Alcohol-based Hand Gel Research Articles

Editorial

From Editor’s Desk… As soon as the United States and thirty-four other nations lifted their COVID-19 lockdowns, a new study from the University of California, San Francisco (UCSF) enables scientists to determine what caused an outbreak of acute severe hepatitis in otherwise healthy children in spring 2022. Due to the rarity of pediatric hepatitis, medical professionals became concerned when they began to observe outbreaks of severe hepatitis that could not be explained. So far, there have been nearly 1,000 incidences; of these children, 50 have required liver transplants, and at least 22 have eventually died. Adeno-associated virus 2 (AAV2) being found in the blood and livers of these children could be the cause. To determine where cases and liver transplants are higher than expected, WHO has started a global survey to estimate the incidence of severe acute hepatitis of unknown aetiology in 2022 compared to the previous five years. After returning to school, these viruses infected children more easily. Multiple infections may have made a small number of these kids more susceptible to severe hepatitis, according to the study. Until more is known about the etiology of these cases, the World Health Organization (WHO) recommends implementing general infection prevention and control (IPC) practices, such as: • Frequently washing your hands with detergent and water or an alcohol-based hand gel • Staying away from people and avoiding busy areas • Maintaining adequate airflow while in indoors • When necessary, wearing a mask that covers your mouth and nostrils. • Covering sneezes and hiccups • Drink only safe water • Important steps to have safer food: 1. Maintain cleanliness; 2. Separate raw and cooked foods 3. Cook food thoroughly 4. Maintain food at safe temperatures 5. Use safe water and raw materials. • Touched objects should be cleaned regularly. • Staying home and getting medical care when sick. Dr. Khalid Mohammed Alabdulwahhab Editor in Chief

Long-term effectiveness evaluation of an action-research intervention to improve hand hygiene in an intensive care unit

ObjectivesTo evaluate the long-term effectiveness of an action research intervention aimed at improving hand hygiene in an intensive care unit of a public hospital in Italy. MethodsAn observational, prospective before-after study was carried out.Compliance with hand hygiene was estimated by measuring the utilization of hand hygiene products before the intervention and four years after the end of the project. Products used were the following: detergent liquid soap, antiseptic liquid soap and alcohol-based hand gel. Endpoints were quantity consumed (in grams) for each product category. Quantitative consumptions per workshift were compared. ResultsIn 2017 the median consumption of antiseptic liquid soap and alcohol-based hand gel per workshift was significantly higher than in 2012 (111.5 g vs 72.5 g, p = 0.014, and 18.0 g vs 5.0 g, p < 0.001). Odds in favour of a higher value in 2017 were 1.99:1 (CI95%: 1.19:1 to 3.73:1) for antiseptic solution, and 5.39:1 (CI95%: 3.09:1 to 13.61:1) for antiseptic gel. Covariates were not associated with consumption of products, and this made it possible to compare the measurements in the two data collections. ConclusionsResults of this study support the long-term effectiveness of the action research intervention to improve practices of hand hygiene in an intensive care setting.

Successfully controlling the incidence of multidrug-resistant Pseudomonas aeruginosa through antibiotic stewardship and infection control programmes at a Chinese university hospital.

