Adequate Hand Research Articles

Prevention of respiratory infections at day care centers: recommendations and systematic review of the evidence.

Attending a day care center is a risk factor for respiratory infections. The objective of this study is to review which nonspecific prevention measures are recommended for day care centers and the evidence of their usefulness in this setting. Recommendations regarding nonspecific prevention at national level were searched using Google and the web sites of the Argentine Society of Pediatrics, the ministries of education and the ministries of health from different countries, both in English and Spanish. Recommendations regarding hand hygiene, clearance of secretions, cleaning the environment and elements, breastfeeding, and exclusion of symptomatic subjects were reviewed. A systematic search of the literature was conducted to find intervention studies at day care centers that evaluated the effectiveness of recommendations, published in Spanish and English. Results and the methodological quality of studies were analyzed. Seven guidelines were found. Hand hygiene and environment cleaning were the only recommendations described in all guidelines. The exclusion of symptomatic subjects is mentioned in all, but criteria are heterogeneous. Clearance of nasal secretions and promotion of breastfeeding are outlined only in a few of the guidelines. Eight intervention studies on hand hygiene, cleaning of the environment, and clearance of secretions were found, whose results were heterogeneous and had major methodological limitations. A timely and adequate hand hygiene and an appropriate cleaning of the environment have been uniformly recommended by different guidelines as non-specific prevention measures against respiratory infections. The evidence on the usefulness of these measures in this setting is limited.

Study of the role of mobile phones in the transmission of Hospital acquired infections

Nosocomial infections are an important cause of morbidity and mortality. The inanimate objects like mobile phones in the immediate environment of the patients can act as a source of infection. Infectious agents from patients can be transferred on to the hands of the health care workers and in the absence of adequate hand hygiene practices can be transferred on to the mobile phones during their use and this can serve as a vehicle for the transmission of nosocomial pathogens from one patient to another. <b>Aim:</b> To evaluate the role of mobile phones in the transmission of pathogens by health care workers in health care centres. <b>Materials and Methods:</b> Mobile phones and hands were tested for micro-organisms before and after application of a disinfectant. A total of 60 mobile phones were tested for micro organisms, 30 from the health care workers (study group) and 30 from relatives of patients attending Out Patient Department (control group). Swabs taken from their hands were also cultured. <b>Results:</b> Hands of all the health care workers and 27 mobile phones showed microorganisms on them. Only <i>Staphylococcus aureus</i> was isolated. The hands and mobile phones of 11 health care workers were contaminated with <i>Methicillin sensitive Staphylococcus aureus (MSSA)</i>. <i>Methicillin resistant Staphylococcus aureus (MRSA)</i> was isolated from the hands of 24 (80%) and mobile phones of 16 (53.3%) health care workers<i>.</i> Ethyl alcohol was found to be 100% effective in disinfecting hands and mobile phones. <b>Conclusions:</b> To prevent the potential spread of infections through mobile phones, strict infection control practices, hand hygiene, and routine decontamination of mobile phones with alcohol should be advocated to prevent the spread of infection in the hospital settings.

The Effect of Automated Monitoring and Real-Time Prompting on Nurses’ Hand Hygiene Performance

Adequate hand hygiene compliance by healthcare staff is considered an effective method to reduce hospital-acquired infections. The electronic system developed at Toronto Rehabilitation Institute automatically detects hand hygiene opportunities and records hand hygiene actions. It includes an optional visual hand hygiene status indication, generates real-time hand hygiene prompting signals, and enables automated monitoring of individual and aggregated hand hygiene performance. The system was installed on a complex continuous care unit at the entrance to 17 patient rooms and a utility room. A total of 93 alcohol gel and soap dispensers were instrumented and 14 nurses were provided with the personal wearable electronic monitors. The study included three phases with the system operating in three different modes: (1) an inactive mode during the first phase when hand hygiene opportunities and hand hygiene actions were recorded but prompting and visual indication functions were disabled, (2) only hand hygiene status indicators were enabled during the second phase, and (3) both hand hygiene status and real-time hand hygiene prompting signals were enabled during the third phase. Data collection was performed automatically during all of the three phases. The system indicated significantly higher hand hygiene activity rates and compliance during the third phase, with both hand hygiene indication and real-time prompting functions enabled. To increase the efficacy of the technology, its use was supplemented with individual performance reviews of the automatically collected data.

