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a
f
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pa
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n
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a
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r
c
o
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t
pa
t
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n
t
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nv
i
r
o
nm
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n
t
[
6
-
8
].
Da
t
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t
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by
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r
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hy
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t
s
f
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r
h
a
n
d
hy
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a
s
f
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ll
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ws
:
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n
c
e
b
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f
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c
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n
t
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c
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pa
t
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n
t
wa
s
24.
54%
,
b
e
f
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r
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c
l
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c
pr
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s
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75
%
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a
f
t
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s
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,
a
f
t
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r
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uc
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n
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h
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t
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t
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s
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t
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s
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.
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a
l
t
h
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m
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.
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Han
d
h
ygiene
c
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p
l
ian
c
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am
on
g
n
u
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s
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s
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m
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ly
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s
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c
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4.
2.
Han
d
h
ygiene
c
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p
l
ian
c
e
am
on
g
d
oc
t
or
s
Do
c
to
r
s
f
r
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que
n
t
l
y
pr
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f
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r
to
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h
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r
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l
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c
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pr
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(
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,
t
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r
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l
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a
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t
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c
t
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a
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d
f
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na
ll
y
be
f
o
r
e
to
uc
hi
ng
pa
t
i
e
n
t
(
20
%
)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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.
.
(
K
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291
5.
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d
a
f
t
e
r
c
o
n
t
a
c
t
w
i
t
h
t
he
pa
t
i
e
n
t
o
r
pa
t
i
e
n
t
e
nvi
r
o
nm
e
n
t
c
o
n
t
a
c
t
,
b
e
f
o
r
e
a
s
e
pt
i
c
pr
o
c
e
dur
e
s
,
a
n
d
a
f
t
e
r
e
x
po
s
ur
e
t
o
b
o
dy
f
l
u
i
d,
w
hi
c
h
i
s
W
HO
s
ugge
s
t
i
o
n
s
,
i
s
r
e
c
o
m
m
e
n
de
d
i
n
a
ll
g
u
i
de
li
ne
s
publi
s
h
e
d
i
nf
e
c
t
i
o
n
c
o
n
t
r
o
l
a
n
d
pu
bl
i
c
h
e
a
l
t
h
.
D
e
s
p
i
t
e
a
ll
t
h
e
s
e
gu
i
de
li
ne
s
f
o
r
h
a
n
d
hy
g
i
e
ne
i
n
he
a
l
t
h
c
a
r
e
uni
t
e
,
t
h
e
c
o
m
p
li
a
n
c
e
w
i
t
h
h
a
n
d
wa
s
hi
ng
i
s
s
t
i
ll
po
o
r
[
9
-
12
]
.
T
h
e
pr
e
s
e
n
t
s
t
udy
a
im
e
d
to
de
f
i
ne
t
h
e
c
o
m
p
li
a
n
c
e
o
f
h
a
n
d
h
y
g
i
e
n
e
a
m
o
n
g
h
e
a
l
t
hc
a
r
e
wo
r
ke
r
s
i
n
t
h
e
n
o
r
t
h
e
a
s
t
o
f
I
r
a
n
.
T
h
e
r
e
a
r
e
s
e
v
e
r
a
l
s
t
udi
e
s
o
n
t
h
e
c
o
m
p
li
a
n
c
e
o
f
ha
n
d
hy
g
i
e
n
e
a
m
o
n
g
HC
W
s
.
I
n
E
ur
o
pe
c
o
m
p
li
a
n
c
e
w
i
t
h
h
a
n
d
hy
g
i
e
n
e
w
a
s
d
if
f
e
r
e
n
t
i
n
t
h
e
r
e
po
r
t
s
r
a
n
g
i
n
g
f
r
o
m
33
t
o
65%
[
13
,
14
]
.
T
h
e
s
t
ud
y
i
n
T
ur
ke
y
s
h
o
we
d
th
a
t
h
a
n
d
wa
s
hi
ng
f
r
e
que
nc
y
a
m
o
n
g
h
e
a
l
t
h
c
a
r
e
wo
r
ke
r
wa
s
12.
