Educational technologies for teaching hand hygiene: Systematic review

Daiane Rubinato Fernandes; Bruna Nogueira dos Santos; Carolina Scoqui Guimarães; Elaine Barros Ferreira; Amanda Salles Margatho; Paula Elaine Diniz dos Reis; Didier Pittet; Renata Cristina de Campos Pereira Silveira

doi:10.1371/journal.pone.0294725

Peer Review History

Original SubmissionSeptember 11, 2023
10 Oct 2023 Decision Letter - Maria José Nogueira, Editor PONE-D-23-28730Educational technologies for teaching hand hygiene: systematic reviewPLOS ONE Dear Dr. Silveira, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The manuscript presents a systematic review of Educational technologies for teaching hand hygiene which continues to be a current topic, for health professionals, particularly for students. The 2 reviewers made very relevant comments that should be carefully considered by the authors. Please submit your revised manuscript by Nov 24 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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Please consider all of the attached reviewers' suggestions and respond to each one carefully. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Congratulations on the choice of the topic for the systematic review. Abstract Describe the main objetive of the study; Explain how the review was done; Summarize the most important results and their significance; Not exceed 300 words. At this point, it would be importante to clarify which target population was selected for the systematic review, as well as in which care contexts. Introduction At this point, it would be importante to demonstrate the worldwide of cross infections caused by improper hand hygiene or incorrect hand hygiene, whith a focus on the risks of mortality and morbidity. Materials and Methods 1. Clarify what type of descriptors were used for the DeCS/MeSH search in the research. 2. Clarify inclusion and exclusion criteria regarding the population (children, adults, elderly?) and the contexts. If all were included, state this explicitly. 3. Clarify the ethical issues inherent in a systematic review. Conclusion Given the richness of the topic, it could be improved by highlighting the conclusions obtained in research of this nature. It would be important to demonstrate what limitations/difficulties were encountered in this work and what suggestions the authors have for future research. Reviewer #2: 1) A Systematic Review (SR) of prevalence must include cross-sectional and longitudinal studies. I missed the inclusion of cohort studies to establish a causal relationship between the outcome and the exposure factor (non-hand hygiene). Therefore, for this relationship to be observed, data must be collected at different moments over time; 2) Prevalence SRs, when well designed and rigorously conducted, produce potential guiding and recommendation results for managers and health professionals in the development of specific policies for conditions that most affect and impact a given population. It is necessary for RS authors to be able to identify the different types of prevalence that are being presented in the included studies; 3) Describe in a clear and detailed way the items of the JBI tool that were most important for the analysis of methodological quality. Which questions had the greatest weight when considering the study with greater or lesser methodological quality?; 4) The discussion was approached in a very general way. Relate the findings of the studies included in the SR with the evidence available in the literature. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0294725.r001
Revision 1
30 Oct 2023 Author Response Dear Maria José Nogueira, Ph.D. Academic Editor PLOS ONE On behalf of all authors, I inform you that we proceeded with a thorough review of the manuscript based on the reviewers' observations and suggestions. We emphasize that all manuscript changes are marked with yellow highlights. In addition to the reviewers' requests, we also revised Table 6 to present the risk of bias assessment as recommended by JBI. The responses to the comments are described below: Reviewer #1: Congratulations on the choice of the topic for the systematic review. Abstract Describe the main objetive of the study; Explain how the review was done; Summarize the most important results and their significance; Not exceed 300 words. At this point, it would be importante to clarify which target population was selected for the systematic review, as well as in which care contexts. Response: We appreciate and accept the reviewer's suggestion. The main objective of the study was described in the Abstract: “To gather available scientific evidence on technologies used to teach hand hygiene to professional populations and lays involved in health care in the hospital setting”, clarifying the target population and the care context of the systematic review, which was professional populations and lays involved in health care in the hospital setting. We also better explained how the review was done. Introduction At this point, it would be importante to demonstrate the worldwide of cross infections caused by improper hand hygiene or incorrect hand hygiene, whith a focus on the risks of mortality and morbidity. Response: We appreciate and accept the reviewer's suggestion. To accomplish this request, we added the second and third paragraphs of the Introduction section: “The prevention of HAIs should be a priority action for healthcare organizations. According to the WHO, out of 100 patients, seven will acquire at least one healthcare-associated infection during their hospital stay, the risk doubles and may even increase 20 times in low- and middle-income countries. The sicker and more fragile patients become, the greater becomes the risk of HAI and their deathly consequences [3]. Infection prevention and control interventions can reduce infections in healthcare by 70%, specially HH programs can reduce the risk by more than half of dying as a result of infections, and also reduce associated long-term complications and healthcare costs [4].” Materials and Methods 1. Clarify what type of descriptors were used for the DeCS/MeSH search in the research. Response: We appreciate and accept the reviewer's suggestion. The DeCS/MeSH descriptors used for the search of this systematic review was described in page 4, and was: “technology”, “health technology” and “hand hygiene”. 