Use Of Alcohol-based Hand Rubs Research Articles

Trends in the hand hygiene practices using alcohol-based hand rubs in Japanese hospitals before and after the novel coronavirus pandemic: an observational study using national surveillance data

Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, for which hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear. This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019-2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC). Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations. This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards.

Italian National Surveillance of Alcohol-Based Hand Rub Consumption in a Healthcare Setting-A Three-Year Analysis: 2020-2022.

Background/Objectives: Hand hygiene (HH) is pivotal in mitigating infectious disease transmission and enhancing public health outcomes. This study focuses on detailing the national surveillance system for alcohol-based hand rub (ABHR) consumption in healthcare facilities across Italy, presenting results from a comprehensive three-year evaluation period, from 2020 to 2022. It aims to delineate this surveillance system and report on ABHR consumption trends in various Regions/Autonomous Provinces (Rs/APs). Methods: ABHR consumption data, collected through the ABHR Italian national surveillance system, coordinated by the Istituto Superiore di Sanità (ISS), were analyzed. Statistical methods, e.g., the Mann-Whitney test, were used to assess trends in ABHR consumption, expressed in liters per 1000 patient days (L/1000PD). Results: The results show significant variation in ABHR consumption across Rs/APs and over the years studied. National median ABHR consumption decreased from 2020 to 2022, with a significant reduction from a median of 24.5 L/1000PD in 2020 to 20.4 L/1000PD in 2021 and 15.6 L/1000PD in 2022. Conclusions: The decline in ABHR consumption raises concerns about the ongoing adherence to HH practices in Italian healthcare settings. This underscores the essential role that systematic ABHR monitoring and improved surveillance play in enhancing HH compliance, suggesting that sustained and strategic efforts are fundamental to uphold high standards of hygiene and to effectively respond to fluctuating ABHR usage trends over time. Further research is needed to explore barriers to effective ABHR use and to develop targeted strategies to improve HH practices.

In vitro assessment and comparison of quality of alcohol-based hand rubs, pre- and peri-COVID-19 pandemic outbreak in Kenya.

In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended the use of alcohol-based hand rubs (ABHRs) to curb transmission, leading to increased production and use. This has posed a danger of production and use of poor-quality ABHRs. This study assessed and compared the quality of ABHRs in the Kenyan market that were produced before and after the outbreak of the COVID-19 pandemic in March 2020. Quality testing was carried out against European EN 1500:2013 and Kenyan EAS 789:2013 Standards and 20 samples analyzed for alcohol content by GC-FID. The study found that 27.8% of the peri-COVID-19 pandemic sanitizers had less than 90% bactericidal reduction activity as compared to 12.5% manufactured pre-COVID-19 pandemic. Only 25% peri-COVID-19 pandemic ABHRs met the EAS 789:2013 acceptable limit of over 60% alcohol content. Product adulteration with methanol was found in 20 % of the samples with only 5% complying with FDA approval limit of <0.063% v/v methanol. Study found no correlation between the total alcohol content and the efficacy of ABHRs. The study found that more substandard products were produced during the pandemic. This raises a concern about possible emergence of alcohol resistant strains of microorganisms. The study therefore recommends an adequate quality monitoring system to curb against substandard products.

In vitro assessment and comparison of quality of alcohol-based hand rubs, pre- and peri-COVID-19 pandemic outbreak in Kenya

Background In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended the use of alcohol-based hand rubs (ABHRs) to curb transmission, leading to increased production and use. This has posed a danger of production and use of poor-quality ABHRs. Methods This study assessed and compared the quality of ABHRs in the Kenyan market that were produced before and after the outbreak of the COVID-19 pandemic in March 2020. Quality testing was carried out against European EN 1500:2013 and Kenyan EAS 789:2013 Standards. Results The study found that 27.8% of the peri-pandemic sanitizers had less than 90% bactericidal reduction activity as compared to 12.5% manufactured pre-pandemic. Only 25% peri-pandemic ABHRs met the EAS 789:2013 acceptable limit of over 60% alcohol content. Product adulteration with methanol was found in 20 % of the samples with only 5% complying with FDA approval limit of &lt;0.063% v/v methanol. Study found no correlation between the total alcohol content and the efficacy of ABHRs. Conclusions The study found that more substandard products were produced during the pandemic. This raises a concern about possible emergence of alcohol resistant strains of microorganisms. The study therefore recommends an adequate quality monitoring system to curb against substandard products.

