Alcohol Hand Rubs Research Articles

OPTIMIZING WATER USAGE: THE IMPACT OF ALCOHOL HAND RUBS IN LOWER LIMB PRIMARY ARTHROPLASTY

Alcohol hand rubs, endorsed by WHO and NICE guidelines, are integral to modern surgical practices. Our objective was to assess how different scrubbing methods impact overall water usage by the surgical team, shedding light on variations among team members and their environmental implications.Over three consecutive arthroplasty lists spanning a week, water usage during scrubbing was observed for the operating team. Blinding all team members, including the anesthetist, consultant surgeon, orthopaedic registrar, orthopaedic SHO, and scrub nurse, during water usage calculations was implemented. Automated taps, using motion sensors, posed a challenge due to variable water quantity, necessitating water flow calculations per sensor movement. The senior surgeon, with over 20 years of experience, follows a traditional approach, starting with a morning prescrub and using an alcohol tub for each case, except when hands are soiled.We observed a total of 14 cases of lower limb primary arthroplasty. The cumulative water usage for scrubbing by the entire team was 193 liters, yielding a mean of 13.8 liters (±1.85) per case. The anaesthetist demonstrated the most conservative water usage, utilizing a total of 11.85 liters with a mean of 0.84 liters per case. Notably, alcohol rub was employed for half of the observed time, contributing to this efficient use. The senior operating surgeon used a total of 15.6 liters, averaging 1.1 liters per case. In contrast, the SHO and the registrar exhibited the highest water consumption, totaling 121.6 liters and yielding a mean of 5.7 liters per case. The nurses’ collective water usage for scrubbing amounted to 44.8 liters.Adopting alcohol rub, as endorsed by WHO, results in a remarkable 10-fold reduction in water usage, aligning with global health guidelines. This highlights significant potential for resource conservation in surgical procedures, presenting a practical and environmentally conscious approach to surgical scrubbing practices.

Strengthening the role of hospital leadership in infection control (LEAD-IC) – a multimodal educational intervention in German acute care hospitals

BackgroundThe effect of leadership support for adherence to infection control and prevention (IPC) measures has been demonstrated. To expand this support, a target group-specific educational study for chief medical officers (CMO) was implemented and its influence on IPC indicators was investigated.MethodsA controlled cohort study was conducted between 2018 and 2019. The intervention based on an initial workshop, an e-learning course, and a final meeting. Participants’ activities involving IPC management were surveyed. Consumption of alcohol hand rub (AHR) and incidence density of hospital-associated (HA) Clostridioides difficile-associated infections (CDI) were analyzed.ResultsEight percent of 360 CMOs invited participated in the initial workshop; 70% of those participants registered for the online course. Overall, 43% completed the post-intervention questionnaire, in which 85% of respondents reported increased collaboration with relevant stakeholders. The pre-intervention median AHR consumption was higher in the intervention group than in the control group. Both groups showed an increase (38.6 (interquartile range (IQR) 33.6; 45.0) to 41.9 ml/patient day (PD) (IQR 35.0; 56.6) and 33.4 (IQR 28.3; 40.8) to 35.8 ml/ PD (IQR 31.6; 43.2), respectively). Pre-intervention median HA CDI cases were lower in the intervention group than in the control group. Both groups reported a decrease (0.22 (IQR 0.17; 0.33) to 0.19 cases/1000 PD (IQR 0.15; 0.26) and 0.32 (IQR 0.2; 0.48) to 0.22 cases/1000 PD (IQR 0.11; 0.33), respectively).ConclusionMultimodal IPC training of CMOs is worthwhile and can lead to changes in IPC-relevant cooperation in hospitals. IPC training of hospital management should be further intensified.

