Transmission Of Hospital-acquired Infections Research Articles

Deconstructing the effects of stochasticity on transmission of hospital-acquired infections in ICUs.

The inherent stochasticity in transmission of hospital-acquired infections (HAIs) has complicated our understanding of transmission pathways. It is particularly difficult to detect the impact of changes in the environment on acquisition rate due to stochasticity. In this study, we investigated the impact of uncertainty (epistemic and aleatory) on nosocomial transmission of HAIs by evaluating the effects of stochasticity on the detectability of seasonality of admission prevalence. For doing so, we developed an agent-based model of an ICU and simulated the acquisition of HAIs considering the uncertainties in the behaviour of the healthcare workers (HCWs) and transmission of pathogens between patients, HCWs, and the environment. Our results show that stochasticity in HAI transmission weakens our ability to detect the effects of a change, such as seasonality patterns, on acquisition rate, particularly when transmission is a low-probability event. In addition, our findings demonstrate that data compilation can address this issue, while the amount of required data depends on the size of the said change and the degree of uncertainty. Our methodology can be used as a framework to assess the impact of interventions and provide decision-makers with insight about the minimum required size and target of interventions in a healthcare facility.

Evaluating the knowledge, attitudes, and practices of healthcare workers regarding high-risk nosocomial infections: A global cross-sectional study.

Healthcare workers (HCWs) play a vital role in delivering care and are frequently exposed to the risk of acquiring infections within the hospital setting. Around 15% of hospitalized patients suffer from these infections globally. However, the role and awareness of HCWs in the transmission of hospital-acquired infections (HAIs) or nosocomial infections is still unclear. This study aimed to evaluate the knowledge, attitude, and practices (KAP) toward high-risk microbial infections among HCWs on a global scale to identify measures to address this problem. A cross-sectional descriptive study was conducted between 2022 and 2023, with HCWs selected as the study population. Data concerning KAP were collected through a self-administered online survey questionnaire, using a nonprobability convenience sampling method. Descriptive statistics and regression analysis were used to analyze the data. A total of 743 HCWs from various countries participated in the study, with the majority of respondents being doctors (64.9%). Data were mainly obtained from Saudi Arabia (26.78%), Iraq (25.84%), India (15.7%), the United States of America (15.2%), and Africa (Sudan, Nigeria) (13.98%). The frequency of good KAP scores among physicians (KAP: 82.5, 80.66, and 70.5), nurses (KAP: 74.1, 73.07, and 88.7), medical practitioners (KAP: 87.2, 77.58, and 75.1), and technicians (KAP: 76.1, 74.38, and 89.6) were obtained as mentioned. With respect to experience, HCWs showed good KAP scores in 1-5 years (KAP: 82.4, 83.3, and 74.1), 5-10 years (KAP: 80.6, 74.54, 83), 10-20 years (KAP: 74.7, 79.1, and 82.7), and >20 years (KAP: 84.6, 78.8, and 82.8) categories. This study suggests that HCWs have good KAP regarding infection prevention, but there is still room for improvement. Educational seminars and awareness programs can provide better adherence to barrier protection measures such as hand washing, use of gloves, and hand disinfection.

An automated contact model for transmission of dry surface biofilms of Acinetobacter baumannii in healthcare

Dry surface biofilms (DSBs) have been recognized across environmental and equipment surfaces in hospitals and could explain how microbial contamination can survive for an extended period and may play a key role in the transmission of hospital-acquired infections. Despite little being known on how they form and proliferate in clinical settings, DSB models for disinfectant efficacy testing exist. In this study we develop a novel biofilm model to represent formation within hospitals, by emulating patient to surface interactions. The model generates a DSB through the transmission of artificial human sweat (AHS) and clinically relevant pathogens using a synthetic thumb capable of emulating human contact. The DNA, glycoconjugates and protein composition of the model biofilm, along with structural features of the micro-colonies was determined using fluorescent stains visualized by epifluorescence microscopy and compared with published clinical data. Micrographs revealed the heterogeneity of the biofilm across the surface; and reveal protein as the principal component within the matrix, followed by glycoconjugates and DNA. The model repeatably transferred trace amounts of micro-organisms and AHS, every 5min for up to 120h on to stainless-steel coupons to generate a biofilm model averaging 1.16× 103cfu/cm2 falling within the reported range for clinical DSB (4.20× 102 to 1.60× 107 bacteria/cm2). Our invitro DSB model exhibits many phenotypical characteristics and traits to those reported in situ. The model highlights key features often overlooked and the potential for downstream applications such as antibiofilm claims using more realistic microbial challenges.

