Hand Hygiene Agents Research Articles

When are the hands of healthcare workers positive for meticillin-resistant Staphylococcus aureus?

Hand hygiene is a key component in reducing infection. There are few reports on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) on healthcare workers' (HCWs') hands. The aim of this study was to establish whether HCWs' fingertips were contaminated with MRSA in a clinical hospital setting. The study was conducted in an acute tertiary referral hospital on four MRSA wards that were part of a larger research study on MRSA epidemiology and four other wards not included in the study. The fingertips from all categories of 523 HCWs were sampled on 822 occasions by the imprinting of fingertips on MRSA chromogenic agar plates. The type of hand hygiene agent used, if any, and the immediate prior activity of the HCW were recorded. Overall, 38/822 (5%) fingertips from 523 HCWs were MRSA-positive; 12/194 (6%) after clinical contact, 10/138 (10%) after contact with the patient's environment and 15/346 (4%) after no specific contact. MRSA was recovered on 2/61 (3%) occasions after use of alcohol hand rub, 2/35 (6%) after 4% chlorhexidine detergent, 7/210 (3%) hand washing with soap and water, and 27/493 (5%) when no hand hygiene had been performed. MRSA was recovered from HCWs on seven of the eight wards. MRSA was more frequently present on fingertips on the four non-study wards vs the four MRSA study wards [18/250 (7%), 3/201 (1%), respectively; P<or=0.004]. The isolation of MRSA from HCWs' fingertips, including after hand hygiene, indicates that more educational programmes are necessary to improve the quality of hand hygiene to prevent transmission of MRSA.

Conspicuous vs customary location of hand hygiene agent dispensers on alcohol-based hand hygiene product usage in an intensive care unit.

Hand washing is considered the single most important nosocomial infection-control strategy, yet compliance rarely meets levels recommended by infection control authorities. To determine whether placement of hand hygiene foam dispensers in more conspicuous positions and closer proximity to patients would increase use of infection control agents as measured by volume of product used. Further, to ascertain the influence of dispenser placement vs the number of dispensers available on usage by volume. This prospective, observational study conducted in an intensive care unit was composed of three observation periods. A control period with standard agent dispenser location (8 dispensers) was followed by two experimental periods: (1) "conspicuous and immediate proximity to patient" placement (16 dispensers) and (2) standard locations with a dramatic increase in the number of dispensers (36 dispensers). Volume of use for alcohol-based hand hygiene agent during the three observation periods revealed a statistically significant increase in daily consumption after conspicuous and proximate positioning of dispensers (P<.001). However, increasing the number of dispensers did not increase agent use (P=.196). More conspicuous placement of dispensers containing alcohol-based hand hygiene agent (ie, immediate proximity to patients) resulted in statistically and clinically significant increases in product usage. An increase in the number of dispensers did not increase usage. The impact of dispenser positioning on usage by volume for these highly effective products should be considered when planning and implementing intensive care unit infection-control policies.

Comparação da eficácia da lavagem das mãos versus fricção alcoólica em protocolos atuais e os hábitos de consumo entre os profissionais de saúde

A higiene das mãos é um exercício primário para reduzir a transmissão por contato de agentes infecciosos. Nós avaliamos a eficácia dos utensílios usualmente utilizados pelos profissionais de saúde para a higiene das mãos. Um total de quarenta profissionais de saúde (HCWs) e de trabalhadores da administração de um hospital de ensino lavavam as mãos com água e sabão, utilizando procedimentos- padrões, mas utilizavam o álcool em gel, com e sem protocolos padronizados. Um número total de unidades formadoras de colônia nas mãos foram de 3,52 e 4,48 para os HCWs e o pessoal da administração, respectivamente (p &lt; 0,05). A média de redução do número de organismos antes e depois de quaisquer procedimentos sempre mostrou diferenças estatisticamente significativas tanto para os procedimentos padronizados quanto para os não-padronizados, e todos eles demonstraram resultados semelhantes quando comparados uns aos outros, com apenas duas exceções. Não houve nenhuma diferença na proporção de Staphylococcus aureus e bactérias Gram-negativas entre os HCWs e o pessoal da administração quando colhido o material das mãos de ambos os grupos. Este estudo demonstrou que o uso regular de álcool em gel é tão bom como lavar as mãos com água e sabão, o que poderá aumentar o hábito da higiene das mãos, especialmente em situações em que existe uma falta de pias ou quando os HCWs estiverem sobrecarregados.

Formulation technology as a key component in improving hand hygiene practices

Proper hand hygiene has long been recognized as a primary tool in reducing transmission of health care-acquired infections. Compliance with recommended practices and an increase in the frequency of hand hygiene can have a negative impact on skin condition. Poor skin condition can result in reduced compliance with hand hygiene guidelines. In addition to reduced compliance with proper hand hygiene, deterioration in skin condition leads to reduced barrier function of the skin, changes in skin microflora, and increased shedding of skin squames. Thus, poor skin condition can increase the risk of infection, increase costs to the facility, and reduce the quality of life for the health care worker. To address the problem of skin irritation and its link to low compliance to hand hygiene practices, the Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene for Health Care Settings recommends that hand hygiene agents should be well accepted, well tolerated, and formulated to minimize irritancy. Sophisticated formulation technologies and the proper selection of ingredients can provide products that encourage hand hygiene compliance through pleasing aesthetic properties and by overcoming the damaging effects of hand hygiene practices.