"Preparation of Copper/Aloe Vera-Based Hand Sanitizer: A Mini Overview"

New hand sanitizer designs with eco-friendly components such as aloe vera and copper can allow pharmaceutical companies to bring enhanced applications onto the market while demonstrating simple and inexpensive preparations associated with improved microbial effectiveness. Alcoholic or non-alcoholic hand rubs are distinctively major classes of hand sanitizer platforms that can be prepared into hydrogels to address solutions for improved formulations. The innovative-utility of these hydrogels seems to be limited only by their ingredients and thus novel materials like copper or aloe vera can lead to optimization of anti-bacterial and anti-viral properties of sanitizers, and therefore a diversified product that may aid further research related to high demands of safe and sustainable materials to combat the current pandemic of COVID-19. The customized designs of starch or cellulosic hydrogels may ensure the diversity and right quality of incorporating these components needed for biocidal activity against microbes in the suggested hand sanitizers. Furthermore, the discussed sanitizer of copper and aloe vera combined in starch or cellulosic hydrogels are believed to exert enhanced texture, tone, and elasticity upon topical application due to their properties that may delve into the enzymatic activities required for less prevalence of skin lesions commonly known in traditional hand sanitizers.

Point prevalence survey of antibiotic use and healthcare-associated infections in acute care hospitals: a comprehensive report from the Marche Region of Italy

Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) are serious health challenges. Point prevalence surveys (PPSs) are valuable tools for monitoring HAIs and AMR. To describe results of the ECDC PPS 2022 dealing with the prevalence of HAIs, antimicrobial consumption, and associated factors, in acute care hospitals. The survey was performed in November 2022 in 14 hospitals according to the protocol proposed by the European Centre for Disease Prevention and Control. Multilevel logistic regression was performed using geographical area/hospital type as cluster variable to evaluate the factors independently associated with HAIs and antibiotics. The point prevalence of HAIs was 7.43%. Patients hospitalized for longer periods were more likely to have an HAI as well as those aged 15-44 years, with a rapidly fatal disease, intubated, and with one or two devices. Antibiotics prevalence was 47.30%. Males, unknown McCabe scores, minimally invasive/non-National Healthcare Safety Network (NHSN) surgery, patients with HAIs, hospitals with a higher alcohol hand-rub consumption, hospitals with a greater number of IPC personnel, geriatric wards, and hospitals with 300-600 beds were more likely to be under antimicrobial therapy. This PPS provided valuable information on the prevalence of HAIs and antimicrobialconsumption and variables associated. The high prevalence of HAIs highlights the need for improved infection control measures.

Antimicrobial use, healthcare-associated infections, and bacterial resistance in general hospitals in China: the first national pilot point prevalence survey report.

The purpose of this study is to implement point prevalence survey (PPS), assess antimicrobial prescribing and resistance in general hospitals and clinical specialties in China, and compare them with similar data from other parts of the world. Twenty general hospitals in China were surveyed in October or November, 2019. A standardized surveillance protocol was used to collect data on patient demographics, diagnosis of infection, the prevalence and intensity of antimicrobial use, prescribing quality, bacterium type and resistance spectrum, and the prevalence and type of healthcare-associated infections (HAIs). Overall, 10,881 beds and 10,209 inpatients were investigated. The overall prevalence of antibiotic use was 37.00%, the use of antibiotic prophylaxis in surgical patients was high (74.97%). The intensity of antimicrobial use was 61.25 DDDs/100 patient days. Only 11.62% of antimicrobial prescriptions recorded the reason for prescribing. Intravenous or combination treatments comprised 92.02% and 38.07%, respectively, and only 30.65% of prescriptions referred to a microbiological or biomarker tests. The incidence of HAIs in all patients was 3.79%. The main associated factors for HAIs included more frequent invasive procedures (27.34%), longer hospital stay (> 1-week stay accounting for 51.47%), and low use of alcohol hand rubs (only 29.79% placed it bedside). Most of the resistant bacteria declined; only carbapenem-resistant Enterobacter is higher than previously reported. The prevalence of antibiotic use in general hospitals fell significantly, the overall bacterial resistance declined, and the incidence of HAI was low. However, the low quality of antimicrobial use requires urgent attention.

Preventing healthcare-associated MRSA bacteremia: getting to the root of the problem.

Bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA) remain a major challenge in most countries worldwide. We describe a quasi-experimental sequential intervention at Mater Dei Hospital, Malta, to reduce hyper-prevalence of healthcare-associated MRSA bacteremia (HA-MRSA-B). The hospital initiated a hand hygiene (HH) campaign in 2008 to improve alcohol hand rub (AHR) use. In 2011, this was followed by root cause analysis (RCA) of all HA-MRSA-B cases and finally universal MRSA admission screening in 2014. Change-point analysis was used to evaluate the impact of the interventions. The effect of the HH campaign became evident when AHR consumption reached 40L/1000 occupied bed days (BD). RCAs identified intravascular devices as the likely risk factor in 83% of all HA-MRSA-B; specifically non-tunneled double-lumen hemodialysis catheters (36%), peripheral venous cannulas (25%), and central venous catheters (22%). Interventions to improve their management resulted in the greatest reduction of HA-MRSA-B rates. They were informed by the RCA findings and targeted behavior change through education, motivation, and system change. Universal MRSA admission screening provided the final decline in incidence. Each intervention affected HA-MRSA-B rates after a lag period of approximately 18-24 months. Overall, HA-MRSA-B incidence decreased from 1.72 cases/10000BD in 2008 to 0.18/10000BD in 2019; a reduction of almost 90%. Intravenous device interventions were also associated with a reduction of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia rates. Significant improvement in HA-MRSA-B is possible, even in highly endemic regions. It requires well-planned behavior change interventions which are compatible with local context and culture.

Impact of a low-cost bundle of interventions on infection prevention and control during labour and delivery in rural health centres in Zambia: results from a quasi-experimental study

Infection remains an important cause of maternal and newborn morbidity and mortality globally despite evidence that it can be reduced with adherence to infection prevention and control (IPC) practices. The implementation of IPC has been especially challenging in rural health centres. This pilot study used a non-randomised quasi-experimental design to examine the impact of a low-cost intervention bundle at five rural health facilities in Southern Province of Zambia. We used the Infection Control Assessment Tool (ICAT) and surveyed the incharge nurse, observed deliveries and reviewed logbooks to collect pre- and post-intervention data on healthcare worker IPC practices and maternal and newborn outcomes. The intervention bundle included education sessions, provision of alcohol hand rubs (AHRs), short message service (SMS) text messages and poster reminders, and monthly study visits. The overall ICAT score did not significantly increase after the intervention (64.0 vs. 71.8, maximum score 133, P = 0.28). There was a significant increase in the labour and delivery practices module score (12.5 vs. 16.6, maximum score 27, P = 0.04) and a trend towards improvement in the hand hygiene module (9.1 vs. 13.6, maximum score 23, P = 0.08). There were no differences in pre- or post-intervention outcomes amongst the 654 mothers who delivered and the 655 newborns during the study period. In conclusion, a low-cost bundle of interventions did neither overall improve healthcare workers’ IPC practices in rural Zambia nor significantly change the rates of newborn and maternal complications. Identified challenges included inconsistent supplies of AHRs, protective and sterile equipment, as well as heavy workload for healthcare workers, which inhibited preventative behaviours.

Comparison of Conventional Hand Wash and Isopropyl Alcohol Hand Rub among Healthcare Workers and Doctors Working in Gastromedicine ICU: An Observational Study

Nosocomial infection rate is often higher for intensive care unit (ICU) than other units of hospitals, and hands of health-care workers (HCWs) as well as on resident duty doctors play a major role in the transmission of the infections. Aim of this study was to compare the efficacy of conventional hand wash with the Isopropyl alcohol Hand rub in reducing the transient bacterial flora on the hands of nurses and posted doctors in a Gastromedicine ICU. The 32 nurses and 14 resident duty doctors posted in our ICU during JanuaryMarch 2022 were included in this observational study. A total of 250 samples were collected for the residual bacterial flora on fingers using the impression method on MacConkey agar plates. The subjects then used Isopropyl alcohol hand rub or conventional hand wash and the residual bacterial flora was rechecked by testing the impression of fingers on MacConkey agar. Escherichia coli, Klebsiella spp., non-lactose fermenting Gram-negative bacilli, staphylococci, and streptococci formed the transient bacterial flora on the hands. Moderate to heavy bacterial density was seen in more than 94 % of the hands before washing or hand rub application. Conventional hand wash resulted in a drastic reduction in the transient bacterial flora on hands in 55 % of cases whereas Isopropyl alcohol hand rub achieved the effect in 97 % of the samples. Compared with conventional hand wash, Isopropyl alcohol hand rub is far more efficient in reducing transient bacterial flora on the hands of HCWs, and in resident duty doctors it is more convenient and timesaving. It is recommended as a hand hygiene practice in critical areas especially in the gastro medicine ICU because most of the patients are immunocompromised and it may act as a protective barrier.