O03 The impact of COVID-19 infection prevention and control measures on transmission of hospital-acquired infections and antimicrobial resistance in Africa

BackgroundPatients who develop serious illness due to COVID-19 are more likely to have bacterial coinfections, for which WHO recommends treatment with antibiotics. As a result, many countries are observing a change in antimicrobial stewardship (AMS), in addition to changes in infection prevention and control (IPC) practices such as the use of personal protective equipment, on COVID-19 wards. Few data on COVID-19 and its impact on nosocomial infections and antimicrobial resistance (AMR) are available from low and middle-income countries (LMICs). As these countries often have high rates of AMR, it is vital to report the effects of COVID-19 on AMS so as to inform clinical practice and IPC guidelines. This study aims to compare prevalence of AMR in COVID-19 wards with general non-COVID-19 hospital wards.MethodsThis pilot hospital-based study is being conducted in two sites in both Sudan and Zambia. IPC and AMS guidelines for COVID-19 and non-COVID-19 wards were identified for each institution. This study is comparing bacterial isolates and AMR patterns of nosocomial associated infections acquired on COVID-19 and non-COVID-19 wards were compared, using microbiological and sequencing methods. A total of 200 patients have been recruited: 100 per country, 50 COVID-19 patients and 50 non-COVID-19 patients. AMR transmission patterns are being identified using Oxford Nanopore Technologies sequencing for phylogenetic analysis.ResultsThe study began recruiting in May 2021 and completed recruitment of patients in October 2021. The majority of microbiological laboratory work will be completed within Q3 2021, with analysis of the results and sequencing completed in Q4 2021. A half-way point summary analysis of the data suggests differences in patient profiles, both between COVID-19 and non-COVID-19 wards at both sites, as well as differences between the two countries. Preliminary analysis also suggests a significant difference between the prevalence of MDR infections in Gram-negatives seen between COVID-19 (53% in Sudan and 83% in Zambia) and non-COVID-19 (14% Sudan, 33% Zambia) (t-test, P=0.0032 Sudan, P=0.0455 Zambia) ward patients in both countries (see Figure 1).Figure 1.Percentage of Gram-negative bacteria isolated from patients on COVID-19 and non-COVID-19 wards in Sudan and Zambia, showing significant difference between the wards in both countries (t-test, P = 0.0032 Sudan, P = 0.0455 Zambia).ConclusionsThe study is providing evidence to inform policy on IPC and AMS measures to be implemented on COVID-19 wards. In addition, the outcomes of the study will be used to create a pragmatic sequencing pipeline for potential AMR outbreaks suitable for use in LMICs clinical settings.

A69 THE EFFECT OF COVID-19 PANDEMIC ON CURRENT AND FUTURE ENDOSCOPIC PERSONAL PROTECTIVE EQUIPMENT PRACTICES: A NATIONAL SURVEY OF 77 ENDOSCOPISTS

BackgroundPersonal protective equipment (PPE) guidelines serve to protect healthcare providers and patients from harmful biohazards. With the rise of the 2019 SARS-CoV-2 disease (COVID-19), many institutions have mandated strictly enforced endoscopic PPE guidelines. We currently do not know how current practitioners perceive these mandates or how they will influence their practice long-term.AimsWe aimed to survey the PPE practices among endoscopists across Canada and compare their perceived differences in practice between the pre- and post-COVID-19 pandemic eras. We hypothesize that the PPE guidelines during the pandemic will influence changes in PPE practices in endoscopy.MethodsA 74-item questionnaire was emailed from June 2020 to September 2020 to all members of the Canadian Association of Gastroenterologists and the Canadian Association of General Surgeons through newsletters. The survey was created by expert consensus and distributed using the REDCap software. Survey questions collected basic demographics and differences between PPE practices pre- and post-COVID-19 pandemic eras. PPE practices were categorized into four endoscopic procedure types: diagnostic or therapeutic, and upper or lower gastrointestinal endoscopy. Individual outcomes were reported as rates, or ranges when evaluating for all procedure types.ResultsA total of 77 respondents completed the survey with the majority of respondents aged 40–49 (34 [44.2%]) and identifying as Gastroenterologists (54 [70.1%]). Gender was evenly split (38 females [49.4%] versus 39 males [50.6%]). In the pre-pandemic era, the majority of endoscopists wore gowns (91.0–93.9%) and all endoscopists wore gloves (100%). However, the majority of endoscopists did not wear surgical masks (20.9%-31.3%), N95 respirators (1.5%-3.2%), face shields (13.4%-33.9%), eye protection (13.4%-21.3%), or hair protection (11.1%-12.5%).In the post-pandemic era, endoscopists reported a plan to dramatically change their pre-pandemic practices and adopt current PPE mandates. All endoscopists reported a plan to fully gown and glove (100%) with the majority reporting they will continue wearing surgical masks (87.7%-90.5%), face shields (57.8%-75.0%), and hair protection (50.8%-53.8%). However, the majority reported a plan to decrease universal use of N95 respirators (6.5%-23.7%) or eye protection (36.5%-40.0%). Over half of the respondents reported changing their practice from no masking pre-pandemic to implementing routine masking.ConclusionsThe COVID-19 pandemic has changed the attitudes of many endoscopists regarding future PPE use in routine endoscopy. Ongoing studies comparing the rates of transmission of hospital-acquired infections in the setting of endoscopy are needed to develop a new post-pandemic PPE consensus.Funding AgenciesNone