The purpose of this study was to investigate the effect of imposing infection control programmes (ICPs) and antimicrobial stewardship (AMS) by monitoring the antimicrobial resistance of Pseudomonas aeruginosa. Antimicrobial susceptibility testing was performed in accordance with the Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines. ICPs and AMS were initiated at the Fourth Hospital from 2013 to 2018. A total of 2,886 P.aeruginosa isolates were assessed. The antimicrobial resistance trends of the P.aeruginosa strains improved after the intervention measures. Multidrug-resistant (MDR) and extensively drug-resistant (XDR) P.aeruginosa contributed to 18.5% and 3.5% of the total P.aeruginosa strains, respectively. Colistin was the most effective antibiotic against 97.6% of XDR-P.aeruginosa and 99.41% of MDR-P.aeruginosa. The consumption of alcohol-based hand gel (ABHG) increased from 0.6L to 10.8L per 1,000 patient-days (PD) (p=0.005). The yearly consumption of antibiotics decreased from 45 to 37.5 defined daily doses (DDD) per 1,000 PD(p=0.04). After 2013, the incidence rate of MDR-P.aeruginosa showed a significant decrease from 22% to 14.1% (p=0.04), and XDR-P.aeruginosa decreased from 5.8% to 0.9%. The use of ABHG was negatively related to MDR-P.aeruginosa morbidity (r=-0.86; p=0.021). The consumption of antibiotics was positively related to MDR-P.aeruginosa morbidity (r=0.86; p=0.021). Successful control of MDR-P.aeruginosa resistance was achieved by imposing comprehensive ICPs and AMS.

A systematic review of human coronaviruses survival on environmental surfaces.

The current pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has led people to implement preventive measures, including surface disinfection and use of alcohol-based hand gel, in order to avoid viral transmission via fomites. However, the role of surface transmission is still debated. The present systematic review aims to summarize all the evidence on surface survival of coronaviruses infecting humans. The analysis of 18 studies showed the longest coronavirus survival time is 28 days at room temperature (RT) on different surfaces: polymer banknotes, vinyl, steel, glass, and paper banknotes. Concerning SARS-CoV-2 human infection from contaminated surfaces, dangerous viral load on surfaces for up to 21 days was determined on polymer banknotes, steel, glass and paper banknotes. For viruses other than SARS-CoV-2, the longest period of survival was 14 days, recorded on glass. Environmental conditions can affect virus survival, and indeed, low temperatures and low humidity support prolonged survival of viruses on contaminated surfaces independently of surface type. Furthermore, it has been shown that exposure to sunlight significantly reduces the risk of surface transmission. Although studies are increasingly investigating the topic of coronavirus survival, it is difficult to compare them, given the methodology differences. For this reason, it is advisable to define a reference working protocol for virus survival trials, but, as an immediate measure, there is also a need for further investigations of coronavirus survival on surfaces.

Pathogenesis-Targeted Preventive Strategies for Multidrug Resistant Ventilator-Associated Pneumonia: A Narrative Review.

Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in the intensive care unit (ICU), accounting for relevant morbidity and mortality among critically ill patients, especially when caused by multidrug resistant (MDR) organisms. The rising problem of MDR etiologies, which has led to a reduction in treatment options, have increased clinician’s attention to the employment of effective prevention strategies. In this narrative review we summarized the evidence resulting from 27 original articles that were identified through a systematic database search of the last 15 years, focusing on several pathogenesis-targeted strategies which could help preventing MDR-VAP. Oral hygiene with Chlorhexidine (CHX), CHX body washing, selective oral decontamination (SOD) and/or digestive decontamination (SDD), multiple decontamination regimens, probiotics, subglottic secretions drainage (SSD), special cuff material and shape, silver-coated endotracheal tubes (ETTs), universal use of gloves and contact isolation, alcohol-based hand gel, vaporized hydrogen peroxide, and bundles of care have been addressed. The most convincing evidence came from interventions directly addressed against the key factors of MDR-VAP pathogenesis, especially when they are jointly implemented into bundles. Further research, however, is warranted to identify the most effective combination.

COVID-19: An International Public Health Concern.