Cost-effectiveness analysis of alcohol handrub for the prevention of neonatal bloodstream infections: Evidence from HAI-Ghana study.

Published evidence of the cost-effectiveness of alcohol-based handrub (ABH) for the prevention of neonatal bloodstream infections (BSI) is limited in sub-Saharan Africa. Therefore, this study evaluates the cost-effectiveness of a multimodal hand hygiene involving alcohol-based hand rub (ABH) for the prevention of neonatal BSI in a neonatal intensive care unit (NICU) setting in Ghana using data from HAI-Ghana study. Design was a before and after intervention study using economic evaluation model to assess the cost-effectiveness of a multimodal hand hygiene strategy involving alcohol-based hand rub plus soap and water compared to existing practice of using only soap and water. We measured effect and cost by subtracting outcomes without the intervention from outcomes with the intervention. The primary outcome measure is the number of neonatal BSI episode averted with the intervention and the consequent cost savings from patient and provider perspectives. The before and after intervention studies lasted four months each, spanning October 2017 to January 2018 and December 2018 to March 2019, respectively. The analysis shows that the ABH program was effective in reducing patient cost of neonatal BSI by 41.7% and BSI-attributable hospital cost by 48.5%. Further, neonatal BSI-attributable deaths and extra length of hospital stay (LOS) decreased by 73% and 50% respectively. Also, the post-intervention assessment revealed the ABH program contributed to 16% decline in the incidence of neonatal BSI at the NICU. The intervention is a simple and adaptable strategy with cost-saving potential when carefully scaled up across the country. Though the cost of the intervention may be more relative to using just soap and water for hand hygiene, the outcome is a good reason for investment into the intervention to reduce the incidence of neonatal BSI and the associated costs from patient and providers’ perspectives.

422. Sustainability of Improvements to Hand Hygiene Performance Throughout the COVID-19 Pandemic

BackgroundHand hygiene (HH) is a standard infection prevention and control precaution to be applied in healthcare settings to prevent transmission of COVID-19. Many healthcare institutions observed significant improvements in HH performance during wave one of the COVID-19 pandemic but the sustainability of this change is unknown. Our aim was to evaluate long-term HH performance throughout subsequent waves of the pandemic across acute care hospitals in Ontario, Canada. MethodsHH adherence was measured using a previously validated group electronic monitoring system which was installed on all alcohol handrub and sink soap dispensers inside and outside each patient room across 56 inpatient units (35 wards and 21 critical care units) spanning 13 acute care hospitals (6 university and 7 community teaching hospitals) from 1 November 2019 to 31 May 2021. Daily HH adherence was compared with daily COVID-19 case count across Ontario. During this period, weekly performance continued to be reported to units but unit-based quality improvement discussions were inconsistent due to the COVID-19 response. ResultsFigure 1 depicts daily aggregate HH adherence plotted against the new daily COVID-19 case count across Ontario. An elevation in HH adherence was seen prior to the start of the first wave, rising almost to 80% and then remained above 70% for the peak of wave one. During waves two and three, peak COVID-19 case counts were associated with a maximum HH adherence of 51%, only marginally above the pre-pandemic baseline. After the end of wave one (from 1 July 2020 to 31 May 2021) the median HH performance was only 49% (interquartile range 47%-50%). Figure 1. Hand hygiene adherence across 13 acute care hospitals in comparison to overall new daily COVID-19 cases in Ontario ConclusionInitial improvements in HH adherence preceding the start of the COVID-19 pandemic were not sustained, possibly due to increasing comfort and reduced anxiety associated with providing care to COVID-19 patients leading to a perception of reduced COVID-19 transmission risk. These findings highlight the need for HH monitoring to be tied to longitudinal unit-led quality improvement in order to achieve durable changes in practice. Disclosures Susy S. Hota, MSc MD FRCPC, Finch Therapeutics (Research Grant or Support) Susy S. Hota, MSc MD FRCPC, Finch Therapeutics (Individual(s) Involved: Self): Grant/Research Support

