Hand Washing Methods Research Articles

조리종사자의 손 위생관리에 관한 연구 - 패스트푸드점 및 일반음식점 종사자의 비교 -

본 연구는 패스트푸드점 종사자와 일반음식점 종사자의 손 위생관리를 조사하고 이들에 대한 비교를 하기 위하여 수행되었다. 패스트푸드점 종사자 30명과 일반음식점 종사자 40명을 대상으로 손 씻기 의식(손 씻기 방법, 손 씻기 이행 상황 등)을 조사하고 손에서 지표세균 및 식중독성 세균(일반세균, total coliforms, fecal coliforms, E. coli, S. aureus 및 Salmonella spp.) 오염도를 시험하였다. 손 씻기 의식은 설문조사에 의하여, 미생물시험을 위한 시료채취는 glove-juice법에 의하여, 그리고 미생물시험은 식품공전에 준하여 수행하였다. 설문조사에서 손 씻기 방법에 있어서는 손 씻기 도구 사용 및 손 씻기 후 물 잠금방법에서 두 집단 간에 유의한 차이가 있었다(p < 0.05). 손 씻기를 이행하는 상황에 대해서는 신체부위나 옷을 만졌을 때, 생식품 취급 후, 그리고 주기적 손 씻기 등에서 두 집단 간에 유의한 차이가 있었다(p < 0.05). 손의 미생물 시험에서 일반세균수 오염도는 패스트푸드점 종사자가 일반음식점 종사자보다 높았고, total coliforms 오염도는 패스트푸드점 종사자가 일반음식점 종사자보다 낮았으며(p < 0.05), 나머지 미생물은 두 집단 간에 유의한 차이를 보이지 않았다. 그렇지만 E. coli, S. aureus 및 Salmonella spp. 양성자 비율은 패스트푸드점 종사자가 일반음식점 종사자에 비하여 낮은 편이었다. 설문조사에서 일부 항목에서 차이를 보였지만 전반적으로 현저한 차이를 보이지 않은 결과와 더불어 두 집단 모두 E. coli, S. aureus 및 Salmonella spp. 양성자가 나타나 있어 손 위생관리가 철저하게 이루어지지 않았음을 알 수 있다. 두 집단 모두 손 위생관리 수준이 향상되어야 할 것이며, 이를 위한 교육 및 훈련 프로그램이 필요한 것으로 본다. This study was performed to investigate hygienic behavior of food workers on the awareness of hand-washing, and the microbial load of their hands. This study focused on the comparison of fast food restaurant workers and full-service restaurant workers. A questionnaire survey and microbiological analysis were carried out for thirty fast food restaurant workers and forty full-service restaurant workers. Samples for microbiological analysis were collected through the glove-juice method from the hands of the food workers, and were analyzed for the presence of aerobic plate counts, total coliforms, fecal coliforms, Escherichia coli, Staphylococcus aureus, and Salmonella spp. Microbiological analysis was done according to the Food Code of Korea. In the survey, significant differences (p < 0.05) were found between the fast food restaurant workers and full-service restaurant workers in the use of hand washing tools and method of turning off water. More full-service restaurant workers responded to wash their hands after touching face, hair, or clothes; after handling raw food materials, and more fast food restaurant workers periodically (p < 0.05). Aerobic plate counts were higher in fast food restaurant workers while total coliforms were higher in full-service restaurant workers (p < 0.05). No remarkable difference was found between the two groups in the load of fecal coliforms, E. coli, S. aureus, and Salmonella spp. Poor hand hygiene practices were indicated by the positive results for E. coli, S. aureus, and Salmonella spp. on the hands of some food workers in both groups. The findings of this study emphasize the need for strict adherence to hand hygiene compliance among the food workers.

Comparison of Surgical Hand Scrub and Alcohol Surgical Hand Rub on Reducing Hand Microbial Burden

This study was performed to compare the effects of two hand decontamination methods on the microbial burden of operating room staff hands. The surgical hand washing methods compared were a traditional surgical hand scrub using a povidone iodine solution, and a social wash using a liquid non-antibacterial soap followed by the application of an alcoholic hand rub.