This review presents a synopsis on the current COVID-19 pandemic, with focus on preventive measures. COVID-19 is a new viral infection, and is in form of a positive-sense, single-stranded RNA Coronavirus which belongs to an expanded group of viruses which were identified six decades ago. Importantly, the new COVID-19 belongs to the group of SARS-CoV, and it originated in bats but infected humans through smuggled pangolins. At first, the mode of transmission of infection was animal-to-person, but person-to-person and community transmission of the virus has been confirmed in many parts of the world. With an incubation period of between two-fourteen days, signs and symptoms of infection are mild to high respiratory illness; characterized with cough, breathing problems (shortness of breath), high temperature (Fever), tiredness (Fatigue) and nausea. Presently, no vaccines or specific treatment is available for COVID-19, in light of the aforementioned; prevention is the only substantial and less expensive option. With the envisaged explosive community transmission of COVID-19 in the coming weeks in places with limited daily testing, especially in African countries, it is recommended among many that social distancing which includes avoiding any form of contact with people; either through greetings, hugging or shaking of hands and large gatherings, avoid contact with animal items, dead or alive animals, sick and dead people from areas experiencing COVID-19 epidemic, and basic hygienic practices like thorough washing of hands with clean water and antiseptic soap for the duration of at least twenty seconds should be practiced always. However, in the absence of the aforementioned, an alcohol-based hand gel should be used on the hands frequently. Furthermore, health care workers should adhere strictly to the standard preventive measures in areas of heightened COVID-19 epidemic.

Improving Visitors’ Hand Hygiene Compliance in a Pediatric Oncology Unit

BACKGROUND Hand Hygiene (HH) is the most important method to prevent spread of healthcare associated infections. Parents, family and visitors (PFV) are integral partners with the healthcare team for optimal patient outcomes. We aim at improving HH compliance by PFV upon entering a pediatric oncology inpatient unit. METHODS A performance improvement project implemented several interventions between July and November 2018 in Plan-Do-Study-Act (PDSA) cycles that included baseline data collection phase where a wall-mounted alcohol-based hand gel dispenser was available next to the unit entrance, Cycle1 (HH station and poster just facing the entrance as a visual cue), Cycle2 (visual cue + PFV symptom screen as verbal reminder of infections, without HH instructions), and Cycle3 (visual cue + verbal PFV symptom screen + HH verbal instructions). Pre-defined paper observation tool and scripts for symptom screening and HH, in English and Spanish, were used by patient care associates (PCA) who were positioned at the unit entrance reception desk between 07:00 and 23:00. Percent HH compliance was calculated for each cycle. Only observations with complete documentation were included in the analysis. A goal of 90% compliance by December 31, 2018 was set. The participating PCAs were surveyed regarding process feasibility and sustainability. RESULTS Of 1272 observed visitors, 76% were adults, 14% children, and 7% adolescents. Of 955 (75%) observations with complete documentation, 204 were baseline, 293 Cycle1, 330 Cycle2, but it decreased to 128 observations for Cycle3. The percent HH compliance increased from 5% at baseline, to 16% in Cycle1, 21% Cycle2, and 65% Cycle3. CONCLUSIONS A multimodal performance improvement project improved PFV HH compliance. Direct verbal instructions for HH?was the most effective, but less efficient as suggested by?the?decreased number of Cycle3 complete observations. The PCA survey results will help develop a plan for process sustainability.

Successful control of resistance in&lt;em&gt; Pseudomonas aeruginosa&lt;/em&gt; using antibiotic stewardship and infection control programs at a Chinese university hospital: a 6-year prospective study

ObjectivePseudomonas aeruginosa is emerging as a highly multidrug-resistant (MDR) nosocomial pathogen. Data on the efficacy of infection control measures in endemic situations are lacking. We investigated the effect of antimicrobial stewardship (AMS) and infection control programs (ICPs) in controlling the resistance of P. aeruginosa at a tertiary hospital center.MethodsSusceptibility and resistance were investigated using broth microdilution, as per the guidelines of the Clinical and Laboratory Standards Institute. Antibiotic use was restricted through AMS, which included a classification management system for antibiotic use. The ICPs included environmental cleaning and disinfection, hand hygiene, active surveillance of P. aeruginosa, and education about infection control.ResultsA total of 2,241 P. aeruginosa isolates were evaluated between 2012 and 2017. Sensitivity and resistance of the isolates to the antipseudomonal antimicrobials colistin and tigecycline were stable. The sensitivity and resistance to other antipseudomonal antimicrobials improved after 2014, after the AMS and ICPs were implemented in 2013. The use of alcohol-based hand gel significantly increased from 0.6 to 10.9 L per 1,000 patient-days (PD) during the study period (P=0.005). The incidence rates of extensively drug-resistant (XDR) and MDR P. aeruginosa showed a sustained decrease from 2013 (4.9 and 22%) to 2017 (1 and 15%), respectively. The yearly consumption of antimicrobial agents also showed a sustained and significant decrease from 45 defined daily doses (DDDs) per 1,000 PD to 38.15 DDDs per 1,000 PD (P=0.04). A significant correlation was found between the incidence rate of MDR P. aeruginosa and the consumption of antimicrobial agents (P=0.01).ConclusionMonitoring of P. aeruginosa, AMS, and comprehensive ICPs could be one of the best and effective methods to prevent the development of resistance in P. aeruginosa.