A hand hygiene intervention to decrease infections among children attending day care centers: design of a cluster randomized controlled trial

BackgroundDay care center attendance has been recognized as a risk factor for acquiring gastrointestinal and respiratory infections, which can be prevented with adequate hand hygiene (HH). Based on previous studies on environmental and sociocognitive determinants of caregivers’ compliance with HH guidelines in day care centers (DCCs), an intervention has been developed aiming to improve caregivers’ and children’s HH compliance and decrease infections among children attending DCCs. The aim of this paper is to describe the design of a cluster randomized controlled trial to evaluate the effectiveness of this intervention.Methods/designThe intervention will be evaluated in a two-arm cluster randomized controlled trial among 71 DCCs in the Netherlands. In total, 36 DCCs will receive the intervention consisting of four components: 1) HH products (dispensers and refills for paper towels, soap, alcohol-based hand sanitizer, and hand cream); 2) training to educate about the Dutch national HH guidelines; 3) two team training sessions aimed at goal setting and formulating specific HH improvement activities; and 4) reminders and cues to action (posters/stickers). Intervention DCCs will be compared to 35 control DCCs continuing usual practice. The primary outcome measure will be observed HH compliance of caregivers and children, measured at baseline and one, three, and six months after start of the intervention. The secondary outcome measure will be the incidence of gastrointestinal and respiratory infections in 600 children attending DCCs, monitored over six months by parents using a calendar to mark the days their child has diarrhea and/or a cold. Multilevel logistic regression will be performed to assess the effect of the intervention on HH compliance. Multilevel poisson regression will be performed to assess the incidence of gastrointestinal and respiratory infections in children attending DCCs.DiscussionThis is one of the first DCC intervention studies to assess HH compliance of both caregivers and children, as well as the incidence of gastrointestinal and respiratory infections in children, as outcome measures. When an effect of the intervention on improving HH compliance and/or reducing incidence of infections is shown, (inter)national dissemination of the intervention in other DCCs may be considered.Trial registrationNetherlands trial registry: NTR3000

Determining a Patient’s Comfort in Inquiring About Healthcare Providers’ Hand-Washing Behavior

To determine whether a patient's level of assertiveness and other factors influences her comfort level in asking her provider to wash his or her hands. In this pilot study, we developed a survey to gather cross-sectional information on a variety of factors that might explain patient willingness to ask her health-care provider to wash his or her hands. Three primary predictor variables are analyzed: (1) patient assertiveness; (2) patient familiarity with her healthcare provider; and (3) whether the patient has observed hand-washing behavior. Fifty patients participated from the Obstetrics and Gynecology Department of Metropolitan Hospital Center. Less assertive patients are much less likely than assertive patients to ask physicians to wash hands (25% versus 68%; Fisher's exact test P = 0.0427). Among the 3 assertiveness questions included in the survey, the ability to ask physicians questions during visits is most strongly indicative of willingness to ask about hand washing. Familiarity with the names of regular health-care providers has a statistically significant impact on willingness to ask about hand washing. Evidence suggests that observing hand washing behavior affects willingness to ask, but differences are not statistically significant. Results by socioeconomic status such as age, education, income, and race/ethnicity are inconclusive. A patient's level of assertiveness alone is not sufficient to determine her willingness to inquire about the hand-washing behavior of her provider. A high percentage of patients did not see their provider engaging in adequate hand washing behavior. If patients feel comfortable with their provider to inquire about their care and request hand-washing behavior, health outcomes are affected by reducing the rates of health care-associated infections.

How can compliance with hand hygiene be improved in specialized areas of a university hospital?

Hand hygiene is considered to be the pillar of infection control and prevention. Despite national and international recommendations on hand hygiene, compliance remains low. Basic requirements allowing adequate hand hygiene compliance, in theory at least, are well known. Why then is it so hard to achieve acceptable compliance despite sufficient access to hand disinfectant dispensers, repeated training, and participation in national campaigns? Could it be that hand hygiene is regarded as too laborious, and changes to the established work-flow are needed to increase compliance? Some practicable examples are presented and pitfalls in defining compliance are discussed. Ownership for compliance must come from within clinical teams, and not solely driven from the infection control team. Support from the hospital management is essential. Ideally, the concepts presented allow a simple and efficient implementation of hand hygiene as part of the clinical work-flow to achieve an increase in compliance in the longer term.