Multimodal strategies to hand hygiene in Ghanaian hospitals: a cross-sectional study in the Eastern Region of Ghana

BackgroundHand hygiene (HH) is one of the core components of infection prevention and control and is critical for a high quality of care. Multimodal approaches are recommended to strengthen and...

Assessment and comparison of quality of alcohol-based hand sanitizers, pre- and peri-COVID-19 pandemic outbreak in Kenya

Background: In the wake of the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization recommended the use of alcohol-based hand rubs (ABHRs) to curb transmission, leading to increased production and use. This has posed a danger of production and use of poor-quality ABHRs. Methods: This study assessed and compared the quality of ABHRs in the Kenyan market that were produced before and after the outbreak of the COVID-19 pandemic in March 2020. Quality testing was carried out against European EN 1500:2013 and Kenyan EAS 789:2013 Standards. Results: The study found that 27.8% of the peri-pandemic sanitizers had less than 90% bactericidal reduction activity as compared to 12.5% manufactured pre-pandemic. Only 25% peri-pandemic ABHRs met the EAS 789:2013 acceptable limit of over 60% alcohol content. Product adulteration with methanol was found in 20 % of the samples with only 5% complying with FDA approval limit of &lt;0.063% v/v methanol. Study found no correlation between the total alcohol content and the efficacy of ABHRs. Conclusions: The study found that more substandard products were produced during the pandemic. This raises a concern about possible emergence of alcohol resistant strains of microorganisms. The study therefore recommends an adequate quality monitoring system to curb against substandard products.

Building capacity for point of care alcohol-based handrub (ABHR) and hand hygiene compliance among health care workers in the rural maternity and surgical units of a hospital in Cameroon

Hand hygiene (HH) is challenging in health care, but particularly in resource-limited settings due to a lack of training, resources, and infrastructure. This study aimed to evaluate the implementation of wall-mounted alcohol-based handrub (ABHR) at the point of care (POC) on HH compliance among health care workers in a Cameroon hospital. It was a three-stage before and after study. The first stage involved baseline collection of ABHR utilization and HH compliance data. The second stage included the implementation of ABHR at the POC, supported by an implementation strategy involving HH training, monitoring and feedback, and HH champions. The third stage involved postimplementation data collection on ABHR use and HH compliance. 5,214 HH opportunities were evaluated. HH compliance significantly increased from 33.3% (baseline) to 83.1% (implementation stage) (P<.001) and to 87.2% (postimplementation stage) (P<.001). Weekly ABHR usage increased significantly during implementation (5,670ml), compared to baseline, (1242.5ml, P=.001), and remained high in postimplementation (7,740ml). Continuous availability of ABHR at POC, supported by implementation strategy, significantly increased HH compliance and ABHR use. Learning from this study could be used to implement ABHR at POC in other facilities.

Tailored positioning and number of hand rub dispensers: the fundamentals for optimized hand hygiene compliance

Availability of alcohol-based hand rub (ABHR) dispensers at positions adapted to the work flow of healthcare workers (HCWs) is decisive in order to carry out indication-based hand rubbing. Although requirements and guidelines regarding the positioning of ABHR dispensers are in place, scientific evidence is often lacking. In order to analyse the impact of the location and number of ABHR dispensers on hand hygiene performance, additional dispensers were systematically placed in patient rooms in a surgical 38-bed ward at Marburg University Hospital, Germany to complement the existing dispenser locations. ABHR use was monitored continuously before and after complementation using the NosoEx hand hygiene monitoring system. The ward had 53 dispensers before the intervention and 82 dispensers after the intervention. The addition of dispensers increased ABHR consumption across the entire ward. Before the intervention, mean consumption was 20.6 mL/patient-day, whereas mean consumption after the intervention was 25.3 mL/patient-day. Depending on the combination of dispenser locations, consumption increased through targeted supplementation in patient rooms. The presence of two or three dispensers per patient room resulted in significantly greater ABHR consumption compared with one dispenser per patient room. The preferred location combinations were entrance-front bed-back bed and entrance-foot end. ABHR consumption can be increased significantly by optimizing the position and number of dispensers. The outstanding factors are visibility and integrability of dispenser use into the work flow; in particular, a dispenser should be positioned in the entrance area. Recommendations should be optimized with regard to the required number and location of dispensers in patient rooms.