Network analysis of intra-hospital transfers and hospital onset clostridium difficile infection.

To explore how social network analysis (SNA) can be used to analyse intra-hospital patient networks of individuals with a hospital acquired infection (HAI) for further analysis in a geographical information systems (GIS) environment. A case and control study design was used to select 2008 patients. We retrieved locational data for the patients, which was then translated into a network with the SNA software and then GIS software. Overall metrics were calculated for the SNA based on three datasets and further analysed with a GIS. The SNA analysis compared cases to control indicating significant differences in the overall structure of the networks. A GIS visual representation of these metrics was developed, showing spatial variation across the example hospital floor. This study confirmed the importance that intra-hospital patient networks play in the transmission of HAIs, highlighting opportunities for interventions utilising these data. Due to spatial variation differences, further research is necessary to confirm this is not a localised phenomenon, but instead a common situation occurring within many hospitals. Utilising SNA and GIS analysis in conjunction with one another provided a data-rich environment in which the risk inherent in intra-hospital transfer networks was quantified, visualised and interpreted for potential interventions.

Stethoscope disinfection is rarely done in Ethiopia: What are the associated factors?

IntroductionThe stethoscope, which is non-critical medical devices and a symbol of healthcare, is likely to be contaminated by pathogenic microorganisms and can play a contributory role in the transmission of hospital-acquired infection. And regular cleaning of the diaphragm of the stethoscope with a suitable disinfectant is decisive. However, in the resource-constrained setting like many healthcare facilities in Ethiopia healthcare provider’s stethoscope disinfection practice and its associated factors have not been well studied so far. Therefore, this study sought to determine stethoscope disinfection practice and associated factors among the healthcare providers in Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was carried out between April and May 2016. For this study, 576 healthcare providers (physicians, health officers, nurses, midwives, and anesthesiologist) were included from 21 healthcare facilities in Addis Ababa. A pre-tested structured questionnaire was used for data collection. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were used to identify factors that were significantly associated with stethoscope disinfection after every use.ResultsA total of 546 healthcare providers participated in this study, for a response rate of 94.7%. Two-fifths, 39.7% (95%CI: 35.9, 44.0%) of healthcare providers disinfecting their stethoscope after every use. And a significant number of participants 34.6% (95%CI: 30.8, 38.5%) never disinfect their stethoscope. Three out of four (76.0%) healthcare providers believe that stethoscope contamination can contribute to the transmission of infections. Safe infection prevention practice (AOR = 3.79, 95%CI: 2.45–5.84), awareness on infection prevention guideline (AOR = 1.93; 95%CI: 1.31, 2.82), and favorable attitude towards infection prevention (AOR = 1.73, 95%CI: 1.02, 2.93) were significantly associated with stethoscope disinfection after every use. The study also found that the odds of stethoscope disinfection were likely to be reduced by 79% among physicians than nurses (AOR = 0.21; 95%CI: 0.09, 0.49).ConclusionsOnly a small proportion of healthcare providers disinfect their stethoscopes after every use. Factors such as safe infection prevention practice, awareness on infection prevention guidelines, and favorable attitude towards infection prevention were the independent predictors of stethoscopes disinfection after every use. Hence, promotion of stethoscope hygiene along with an educational program to enhance disinfection compliance in healthcare facilities may have a positive effect.