Typhoid fever: hurdles to adequate hand washing for disease prevention among the population of a peri-urban informal settlement in Fiji.

The Pacific island nation of Fiji Islands has high rates of endemic typhoid fever which is difficult to diagnose and often underreported. However, the majority of cases are preventable through use of safe water; adequate sanitation; vaccination; and, most sustainable of all, simple hygienic behaviour, such as hand washing with soap (HWWS). Despite many attempts by public health authorities, little progress has been made in the area of environmental adaptation and behaviour change. To explore perceptions of typhoid fever risk among urban squatters and behavioural determinants surrounding HWWS, indigenous Fijians living in informal settlements with high typhoid fever incidence were invited to participate in focus group discussions. In-depth interviews were conducted with community leaders. Perceptions of typhoid fever suggest confusion about risk factors, symptoms and communicability. Environmental barriers for hand washing were related to water and soap access. Standard social marketing approaches have been trialled with little clear evidence of impact. Despite this, we continue to advocate for the social and cultural determinants of typhoid prevention to remain central to future public health strategies. Despite behaviour change being notoriously difficult, we argue that community-driven behaviour adaptation initiatives based on sound epidemiological evidence and health communication theory are likely to have significant impact and greater likelihood of sustainability.

Comparison of Antimicrobial Effect of Alcohol Gel according to the Amount and Drying Time in Health Personnel Hand Hygiene

The purpose of this study was to compare the effect of alcohol gel according to the amount and drying time in health personnel hand hygiene and to promote in their practice adequate and effective hand hygiene. The cross-over experimental study was performed with 14 volunteers. Hands were artificially contaminated with 5 mL of 10⁸ CFU/mL of Serratia marcescens (ATCC 14756) and four different alcohol gel hand hygiene methods varying by the amount of alcohol gel (2 mL vs. 1 mL) and drying time (complete vs. incomplete) were compared. Samples were collected by glove juice sampling procedures. Mean log reduction values of the four different hand hygiene methods were 2.22±0.36, 1.26±0.53, 1.49±0.60, 0.89±0.47 respectively for the 4 groups: adequate amount (2mL) and complete dry (30 seconds rubbing followed by 2 min air-dry), inadequate amount (1 mL) and complete dry, adequate amount and incomplete dry (15 seconds rubbing and no air-dry), and inadequate amount and incomplete dry. The difference was statistically significant in the adequate amount and complete dry group compared to other three groups (p<.001). Only alcohol gel hand hygiene with adequate amount and complete drying was satisfactory by U.S. FDA-TFM efficacy requirements for antiseptic hand hygiene products.

Observance of hand washing procedures performed by the medical personnel after the patient contact. Part II

The Centers for Disease Control and Prevention (CDC) as well as the World Health Organization (WHO) state that adequate hand hygiene maintained by medical personnel is an indispensable prerequisite for controlling nosocomial infections. The recommendations of CDC and WHO emphasize the obligation to wash hands after each contact with a patient, after the exposure to a potentially infectious material or upon the contact with objects surrounding the patient. The study was performed by quasi-observation among the group of 188 medical staff members (nurses and physicians) working in three selected hospitals of the Łódź Province. The procedure of hand washing/disinfection performed directly after the patient contact according to the recommendations of CDC and WHO was observed. The results were subject to statistical analysis (p < 0.05). During 1544 h of observations, 4101 activities requiring hand washing were recorded. The medical personnel followed the hand hygiene procedures after the patient contact in 26.4% of the situations that require hygiene according to the guidelines. The level of observance of the hand washing procedures depended significantly on the type of performed activity, profession, degree of workload, index of activity, and time of duty hours. The mean time of hand washing after patient contact was 9.2 s for physicians and 6.7 s for nurses. Both the level of observance of hygienic procedures after the contact with patients as well as the time of hand washing are insufficient. There is an urgent need to work out educational programs on maintaining proper hand hygiene for medical personnel.