Supplementing hand washing with proper use of alcoholic hand rub in a special neonatal care unit in a large academic public health institute at Jabalpur, Madhya Pradesh, India

ObjectiveThe purpose was to increase use of alcoholic hand rub (AHR) in specialised newborn care unit (SNCU) to improve hand hygiene in order to reduce neonatal sepsis and mortality at...

Coronavirus Disease 2019 Outbreak in a Psychiatric Closed Ward: What We Have to Learn.

An outbreak of COVID-19 with an extremely high attack rate happened in a psychiatric closed ward. One hundred two (98.1%) out of 104 patients were diagnosed with COVID-19 between February 20th and 26th, 2020, most of whom were with schizophrenia. Facility factors (such as multi-share rooms, closed windows, and absence of alcohol hand rubs), along with chronic medical conditions, and difficulty to explain symptoms for psychiatric patients might have contributed to the high attack rate. To overcome these hurdles, efficient ventilating with filtration system in psychiatric facilities, strict access control to closed wards, and prompt response to febrile patients could prevent nosocomial outbreak. We must consider that the influx of COVID-19 into a closed ward could cause an extremely high attack rate, and have to be vigilant against COVID-19 in psychiatric wards.

What Is Driving the Epidemiology of Methicillin-Resistant Staphylococcus aureus Infections in Europe?

Introduction: The burden from infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the European Union/European Economic Area (EU/EEA) has increased in recent years, especially in the higher prevalence southern and eastern countries. Addressing this challenge requires a clear knowledge of the factors driving this epidemiology to inform effective national interventions and campaigns. Methods: We identified national quality metrics for antibiotic use and hand hygiene from the 2016/2017 European Centre for Disease Control (ECDC) Point Prevalence study as well as structural, cultural, and governance indicators from other sources. We then utilized general linear modeling to identify parsimonious correlations with national MRSA proportions reported by the European Antimicrobial Resistance Surveillance Network (EARS-Net). Results: The main process predictor of MRSA prevalence in EU/EEA countries was the use of more than one concurrent antibiotic per patient. The impact of hand hygiene was less clear, possibly because consumption of alcohol hand-rub was suboptimal throughout Europe. Hospital and infection control structural factors did not appear relevant at overall national level. Culture and governance were collectively key predictor groups; uncertainty avoidance, masculinity, and corruption indices strongly correlated with MRSA prevalence. Discussion: Our results suggest that the critical antibiotic stewardship factor associated with MRSA in EU/EEA countries is the quality of antibiotic prescribing, especially spectrum of activity, rather than overall consumption levels in hospitals or proportion of patients treated. Above all, MRSA hyperendemicity is correlated with a set of sociocultural behavioral constructs that typically manifest themselves in lack of urgency to address risk and normalization of deviance in relation to noncompliant practices.

