Frequency Of Hand Hygiene Research Articles

Evaluation of an Electronic Device for Real-Time Measurement of Alcohol-Based Hand Rub Use

Observational surveys of hand hygiene compliance are time consuming. Measuring the use of a hand hygiene product is a less time-consuming method of monitoring the frequency of hand hygiene performance. To evaluate the usefulness of electronic devices for monitoring alcohol-based hand rub use. Prospective observational trial. A university-affiliated teaching hospital. Prototypes of an electronic device designed to record each time a dispenser is used (hereafter referred to as a hand hygiene event) were placed in alcohol-based hand rub dispensers on the general medical ward and in the surgical intensive care unit. Data were downloaded wirelessly to a data logger and then uploaded to a dedicated Web site for analysis. Alcohol-based hand rub dispensers were located in patient rooms and in corridors. During a 6-month trial, 105,462 hand hygiene events occurred in the surgical intensive care unit, and 44,845 events occurred on the general medical ward. The dispensers located in patient rooms accounted for 47% of the hand hygiene events performed in the surgical intensive care unit but for only 36% of events on the general medical ward (P < .001). The dispensers most often used were located in corridors. Hand hygiene events were most common on Tuesdays, Wednesdays, and Thursdays, between 7:00 am and 11:00 am. The use of these electronic devices provided an efficient and accurate method of monitoring the frequency of alcohol-based hand rub performance on the general medical ward and in the surgical intensive care unit, and yielded more detailed information on usage patterns than did expressing use as liters per 1,000 patient-days. The wireless downloading of data from dispensers required a limited amount of time, and the dedicated Web site facilitated data analysis. Such devices should prove useful in monitoring the impact of various interventions on the frequency of hand hygiene performance.

Measuring adherence to hand hygiene guidelines: A field survey for examples of effective practices

Measuring adherence to hand hygiene guidelines is resource intensive and complicated by lack of standardized methodology. The multiplicity of approaches in use makes it difficult to meaningfully compare performance across health care organizations. The goal of this project was to identify promising and effective practices for measuring adherence with hand hygiene guidelines across a variety of settings. A cross-sectional survey was conducted electronically in February 2007 to collect information on aspects of hand hygiene measured (eg, frequency, thoroughness of technique, glove use, product consumption), data collection approaches, training and resources, reports, and others. Invitations to respond were widely distributed through Web site announcements and list-serve messages of The Joint Commission and collaborating organizations. A panel of national experts developed and applied criteria for evaluating the methods. Two hundred forty-two responses were submitted from a variety of settings and countries. Most (approximately 75%) measured frequency of hand hygiene; approximately 50% measured thoroughness, glove use, product usage, patient and provider satisfaction, or other aspects. Seventy-two percent relied exclusively on manual data collection, and most methods (80%) had been in use for less than 3 years. Most (65%) spent less than 1 hour in training data collectors, and few had evidence of reliability or validity. Forty submissions met most criteria for inclusion in an educational monograph. Among respondents who considered their approach to be an example of an effective practice, there was substantial variation in methods and little evidence of reliability. Standardization of methods is needed to compare performance across organizations or within an organization over time.