Improving Hand Hygiene Compliance in Hospitals by Design

Essential in reducing hospital-acquired infections is adequate hand hygiene (HH) among healthcare workers (HCWs). International studies show, however, that HH guidelines are adhered to in less than 50% of required times. Research into HH behavior has shown that self-reported compliance is often higher than observed compliance, which seems to indicate that HCWs are unaware of their HH behavior. In addition, because of its frequency, HH behavior could be considered an automatic (or subconscious) behavior. Therefore, a (temporary) shift from the subconscious to the conscious could be a solution to change current HH behavior and create new habits. These insights formed the points of departure of the design project described here, which aimed to develop an alcohol-based hand rub (ABHR) dispenser to stimulate HCWs to better adhere to the international guidelines of HH. In order to increase the chance of success of the new dispenser, a participatory design approach was applied, meaning that all stakeholders of the dispenser (nurses, physicians, infection control practitioners, housekeeping) were actively involved in the different phases of the development process.The development process of the new dispenser consisted of 5 phases: analysis, idea finding (identifying promising design directions), and 3 idea iterations. Interim ideas were evaluated using functional 3-dimensional prototypes and the results applied to further develop the final concept. Methods of user research included observations and individual and focus group interviews.

Commentary

Commentary

76 Viral Infections in Neonates

Infections are an important cause of mortality and morbidity in the neonatal period. In the past viral infections were difficult to diagnose. Since the introduction of sensitive molecular methods such...

Utilizing Improvement Science Methods to Improve Physician Compliance With Proper Hand Hygiene

In 2009, The Joint Commission challenged hospitals to reduce the risk of health care-associated infections through hand hygiene compliance. At our hospital, physicians had lower compliance rates than other health care workers, just 68% on general pediatric units. We used improvement methods and reliability science to increase compliance with proper hand hygiene to >95% by inpatient general pediatric teams. Strategies to improve hand hygiene were tested through multiple plan-do-study-act cycles, first by 1 general inpatient medical team and then spread to 4 additional teams. At the start of each rotation, residents completed an educational module and posttest about proper hand hygiene. Team compliance data were displayed daily in the resident conference room. Real-time identification and mitigation of failures by a hand-washing champion encouraged shared accountability. Organizational support ensured access to adequate hand hygiene supplies. The main outcome measure was percent compliance with acceptable hand hygiene, defined as use of an alcohol-based product or hand-washing with soap and turning off the faucet without using fingers or palm. Compliance was defined as acceptable hand hygiene before and after contact with the patient or care environment. Covert bedside observers recorded at least 8 observations of physicians' compliance per day. Physician compliance with proper hand hygiene improved to >95% within 6 months and was sustained for 11 months. Instituting a hand-washing champion for immediate identification and mitigation of failures was key in sustaining results. Improving physician compliance with proper hand hygiene is achievable and a first step in decreasing health care-associated infections.

Improved ICU design reduces acquisition of antibiotic-resistant bacteria: a quasi-experimental observational study

IntroductionThe role of ICU design and particularly single-patient rooms in decreasing bacterial transmission between ICU patients has been debated. A recent change in our ICU allowed further investigation.MethodsPre-move ICU-A and pre-move ICU-B were open-plan units. In March 2007, ICU-A moved to single-patient rooms (post-move ICU-A). ICU-B remained unchanged (post-move ICU-B). The same physicians cover both ICUs. Cultures of specified resistant organisms in surveillance or clinical cultures from consecutive patients staying >48 hours were compared for the different ICUs and periods to assess the effect of ICU design on acquisition of resistant organisms.ResultsData were collected for 62, 62, 44 and 39 patients from pre-move ICU-A, post-move ICU-A, pre-move ICU-B and post-move ICU-B, respectively. Fewer post-move ICU-A patients acquired resistant organisms (3/62, 5%) compared with post-move ICU-B patients (7/39, 18%; P = 0.043, P = 0.011 using survival analysis) or pre-move ICU-A patients (14/62, 23%; P = 0.004, P = 0.012 on survival analysis). Only the admission period was significant for acquisition of resistant organisms comparing pre-move ICU-A with post-move ICU-A (hazard ratio = 5.18, 95% confidence interval = 1.03 to 16.06; P = 0.025). More antibiotic-free days were recorded in post-move ICU-A (median = 3, interquartile range = 0 to 5) versus post-move ICU-B (median = 0, interquartile range = 0 to 4; P = 0.070) or pre-move ICU-A (median = 0, interquartile range = 0 to 4; P = 0.017). Adequate hand hygiene was observed on 140/242 (58%) occasions in post-move ICU-A versus 23/66 (35%) occasions in post-move ICU-B (P < 0.001).ConclusionsImproved ICU design, and particularly use of single-patient rooms, decreases acquisition of resistant bacteria and antibiotic use. This observation should be considered in future ICU design.