Escherichia coli contamination of babies' food-serving utensils in a district of West Sumatra, Indonesia.

Contamination of baby's complementary food may occur with Escherichia coli from several sources including unclean utensils. We examined the relationship between socio-economic conditions, environmental factors, characteristics of food handlers and contamination of babies food-serving utensils with E. coli. The study was conducted in 21 villages of the Community Health Centre (CHC) Selayo in Indonesia. A cross-sectional design was used. A sample of 142 households, which had a 6-12 month-old baby on complementary food, was chosen randomly using midwives' registration books. Respondents were interviewed using a semi-structured questionnaire. Check-lists were used for observations. Standard laboratory methods were used for collection of specimen and confirmation of contamination with E. coli. More than half of the respondents (59.2%) used water that had high risk of contamination and 61.3% of the latrines did not meet the criteria of a healthy latrine. Waste management practices of nearly all respondents (97.9%) were below the standards set by the Ministry of Health. More than half of the respondents (68.3%) did not wash their hands with soap for 20 seconds and 52.1% did not use flowing water for washing hands. Majority of the respondents' hands (57%, 81/142) and 72.2% (104/142) of the eating utensils were found to be contaminated by E. coli. Contaminated hands of food handlers were more likely to contaminate the babies food-serving utensils (OR: 3.7; 95%CI: 1.62-8.46, p 0.002). Contamination of the hands of food handler was associated with contamination of babies food-serving utensils by E. coli. Hence, food handlers should be trained on proper hand washing methods.

Compliance with the aseptic precautions during intravenous access among the nursing staff at the National Hospital of Sri Lanka (NHSL)

Intravenous access is one of the most commonly performed invasive procedures in the clinical practice, during which the improper practice of the aseptic precautions could lead to fatal healthcare associated infections. A descriptive cross sectional study was conducted to assess the compliance with aseptic precautions during intravenous access and to identify the determinants of the substandard practice and practical difficulties encountered at the National Hospital of Sri Lanka using a self administered questionnaire and an observational check list. The majority (60.2%) of the participants fell in to the ‘substandard’ practice category. Compliance for the accepted method of hand washing was 8.4%. Compliance was significantly better among the nursing students (P=0.001), nursing staff that had less experience (P=0.001) and who had updated their knowledge recently (P=0.043). The work load (95.2%) and the shortage of equipment (65.06%) were the main practical difficulties identified. Hand washing practice should be further encouraged in the hospital setting. Continuing education and provisions of the necessary equipment are equally important.

In vivo Efficacy of Novel Alcohol-Based Hand Rubs Utilizing the Standard Test Method ASTM E 2755 to Represent In-Use Conditions

The current U.S. standard for evaluating the in vivo activity of alcohol-based hand rubs (ABHR) is the Health Care Personnel Hand Wash (HCPHW) method, ASTM E 1174. The HCPHW method was developed for the evaluation of hand wash products and does not reflect the in-use conditions of ABHR. ASTM E 2755, a recently approved Standard Test Method specifically designed for evaluation of hand rubs, is more reflective of normal use conditions.

In Vitro Skin Comparison of Alcohol and Non-Alcohol Hand Sanitizers

Methods: Three commercial products were evaluated: two recently introduced novel ABHRs, Product A (70% v/v ethanol gel) and Product B (70% v/v ethanol foam); and Product C, an ABHR gel (85% w/w ethanol (90% v/v)). WHOrecommended hand rub formulations were included as benchmarks: WHO-EtOH (80% v/v ethanol) and WHO-IPA (75% v/v isopropanol). Test articles were evaluated on the hands of adult subjects at a 2 ml dose using the Health Care Personnel Handwash (HCPHW) method according to US FDA requirements. Log reductions from baseline were calculated after one and ten product applications. Statistical analysis was conducted using one-way ANOVA (a50.05).