2. Clarify inclusion and exclusion criteria regarding the population (children, adults, elderly?) and the contexts. If all were included, state this explicitly. Response: We appreciate and accept the reviewer's suggestion. Inclusion and exclusion criteria were rewritten on page 5 as: “This review included studies reporting primary, quantitative research findings identifying the use of educational technologies about HH among populations of health professionals, patients, family members and visitors involved in health care in the hospital setting, of any age group, published in English, Portuguese or Spanish, no data limit. Excluded from this review were case reports, case series, secondary studies (other reviews), editorials, letters to the editor, books, book chapters, guidelines, expert opinion articles, experience reports, conference proceedings and abstracts, dissertations and theses, in addition to studies outside the scope of this review”, clarifying that the population was health professionals, patients, family members and visitors, of any age group, in the context of health care in the hospital setting. 3. Clarify the ethical issues inherent in a systematic review. Response: We appreciate and accept the reviewer's suggestion. Since the review did not involve human participants, it did not require ethical committee approval. However, the authors conducted this review with a strong emphasis on transparency and reproducibility, avoiding bias, and ensuring a comprehensive and fair evaluation. This was clarified on page 6. Conclusion Given the richness of the topic, it could be improved by highlighting the conclusions obtained in research of this nature. It would be important to demonstrate what limitations/difficulties were encountered in this work and what suggestions the authors have for future research. Response: We appreciate and accept the reviewer's suggestion. We highlighted the conclusions obtained in this systematic review adding the paragraph: “The presentation of educational content on HH through technological resources such as mobile devices, virtual reality, and audio-visual reminders, among others, facilitates HH teaching in sharing and accessing information, and helping patients and family members learn the hand washing procedure. Furthermore, they are efficient tools for improving HHC rates among health professionals and open up opportunities for repetitive, efficient, and evidence-based learning”. We demonstrated the limitations/difficulties encountered in this work with the paragraph: “As a limitation, the small number of studies included in this review had different populations, interventions, and outcomes, due to these it was not possible to perform a metanalysis. Moreover, they have a vulnerable methodological quality, which can compromise generalization of the results to other contexts. However, the results presented in this review may support the development of new studies with other designs on the theme and its practical relevance.” We added the suggestions for future research with the paragraph: “The scientific literature gathered in this review also highlights the importance of encouraging the development of studies aiming to develop technologies for teaching such practice to the entire population. New studies with robust methodological approaches are needed to establish which technological tool for teaching HH is the most effective to be implemented”. Reviewer #2: 1) A Systematic Review (SR) of prevalence must include cross-sectional and longitudinal studies. I missed the inclusion of cohort studies to establish a causal relationship between the outcome and the exposure factor (non-hand hygiene). Therefore, for this relationship to be observed, data must be collected at different moments over time. Response: Thank you for your comment. We did not plan to conduct a prevalence review, as this review did not assess how many people did HH (yes- hand hygiene) and how many people did not (non-hand hygiene). Therefore, quasi-experimental studies and randomized clinical trials, were included. The studies addressed the use of technologies to teach professionals or lay populations (such as family members, visitors, relatives, and patients) about hand hygiene and to support and encourage their development for this purpose, as proposed in the objective of our review. Finally, given the heterogeneity of the included studies, we did not perform a meta-analysis of the obtained data. 2) Prevalence SRs, when well designed and rigorously conducted, produce potential guiding and recommendation results for managers and health professionals in the development of specific policies for conditions that most affect and impact a given population. It is necessary for RS authors to be able to identify the different types of prevalence that are being presented in the included studies. Response: Thank you for your comment. In this review, we did not intend to conduct a prevalence review with meta-analysis. While the topic of hand hygiene is broad and comprehensive, the use of technologies for teaching hand hygiene is still in its early stages, which would preclude analyses like prevalence meta-analyses. For this reason, we adhered to the objective of our review and included studies that addressed educational strategies for teaching hand hygiene, presenting the results in a descriptive manner. 3) Describe in a clear and detailed way the items of the JBI tool that were most important for the analysis of methodological quality. Which questions had the greatest weight when considering the study with greater or lesser methodological quality? Response: We appreciate and accept the reviewer's suggestion. To accomplish this request, we added three paragraphs below the subitem “Critical appraisal of the methodological quality” on page 10. 4) The discussion was approached in a very general way. Relate the findings of the studies included in the SR with the evidence available in the literature. Response: We appreciate and accept the reviewer's suggestion. To accomplish this request, we added and rewrite some paragraphs of the Discussion section, corroborating our findings with data from the literature. Renata Cristina de Campos Pereira Silveira RN PhD Associate Professor University of São Paulo Ribeirão Preto College of Nursing Attachments Attachment Submitted filename: Response to reviewers .pdf https://doi.org/10.1371/journal.pone.0294725.r002
7 Nov 2023 Decision Letter - Maria José Nogueira, Editor Educational technologies for teaching hand hygiene: systematic review PONE-D-23-28730R1 Dear Dr. Renata Cristina de Campos Pereira Silveira, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Maria José Nogueira, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Dear Autor All the concerns mentioned by the reviewers, were clarified by the authors, which provided greater clarity and robustness to the manuscript. Now the work complies with the journal's scientific requirements. The manuscript may be accepted for publication. Reviewers' comments: https://doi.org/10.1371/journal.pone.0294725.r003
Formally Accepted
4 Jan 2024 Acceptance Letter - Maria José Nogueira, Editor PONE-D-23-28730R1 PLOS ONE Dear Dr. Silveira, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Professor Maria José Nogueira Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0294725.r004

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