Hand Hygiene: It's All About When and How

From the Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, and World Health Organization First Global Patient Safety Challenge, Word Health Organization Headquarters, Geneva, Switzerland. Received July 25, 2008; accepted July 31, 2008; electronically published August 28, 2008. Infect Control Hosp Epidemiol 2008; 29:957-959 2008 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2008/2910-0010$15.00.DOI: 10.1086/592218 Hand hygiene is the primary measure for infection prevention. When appropriately performed, it reduces the crosstransmission of microbial pathogens and the burden of infectious diseases, both in the community and in the healthcare setting. The major challenge for hand hygiene is compliance, which is usually much less than 50% in most hospitals. Barriers to compliance have been identified at individual, group, and institutional levels. In healthcare settings where epidemiological studies assessed and quantified the role played by such barriers, promotion strategies have been developed and applied successfully—resulting in improved compliance and decreased rates of cross-transmission and infection. To succeed, however, strategies must be multimodal and include at least 5 components: staff education, monitoring of practices and performance feedback, reminders in the workplace, adoption of an institutional safety climate, and, last but not least, a system change—the preferential recourse to the use of alcohol-based hand rub as the new standard for patient care. Hand hygiene with alcohol-based formulations is preferred to hand washing with soap and water in most instances, because it is fast-acting, more efficacious, causes less damage to the skin, and has the major advantage of being immediately accessible at the point of patient care, thus bypassing the time constraint—one of the most critical barriers to hand hygiene in a healthcare setting. Although the majority of studies on hand-hygiene compliance have focused on the time and frequency of action (ie, when to clean hands), only a few have addressed the topic of how to clean hands. In this issue of the journal, Laustsen et al. report on their study that monitored how hand rubbing with alcohol gel was performed at the bedside and corroborated correctness of practice with antimicrobial efficacy. The findings are staggering. Only 55% of staff performed the action correctly, despite being closely monitored by an observer who took imprints of their fingertips before and after hand rubbing with alcohol gel during clinical care procedures. Incorrect practice was associated with a 35% decrease in efficacy, regardless of whether imprints for culture were obtained before the clinical procedure (when hand hygiene was performed to protect the patient) or after (when hand hygiene was performed to protect the healthcare worker or the next patient that he or she would be in contact with). This study adds to previous findings regarding both hand rubbing with alcohol gel and hand washing with soap in suggesting that not only the timing and frequency of hand hygiene must improve, but also its basic qualitative performance. Tools and innovative strategies exist; they just have to be taught and applied. It is obvious that the clinical significance of the findings of Laustsen et al. remains unknown as yet. However, let us stand back and reconcile it with current evidence-based knowledge. Infection control professionals would ideally ask healthcare workers to be 100% compliant with hand-hygiene

Grado de cumplimiento y determinantes de las recomendaciones sobre la higiene de manos

A basic indicator for assessing a program aimed at improving hand hygiene (HH) is the degree of compliance with the recommendations established for this purpose. The aim of this study is to investigate this indicator and related determinant factors in a general hospital. We performed 166 observation periods of one hour's duration, distributed over three work shifts and covering all the hospitalization units; 3957 HH opportunities were recorded. Variables associated with the observation period, the professionals involved and the medical activity taking place were also recorded. The Chi-square test, and calculation of the raw OR and the adjusted OR with a logistic regression model were used to study associations between the variables studied and failure to perform HH. The overall frequency of HH activity was 30%, ranging from 8.9% to 60.5% depending on the professional tasks involved. The most important independent risk factors for failure to perform HH were the following: no availability of alcohol in a pocket size bottle (OR: 2.3 [1.7-3.3]); medical activities carried out in the surgical unit (OR: 2.6 [2.0-3.3]); activities taking place before entering into contact with patients (OR: 3.2 [2.4-4.2]); and use of gloves during the activity (OR: 2.2 [1.6-3.2]). The frequency of HH is low, but there are several potentially modifiable factors involved, which could improve with interventions. One example might be better education of hospital personnel on the importance of HH.

Multicenter Intervention Program to Increase Adherence to Hand Hygiene Recommendations and Glove Use and to Reduce the Incidence of Antimicrobial Resistance