Knowledge and Practice Level of Infection Management for Child Guardians with Respiratory Infections after H1N1 Diffusion (2009)

Purpose: The purpose of this study was to investigate the knowledge and practice level of infection managements in child guar­ dians with respiratory infections after H1N1 diffusion of 2009. Methods: The data were collected during February and March 2010 using a self­report questionnaire. The participants were 228 child guardians. Data were analyzed using frequency, per­ centage, means, SD, t­test, F­test, Pearson correlation coefficients, and Cronbach’s alpha with the SPSS 17.0 program. Results: Mean age of the guardians and children were 37.8 years, 4.1 years respectively. For knowledge level of respiratory infec­ tions, hand washing method had the highest score and snuffles prevention method, the lowest. For practice level for respiratory infections, environmental hygiene management had the highest score and symptom management, the lowest. Infection man­ agement knowledge and practice level had a positively significant correlation in every area. Conclusion: The results indicate the necessity of continual education on infection management, and that the most efficient timing for the education appears be for participants during their first pregnancy or after the woman has delivered her child.

Survey of hand hygiene knowledge and needs for hand hygiene facilities among nurses

Objective To investigate the hand hygiene knowledge and needs for hand hygiene facilities among nurses, and to provide evidence for implementing valid intervention to increase hand hygiene compliance (HHC). Methods Self-designed questionnaire was used to survey knowledge of hand hygiene, HHC selfevaluation, and needs for hand hygiene Results 85.8% of the objects exhibited good command of the standard method of hand-washing, while 31.9% of which were not familiar with the time of hand-washing. There was a low command rate of the indications of antiseptic hand-rubbing after hand-washing. 22.2% of the objects reported over 50 times of hand hygiene behavior per day. Top causes of low HHC rates were listed as harm of the hand antiseptic agent to the skin, heavy workload and insufficient hand hygiene facilities. Automatic tap and antiseptic tissue were the most needed hand hygiene Conclusions Comprehensive measures should be adopted and hand hygiene facilities should be provided in order to increase HHC. Key words: Hand hygiene; Knowledge; Facilities; Nurse

Effect of care bundle in improving the hand hygiene compliance of neonatal intensive care unit staffs

Objective To evaluate the effect of care bundle in improving the hand hygiene compliance of neonatal intensive care unit staffs. Methods We implemented care bundle strategy through QCC activity: strengthening training and management to improve the hand hygiene awareness of the medical staffs, environmental and workflow reform,improving the hand washing method and facilities and creating hand hygiene atmosphere, all staffs participated and supervised each other to ensure right way of washing hands. The hand hygiene compliance rate of medical staff after entering the neonatal intensive care unit (NICU) and before touching the neonates before and after the intervention were compared. Results After care bundle intervention, the hand hygiene compliance rate of medical staff after entering the NICU and before touching the neonates raised obviously from 32.1% to 97.4% and from 92.0% to 99.3%. The occurrence of nosocomial infection reduced from 2.22% to 1.38%. Conclusions Care bundle can significantly improve the hand hygiene compliance of medical staff, and prevent nosocomial infection. Key words: Neonatal intensive care unit; Hand hygiene; Nosocomial infection

A Comparison of Hand-washing Methods by theDetergency Evaluation Technique (III)

A Comparison of Hand-washing Methods by theDetergency Evaluation Technique (III)

Usefulness of the waterless method for surgical hand washing : A comparison with the conventional scrub method

To evaluate the usefulness of the waterless hand washing method for surgical anti-sepsis, we conducted a microbial sampling study, comparing it to a conventional surgical scrub method. A total of 18 operating-room nurses were undertaking the following three-hand washing protocols : scrubbing with blushes using 4w/v% chlorhexidine gluconate (CHG) and also rubbing with CHG, followed by application of a 0.2w/v% CHG with ethanol (HS) preparation. (conventional method); rubbing with CHG and application of HS (two-stage surgical scrub method; TSS); rubbing with anti-septic soap and application of HS (waterless method; WL). Microbial sampling was conducted after hand washing using the glove juice method. No statistically significant differences in bacterial numbers were found among these three methods. The number of bacterially positive subjects was significantly higher in the conventional method than the TSS method. These results indicate that there are adverse effects of blush-scrubbing, as the detected bacteria were related to normal skin flora. As such, the WL method for hand anti-sepsis appears to be equivalent to the conventional surgical scrubbing method in terms of microbial detection. The WL method should therefore be introduced as a standard hand anti-sepsis method at the time of surgery because it is cost-effective as well as time-efficient.