Poor quality alcohol hand-rub associated multidrug resistant Klebsiella pnemoniae outbreak in a neonatal unit

Background: Klebsiella pneumoniae represents an important pathogen in hospital acquired infections. Outbreak of sepsis with ESBL producing Klebsiella pneumoniae with fatal outcome was reported in a neonatal unit of a District General Hospital in Sri Lanka. This study is to describe an outbreak of fatal sepsis caused by Klebsiella pneumoniae in 5 neonates, in a neonatal unit during May and June 2015, addressing the range of infection control measures in an outbreak including hand hygiene, in-ward intravenous fluid preparation and administration, under suboptimal infection control conditions. Methods and materials: Collection and culturing of suspected fluid samples, including infusates, humidifier water, prepared intravenous fluids done in stages; culturing the samples collected initially and repeat collection and culturing the fluid samples, after strengthening infection control practices. Observation and correction of infection control procedures according to the infection control manual, strengthening hand hygiene practice, stopping reuse of multi-vials after 24 hours. Inspecting hands of the staff, who prepare infusates, for absence of micro-organisms, after using locally prepared alcohol hand-rub. As the outbreak continued infecting new admission with same organism in blood cultures, quality of the local hand-rub was tested. After replacing local hand-rub with quality assured commercial hand-rub and thorough cleaning of the unit, resampling done. Results: Out of 13 fluid samples of initial cultures, 3 infusates connected to 3 neonates grew Klebsiella pneumoniae, whose blood cultures became positive with the same, subsequently. Awareness programme on hand hygiene, improved staff hand hygiene compliance from 30% to 94%. Samples of infusates taken following corrected infection control practices and strict hand hygiene grew same organism in 3 samples out of 12. Hand prints of staff, following hand-rub usage, grew micro-organisms, including Klebsiella pneumoniae. For local hand-rub preparation, as the starting solution, 70% isopropyl alcohol was used and alcohol percentage of final product was not tested. Samples taken after quality assured hand-rub, did not grow organisms. Conclusion: Poor quality of hand-rub, re-using multi-vials after 24 hours and poor hand hygiene practices have resulted the outbreak. Therefore it is compulsory to look into all the contributing factors and timely correction of them is lifesaving in management of outbreak.

How irritant are n-propanol and isopropanol? - A systematic review.

BackgroundThe use of alcoholic‐based hand rubs (ABHRs) is an important tool for hand hygiene, especially in times of the COVID‐19 pandemic. Possible irritant effects of ABHR may prevent their use by persons at risk of infection.MethodsThis systematic review is based on a PubMed search of articles published between January 2000 and September 2019 in English and German, and a manual search, related to the irritation potential of alcohol‐based disinfectants restricted to n‐propanol (1‐propanol) and its structural isomer isopropanol (isopropyl alcohol, 2‐propanol).ResultsThe majority of the included studies show a low irritation potential of n‐propanol alone. However, recent studies provide evidence for significant barrier damage effects of repeated exposure to 60% n‐propanol in healthy, as well as atopic skin in vivo. The synergistic response of combined irritants, (ie, a combination of n‐propanol or isopropanol with detergents such as sodium lauryl sulfate) is greater, compared with a quantitatively identical application of the same irritant alone.ConclusionWhile recent studies indicate a higher risk of skin irritation for n‐propanol and isopropanol than reported in the past, this risk still seems to be lower than that for frequent handwashing with detergents, as recommended by some to prevent COVID‐19 infections.

Alcohol Hand Rub Significantly Reduces Overall Bacterial Bioburden on Stethoscopes in a Real-World Clinical Setting