Recommendations for Best Disinfectant Practices to Reduce the Spread of Infection via Wrestling Mats.

At the request of the National Wrestling Coaches Association and the head wrestling coach at our university, we conducted a study of infection transmission in collegiate wrestlers. To examine disinfectant effectiveness and develop best-practice guidelines for minimizing the spread of skin infections via wrestling mats. Controlled laboratory study and crossover study. Laboratory and two 15-college wrestling invitational meets. A total of 231 collegiate wrestlers and 8 officials. In the laboratory-based part of the study, we measured the bacterial load of mats disinfected with 10% bleach, OxiTitan, Benefect, eWater, and KenClean and inoculated with Staphylococcus epidermidis (strain ATCC 12228) at a concentration of 6.5 × 104 bacteria/cm2. In the empirical part of the study, we used these disinfectants during 2 invitational meets and measured mat and participant bacterial load during competition. Participants were swabbed at weigh-in and after their last bout. Mat bacterial load was monitored hourly. We determined total colony counts and species. With controlled testing, we observed that products claiming to have residual activity reduced bacterial load by 63% over the course of competition compared with nonresidual agents. Only 4 of 182 participating wrestlers tested positive for methicillin-resistant Staphylococcus aureus , which is the normal population occurrence. The predominant species on mats were skin bacteria ( Staphylococcus epidermidis ) and substantial levels of respiratory bacteria ( Streptococcus pneumoniae ), as well as several soil species and a surprisingly low incidence of fecal bacteria ( Escherichia coli ). Disinfectant effectiveness during the meets was consistent with controlled study findings. Cleaning mats with residual disinfectants reduced the average bacterial load by 76% compared with nonresidual cleaners. Using a footbath did not reduce the bacterial load compared with a bleach-cleaned mat, but using alcohol-based hand gel reduced it by 78%. Best practices based on these data include backward mopping of the mats with a residual disinfectant pulled behind the cleaner, allowing mats to dry before walking on them, having wrestlers use hand gel before each bout, and strongly recommending that all wrestlers receive annual influenza vaccinations.

Successful control of carbapenem-resistant Acinetobacter baumannii in a Korean university hospital: A 6-year perspective

This study evaluated the effect of infection control interventions on the incidence of carbapenem-resistant Acinetobacter baumannii (CRAB) in a tertiary hospital over a 6-year period. Multiple interventions, including cohorting, promotion of hand hygiene, active surveillance in the intensive care units, and environmental cleaning, were implemented from 2007 through 2009 (period 1). From 2009 through 2012 (period 2), infection control programs were enhanced by the introduction of an onsite education and hand hygiene campaign in preparation for hospital accreditation. To assess the efficacy of the infection control intervention programs, the nosocomial incidence density of CRAB, consumption of alcohol-based hand gel, and consumption of antimicrobials during the study period were measured. The incidence density of CRAB increased from 0.35 to 0.46 per 1000 patient-days (PD) during period 1, but decreased to 0.06 per 1000 PD in period 2 (P = .011). The consumption of alcohol-based hand gel increased from 5.6 L to 11.9 L per 1000 PD during the study period (P < .001). There was a significant association between the incidence density of CRAB and carbapenem use (P = .008). Education for infection control programs, hand hygiene campaign, and the judicious use of carbapenem may decrease the nosocomial incidence of CRAB.