The effect of low-temperature laundering and detergents on the survival ofEscherichia coliandStaphylococcus aureuson textiles used in healthcare uniforms

To determine the survival of Escherichia coli and Staphylococcus aureus on cotton and polyester and the effectiveness of low-temperature laundering and detergents on the removal of micro-organism from healthcare laundry. Survival of E.coli and S. aureus on polyester or cotton was assessed over 3weeks and the efficacy of a domestic wash (40 and 60°C) and a range of detergents was also determined. Both bacteria were able to survive on cotton (5 log(10) ) and polyester (0·28 log(10) ) for up to 3weeks. Laundering at 40°C resulted in a 3·5 log(10) removal of the initial 7·7 log(10) inoculum and some cross-contamination to sterile fabrics (3log(10) ). Increasing the temperature to 60°C resulted in the complete removal of the initial inoculum. This study shows that most of the micro-organisms are removed at 40°C, however, those cells still remaining may have the potential for further contamination to the clinical environment and patients. National Health Service (NHS) nurses are required to domestically launder their uniforms at 60°C to ensure safe removal of micro-organisms, 33% of NHS staff questioned said they launder their uniforms at 40°C, which could potentially result in transmission of hospital-acquired infections.

Environmental Biodecontamination: When a Procedure Performed by the Nursing Staff has an Economic Impact in ICU Rooms

Objective: The transmission of hospital-acquired infections most commonly occurs by means of healthcare workers coming into contact with contaminated surfaces or patients during routine care and the lack of or poor implementation of hygiene procedures. We present this study to assess the efficacy of a new environmental infection control system, managed by a nurse in charge of infection control, in terms of safety, clinical outcome and hospital/healthcare costs. Methods: The following is an observational retrospective study performed at University Hospital of Catania; containing data on HAI infections from years 2013 and 2014, before and after a new disinfection procedure was introduced. The procedure used a no-touch technology for the indoor environment, using micronebulized hydrogen peroxide and silver cations. Cases of infections concerned adult inpatients with hospitalization time being greater than three days. The efficacy of the procedure was evaluated by comparing the decrease in number of infections, related deaths, and changes in antimicrobial load, whereas economic impact of the new procedure was assessed by a cost-effectiveness analysis. User satisfaction and environmental safety issue were also addressed. Results: A total of 489 patients were hospitalized in the ICU between January 1, 2013 and December 31, 2014. The introduction of the procedure coincided with a significant decrease overall in infection-related deaths, as well as hospital days (16.95 ± 20.46 (mean ± SD) to 11.55 ± 10.03 (mean ± SD: p value <0.05). Bacterial load in samples from CVC and from broncho-alveolar lavage decreased, as well. The incremental cost-effective ratio resulted in € 807.80 to be added for each infection-related death avoided. Conclusion: We demonstrated that HyperDRYMist technology with hydrogen peroxide and silver cations is effective, safe and cost-effective without evidence of safety risk. Biodecontamination performed by motivated and experienced nurses could be useful in reducing microbial load and nosocomial infections. The system can contribute to improving the ICU patient's final outcome.

Identifying Opportunities For Value-Based Contracting For Molecular Diagnostics As A Means To Improve Outcomes Of Hospital Acquired Infections

Hospital acquired infections (HAIs) can have a serious impact on both clinical and economic outcomes. As a result, hospitals implement infection control (IC) policies to prevent and reduce the transmission of HAIs including various approaches to screening and testing incoming or admitted patients. Early identification of HAIs is key to limiting their clinical and economic impact. Molecular diagnostics (MDx) have the potential to improve IC strategies by quickly and accurately identifying patients with suspected or confirmed infections. To increase adoption of this technology, both MDx manufacturers and hospital quality stakeholders have expressed interest in value-based contracting for HAI tests. To further understand this opportunity, this research sought to identify key IC practices that would be impacted by MDx testing and could support improved HAI outcomes. Telephone-based primary research was conducted with 34 hospital quality and IC stakeholders across the US and UK to understand the impact of HAIs, current IC practices, quality metrics, outcomes and opportunities for MDx. Desk research was carried out to further investigate hospital IC strategies and reporting metrics. Hospitals have implemented a variety of strategies aimed at reducing and preventing the incidence of HAIs. Hospitals assess the success of their IC strategies by benchmarking their infection rates against national or regional reports and measuring compliance with certain IC protocols. There are various IC practices that could be impacted by MDx testing such as patient isolation and timely administration of targeted antibiotic therapy; however, metrics associated with these protocols are generally not reported. Primary and secondary research findings suggest that compliance with IC protocols is critical to improving HAI outcomes. Expanding hospital quality reporting metrics to include factors impacted by MDx could support value-based contracting efforts by associating testing with improved IC practices, and will ultimately support improved HAI outcomes.