Background: Stethoscopes are a known vector for microbial transmission; however, common strategies used to clean stethoscopes pose certain barriers that prevent routine cleaning after every use. We aimed to determine whether using readily available alcohol-based hand rub (ABHR) would effectively reduce bacterial bioburden on stethoscopes in a real-world setting. Methods: We performed a randomized study on inpatient wards of an academic medical center to assess the impact of using ABHR (AlcareExtra; ethyl alcohol, 80%) on the bacterial bioburden of stethoscopes. Stethoscopes were obtained from healthcare providers after routine use during an inpatient examination and were randomized to control (no intervention) or ABHR disinfection (2 pumps applied to tubing and bell or diaphragm by study personnel, then allowed to dry). Cultures of the tubing and bell or diaphragm were obtained with premoistened cellulose sponges. Sponges were combined with 1% Tween20-PBS and mixed in the Seward Stomacher. The homogenate was centrifuged and all but ~5 mL of the supernatant was discarded. Samples were plated on sheep’s blood agar and selective media for clinically important pathogens (CIPs) including S. aureus, Enterococcus spp, and gram-negative bacteria (GNB). CFU count was determined by counting the number of colonies on each plate and using dilution calculations to calculate the CFU of the original ~5 mL homogenate. Results: In total, 80 stethoscopes (40 disinfection, 40 control) were sampled from 46 physicians (MDs) and MD students (57.5%), 13 advanced practice providers (16.3%), and 21 nurses (RNs) and RN students (26.3%). The median CFU count was ~30-fold lower in the disinfection arm compared to control (106 [IQR, 50–381] vs 3,320 [986–4,834]; P < .0001). The effect was consistent across provider type, frequency of recent usual stethoscope cleaning, age, and status of pet ownership (Fig. 1). Overall, 26 of 80 (33%) of stethoscopes harbored CIP. The presence of CIP was lower but not significantly different for stethoscopes that underwent disinfection versus controls: S. aureus (25% vs 32.5%), Enterococcus (2.5% vs 10%), and GNB (2.5% vs 5%). Conclusions: Stethoscopes may serve as vectors for clean hands to become recontaminated immediately prior to performing patient care activities. Using ABHR to clean stethoscopes after every use is a practical and effective strategy to reduce overall bacterial contamination that can be easily incorporated into clinical workflow. Larger studies are needed to determine the efficacy of ABHR at removing CIP from stethoscopes as stethoscopes in both arms were frequently contaminated with CIP. Prior cleaning of stethoscopes on the study day did not seem to impact contamination rates, suggesting the impact of alcohol foam disinfection is short-lived and may need to be repeated frequently (ie, after each use).Funding: NoneDisclosures: NoneDisclosures: NoneFunding: None

Handwash versus hand-rub practices for preventing nosocomial infection in hospital intensive care units: A systematic review and meta-analysis

Background: Compliance with handwashing in busy healthcare facilities, such as intensive care units (ICUs), is suboptimal and alcohol hand-rub preparations have been suggested to improve compliance. There is no evidence on the comparative effectiveness between handwash and hand-rub strategies. This systematic review was to assess the effectiveness of handwash versus hand-rub strategies for preventing nosocomial infection in ICUs. Methods Studies conducted in ICUs and indexed in PubMed comparing the clinical effectiveness and adverse events between handwash and hand-rub groups were included in a systematic review. The primary outcome was nosocomial infection rates. Secondary outcomes included microbial counts on healthcare providers’ hands, mortality rates, patient/hospital cost of treatment of healthcare-associated infections (HCAIs), length of ICU/hospital stays, and adverse events. Studies were independently screened and data extracted by at least two authors. Meta-analyses of risk ratios (RR), incidence rate ratios (IRR), odds ratios (OR) and mean differences (MD), were conducted using the RevMan 5.3 software. Results: Seven studies published between 1992-2009 and involving a total of 11,663 patients were included. Five studies (10,981 patients) contributed data to the ICU acquired nosocomial infection rates. The pooled IRR was 0.71 (95% CI 0.61, 0.82; I2 = 94%). On sensitivity analysis, pooled IRR was 0.39 (95% CI 0.32, 0.48; 4 studies; 8,247 patients; I2 = 0%) in favour of hand rub. The pooled OR for mortality was 0.95 (95% CI 0.78, 1.61; 4 studies; 3,475 patients; I2 = 39%). The pooled MD for length of hospital stay was -0.74 (95% CI -2.83, 1.34; 3 studies; 741 patients; I2 = 0%). The pooled OR for an undesirable skin effect was 0.37 (95% CI 0.23, 0.60; 3 studies;1504 patients; I2 = 0%) in favour of hand rub. Overall quality of evidence was low. Conclusion: Hand rub appeared more effective when compared to handwash in ICUs.

Tracking Australian Hajj Pilgrims' Health Behavior before, during and after Hajj, and the Effective Use of Preventive Measures in Reducing Hajj-Related Illness: A Cohort Study.