To determine whether a multimodal intervention could improve adherence to hand hygiene and glove use recommendations and decrease the incidence of antimicrobial resistance in different types of healthcare facilities. Prospective, observational study performed from October 1, 1999, through December 31, 2002. We monitored adherence to hand hygiene and glove use recommendations and the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures. We evaluated trends in and predictors for adherence and preferential use of alcohol-based hand rubs, using multivariable analyses. Three intervention hospitals (a 660-bed acute and long-term care hospital, a 120-bed community hospital, and a 600-bed public teaching hospital) and a control hospital (a 700-bed university teaching hospital).Intervention. At the intervention hospitals, we introduced or increased the availability of alcohol-based hand rub, initiated an interactive education program, and developed a poster campaign; at the control hospital, we only increased the availability of alcohol-based hand rub. We observed 6,948 hand hygiene opportunities. The frequency of hand hygiene performance or glove use significantly increased during the study period at the intervention hospitals but not at the control hospital; the maximum quarterly frequency of hand hygiene performance or glove use at intervention hospitals (74%, 80%, and 77%) was higher than that at the control hospital (59%). By multivariable analysis, preferential use of alcohol-based hand rubs rather than soap and water for hand hygiene was more likely among workers at intervention hospitals compared with nonintervention hospitals (adjusted odds ratio, 4.6 [95% confidence interval, 3.3-6.4]) and more likely among physicians (adjusted odds ratio, 1.4 [95% confidence interval, 1.2-1.8]) than among nurses at intervention hospitals. A significantly reduced incidence of antimicrobial-resistant bacteria among isolates from clinical culture was found at a single intervention hospital, which had the greatest increase in the frequency of hand hygiene performance. During a 3-year period, a multimodal intervention program increased adherence to hand hygiene recommendations, especially to the use of alcohol-based hand rubs. In one hospital, a concomitant reduction was found in the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures.

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.

Skin reactions related to hand hygiene and selection of hand hygiene products

In October 2004, The World Health Organization (WHO) launched the World Alliance for Patient Safety. Within the alliance, the first priority of the Global Patient Safety Challenge is to reduce health care-associated infection. A key action within the challenge is to promote hand hygiene in health care globally as well as at the country level through the campaign "Clean Care is Safer Care." As a result, the WHO is developing Guidelines on Hand Hygiene in Health Care, designed to be applicable throughout the world. This paper summarizes one component of the global WHO guidelines related to the impact of hand hygiene on the skin of health care personnel, including a discussion of types of skin reactions associated with hand hygiene, methods to reduce adverse reactions, and factors to consider when selecting hand hygiene products. Health care professionals have a higher prevalence of skin irritation than seen in the general population because of the necessity for frequent hand hygiene during patient care. Ways to minimize adverse effects of hand hygiene include selecting less irritating products, using skin moisturizers, and modifying certain hand hygiene practices such as unnecessary washing. Institutions need to consider several factors when selecting hand hygiene products: dermal tolerance and aesthetic preferences of users as well as practical considerations such as convenience, storage, and costs.

An examination of covert observation and solution audit as tools to measure the success of hand hygiene interventions

Many studies have examined hand hygiene (HH) frequency and adherence in response to various interventions. This study used 2 methods to determine HH frequency and adherence to see how well the outcomes correlated. HH frequency was measured over 4, 1-month periods (phases 1-4), using 2 methods: an audit of HH solution used during each phase adjusted for patient-days and covert observation of HH adherence. The number of x-ray technician contacts with patients (a known quantity) across the study period was retrospectively compared with the number of observations made of x-ray technicians' HH behavior to see what proportion of contacts were observed. HH solution use doubled in phase 2 and was 65% and 55% higher than the baseline level in phases 3 and 4, respectively. Observed HH adherence fell from 51% to 37% in phase 2 and then rose to 58% in phases 3 and 4. Three percent of x-ray technicians' patient contacts were observed across the 4 phases. Observation of HH may not adequately sample patient contacts to provide an accurate measure of HH adherence. Further studies are needed to confirm this finding.

Transmission of methicillin-resistant Staphylococcus aureus (MRSA) from mother to neonate

ISSUE: Possible transmission of MRSA from mother to 25-week gestation twin neonates weighing PROJECT: A mother gave birth via C-section to 25-week gestation twins. Within 72 hours post op, the mother developed MRSA bacteremia with no clearly identified source. The mother and babies were immediately placed in contact isolation. Staff wore gowns and gloves when handling each baby. Due to their low birthweight, the parents were not allowed to hold the babies, but were allowed to touch the babies without wearing gloves. The babies were fed breastmilk via feeding tube. At 12 days after birth, Baby A grew MRSA from a blood culture. At 14 days after birth, Baby B grew MRSA from a sputum and blood culture. Typing of the isolates by pulsed-field gel electrophoresis (PFGE) proved they were the same as the mother's. A review of literature is mixed regarding breastfeeding. A recent article suggested transmission of MRSA may occur through breastmilk. The breastmilk was cultured with no MRSA detected. It is also unknown as to whether or not transmission occurred at birth. A policy was developed to guide HCWs in the future management of this occurrence. The policy states that gown and gloves should be worn for each HCW and parental contact with the babies. Frequent hand hygiene is an essential component of the policy. Skin-to-skin contact and breastfeeding is left to the discretion of the physician based on the clinical picture of the infant. An educational sheet is given to parents to assist in their understanding of the risk and the precautions that must be taken to prevent transmission of MRSA from parent to baby. RESULTS: There have not been any similar situations in our facility previous to or since this initial occurrence. However, staff is now educated and informed and will be able to assist MRSA-positive parents in making an informed decision regarding their newborn. LESSONS LEARNED: Any family member having MRSA or a history of MRSA who has a baby in the NICU must use contact precautions when touching the baby. It is our responsibility as HCWs to educate and inform the parents of the possible risks and necessary measures for prevention of transmission.

