time they developed symptoms until they took leave from work. Stylists A and B and the 139 clients followed the City of Springfield ordinance* and salon A policy recommending the use of face coverings (i.e., surgical masks, N95 respirators,† or cloth face coverings) for both stylists and clients during their interactions. Other stylists at salon A who worked closely with stylists A and B were identified, quarantined, and monitored daily for 14 days after their last exposure to stylists A or B. None of these stylists reported COVID-19 symptoms. After stylist B received a positive test result on day 10, salon A closed for 3 days to disinfect frequently touched and contaminated areas. After public health contact tracings and 2 weeks of follow-up, no COVID-19 symptoms were identified among the 139 exposed clients or their secondary contacts. The citywide ordinance and company policy might have played a role in preventing spread of SARS-CoV-2 during these exposures. These findings support the role of source control in preventing transmission and can inform the development of public health policy during the COVID-19 pandemic. As stay-at-home orders are lifted, professional and social interactions in the community will present more opportunities for spread of SARS-CoV-2. Broader implementation of masking policies could mitigate the spread of infection in the general population.
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              Factors influencing the implementation of clinical guidelines for health care professionals: A systematic meta-review

              Background Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field. Methods A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1) screening on the basis of references and abstracts and (2) screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews. Results Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all) of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals – e.g., awareness of the existence of the guideline and familiarity with its content – likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for instance, co-morbidity reduces the chance that guidelines are followed. Finally, environmental characteristics may influence guideline implementation. For example, a lack of support from peers or superiors, as well as insufficient staff and time, appear to be the main impediments. Conclusion Existing reviews describe various factors that influence whether guidelines are actually used. However, the evidence base is still thin, and future sound research – for instance comparing combinations of implementation strategies versus single strategies – is needed.
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                Author and article information

                Contributors
                michaelis@ffas.de
                Journal
                Zentralbl Arbeitsmed Arbeitsschutz Ergon
                Zentralbl Arbeitsmed Arbeitsschutz Ergon
                Zentralblatt Fur Arbeitsmedizin, Arbeitsschutz Und Ergonomie
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0944-2502
                2198-0713
                15 June 2021
                15 June 2021
                : 1-7
                Affiliations
                [1 ]FFAS – Freiburger Forschungsstelle Arbeits- und Sozialmedizin, Bertoldstr. 63, 79098 Freiburg, Deutschland
                [2 ]GRID grid.491653.c, ISNI 0000 0001 0719 9225, Abt. Arbeitsmedizin/Gefahrstoffe/Gesundheitswissenschaften, , Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege (BGW), ; Hamburg, Deutschland
                Article
                433
                10.1007/s40664-021-00433-x
                8204058
                © The Author(s) 2021

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