Abstract
BackgroundHand hygiene is a critical component of infection control. Much of the focus on improving hand hygiene in healthcare settings has been directed towards healthcare worker compliance but its importance for patients, including those in long-term care facilities (LTCFs), is increasingly being recognised. Alcohol-based hand rub (ABHR) can lead to improved compliance. We aimed to determine acceptability and tolerability of two ABHRs for hand hygiene of elderly LTCF residents using a modified version of the WHO protocol.MethodsThirty six elderly LTCF residents participated in this crossover study. A modified and translated (Chinese) version of the WHO protocol for evaluation of two or more ABHRs was used to determine product acceptability and tolerability for one gel (bottle with reclosable cap) and one foam (pump). During the 3-day testing period, participants were provided with their own portable bottle of ABHR. A research nurse objectively assessed the skin integrity of the hands at baseline and throughout the study. Skin moisture content was determined using a Scalar Moisture Checker Probe (Science Technology Resources, Ca, USA). Participants rated ABHR tolerability and acceptability using the WHO checklist at the end of each test period.ResultsBoth products passed the WHO criteria for acceptability and tolerability. The foam (86%) scored higher than the gel (51%) for ease of use possibly because some participants found the cap of the gel bottle difficult to open due to finger stiffness. No evidence of damage to skin integrity was observed. Overall, skin moisture content had improved by the end of the study. Residents preferred either of the test products to the liquid formulation currently in use by the LTCF.ConclusionsOverall, the elderly were willing to use ABHR for hand hygiene. Both products were well tolerated and preferred over the usual product provided by the LTCF. However, forgetfulness and difficulty rubbing the product over the hands due to finger stiffness posed a challenge for some residents. This could be overcome by using healthcare worker-assisted hand hygiene at specified times each day and prompts to serve as reminders to perform hand hygiene.
Highlights
Hand hygiene is a critical component of infection control
Residents of long-term care facilities (LTCFs) are recognized as an important reservoir of multidrug resistant organisms (MDROs) in hospital settings [3, 4]
We aimed to investigate the acceptability and tolerability of two Alcohol-based hand rub (ABHR) for elderly residents in long-term care using a modified version of the World Health Organisation (WHO) Protocol Method 2 [15] for evaluation of two or more hand hygiene products
Summary
Much of the focus on improving hand hygiene in healthcare settings has been directed towards healthcare worker compliance but its importance for patients, including those in long-term care facilities (LTCFs), is increasingly being recognised. Colonized or infected residents may have MDRO contamination of their hands [5] Such hand contamination could lead to cross-transmission by direct contact with staff of the home or other residents [5], or indirectly via environmental contamination [2, 6]. In a separate study of MRSA nasal carriage, 95% (40/42) of elderly LTCF residents with proven nasal carriage, were culture positive for hand contamination with MRSA [8] Organisms such as MRSA and vancomycin resistant enterococci (VRE) can be transmitted indirectly via the environment [9]. This study did not include contact between staff and patients during patient care procedures
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