Does the use of alcohol-based hand gel sanitizer reduce travellers' diarrhea and gastrointestinal upset?: A preliminary survey.

Use of alcohol-based hand sanitizer is recommended by the CDC to reduce the risk for travellers' diarrhoea, but its effectiveness has not been assessed. We investigated the potential protective effect of hand sanitizer use on the occurrence of diarrhoea and/or vomiting in 200 international travellers, who were returning home, at an international airport. We also conducted a knowledge, aptitude and practice survey about hand gel use among international travellers consulting for pre-travel advice at a specialized clinic. 200 returning travellers were included of which 32.5% declared having used alcohol-based hand sanitizer during travel. Travellers who used hand sanitizer reported diarrhoea and vomiting significantly less frequently than those who did not (17% vs. 30%, OR = 0.47; 95% CI [0.21-0.97], p = 0.04). A total of 257 travellers consulting for pre-travel advice were included. A majority of travellers knew that hand sanitizer may be used for hand hygiene and had already used hand sanitizer; 72% planned to bring hand sanitizer during their next travel. Use of hand sanitizer is highly acceptable by travellers and is associated with a reduction in the incidence of travellers' diarrhoea and/or vomiting.

Assessing most practical and effective protocols to sanitize hands of poultry catching crew members

Catching crew members can heavily contaminate their hands with organic material. They can act as mechanical vector and spread diseases between farms. Hand hygiene is an important issue for the industry as a whole and for human health by reducing contamination risks. Many studies, in human medicine, tend to make hand rub a standard for hand hygiene. However, few studies have tested the effectiveness of hand hygiene products on visibly contaminated hands. The objective of this study was to evaluate the effectiveness of practical hand sanitization protocols: water and soap, degreasing cream and hand wipes, all combined with alcohol-based hand gel. The use of alcohol-based gel alone was also evaluated. For the reduction of coliforms after washing, there was no statistically significant difference between protocols when the initial level of bacterial contamination was low to moderate. When hands were highly contaminated, the alcohol-based gel alone was less effective than the degreasing cream combined with the alcohol-based gel (p=0.002). As for the reduction in total aerobic bacteria counts, there was no difference between protocols when the initial level of bacterial contamination was low. The water, soap and alcohol-based gel protocol was more effective than the scrubbing wipes and alcohol-based gel protocol when hands were moderately (p=0.002) and highly contaminated (p=0.001). All protocols were effective in neutralizing Salmonella on hands. Reducing the level of bacterial contamination on hands before using an alcohol-based gel seems important to ensure effective hand sanitation for highly and moderately contaminated hands. This can be done by using a degreasing cream or water and soap. Based on the survey, catching crew members preferred using warm water and soap compared to a degreasing cream.

Hand Hygiene, and Not Ertapenem Use, Contributed to Reduction of Carbapenem-Resistant Pseudomonas aeruginosa Rates

To evaluate the impact of ertapenem use in Pseudomonas aeruginosa carbapenem resistance, taking into account the volume of antimicrobial consumption, the consumption by the entire hospital of alcohol-based antiseptic hand rub, and the density rate of invasive practices. Before-and-after trial. A tertiary care university hospital in southern Brazil. Ertapenem was first added to the hospital formulary in June 2006, and it was excluded in February 2009. We evaluated Pseudomonas aeruginosa resistance rates through 3 study periods: period 1, before ertapenem use (17 months); period 2, during ertapenem use (33 months); and period 3, after exclusion of ertapenem (15 months). After introduction of ertapenem, there was a significant decrease in median consumption of imipenem or meropenem, from 2.6 to 2.2 defined daily doses (DDDs) per 100 patient-days (level change from 0.04 to -1.08; P < .01), and an increase in the use of these medications after ertapenem exclusion, from 2.2 to 3.3 DDDs per 100 patient-days (level change from -0.14 to 0.91; P < .01), by segmented regression analysis. There was no difference in the incidence density of carbapenem-resistant P. aeruginosa infection related to ertapenem use throughout the study periods. However, by multiple regression analysis, the reduction in the rate of carbapenem-resistant P. aeruginosa infection correlated significantly with the increase in the volume of alcohol used as hand sanitizer, which was from 660.7 mL per 100 patient-days in period 1 to 2,955.1 mL per 100 patient-days in period 3 (P = .04). Ertapenem use did not impact the rate of carbapenem-resistant P. aeruginosa infection. Use of alcohol-based hand gel, rather than ertapenem, was associated with a reduction in the rates of carbapenem-resistant P. aeruginosa infection. Measures to reduce resistance must include factors other than just antimicrobial stewardship programs alone.