Hand-washing Practices of Facial Plastic Surgeons

(1) To define and characterize knowledge of effective hand hygiene and its scientific basis among practicing facial plastic surgeons; (2) to review the existing literature of, basis for, and guidelines on hand washing in clinical practice; and (3) to motivate and facilitate optimum hand hygiene among facial plastic surgeons. National Web-based physician survey and literature review. We conducted a national Web-based survey of members of the American Academy of Facial Plastic and Reconstructive Surgery regarding general patient safety practices. A subset of the survey assessed physicians' knowledge of hand hygiene, including supporting rationale and actual practices. One hundred and twenty-two facial plastic surgeons of various demographics replied to the online survey. Of these, 65 (53%) correctly knew which hand washing agents are most effective at killing microorganisms, 88 (74%) knew the preferred hand-washing method for visibly soiled hands, and 51 (42%) correctly identified the indications for hand washing. Adherence to hand hygiene practices is suboptimal among facial plastic surgeons. There seems to be a lack of knowledge regarding indications, methods, and appropriate agents for hand hygiene. Promotion of Centers for Disease Control and Prevention guidelines is an important step in increasing hand hygiene compliance among facial plastic surgeons.

Characterization of mucosa-associated bacterial communities of the mouse intestine by terminal restriction fragment length polymorphism: Utility of sampling strategies and methods to reduce single-stranded DNA artifacts

Terminal restriction fragment length polymorphism (T-RFLP) is a molecular technique used for comparative analysis of microbial community structure and dynamics. We evaluated three sampling methods for recovering bacterial community DNA associated with intestinal mucosa of mice (i.e. mechanical agitation with PBS, hand washing with PBS containing Tween 80, and direct DNA extraction from mucosal plugs). In addition, the utility of two methods (i.e. Klenow fragment and mung-bean nuclease) to reduce single-stranded DNA artifacts was tested. T-RFLP analysis indicated that diverse communities of bacteria are associated with mucosa of the ileum, cecum, and descending colon of mice. Although there was no significant difference in bacterial community structure between the mechanical agitation and direct DNA extraction methods regardless of intestinal location, community diversity was reduced for the hand wash method in the colon. The use of Klenow fragment and mung-bean nuclease have been reported to eliminate single-stranded DNA artifacts (i.e. pseudo-T-restriction fragments), but neither method was beneficial for characterizing mucosa-associated bacterial communities of the mouse cecum. Our study showed that the mechanical agitation and direct plug extraction methods yielded equivalent bacterial community DNA from the mucosa of the small and large intestines of mice, but the latter method was superior for logistical reasons. We also applied a combination of different statistical approaches to analyze T-RFLP data, including statistical detection of true peaks, analysis of variance for peak number, and group significance test, which provided a quantitative improvement for the interpretation of the T-RFLP data.

Research in effect of nursing intervention on prevention of surgical site infection after gastrointestinal operation

Objecltive To intensify the coordination and nursing in the operation room in order to prevent surgical site infection after gastrointestinal operation. Methods 337 medical history of patients received gastrointestinal operation and third rate healing from 1999 to 2006 were collected. A series of intensified measures were applied to surgical site infection from 2003 gradually, including invocation of new surgical handwashing method, modified skin disinfection manner, adoption of degreasing with ethanol first before disinfection with iodophor, placement of incision protector and clean bag for incision protection after entering abdomen, changing to use new gastrointestinal anastomofic thimerosal,standardization of operation order and clean manage-ment in operation room. The incidence rate of surgical site infection after gastrointestinal operation of patients from 1999 to 2002 and from 2003 to 2006 underwent χ2 test. Results The incidence rate of surgical site in-fection after gastrointestinal operation greatly decreased after adoption of intensified nursing intervention, Signifi-cant difference existed in rate of patients with third rate healing between the year 1999 to 2002 and 2003 to 2006. Conclusions Modified nursing intervention for surgical incision after gastrointestinal operation can de-crease incision infection rate evidently. Key words: Gastrointestinal operation; Surgical site infection; Nursing