Comparison of two instructional modalities for nursing student CPR skill acquisition

Aims The purpose of the study was to compare performance based measures of CPR skills (compressions, ventilations with bag-valve-mask (BVM), and single rescuer CPR) from two types of CPR courses: a computer-based course (HeartCode™ BLS) with voice advisory manikin (VAM) feedback and instructor-led (IL) training with traditional manikins. Methods 604 nursing students from 10 schools of nursing throughout the United States were randomized by school to course type. After successful course completion, students performed 3 min each of compressions; ventilations with BVM; and single rescuer CPR on a Laerdal Resusci Anne ® SkillReporter™ manikin. The primary outcome measures were: (1) compression rate, (2) percentage of compressions performed with adequate depth, (3) percentage of compressions performed with correct hand placement, (4) number of ventilations/min, and (5) percentage of ventilations with adequate volume. Results There were no differences in compression rates between the two courses. However, students with HeartCode BLS with VAM training performed more compressions with adequate depth and correct hand placement and had more ventilations with adequate volume than students who had IL courses particularly when learning on hard molded manikins. During single rescuer CPR, students who had HeartCode BLS with VAM training had more compressions with adequate depth and ventilations with adequate volume than students with IL training. Conclusion Students who trained using HeartCode BLS and practiced with VAMs performed more compressions with adequate depth and ventilations with adequate volume than students who had IL courses. Results of this study provide evidence to support use of HeartCode BLS with VAM for training nursing students in CPR.

Significant Reduction of Ventilator-Associated Pneumonia Rates Associated With the Introduction of a Prevention Protocol and Maintained for 10 Years

Objective: To determine if the institution of a ventilator-associated pneumonia (VAP) prevention protocol was associated with VAP decrease in mechanically ventilated patients at a long-term acute care (LTAC) hospital over time. Introduction: VAP is the most common serious nosocomial infectious disease in mechanically ventilated patients. It has a high mortality and morbidity and significantly increases the cost of care. Design: A prospective preintervention and postintervention observational study comparing the number of episodes of VAP per 1000 patient ventilator-days in the 16 months preceding and 120 months (10 years) after the introduction of a VAP prevention protocol. Setting: A 73-bed, university-affiliated LTAC hospital. Methods: The implementation of a VAP prevention protocol included the following: (1) head of bed raised at 30°; (2) twice-weekly whole-body chlorhexidine-based bath with mupirocin 2% ointment applied to nares; (3) adequate hand washing; (4) adequate nutrition; (5) early tracheotomy by Day 7 if patients had endotracheal tubes; (6) monitor staff compliance; (7) infection control–run campaign involving posters, handouts, small group education events, positive reinforcement of good infection control practices, and focus on hand washing and universal precautions. Results: The initial VAP rate of 6.1 fell to 1.98/1000 ventilator-days within 5 months ( P &lt; .001), and this was maintained. Relative risk was 0.32 ( P = .001) (68% relative risk reduction). Conclusion: The institution of a VAP prevention protocol showed a significant reduction in VAP episodes after the first 5 months of implementation. This rate was sustained for 10 years.

School environment and sanitation in rural India

Context:A school child educated about the benefits of sanitation and good hygiene behavior is a conduit for carrying those messages far beyond the school walls, bringing lasting improvement to community hygienic practices.Aims:To study the status of school environment and sanitation in rural India.Settings and Design:Government schools in rural Karnataka, cross sectional study.Materials and Methods:Twenty schools were randomly selected for the study. Informed consent was taken from the Heads of the schools. A pre tested close ended questionnaire was used to get the information. The minimum standards for sanitation of the school and its environment in India were used as the guiding principles to evaluate the appropriateness/ adequacy of the various attributes.Statistical analysis used:Percentages and proportions.Results:Out of 20 schools selected, one fourth of the schools were located/ sited at inappropriate places. Only half of the schools had appropriate/ adequate structure. Eighteen (90%) of the schools were overcrowded. Ventilation and day light was adequate for 12(60%) and 14(70%) of the schools respectively. Cleanliness of school compound/classrooms was adequate in 80% of the schools. There were no separate rooms for serving the midday meals in any of the schools under study. Eighteen (90%) of the schools were having drinking water points. Liquid and solid waste disposal was insanitary in six (30%) and eight (40%) of the schools respectively. Only half of the schools had adequate latrines for boys and 60% for girls. Only two (10%) of the schools had adequate hand washing points with soap.Conclusions:Environment and sanitation facilities at many of the schools are not fully satisfactory.