9%
i
n
a
n
i
n
t
e
n
s
i
ve
c
a
r
e
u
ni
t
,
a
ls
o
ot
h
e
r
o
b
s
e
r
v
a
t
i
o
n
a
l
s
t
ud
i
e
s
s
h
o
w
t
h
a
t
h
a
n
d
s
we
r
e
wa
s
he
d
b
o
t
h
b
e
f
o
r
e
a
n
d
a
f
t
e
r
v
e
ni
pu
n
c
t
ur
e
i
n
o
nl
y
41
(
45.
1
%
)
c
a
s
e
s
[
15
,
16
]
.
I
n
I
r
a
n
,
t
h
e
r
e
a
r
e
f
e
w
s
t
ud
i
e
s
o
n
t
he
c
o
m
p
li
a
n
c
e
o
f
h
a
n
d
hy
g
i
e
n
e
.
M
o
r
e
o
v
e
r
,
thi
s
s
t
ud
y
a
tt
e
m
pt
e
d
to
m
e
a
s
ur
e
t
h
e
us
e
o
f
h
a
n
d
hy
g
i
e
n
e
t
e
c
hni
que
s
b
a
s
e
d
o
n
t
h
e
W
HO
f
i
ve
r
e
c
o
m
m
e
n
d.
T
h
e
r
e
s
e
a
r
c
h
e
r
s
i
n
va
r
i
e
s
s
t
ud
y
c
o
ns
i
de
r
e
d
t
h
a
t
m
o
s
t
o
f
t
h
e
h
e
a
l
t
h
wo
r
ke
r
s
pr
e
f
e
r
t
o
us
e
h
a
n
d
hy
g
i
e
n
e
a
f
t
e
r
c
o
n
t
a
c
t
w
i
t
h
t
h
e
p
a
t
i
e
n
t
o
r
t
h
e
pa
t
i
e
nt
s
'
e
nvi
r
o
nm
e
n
t
.
T
h
e
s
e
f
i
nd
i
ngs
l
e
a
d
t
o
t
h
e
a
s
s
u
m
p
t
i
o
n
t
h
a
t
HC
W
s
pr
e
f
e
r
t
o
pr
ot
e
c
t
t
h
e
m
s
e
l
ve
s
r
a
t
h
e
r
t
h
a
n
pa
t
i
e
n
t
s
[
17
-
20
].
T
h
e
gu
i
de
li
ne
s
o
f
W
HO
a
n
d
C
D
C
f
o
r
h
a
n
d
hy
g
i
e
n
e
i
n
h
e
a
l
t
hc
a
r
e
c
e
n
t
r
e
,
a
n
d
pr
e
ve
n
t
i
o
n
s
ugg
e
s
t
di
r
e
c
t
o
b
s
e
r
v
a
t
i
o
n
o
f
c
o
m
p
li
a
nc
e
a
n
d
m
e
a
s
ur
i
ng
t
h
e
us
e
o
f
h
a
n
d
hy
g
i
e
n
e
pr
o
duc
t
s
[
3
,
8
,
21
].
D
i
r
e
c
t
o
b
s
e
r
v
a
t
i
o
n
i
s
a
us
e
f
u
l
m
e
t
h
o
d
to
i
de
n
t
i
f
y
t
h
e
s
t
r
e
n
gt
h
s
a
n
d
we
a
k
n
e
s
s
e
s
o
f
h
a
n
d
hy
g
i
e
n
e
,
to
m
e
n
t
i
o
n
t
h
e
n
u
m
be
r
o
f
ha
n
d
hy
g
i
e
n
e
o
ppo
r
t
uni
t
i
e
s
,
f
o
r
de
f
i
ni
ng
t
h
e
t
e
c
hni
que
s
,
a
n
d
t
o
pr
o
vi
de
f
e
e
db
a
c
k
to
h
e
a
l
t
h
c
a
r
e
wo
r
ke
r
s
[
20
,
18
,
22
,
23
]
.