Effect of Antiseptic Handwashing vs Alcohol Sanitizer on Health Care–Associated Infections in Neonatal Intensive Care Units

The Centers for Disease Control and Prevention, Atlanta, Ga, recommend use of waterless alcohol hand products in lieu of traditional handwashing for patient care, but there are few data demonstrating the impact of this recommendation on health care-associated infections. To compare the effect of 2 hand hygiene regimens on infection rates and skin condition and microbial counts of nurses' hands in neonatal intensive care units. Clinical trial using a crossover design in 2 neonatal intensive care units in Manhattan, NY, from March 1, 2001, to January 31, 2003, including 2932 neonatal hospital admissions (51 760 patient days) and 119 nurse participants. Two hand hygiene products were tested: a traditional antiseptic handwash and an alcohol hand sanitizer. Each product was used for 11 consecutive months in each neonatal intensive care unit in random order. After adjusting for study site, birth weight, surgery, and follow-up time, there were no significant differences in neonatal infections between the 2 products; odds ratios for alcohol compared with handwashing were 0.98 (95% confidence interval [CI], 0.77-1.25) for any infection, 0.99 (95% CI, 0.77-1.33) for bloodstream infections, 1.61 (95% CI, 0.57-5.54) for pneumonia, 1.78 (95% CI, 0.94-3.37) for skin and soft tissue infections, and 1.26 (95% CI, 0.42-3.76) for central nervous system infections. The skin condition of participating nurses was significantly improved during the alcohol phase (P = .02 and P = .049 for observer and self-assessments, respectively), but there were no significant differences in mean microbial counts on nurses' hands (3.21 and 3.11 log(10) colony-forming units for handwashing and alcohol, respectively; P = .38). Infection rates and microbial counts on nurses' hands were equivalent during handwashing and alcohol phases, and nurses' skin condition was improved using alcohol. However, assessing the impact on infection rates of a single intervention is challenging because of multiple contributory factors such as patient risk, unit design, and staff behavior. Other practices such as frequency and quality of hand hygiene are likely to be as important as product in reducing risk of cross-transmission.

A Hand Hygiene Campaign To Prevent the Transmission of RSV in the Pediatric Intensive Care Unit

ISSUE: Respiratory Syncytial Virus (RSV) is a common cause of bronchiolitis and pneumonia in children. Every “season” we are inundated with RSV admissions and challenged to prevent nosocomial transmission. Historically, our nosocomial transmission rate has been kept to a minimum (0–2 cases/season). However, between August 24 and November 6, 2003, we had three cases of nosocomial acquisition (two cases occurring within 2 days of each other) in our 12-bed pediatric intensive care unit (PICU). PROJECT: Although staff education has been required with the start of every RSV season, this year required additional interventions. A program to increase staff and family awareness was initiated, “Clean hands across the PICU.” This innovative educational tool stressed the importance of frequent and appropriate hand hygiene. Education was provided to staff, family, and visitors by Epidemiology and members of the PICU staff. Posters were displayed, and newly designed handouts were included in every pediatric admission packet. RESULTS: We have received positive feedback from staff and family members and have directly observed an increase in hand hygiene, especially with the alcohol-based product. Two months after this initiative, no additional nosocomial transmission has occurred despite continued RSV admissions (27 cases to date). LESSONS LEARNED: “Clean hands across the PICU” has greatly heightened the awareness of appropriate and frequent hand hygiene for staff and family. It has proven to be an effective means of preventing nosocomial transmission. Because of our success, we have extended this initiative to include our other two pediatric units.