Correlation factors and countermeasure of the standard prevention for nurses

Objective To find out the eorre]afion factors of the standard prevention for nurses. Methods Questionnaire was designed according to the principal of standard prevention. 1216 nurses completed the ques-tionnaire. Results Nurses didn't know standard prevention knowledge more enough. The ratio of using the six-step hand-washing method was 4. 89%, and the ratio of uncapping the syringe after using was 45.35%. The ratio of wearing gloves correctly was 33. 83%. Conclusion Strengthening the standard prevention education for nurses, improving the standard prevention ability, and equipping enough medical safeguard can make sure the standard prevention was carried out more efficiency. Key words: Standard prevention measure; Nurses

Intestinal helminths in Luweero district, Uganda.

Intestinal helminthiasis is a debilitating parasitic disease found in many parts of Uganda including Luweero district. In the district, the disease causes as high as 9% morbidity in children below five years. There was very scanty district information on the disease based mainly on hospital records despite this figure. The current study was carried out to provide data to plan for its effective control. To investigate risk factors that promote helminth infections among children under five years of age in Luweero district. Stool samples from 727 children were examined for presence of helminth ova using Kato-Katz technique. The subjects' parents or guardians were interviewed using a semi-structured questionnaire to establish their demographic, social-cultural characteristics; information on water accessibility and usage; child toileting practices and knowledge about helminthiasis. Risk factors strongly associated with helminth infections included methods of anal cleaning, how compounds and latrines were maintained, keeping of pigs and age of the subjects, (P <0.001). In addition, methods of hand washing after latrine visits, the respondents' education level, type of house floor and household compound as well as accessibility to water were associated with worm infection. The hygiene practices of the parents/guardians and environmental surroundings in which the child grows play a big part in determining his or her helminth status. The District Health workers, community leaders and extension staff should educate the community on the importance of personal hygiene and environmental sanitation to minimize the risks of helminth infections.

Linking Quantitative Exposure Assessment and Risk Management Using the Food Safety Objective Concept: An Example with Listeria monocytogenes in Different Cross-Contamination Scenarios

A practical approach was used to achieve specified food safety objectives (FSOs) by incorporating risk assessment methodology. A series of cross-contamination scenarios at the retail level were evaluated in a spreadsheet and ranked according to their level of risk, and the degree to which they exceeded an FSO for Listeria monocytogenes (100 CFU/g) was determined. Percentiles and analyses of variance were used to identify which scenarios would be most likely not to achieve the FSO. It was also possible to incorporate into the model the effect of additional risk management interventions (e.g., hand washing method) by using “what if” scenarios analysis. The highest risk corresponded to the use of the same gloves to handle contaminated meat and then sliced ham compared with the safer method of using different gloves to handle each product. Nevertheless, in all scenarios bacterial concentrations could be higher than 108 CFU/g. A significant lack of knowledge regarding the transfer rates of L. monocytogenes was revealed, which provided the model with an important uncertainty component. The “what if” scenarios analysis based on the scenario representing handling food with bare hands followed by hand washing (scenario 2) revealed that the hand washing procedure had less impact than expected. This study illustrates the use of scenarios to model the most effective food processes and thus provide risk managers with appropriate information on which to base their decisions.

Dermal Exposure to Polycyclic Aromatic Hydrocarbons among Road Pavers

Dermal exposure to polycyclic aromatic hydrocarbons (PAHs) and the role of an industrial by-product, coal fly ash, on workers' PAH exposure were investigated during stone mastic asphalt (SMA) paving and remixing. PAH exposure was measured at eight sites during the laying of SMA containing coal fly ash or limestone (conventional SMA) as the filler. Six of the surveys were carried out during SMA paving and two during remixing of SMA (hot recycling at the paving site). Dermal PAH exposure was measured by hand washing (using sunflower oil and wiping with Kleenex tissues) before and after the work shift, and by placing exposure pads on the workers' wrists during the work shift. The analyses included 15 native PAHs from the hand-washing samples determined using high-performance liquid chromatography equipped with a two-channel fluorescence detector and 16 native PAHs and four methylated PAHs from the exposure pads using gas chromatography with mass-selective detection. The PAH results obtained using the pad and hand-washing methods (concentrations after the work shift) were equivalent and showed a strong correlation (r = 0.757, P < 0.001, N = 23 for total PAHs). There was a statistically significant difference between pre- and post-shift samples as measured by hand washing. The skin contamination by PAHs was significantly higher (P < 0.01) during remixing than during SMA paving. The variation in PAH contamination on the skin explained more of the variation in the excretion of urinary 1-hydroxypyrene and phenanthrols than the variation in the respiratory PAH concentrations. The industrial by-product investigated in asphalt, coal fly ash, had no statistically significant effect on the workers' dermal PAH exposure. The dermal exposure of paving workers to PAHs was higher during remixing than during SMA paving.