The covid-19 pandemic led to an upsurge of irritant contact hand dermatitis

The COVID-19 Pandemic has brought about a transition in hand hygiene practices since the disease has no cure. WHO recommends frequent hand washing for at least 20 seconds each time or the use of alcohol-based hand rubs to prevent infection. This change has led to a variety of skin changes over hands including dryness, redness, irritation, etc. Dermatitis is a medical term for skin inflammation (irritation). Contact dermatitis is an allergic or irritant reaction that causes a painful or itchy skin rash. Frequent use of hand hygiene products, particularly soaps, and other detergents, is one of the leading causes of irritant contact dermatitis among health workers in this Covid pandemic era. : To know the impact of change in hand hygiene practices after the start of the COVID-19 pandemic, an online survey was conducted using google forms. Participants included only medical students and professionals aged 18 and above till 35 years. Informed consent was obtained from all individual participants included in the study. Information was recorded and analyzed.: The study included a total of 151 participants including medical students and professionals out of which 71 (47%) were male, 79(53%), and female, all aged between 18-35 years. 136 (90.1%) of the total participants agreed with an increase in hand hygiene practices brought about by the pandemic, using various means for the same including soap, alcohol-based gels, rubs, and wipes. 51 participants (33.8 %) noticed explicit changes in the skin of their hands after the switch in their respective hand hygiene practices.: This study highlights the changes in hand hygiene practices due to the pandemic and the prevalence of dermatitis due to the same in medical students and professionals. The study will highlight the awareness about the prevention of skin changes in hand due to frequent sanitation and the need to seek a dermatologist if and when required

The danger of the toxicity and inefficacy of alcohol-based hand rubs in Iran during COVID-19: a cross-sectional study

BackgroundThe use of disinfectants and alcohol-based hand rubs (ABHR) to prevent COVID-19 transmission increased in the first wave of the infection. To meet the increased demand, the Iranian Ministry of Health issued an emergency use authorization allowing new manufacturers to enter the market, despite the limited capacity for surveillance of these products during COVID-19. Methanol poisoning outbreaks spread rapidly, and more people died from methanol poisoning than COVID-19 in some cities. The aim of this study was to analyze some ABHRs in the Iranian market to see if (a) ABHRs are standard and suitable for hand antisepsis and (b) contained potentially dangerous toxic alcohols.MethodBetween February and March 2020, 64 brands of ABHR were conveniently collected from pharmacies, supermarkets, and shops selling hygienic products and analyzed using Gas Chromatography. World Health Organization and Food and Drug Administration guidelines were used to define minimum requirements for ABHR. For estimating the risk for acute methanol poisoning, we assumed a serum methanol concentration of 200 mg/L following ABHR ingestion was sufficient to cause intoxication. This threshold concentration would be achieved in an average 75-kg adult after consuming 8000 mg (or eight grams) methanol in 1–2 h.ResultsThe median [IQR] (range) concentration of ethanol, isopropanol, and methanol were 59% v/v [32.2, 68] (0, 99), 0 mg/L [0, 0] (0, 197,961), and 0 mg/L [0, 0] (0, 680,100), respectively. There was a strong negative correlation between methanol and ethanol contents of hand rubbers (r= -0.617, p < 0.001). Almost 47% of ABHRs complied with minimum standards. In 12.5% of ABHRs, high concentrations of methanol were observed, which have no antiseptic properties but could cause acute methanol poisoning if ingested.ConclusionCOVID-19 initiated a policy for distribution and use of ABHR with little control. As ABHR and masks are still accepted preventive measures of the disease, non-standard ABHR compositions may increase the population’s risk to both COVID-19 infection and methanol poisoning.