Effects of age and race on skin condition and bacterial counts on hands of neonatal ICU nurses

Objective The purpose of this study was to assess the relationship between demographic factors such as age and race and skin condition and bacterial counts on hands of nurses. Methods Nurses ( n = 111) working in 1 of 2 neonatal ICUs in New York City were surveyed regarding reported hand care practices and demographics, the condition of their hands was assessed by a trained observer and by themselves using validated instruments, and a hand culture was obtained. Results There were no significant differences in any skin care practices by race, but nurses who wore powder-free gloves were significantly younger than those who did not ( P = .004). There were no significant differences in bacterial counts on hands of black or white nurses (mean log colony-forming units 3.49 and 3.61 respectively, P = .63) and no significant correlation between age and microbial counts (r = 0.04, P = .72). In a logistic regression analysis, race, but not age, was a significant predictor of skin health. By both observer ( P = .02) and self-assessment ( P = .004) black nurses had healthier skin. Conclusion Physiochemical differences in skin associated with demographic factors such as age and race may be exacerbated among those in disciplines such as nursing, for whom the skin of the hands is continually stressed by occupational practices such as frequent hand hygiene. Such demographic factors need be considered when assessing skin condition and when advocating for appropriate strategies to maximize skin health. The recommendations of the new CDC Hand Hygiene Guideline for Healthcare Settings 23 regarding maintaining skin health and providing moisturizers and products that are milder to the skin are timely and should be followed.

A multicenter questionnaire investigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway

A questionnaire survey was carried out anonymously among 2557 health care workers in Denmark and Norway to identify and quantify factors that affect the handwashing behavior of physicians, nurses, and other staff groups who perform direct patient care. For number of daily patient contacts physicians reported significantly fewer instances of hand hygiene (HH) per day than did those in other medical professions. Male physicians reported significantly fewer HH per day than did their female colleagues. Significant differences were found among staff groups in emphasis on factors motivating and discouraging HH. The main motivating factor for all groups, however, was an awareness that HH is important for the prevention of infection. Skin problems from frequent handwashing and the use of agents that irritate and dry the skin were the main reasons for disinclination toward HH. The number of points given to these statements correlated well with the stated frequency of HH in staff groups with relatively many (9 to 24) patient contacts per day. Many studies have revealed low standards of HH in health care settings. Whenever HH is taught, the significance of HH for the prevention of infection is always stressed. The participants in this survey were well aware of this significance, but there is still a discrepancy between theory and practice. Goal-specific strategies to improve HH practices would probably be more effective if more were done to minimize the factors that health care workers find detrimental to HH. Continual evaluation of the possibly detrimental effects of current hand washing agents should also be carried out.

Mortality and incidence of cancer to workers in the man made vitreous fibres producing industry: An international investigation at 13 European plants

Occupational dermatoses caused by personal protective equipment (PPE) in the ongoing COVID-19 pandemic are emerging occupational health challenges that must be promptly and effectively addressed to ease burden on our health care workers.A systematic review was conducted to determine common PPE-related dermatoses, affected body sites, and implicated occupational contactants. We further proposed solutions to mitigate this problem.Online databases were searched for articles on PPE-related dermatoses in health care workers during the COVID-19 pandemic written in English and published from January 1, 2020, to January 30, 2021.Sixteen studies, including a total of 3958 participants, were included. The most common dermatoses were xerosis, pressure-related erythema, and contact dermatitis, mainly affecting the face and hands. The most widely implicated contactants were increased frequency of hand hygiene, gloves, N95 masks, and goggles. Proposed solutions were categorized as individual self-care, protection of the workforce, and long-term preventive measures.Through measures such as regular basic skin care education, early access to specialty clinics via telemedicine, and designing of better-fit PPE, the challenges posed by PPE-related occupational dermatoses can be significantly reduced.