Lower Trapezius Muscle Transfer for Reconstruction of Elbow Extension in Brachial Plexus Injuries

Elbow extension is a prerequisite for adequate hand position. Muscle transfers are often employed in partial injuries of the brachial plexus, when neurological surgery is unlikely to achieve desired results. The posterior deltoid and latissimus dorsi are the two muscles most commonly used for transfer but there are few alternatives when these two muscles are paralysed. We now report on the successful transfer of the lower trapezius muscle to reconstruct triceps function in three patients with longstanding lesions of the brachial plexus that had not been previously treated surgically.

ESPEN Guidelines on Parenteral Nutrition: Central Venous Catheters (access, care, diagnosis and therapy of complications)

When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or - for limited period of time and with limitation in the osmolarity and composition of the solution - through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or - if planned for an extended or unlimited time - long-term venous access devices (tunneled catheters and totally implantable ports). The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure. Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary. Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion and maintenance. These too depend on appropriate choice of device, skilled implantation and correct positioning of the catheter, adequate stabilization of the device (preferably avoiding stitches), and the use of infusion pumps, as well as adequate policies for flushing and locking lines which are not in use.

Health and safety aspects of deployment of Australian Disaster Medical Assistance Team members: Results of a national survey

Disaster medical assistance teams (DMATs) have responded to numerous international disasters in recent years. As part of a national survey, the present study was designed to evaluate Australian DMAT experience in relation to health and safety aspects of actual deployment. Data were collected via an anonymous mailed survey distributed by State and Territory representatives on the Australian Health Protection Committee, who identified team members associated with Australian DMAT deployments from the time of the 2004 South East Asian tsunami disaster. The response rate for this survey was 50% (59/118). Most of the personnel had deployed to the tsunami affected areas. The DMAT members were quite experienced with 53% of personnel in the 45-55 years age group (31/59) and a mean level of clinical experience of 21 years. 76% of the respondents were male (44/58). Once deployed, most felt that their basic health needs were adequately met. Almost all stated there were adequate shelter (95%, 56/59), adequate food (93%, 55/59) and adequate water (97%, 57/59). A clear majority, felt there were adequate toilet facilities (80%, 47/59), adequate shower facilities (64%, 37/59); adequate hand washing facilities (68%, 40/59) and adequate personal protective equipment (69%, 41/59). While most felt that there were adequate security briefings (73%, 43/59), fewer felt that security itself was adequate (64%, 38/59). 30% (18/59) felt that team members could not be easily identified. The optimum shift period was identified as 12h (66%, 39/59) or possibly 8h (22%, 13/59) with the optimum period of overseas deployment as 14-21 days (46%, 27/59). Missing essential items were just as likely to be related to personal comfort (28%) as clinical care (36%) or logistic support (36%). The most frequently nominated personal items recommended were: suitable clothes (49%, 29/59); toiletries (36%, 22/59); mobile phone (24%, 14/59); insect repellent (17%, 10/59) and a camera (14%, 8/59). The most common personal hardship reported during their deployment was being away from home/problems at home (24%, 14/59); however, most felt that their family was adequately informed of their whereabouts and health status (73%, 43/59). This study of Australian DMAT members suggests that, in the field, attention should be given to basics, such as adequate food, water, shelter and personal hygiene as well as appropriate clothing, sunscreen and vector protection. The inclusion of appropriate personal items can be assisted by provision of a minimum suggested personal equipment list, with local conditions and the nature of the deployment being taken into account. A personal survival kit should also be recommended. There should be medical and psychological support for team members themselves, including the provision of a dedicated team member medical cache. Concern for their own health and ability to communicate with family members at home are major issues for deployed team members and need to be addressed in mission planning. This should also recognise security issues, including briefings, evacuation plans and exit strategies. The team members concerns about adequate security and the risk profile of humanitarian intervention in natural disasters compared with complex humanitarian emergencies may help determine future deployment of civilian or defence based teams.