This study assessed Australian Hajj pilgrims’ knowledge, attitude and practices throughout their Hajj journey to understand their health behaviors, use of preventative measures and development of illness symptoms. A prospective cohort study with data collection at three phases (before, during and after Hajj) was conducted among Australian pilgrims between August and December 2015. Baseline data were collected from 421 pilgrims before Hajj, with 391 providing follow-up data during Hajj and 300 after their home return. Most participants (78% [329/421]) received one or more recommended vaccines; travel agents’ advice was the main factor affecting vaccination uptake. Most participants (69% [270/391]) practiced hand hygiene with soap and sanitizers frequently, followed by disposable handkerchief use (36% [139/391]) and washing hands with water only (28% [111/391]). During Hajj 74% (288/391) of participants reported one or more illness symptoms, 86% (248/288) of these symptoms were respiratory. Cough was less often reported among pilgrims who received vaccinations, cleaned their hands with soap or alcoholic hand rubs, while a runny nose was less common among those who frequently washed their hands with plain water but was more common among those who used facemasks. This study reveals that most Australian Hajj pilgrims complied with key preventative measures, and that tour group operators’ advice played an important role in compliance. Pilgrims who were vaccinated and practiced hand hygiene were less likely to report infection symptoms.

Impact of improved observed hand hygiene on bloodstream infection rates in Ireland. A prospective segmented regression analysis, 2009-2016.

Participation in European surveillance for bloodstream infection (BSI) commenced in Ireland in 1999 with all laboratories (n = 39) participating by 2014. Observational hand hygiene auditing (OHHA) was implemented in 2011. The aim of this study was to evaluate the impact of OHHA on hand hygiene compliance, alcohol hand rub (AHR) procurement and the incidence of sensitive and resistant Staphylococcus aureus and Enterococcus faecium and faecalis BSI. A prospective segmented regression analysis was performed to determine the temporal association between OHHA and outcomes. Observed hand hygiene improved from 74.7% (73.7-75.6) in 2011 to 90.8% (90.1-91.3) in 2016. AHR procurement increased from 20.1 l/1000 bed days used (BDU) in 2009 to 33.2 l/1000 BDU in 2016. A pre-intervention reduction of 2% per quarter in the ratio of methicillin sensitive Staphylococcus aureus BSI/BDU stabilized in the time period after the intervention (P < 0.01). The ratio of Methicillin resistant Staphylococcus aureus (MRSA) BSI/BDU was decreasing by 5% per quarter pre-intervention, this slowed to 2% per quarter post intervention, (P < 0.01). There was no significant change in the ratio of vancomycin sensitive (P = 0.49) or vancomycin resistant (P = 0.90) Enterococcus sp. BSI/BDU post intervention. This study shows national OHHA increased observed hand hygiene compliance and AHR procurement, however there was no associated reduction in BSI.

Impact of implementation of a modified World Health Organization multimodal hand hygiene strategy in a university teaching hospital

Although educational programs could enhance knowledge, practices, and compliance with hand hygiene (HH) for health care workers, the researches focusing on effective methods for educating and increasing the compliance with HH practices are scanty. Consequently, the researchers conducted the present study to assess HH-related knowledge, attitude, and compliance rate after the implementation of a modified version of the World Health Organization (WHO) multimodal strategy was written in the background. A pretest-posttest quasiexperimental study was conducted in a university hospital in Cairo among 84 nurses. The study consisted of 4 phases: baseline assessment, intervention, postintervention assessment, and follow-up phase. The intervention (HH-campaign) consisted of 4 components: infrastructure change, training/education of health care workers, posting visual reminders, and development of institutional safety climate "hand hygiene champions." HH compliance rate significantly increased from 28% before the intervention to 50% after the intervention and 58% after the follow-up period (P < .001). The knowledge score and the attitude score significantly improved before and after the intervention (P < .001). The use of alcohol handrub significantly increased from 9.5% before the intervention to 65% after the intervention and 76% after the follow-up period. Implementation of a modified version of the World Health Organization multimodal strategy successfully doubled HH compliance rates. Tackling a social way of thinking together with regular frequent training and follow-up are essential to sustain adherence to safe HH practices.