Assessment of the antibacterial activity of tea tree oil using the European EN 1276 and EN 12054 standard suspension tests

The activity of tea tree oil (TTO) and TTO-containing products was investigated according to the EN 1276 and EN 12054 European suspension methods. The activity of different concentrations of TTO, a hygienic skin wash (HSW), an alcoholic hygienic skin wash (AHSW) and an alcoholic hand rub (AHR) was investigated. These formulations were assessed in perfect conditions with the EN 12054 test, and in perfect conditions as well as in the presence of interfering substances with the EN 1276 test, against Staphylococcus aureus, Acinetobacter baumannii, Escherichia coli and Pseudomonas aeruginosa. With the latter test, the activity of the same formulations without TTO was also assessed as a control. With the EN 1276 test, the AHR achieved a >10(5)-fold reduction against all four test organisms within a 1-min contact time. The AHSW achieved a >or=10(5)-fold reduction against A. baumannii after a 1-min contact time and against S. aureus, E. coli and P. aeruginosa after a 5-min contact time. The efficacy of TTO appeared to be dependent on the formulation and the concentration tested, the concentration of interfering substances and, lastly, the organism tested. Nevertheless, 5% TTO achieved a >10(4)-fold reduction in P. aeruginosa cell numbers after a 5-min contact time in perfect conditions. TTO (5%) in 0.001% Tween 80 was significantly more active against E. coli and P. aeruginosa than against S. aureus and A. baumannii. With the EN 12054 test, after a 1-min contact time, 5% TTO in 0.001% Tween 80 and the AHSW achieved a >10(4)-fold reduction in E. coli and A. baumannii cell numbers, respectively, and the AHR achieved a >4 log10 reduction against all organisms tested. The formulations used in this study are now being tested using a novel ex vivo method as well as the in vivo European standard handwashing method EN 1499.

Effectiveness of hand-cleansing formulations containing tea tree oil assessed ex vivo on human skin and in vivo with volunteers using European standard EN 1499

The efficacy of formulations containing tea tree oil (TTO) has been assessed in vitro in previous studies. Products that passed the European suspension test guidelines were investigated further in this study, in vivo with volunteers using the European handwashing method (EN 1499) and ex vivo using freshly excised human skin samples. The activity of 5% TTO in 0.001% Tween 80, in a hygienic skin wash (HSW) and in an alcoholic hygienic skin wash (AHSW) was investigated and compared with that of a non-medicated soft soap (SS, control). These formulations were assessed against Escherichia coli K12 as recommended by the European standard. In-vivo results showed that 5% TTO in Tween 80 and the AHSW were significantly more active than the SS after 1 min of handwashing. When assessed ex vivo, these two products were also significantly more active than the reference soap after 1 min of rubbing. Both methods showed that 5% TTO in Tween 80 was generally, although not always, more active than a handwash formulation, and that the AHSW was generally more active than the HSW, although this difference was not significant. The formulations tested, as well as the SS, were more active when assessed in vivo than ex-vivo against E. coli, although only the SS and the HSW were significantly more active in vivo. There appeared to be a pattern in the comparison between ex vivo and in vivo results. The antiseptics tested were, on average, 1.28+/-0.06 times more active when assessed in-vivo than when assessed ex vivo. Nevertheless, the main outcome of the European handwashing method is for the formulation tested to be significantly more active than the SS; both 5% TTO in Tween 80 and the AHSW achieved this both in-vivo and ex-vivo. TTO in Tween 80 and in formulations met the European in-vivo method requirements.