Effect of the dried residues of two hand gels on the survival of meticillin-resistant Staphylococcus aureus and Acinetobacter calcoaceticus-baumannii

We assessed the ability of the residues of an alcohol-based hand gel (hand gel A) and an Aloe vera-based CuAL42 copper biocide-containing hand gel (hand gel B), to support the survival of meticillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter calcoaceticus-baumannii (ACCB). One-millilitre samples of hand gels A and B were spread over marked 20 cm2 areas and dried overnight. MRSA or ACCB (1 × 104 CFU) were spread onto the dried residue and contact plated at various times. MRSA and ACCB survived for 8 hours on hand gel A residue, whilst MRSA did not survive on hand gel B residue and ACCB survived less than 30 min. Low concentrations of hand gel A facilitate the growth of ACCB, but this is not the case for hand gel B. Hand gel A is extensively used in UK hospitals and its residue left on high-touch surfaces may support the survival of bacteria that cause healthcare-acquired infections.

Factors determining poor practice in alcoholic gel hand rub technique in hospital workers

Hand hygiene of healthcare personnel is one of the most important interventions for reducing transmission of nosocomial pathogens. Previous studies have demonstrated that the use of alcohol-based hand gel increases hand hygiene compliance, but that effective use of this product cannot be taken for granted. Evaluate factors associated with poor hand hygiene effectiveness of hospital workers using an alcohol-based hand gel and the effect of an education program. A direct observational prospective study of hand hygiene effectiveness prior to training and immediately after training. 3067 hospital workers of different professional categories in several hospital units in the University Hospital of Nancy (France). Time after program start (OR 0.97, 95%CI 0.96-0.97) and being female (OR 0.37, 0.24-0.58) were highly associated with increased effectiveness of hand hygiene prior to training. Wearing rings other than a wedding ring (OR 1.8, 1.2-2.7), a bracelet (OR 2.0, 1.1-3.6), a watch (OR 1.9, 1.3-2.9) and having long nails were associated with ineffective hand rub use. Professional background was also a strong predictor with nurses and especially senior nurses demonstrating much better effectiveness than all other professional groups. Wearing wedding rings or long sleeves, and having varnished nails, visibly dirty hands prior to washing and cutaneous lesions were not associated with effective gel use. These results demonstrate that an educational program can significantly improve the proper practices for using hand rub and hand washing compliance. This study has also demonstrated that wearing rings, bracelets, watches and long nails impair hand gel application but that wedding rings, long sleeves and varnished nails do not. The finding of that hand hygiene effectiveness increased with time even prior to training indicates that knowledge gained by staff trained early diffused into those who had not yet been trained.

Trial of Alcohol-Based Hand Gel in Critical Care Units

Trial of Alcohol-Based Hand Gel in Critical Care Units

Prospective, Controlled, Cross-Over Trial of Alcohol-Based Hand Gel in Critical Care Units

There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes. A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel. The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital. An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months. During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P< .001). Improvement was observed among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P= .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel. The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.