T
h
e
r
e
s
e
a
r
c
he
r
s
o
f
t
hi
s
s
t
ud
y
pr
e
f
e
r
to
e
s
t
i
m
a
t
e
t
h
e
c
o
m
p
li
a
n
c
e
o
f
h
a
n
d
hy
g
i
e
n
e
by
d
i
r
e
c
t
o
b
s
e
r
va
t
i
o
n
li
ke
m
a
ny
s
t
ud
i
e
s
i
n
t
h
e
li
t
e
r
a
t
ur
e
.
W
h
e
n
t
h
e
h
e
a
l
t
h
wo
r
ke
r
s
kn
o
w
t
h
a
t
t
h
e
y
a
r
e
un
de
r
o
b
s
e
r
v
a
t
i
o
n
,
h
a
n
d
hy
g
i
e
ne
e
f
f
i
c
i
e
n
c
y
u
s
ua
ll
y
im
pr
o
v
e
s
[
20
]
.
H
o
we
v
e
r
,
i
n
t
hi
s
s
t
ud
y
,
he
a
l
t
h
wo
r
ke
r
s
kn
e
w
t
h
a
t
t
h
e
y
we
r
e
u
n
de
r
o
b
s
e
r
v
a
t
i
o
n
,
b
ut
t
h
e
c
o
m
p
li
a
n
c
e
w
i
t
h
ha
n
d
hy
g
i
e
n
e
wa
s
v
e
r
y
l
o
w.
V
a
l
i
da
t
e
d
o
b
s
e
r
v
e
r
s
,
a
l
s
o
,
r
a
n
do
m
ly
s
e
l
e
c
t
i
n
g
t
h
e
l
o
c
a
t
i
o
n
s
a
n
d
da
y
s
hi
f
t
s
o
f
o
b
s
e
r
v
a
t
i
o
n
c
a
n
mi
n
im
i
z
e
t
h
e
o
b
s
e
r
v
e
r
bi
a
s
.
I
n
t
h
e
pr
e
s
e
n
t
s
t
udy
we
n
o
t
i
c
e
d
t
h
a
t
t
h
e
h
e
a
l
t
h
wo
r
ke
r
pr
e
f
e
r
t
o
us
e
s
o
a
p
a
n
d
wa
t
e
r
c
o
m
pa
r
e
d
to
a
l
c
o
h
o
l
-
b
a
s
e
d
d
i
s
i
n
f
e
c
t
e
d
h
a
n
d
hy
g
i
e
n
e
s
im
il
a
r
t
o
s
o
m
e
do
c
u
m
e
n
t
i
n
t
h
e
li
t
e
r
a
t
ur
e
;
h
o
we
v
e
r
,
a
l
c
o
ho
l
-
b
a
s
e
d
d
i
s
i
n
f
e
c
t
a
n
t
s
pr
o
vi
de
a
r
e
m
a
i
ni
ng
e
f
f
e
c
t
t
h
a
t
s
oa
p
a
n
d
wa
t
e
r
do
n
o
t
pr
o
vi
de
,
i
t
's
m
a
y
be
b
e
c
a
u
s
e
o
f
t
h
e
un
p
l
e
a
s
a
n
t
e
f
f
e
c
t
s
o
n
t
h
e
h
a
n
d
s
a
n
d
l
a
c
k
o
f
k
n
o
w
l
e
dge
c
o
n
c
e
r
ni
ng
i
t
s
b
e
n
e
f
i
t
s
.
6.
CONC
L
USI
ON
T
hi
s
s
t
udy
n
o
t
i
c
e
e
vi
de
nc
e
t
h
a
t
ha
n
d
hy
g
i
e
n
e
c
o
m
p
l
i
a
n
c
e
a
m
o
n
g
h
e
a
l
t
h
wo
r
ke
r
s
i
s
s
o
l
o
w.