Knowledge of Hand Hygiene and Use of Alcohol-Based Hand Rub Among Interns in a Nigerian Tertiary Health Facility

Background: Healthcare-associated infections and antimicrobial resistance are both largely prevented through hand hygiene. There are still gaps in hand hygiene knowledge and routine use of alcohol-based hand rub among healthcare workers. Objectives: This study assessed the knowledge of hand hygiene and the use of alcohol-based hand rub among interns at the University of Nigeria Teaching Hospital, Enugu State, Nigeria. Materials and Methods: A cross-sectional study was conducted among 230 interns using a structured WHO hand hygiene knowledge questionnaire. A two-stage sampling technique was employed. Descriptive and inferential statistics were carried out and p-value was set at ≤ 0.05. Results: Two respondents (0.9%) had good knowledge of hand hygiene while slightly more than half (117/230, 50.9%) had moderate knowledge. Also 50.9% (n = 117) used alcohol-based hand rub. Majority of the respondents, 140 (60.9%) had attended training in hand hygiene. Sex was significantly associated with the knowledge of hand hygiene (p=0.03) as male respondents had a higher proportion of good knowledge while having received training on hand hygiene was significantly associated with routine use of hand hygiene (p=0.004). Conclusions: Since only very few of the interns had overall good knowledge of hand hygiene, targeted structured training on hand hygiene and infection prevention and control practices to improve the knowledge of such healthcare workers is highly recommended.

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit.

Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate. Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.

Safe Hands 3.0: new tool to prevent healthcare associated infection

Abstract Background Healthcare associated infection (HAI) is a Public Health problem. Hands of healthcare workers are a key for transmission. Compliance with WHO 5 moments for hand hygiene (HH) has been emphasized, but there are other aspects: appropriate use of gloves and healthy hands skin of professionals. Gloves protect the professionals but it may increase cross-transmission. Hands dermatitis is a handicap for the use of alcohol-based handrubs. Data collection and analysis, to have a good communication system to improve training, information and to get feedback from professionals are necessary. The aim of this work is to develop the Safe Hands 3.0 Project in a General Hospital. Methods Preventive Medicine and Public Health Department carried out a descriptive study carried out in a 477-bed General Hospital in last semester 2021. Compliance with HH and the possible causes of non-compliance were assessed with observations and knowledge surveys included appropriate use of gloves in healthcare practice and the impact on hand in professionals. The surveys were carried out using Lime Survey for mobile devices and Google for WhatsApp. Results From 550 observations of HH compliance for the WHO 5 moments is less than 40%. Half of non-compliance was due to inappropriate use of gloves. 266 surveys answered highlighting the need for continued training. Survey on hand skin health perception was answered by 182 professionals, 44% reported dermatological issues and 81% notice that their work damaged their hands skin. A corporate logo was created, use the hospital website and a structured Communication Plan for its implementation. Conclusions To prevent HAI transmission, the concept of Hand Hygiene is limited. Safe Hands 3.0 Project comes up with a bundle of care: proper use of gloves, compliance the WHO 5 moments and skin care of healthcare workers’ hands. Update data management and a corporate communication plan with social networks is necessary to improve training and compliance. Key messages • A bundle of care is the key for Safe Hands: proper use of gloves, compliance the WHO 5 moments and skin care of healthcare workers’ hands. • Update data management and a corporate communication plan with social networks is necessary to improve training and compliance.

Hand eczema, wet work exposure, and quality of life in health care workers in Denmark during the COVID-19 pandemic

BackgroundThe focus on hand hygiene during the pandemic has been reported to increase the hand eczema (HE) prevalence in health care workers (HCWs); however, detailed prospective data are missing.ObjectiveTo evaluate changes in HE prevalence, exposures, and health-related quality of life among HCWs during the COVID-19 pandemic.MethodsIn this prospective cohort study, HCWs employed at the hospitals in Copenhagen responded to a digital questionnaire at the beginning of the pandemic and 11 months thereafter.ResultsA total of 795 HCWs responded to both questionnaires (83.4% women). The calculated 1-year HE prevalence decreased from 16.0% at baseline to 13.0% at follow-up. The number of hand washings decreased significantly, whereas the use of alcohol-based hand rubs on wet skin increased significantly. In a logistic regression model, increased use of alcohol-based hand rubs on wet skin was associated with HE at follow-up (odds ratio, 1.78; 95% CI, 1.11-2.87). Health-related quality of life worsened slightly at follow-up, with HE severity and frequent flareups being risk factors for a reduced health-related quality of life.LimitationsSample size.ConclusionIn contrast to previous studies undertaken during the pandemic, we found a relatively low and stable HE prevalence. Our findings suggest that the interaction between changed exposures and HE is complex and cannot be linked to a single factor.