Evaluation and quantitative microbial risk assessment of a unique antimicrobial agent for hospital surface treatment

It is generally agreed that contaminated hospital surfaces play a role in the transmission of hospital-acquired infections (HAIs). The ability of an antimicrobial agent, engineered at Emory University, to reduce bacterial bioburden on hospital surfaces was examined. A quantitative microbial risk assessment was also conducted to quantify the potential reduction of human health risks associated with application of this antimicrobial product. A 1-arm, prospective observational study was conducted. High-frequency contact surfaces within 18 hospital patient rooms were sampled in between patient use. Negative binomial regression with repeated measures was used to examine log CFU/100cm(2) reductions in total, gram-negative, and Staphylococcus aureus microorganisms. Standard risk assessment methods were used. Multivariate regression demonstrated significant reductions in gram-negative (P<.0001) and S aureus (P=.009) bacteria with increasing patient turnover. No reduction was observed in total bacteria (P=.93). Infection risks were reduced by 4 and 3 logs for gram-positive and gram-negative bacteria, respectively. These risk reductions, along with HAI survey studies, suggest that application of this antimicrobial product could prevent as many as 5%-10% of HAIs. This study was the first evaluation of a distinctive antimicrobial agent for hospital surface treatment. The findings provide support for the utility of an antimicrobial product in potentially reducing HAI transmission from contaminated environment surfaces.

English

The role of hospital surfaces (including surfaces in food preparation areas) in the transmission of hospital-acquired infections (HAI) has been long recognized; however,evidence regarding this critical information is not well documented. This study was conducted at a typical district hospital in the Free State Province of South Africa. Using swabs, surface samples were collected from nine kitchen areas, quantified and identified using the MALDI-TOF MS and API. Fungal counts (1 x 103&nbsp;to 2.3 x 105&nbsp;cfu.cm-2) were higher compared to bacterial counts (1.5 x 103&nbsp;to 1.1 x 105&nbsp;cfu.cm-2). A total of 25 bacterial species and 14 fungal species were identified from hospital kitchen surfaces using the MALDI-TOF MS.&nbsp;Candida&nbsp;was the most common fungal genus identified represented by 11 species while&nbsp;Bacillus&nbsp;was the most common bacterial genus isolated represented by 7 species. The presence of species from the genera&nbsp;Acinetobacter,Enterobacter,&nbsp;Pseudomonas&nbsp;and&nbsp;Candida&nbsp;amongst others on kitchen surfaces could have serious consequences as they have been implicated in various studies as probable causes of hospital acquired infections. The study highlights the need to ensure proper cleaning of working surfaces in the kitchen as well as stringent surveillance and monitoring to ensure the minimal contamination of food products prepared for patients. &nbsp; Key words:&nbsp;Hospital-acquired infection, kitchen, MALDI Biotyper, surface swabs, food safety.

P184: Production and efficacy testing of antimicrobial fabrics for use in hospitals

In recent years, hospital acquired infections (HAIs) have become a major issue of concern in the European health care system. The most common routes of transmission of HAIs are either by airborne routes or by direct contact. Direct contact can be mediated through many textile items including: bedding, clothing, wound dressings and curtains. Antimicrobial textiles could be used widely in health care environments in order to reduce the spread of HAIs.

Equal Efficacy of Glucoprotamin and an Aldehyde Product for Environmental Disinfection in a Hematologic Transplant Unit: A Prospective Crossover Trial