Al
t
h
o
ugh
t
h
e
h
a
n
d
hy
g
i
e
ne
m
e
t
h
o
ds
a
r
e
s
i
m
p
l
e
,
t
h
a
t
m
a
y
b
e
b
e
c
a
us
e
o
f
t
h
e
l
a
c
k
o
f
m
o
t
i
v
a
t
i
o
n
a
n
d
i
nc
r
e
a
s
e
d
wo
r
kl
o
a
d,
s
o
i
t
s
n
e
e
d
t
o
de
s
i
g
n
h
a
n
d
hy
g
i
e
n
e
pr
o
m
o
t
i
o
n
pr
ogr
a
m
m
e
s
i
n
t
hi
s
he
a
l
t
h
c
e
n
t
r
e
s
.
I
n
a
ddi
t
i
o
n
,
ha
n
d
hy
g
i
e
ne
t
r
a
i
ni
ng
a
n
d
pr
o
m
o
t
i
o
n
i
n
t
h
e
h
o
s
p
i
t
a
l
s
h
o
u
l
d
i
nc
l
ude
t
h
e
i
n
t
r
o
duc
t
i
o
n
o
f
a
l
c
o
h
o
l
-
b
a
s
e
d
ha
n
d
r
ub
s
a
s
a
n
a
v
a
il
a
bl
e
a
n
d
e
f
f
e
c
t
i
v
e
o
pt
i
o
n
f
o
r
t
h
e
h
a
n
d
hy
g
i
e
ne
.
RE
F
E
R
E
NC
E
S
[
1]
K
araas
l
a
n
A
,
K
e
p
e
n
ek
l
i
K
ad
a
y
i
f
c
i
E
,
A
t
ı
cı
S,
S
i
l
i
U
,
So
y
s
al
A
,
Çu
l
h
a
G
,
e
t
al
.
"
C
o
m
p
l
i
a
n
c
e
o
f
H
e
al
t
h
c
ar
e
W
o
r
k
e
rs
w
i
t
h
H
a
n
d
H
y
g
i
e
n
e
Pra
c
t
i
ce
s
i
n
N
eo
n
at
al
a
n
d
P
e
d
i
at
ri
c
In
t
en
s
i
v
e
Car
e
U
n
i
t
s
:
O
v
e
rt
O
b
s
e
rv
at
ion
,"
In
t
er
d
i
s
ci
p
P
er
s
p
ect
In
f
ec
t
D
i
s
.
2
0
1
4
;
2
0
1
4
:
3
0
6
4
7
8
.
[2
]
Y
a
w
s
o
n
A
E
,
H
e
s
s
e
A
A
.
"
H
an
d
H
y
g
i
en
e
Pra
c
t
i
ces
a
n
d
R
e
s
o
u
r
ce
s
i
n
a
T
e
a
c
h
i
n
g
H
o
s
p
i
t
a
l
i
n
G
h
a
n
a
,"
J
In
f
ect
.
;
7
(
0
4
):
3
3
8
-
47
,
2
0
1
3
.
[3
]
Bo
y
ce
J
M,
Pi
t
t
e
t
D
.
"
G
u
i
d
el
i
n
e
f
o
r
H
a
n
d
H
y
g
i
e
n
e
i
n
H
e
a
l
t
h
-
Car
e
S
e
t
t
i
n
g
s
:
R
ec
o
mmen
d
at
i
o
n
s
o
f
t
h
e
H
e
a
l
t
h
c
ar
e
I
n
f
ec
t
i
o
n
C
o
n
t
ro
l
Pra
c
t
i
ce
s
A
d
v
i
s
o
r
y
C
o
mm
i
t
t
ee
a
n
d
t
h
e
H
I
CPA
C/
SH
E
A
/
A
P
I
C/
I
D
S
A
H
a
n
d
H
y
g
i
en
e
T
as
k
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