Comparative efficacy of hand hygiene agents in the reduction of bacteria and viruses

BackgroundHealth care-associated infections most commonly result from person-to-person transmission via the hands of health care workers.MethodsWe studied the efficacy of hand hygiene agents (n = 14) following 10-second applications to reduce the level of challenge organisms (Serratia marcescens and MS2 bacteriophage) from the hands of healthy volunteers using the ASTM-E-1174-94 test method.ResultsThe highest log10 reductions of S marcescens were achieved with agents containing chlorhexidine gluconate (CHG), triclosan, benzethonium chloride, and the controls, tap water alone and nonantimicrobial soap and water (episode 1 of hand hygiene, 1.60-2.01; episode 10, 1.60-3.63). Handwipes but not alcohol-based handrubs were significantly inferior from these agents after a single episode of hand hygiene, but both groups were significantly inferior after 10 episodes. After a single episode of hand hygiene, alcohol/silver iodide, CHG, triclosan, and benzethonium chloride were similar to the controls in reduction of MS2, but, in general, handwipes and alcohol-based handrubs showed significantly lower efficacy. After 10 episodes, only benzethonium chloride (1.33) performed as well as the controls (1.59-1.89) in the reduction of MS2.ConclusionsAntimicrobial handwashing agents were the most efficacious in bacterial removal, whereas waterless agents showed variable efficacy. Alcohol-based handrubs compared with other products demonstrated better efficacy after a single episode of hand hygiene than after 10 episodes. Effective hand hygiene for high levels of viral contamination with a nonenveloped virus was best achieved by physical removal with a nonantimicrobial soap or tap water alone.

Emergence of resistant staphylococci on the hands of new graduate nurses.

To describe the aerobic microbial flora on the hands of experienced and new graduate nurses over time. A prospective cohort design that examined the relationship between duration of employment in an intensive care unit (ICU) and the microbial flora on the hands of experienced and new graduate nurses during a 23-month period. A 50-bed, level III-IV neonatal ICU in New York City. Twelve experienced nurses and 9 new graduate nurses working full time in the NICU. One hundred fifty samples were obtained from the clean, dominant hands of the nurses. Cultures were performed at baseline and then quarterly for each experienced and new graduate nurse. Baseline and final cultures of Staphylococcus epidermidis were further examined using pulsed-field gel electrophoresis. At baseline, a significantly larger proportion of the experienced nurses had methicillin-resistant, coagulase-negative staphylococci isolated from their hands compared with the new graduate nurses (95% and 33%, respectively; P = .0004). For a second culture, performed 1 to 4 months later, there were no longer significant differences between the two groups (82% and 54%, respectively; P = .12). By the last culture, all staphylococcal isolates were methicillin resistant in both groups of nurses; 3 were methicillin-resistant S. aureus. Colonization with methicillin-resistant staphylococci occurred after brief exposure to the hospital environment, despite the use of antiseptic hand hygiene agents. Furthermore, at final culture, the two groups shared one dominant hospital-acquired strain of S. epidermidis.

The effects of test variables on the efficacy of hand hygiene agents

Background Hand hygiene is essential to interrupting disease transmission in health care facilities. Multiple hand hygiene agents are currently available for use in the health care setting. To evaluate the utility of these agents, both the user acceptability and the efficacy need to be evaluated. Different hand hygiene test methodologies have been used to measure the efficacy of these agents, but efficacy results vary depending on variations to key parameters in these methodologies. The purpose of this study was to evaluate the effect of test variables on the efficacy of hand hygiene agents. Methods Both a comprehensive literature review and original hand hygiene efficacy studies were undertaken. The literature review was conducted using a Medline search, and hand hygiene efficacy studies were conducted under the American Society for Testing and Materials (ASTM). E 1174 Standard Test Method for Evaluation of the Effectiveness of Health Care Personnel Handwash Formulation. Results The literature review and our original data showed that the following variables affected the hand hygiene efficacy measurements: hand jewelry, experimental contamination versus normal flora, method of application of test organism, hand hygiene agent, concentration of active ingredient, volume of hand hygiene agent, duration of application of hand hygiene agent, method of application of hand hygiene agent, and study method (human challenge trial versus in vitro suspension test). Conclusions Although many methodological variables affect efficacy results, infection control professionals in their analysis of product information should always assess the results in light of the following key variables: concentration and type of active ingredient, duration of exposure to hand hygiene agent, volume of hand hygiene agent applied, test organism, and study method (ie, human challenge vs. in vitro suspension test).