The inanimate hospital environment has emerged as an important reservoir of nosocomial pathogens. In particular, multidrug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus, Acinetobacter species, and Clostridium difficile, play a major role in the transmission of hospital-acquired infections. In Europe, aldehydes, chlorine, and quaternary ammonium compounds have been commonly used for environmental disinfection. Glucoprotamin, a newer active compound for disinfectants, has been clinically tested for disinfection of instruments but not for environmental disinfection. This study evaluated the antimicrobial effectiveness of a glucoprotamin-containing product (Incidin) compared with that of an aldehyde-containing product (Deconex), the current standard at our institution. This prospective crossover study was conducted in our access-restricted hematologic transplant unit. A total of 3,086 samples from the environment were processed and examined for overall bacterial burden as well as selectively for S. aureus, C. difficile, and gram-negative bacteria. There was no significant difference in residual bacteria after disinfection between the 2 products in terms of overall burden and selected pathogens. Enterococci were the predominant pathogens recovered from surfaces, but no vancomycin-resistant enterococci were recovered. Similarly, C. difficile could not be found in the patients' environment, even in rooms, despite the use of selective media. The aldehyde-containing product (Deconex) and the glucoprotamin-containing product (Incidin) demonstrated similar efficacy against environmental contamination in a hematologic transplant unit with the application of selective media for C. difficile, S. aureus, and gram-negative bacteria in addition to standard medium.

Exploring the effects of network structure and healthcare worker behavior on the transmission of hospital-acquired infections

We investigate the transmission of infectious diseases in hospitals using a network-centric perspective. Patients who share a healthcare worker are inherently connected to each other and those connections form a network through which transmission can occur. The structure of this network can be a strong determinant of the extent and rate of transmission. We explore the effects of healthcare worker behavior, including sharing patients and incorporating the ability for healthcare workers to infect each other. Finally, we examine how patient turnover can affect transmission dynamics in a patient network under the influence of other effects. Our results show that all of these factors can affect transmission significantly, and that this model can be used to provide additional insight to hospital administrators who are looking to improve their ability to control infections.

Infectious Disease Management through Point-of-Care Personalized Medicine Molecular Diagnostic Technologies.

Infectious disease management essentially consists in identifying the microbial cause(s) of an infection, initiating if necessary antimicrobial therapy against microbes, and controlling host reactions to infection. In clinical microbiology, the turnaround time of the diagnostic cycle (>24 hours) often leads to unnecessary suffering and deaths; approaches to relieve this burden include rapid diagnostic procedures and more efficient transmission or interpretation of molecular microbiology results. Although rapid nucleic acid-based diagnostic testing has demonstrated that it can impact on the transmission of hospital-acquired infections, we believe that such life-saving procedures should be performed closer to the patient, in dedicated 24/7 laboratories of healthcare institutions, or ideally at point of care. While personalized medicine generally aims at interrogating the genomic information of a patient, drug metabolism polymorphisms, for example, to guide drug choice and dosage, personalized medicine concepts are applicable in infectious diseases for the (rapid) identification of a disease-causing microbe and determination of its antimicrobial resistance profile, to guide an appropriate antimicrobial treatment for the proper management of the patient. The implementation of point-of-care testing for infectious diseases will require acceptance by medical authorities, new technological and communication platforms, as well as reimbursement practices such that time- and life-saving procedures become available to the largest number of patients.

The Potential for Transmission of Hospital-Acquired Infections by Non-critical Medical Devices: The Role of Thermometers and Blood Pressure Cuffs

Healthcare-associated infection (HAI) is a major but often neglected public health problem. Most attention to HAI prevention is given to high-risk invasive diagnostic and therapeutic healthcare tools, while the importance of less critical tools tends to be underestimated. This study was designed to assess the potential contributory role played by thermometers and blood pressure cuffs in HAI transmission in a Nigerian teaching hospital. Analysis of swabs from thermometers and blood pressure cuffs used in the teaching hospital was conducted using standard microbiological techniques.

A comparison of soap, alcohol and glove use during the nappy-changing procedure in a special care baby unit

This study was conducted in a special care baby unit (SCBU) in a district general hospital and concentrated on hand decontamination and glove-wearing during the nappy-changing procedure. The aims were to determine whether or not nurses were adhering to existing infection control policies and guidelines, and to determine the most appropriate product to be used for hand decontamination. Nurses were observed carrying out nappy changes to determine their existing hand-washing and glove-wearing practices. A microbiological analysis of nurses' hands during the nappy change was performed in order to compare the effectiveness of soap, alcohol, and glove use in eliminating bacteria from the hands. The observation study demonstrated that not all nurses were adhering to existing infection control policies and guidelines. The microbiological analysis found that on the majority of occasions, alcohol was better than soap at removing bacteria from the hands but that gloves provided the best protection overall for both babies and nurses by preventing the acquisition of bacteria. Together these findings suggest that nurses' hands may be providing a route for the transmission of hospital-acquired infection in the SCBU. Ideally, nurses should be wearing gloves during the nappy-changing process and using alcohol to decontaminate their hands.