A review of the science and clinical use of alcohol-based hand rubs

Alcohol has a longstanding history as an antiseptic, and the coronavirus disease 2019 (COVID-19) pandemic has sparked a renewed interest in its use as a hand sanitizer. Alcohol works by denaturing protein and rendering cell membranes permeable. It offers excellent germicidal effects against Gram-positive and Gram-negative bacteria, Mycobacterium tuberculosis, fungi, and lipid-containing viruses. However, it is less reliable against non-lipid containing viruses and is ineffective against bacterial and fungal spores. Alcohol-based hand rub (ABHR) usually contains 60–90% isopropanol or ethanol. Additives such as chlorhexidine to complement the action of alcohol and emollients to ameliorate the drying effect of alcohol are often included to improve the formulation of ABHR. In the clinical setting, ABHR provides biocidal activity against multidrug resistant bacteria such as methicillin-resistant Staphylococcus aureus as well as viruses like human coronavirus, severe acute respiratory syndrome coronavirus, and Middle East respiratory syndrome. Moreover, its use is associated with an improved compliance with hand hygiene, which has been shown to translate into better patient outcomes. However, there are cases of intoxications secondary to ingestion of ABHR or adulterated alcohol when resources are diverted away from the normal beverage production to meet the increased need for hand sanitizer during the COVID-19 pandemic. The risk of unintentional topical absorption and fire hazard among healthcare workers is low but should not be ignored. We proposed recommendations to mitigate the risk of ABHR ingestion and poisoning as well as that of fire hazard.

Inexpensive Portable Infrared Device to Detect and Quantify Alcohols in Hand Sanitizers for Public Health and Safety.

The onset of Covid-19 pandemic has resulted in the exponential growth of alcohol-based hand rub (ABHR)/hand sanitizer use. Reports have emerged of ABHR products containing methanol, a highly toxic compound to humans, exposing users to acute and chronic medical illnesses. While gas chromatography-mass spectrometry (GC-MS) remains the gold-standard method for the detection and identification of impurities in ABHRs, there exist limitations at widespread volume testing. This paper demonstrates the capability of an inexpensive portable pyroelectric linear array infrared spectrometer to rapidly test ABHR and compare the performance with a benchtop Fourier transform infrared spectrometer and HS-GC-MS. Multicomponent partial least square quantification models were built with performance found to be comparable between the two spectrometers and with the HS-GC-MS. Furthermore, the portable spectrometer was field-tested with real-world samples in Malaysia on both retail products (Group A) and freely deployed public dispensers (Group B) between May and November 2020. A total of 386 samples were tested. Only 75.2% of Group A met the criteria of safe and effective ABHR [no detectable methanol and alcohol concentration above 60% (v/v)], while <50% of Group B did. In addition, 7.4 and 18.8% of Group A and Group B, respectively, were found to contain methanol above permissible limits. The high percentage of sub-standard and methanol-containing samples combined with the frequent use of ABHR by the public highlights the need for and importance of a portable and rapid testing device for widespread screening of ABHR against falsified products and protects the general public.

An update on the prevalence and risk exposures associated with hand eczema in Danish hospital employees: A cross-sectional questionnaire-based study.

Hand eczema (HE) is common in health care workers (HCWs). During the last decade, new recommendations have supported increased use of alcohol-based hand rub (ABHR) to partially replace hand washings to lower the prevalence of HE. However, newer data on this recommendation is lacking. To assess current 1-year prevalence of HE in HCWs, to investigate exposure, and the extent of subjective discomfort to hand washings and ABHR. A digital questionnaire was sent to 4876 HCWs from April to May 2020. Of 2125 respondents (1779 women, 346 men), 14.7% reported HE within the last year. In total, 9.1% reported >20 hand washings per shift and 76.0% reported ABHR use >20 times per shift. HE was significantly associated with hand washings (adjusted odds ratio [OR] 1.73 [95% confidence interval [CI] 1.26-2.36]) and glove use on wet skin (adjusted OR 1.99 [95% CI 1.27-3.12]). Subjective discomfort to ABHR was reported significantly more often than to hand washings (P< .001) and significantly more often in HCWs with HE than in those without HE (P< .001). The current 1-year HE prevalence in HCWs of 14.7% was lower than in previously reported Scandinavian data. HE was related to frequent hand washings, as previously reported, and to glove use on wet skin, which is a possible risk factor for HE that should be further explored.