Infection Control Policies and Practices for Iowa Long-Term Care Facility Residents With Clostridium difficile Infection

To identify infection control policies and practices used by Iowa long-term care facilities (LTCFs) for residents with Clostridium difficile infection or C. difficile-associated diarrhea and to assess use of antimicrobial agents. Survey. LTCFs in Iowa that responded between March 25, 2005 (ie, when surveys were mailed), and July 2005. Of the 418 LTCFs in Iowa, 263 (62.9%) responded. Most facilities (94.3%) reported that they accept persons known to have C. difficile infection. Few LTCFs reported that clusters of C. difficile infection had been identified. However, only 111 facilities (42.2%) had a protocol to identify residents with C. difficile infection, and most (77.5%) did not test for C. difficile unless a resident had severe diarrhea. Only 58.5% of the facilities placed residents with C. difficile infection in private rooms, and 60.9% cohorted residents infected with C. difficile with other residents with C. difficile colonization or infection. Only 66 facilities (25.1%) have a program to control the use of antimicrobial agents. Staff could use alcohol-based hand gel products after contact with residents known to have C. difficile infection (in 188 facilities [71.5%]) or diarrhea (in 173 [65.8%]). However, the survey did not ask whether the staff used alcohol-based products instead of soap and water. C. difficile is present in Iowa LTCFs, but many C. difficile infections probably remain undiagnosed. Staff in LTCFs should be educated about this organism so that they can implement appropriate testing and preventive strategies.

Assessment of Healthcare Professionals' Adherence to Hand Hygiene After Alcohol-Based Hand Rub Introduction at an Intensive Care Unit in São Paulo, Brazil

We analyzed the impact of introducing an alcohol-based hand gel and an educational program on hand hygiene adherence among healthcare workers in an intensive care unit. Adherence to hand hygiene was significantly higher after the intervention for the night shift work period (P=.001), among nursing assistants (P=.001), among nurses (P=.007) on weekend days (P=.016), and for invasive procedures (P=.012).

Monitoring hand hygiene compliance in a university-affiliated medical center

BACKGROUND: HICPAC hand hygiene (HH) guidelines recommend periodic monitoring of HH compliance. Thus, we carried out a 3-month observational assessment of HH practice in our 719-bed hospital using “light-duty” nursing personnel. OBJECTIVES: To determine the reliability of using alternative available hospital resources to obtain baseline HH compliance data for use in the development of an effective HH program. METHODS: Two light-duty nursing staff members were deployed during the day and evening shifts over a 3-month period (576 hours) to observe compliance with HH policy throughout the adult and pediatric units and departments. Observers were trained and supervised by infection control (IC) staff to ensure inter-observer reliability. Staff members were observed to determine if hands were washed with soap and water or if alcohol-based hand gels was used before and after A) patient contact, after removal of gloves, and when caring for patients on contact precautions. RESULTS: From June through August 2004, 3890 opportunities for HH were observed. Overall compliance with use of soap and water or alcohol-based hand gel was 31% (1216/3890). HH before patient contact was 9% (170/1802) and after patient contact was 50% (1046/2088). Alcohol-based hand gel was used before or after patient contact 69% of the time compared to soap and water. Staff members were more likely to perform HH after contact with contact precautions patients and were more likely to use HH if they worked in pediatrics or intensive care units. HH occurred more often during the day (7 am–3 pm) (p CONCLUSIONS: Light-duty nursing personnel can be an important adjunct to IC departments when monitoring infection control practice. An additional 48 hours/week for 12 weeks (equivalent IC practitioner salary value of $16,883) were devoted to monitoring HH compliance and data entry by light-duty nursing staff. This effectively relieved the IC department staff from the data collection burden and allowed IC staff time to focus on interventions. The additional resources were IC budget-neutral and allowed us to obtain a level of detail that would otherwise not have been possible given our current IC staffing. The experience provided the opportunity to develop additional IC resources as well as provide immediate feedback for staff regarding HH practice. In addition, the data collected will serve as the basis for current and future interventions to improve HH compliance at our institution.