Insight into the knowledge, attitude and practices of hand hygiene with alcohol based hand rubs in a public sector tertiary care hospital of a developing country

Background: Health care worker’s hands are mostly responsible for transmission of healthcare associated infections (HCAI). In such instances, alcohol based hand rubs have been endorsed by WHO as the gold standard for hand hygiene for visibly clean hands; whereas, for visibly dirty hands soap and water is recommended. In developing countries (like Pakistan), affected people frequently exceed 25%. However, limited infrastructure in these countries hinders the performance of hand hygiene, but the use of alcohol-based hand rubs in such adverse situations is a practical solution to these constraints.Methods: In January 2021, we initiated a 12 week cross-sectional study in a public sector tertiary care hospital of Karachi, Pakistan. All participants were given a self-designed questionnaire with a consent form thereby giving us permission to use the data. Data was analyzed using statistical package for the social sciences (SPSS version 23).Results: 84.3% of the participants had received prior instructions on hand hygiene; however 71.7% respondents did not have access to alcohol based hand rubs. When questioned if they followed WHO’s five moments of hand hygiene, only 50.5% use alcohol based hand rubs before patient contact; 88.6% used it after patient contact; 83.2% after body fluid exposure risk; 77% before an aseptic task and 78.6% after contact with patient’s surroundings.Conclusions: There is a dire need for concerned authorities to enforce proper hand hygiene in public hospitals of developing countries in order to curb health care associated infections and prolonged hospital stays.

Three-year hand hygiene monitoring and impact of real-time reminders on compliance

Hand hygiene remains both the major strategy and an ongoing challenge for infection control. The main issues in the sustainability of hand hygiene automatic monitoring are healthcare worker (HCW) turnover rates and declining participation. To assess hand hygiene compliance and the impact of real-time reminders over three years. HCW compliance was observed for the use of alcohol-based hand rubs (AHR) on room entry and exit. Linear multi-level mixed models with time autocorrelations were performed to analyse the repeated measurements of daily room compliance and the effect of reminders over eight quarters (24 months). In all, 111 HCWs were observed and 525,576 activities were identified in the database. There was an improvement in compliance both on room entry and exit over two years, and the rooms which had activated reminders had better performance than the rooms which did not have activated reminders. This study showed the benefit of using real-time reminders; even 20% of rooms with an activated reminder improved overall hand hygiene compliance. A randomized real-time reminder setting may be a potential solution in reducing user fatigue and enhancing HCW self-awareness.

Bacteriological profile and antimicrobial efficacy of alcohol-based hand rubs among health care workers and family caregivers at the children's university teaching hospital in Lusaka, Zambia

BackgroundHands of healthcare workers (HCWs) and family caregivers are a potential source of bacterial pathogens that may be transferred to susceptible individuals. However, there is a paucity of data regarding the effect of hand rubs used in Zambian hospitals. Therefore, we determined the effect of locally made alcohol-based hand rubs in three selected wards of the Children Hospital at the University Teaching Hospital in Zambia. MethodsThis was a cross-sectional study involving 31 participants (12 family caregivers, 5 doctors and 14 nurses). The samples were collected before and after the use of the alcohol-based hand rub by direct fingerprints. They were then cultured and identified using conventional microbiological methods. The Kirby-Bauer Disc Diffusion method was used for antimicrobial susceptibility testing. ResultsAll samples collected from the participants yielded bacterial growth with a total of 7 species isolated. These included coagulase-negative staphylococcus (33.3%), Bacillus species (28.9%), Staphylococcus aureus (22.2%), Enterobacter agglomerans (6.7%), Corynebacterium species (4.4%), Escherichia coli (2.2%) and Burkholderia pseudomallei (2.2%). Notably, all study participants hands were not only contaminated but with drug-resistant organisms as most of the bacterial isolates were resistant to routine antibiotics used at the hospital including ciprofloxacin. S. aureus was also resistant to oxacillin thus suggesting the presence of Methicillin-Resistant S. aureus. The use of alcohol-based hand rubs reduced the bacterial load by 92.6% on doctors and nurses’ hands and by 84.5% on the hands of family caregivers. ConclusionThis study confirms that the hands of HCWs and family caregivers may play a role in the transmission of drug-resistant bacteria and that alcohol-based hand rubs can be an effective way of reducing bacterial hand contamination among healthcare workers and family caregivers. Therefore, we recommend that measures be put in place by the hospital to ensure the availability of hand rubs to HCWs as well as caregivers.