Use Of Alcohol-based Hand Rubs Research Articles

A quasi-experimental study to determine the effects of a multifaceted educational intervention on hand hygiene compliance in a radiography unit.

BackgroundWhilst numerous studies have investigated nurses’ compliance with hand hygiene and use of alcohol-based hand rub (ABHR), limited attention has been paid to these issues in allied health staff. Reports have linked infections to breaches in infection control in the radiography unit (RU). With advances in medical imaging, a higher proportion of patients come into contact with RU staff increasing the need for good hand hygiene compliance. This study aimed to evaluate effectiveness on compliance of an intervention to improve awareness of hand hygiene in the RU of a district hospital.MethodsA quasi-experimental study design including questionnaires assessing knowledge and attitudes of hand hygiene and direct observation of participants was used to evaluate an educational programme on hand hygiene of the RU of a large district hospital. All healthcare workers (HCW), comprising 76 radiographers, 17 nurses, and nine healthcare assistants (HCA), agreed to participate in the study. Of these, 85 completed the initial and 76 the post-test anonymous questionnaire. The hand hygiene compliance of all 102 HCW was observed over a 3-week period prior to and after the intervention. The 2-month intervention consisted of talks on hand hygiene and benefits of ABHR, provision of visual aids, wall-mounted ABHR dispensers, and personal bottles of ABHR.ResultsBefore the intervention, overall hand hygiene compliance was low (28.9 %). Post-intervention, compliance with hand hygiene increased to 51.4 %. This improvement was significant for radiographers and HCA. Additionally, knowledge and attitudes improved in particular, understanding that ABHR can largely replace handwashing and there is a need to perform hand hygiene after environmental contact. The increased use of ABHR allowed HCW to feel they had enough time to perform hand hygiene.ConclusionsThe educational intervention led to increased awareness of hand hygiene opportunities and better acceptance of ABHR use. The reduced time needed to perform hand rubbing and improved access to dispensers resulted in fewer missed opportunities. Although radiographers and other allied HCW make frequent contact with patients, these may be mistakenly construed as irrelevant with respect to healthcare associated infections. Stronger emphasis on hand hygiene compliance of these staff may help reduce infection risk.

Occupational skin disease among Australian healthcare workers: a retrospective analysis from an occupational dermatology clinic, 1993-2014.

Healthcare workers (HCWs) are at risk of developing occupational skin disease (OSD). To ascertain the causes of OSD in Australian HCWs in a tertiary referral clinic. A retrospective review was performed of patients assessed at the Occupational Dermatology Clinic in Melbourne from 1993 to 2014. Of 685 HCWs assessed in the clinic over a period of 22 years, 555 (81.0%) were diagnosed with OSD. The most common diagnosis was irritant contact dermatitis (ICD) (79.1%), followed by allergic contact dermatitis (ACD) (49.7%). Natural rubber latex allergy was also relatively frequent (13.0%). The major substances causing ACD were rubber glove chemicals (thiuram mix and tetraethylthiuram disulfide), preservatives (formaldehyde, formaldehyde releasers, and isothiazolinones), excipients in hand cleansers, which are hard-to-avoid weak allergens, and antiseptics. ACD caused by commercial hand cleansers occurred more frequently than ACD caused by alcohol-based hand rubs (ABHRs). Occupational ICD was mostly caused by water/wet work and hand cleansers, and environmental irritants such as heat and sweating. Understanding the causes of OSD in HCWs is important in order to develop strategies for prevention. We suggest that skin care advice should be incorporated into hand hygiene education. The use of ABHRs should be encouraged, weak allergens in skin cleansers should be substituted, and accelerator-free gloves should be recommended for HCWs with OSD.

Using medical student observers of infection prevention, hand hygiene, and injection safety in outpatient settings: A cross-sectional survey

Health care-associated infection outbreaks have occurred in outpatient settings due to lapses in infection prevention. However, little is known about the overall infection prevention status in outpatient environments. A cross-sectional design was employed to assess infection prevention policies and practices at 15 outpatient sites across New Mexico in 2014 during a medical student outpatient rotation. A standardized infection prevention checklist was completed via staff interview; observations of injection safety practices and hand hygiene behavior were conducted. Aggregate data were analyzed using Excel (Microsoft, Redmond, WA) and Stata (version 12.1, Stata Corp, College Station, TX) statistical software. Medical practice staff interviews reported a mean of 92.8% (median, 96.7%; range, 75.0%-98.9%) presence of recommended policies and practices. One hundred sixty-three injection safety observations were performed that revealed medication vial rubber septums were disinfected with alcohol 78.4% (95% confidence interval [CI], 71.1%-84.7%) of the time before piercing. Three hundred thirty hand hygiene observations revealed 33.9% (95% CI, 28.8%-39.1%) use of alcohol-based handrub, 29.1% (95% CI, 24.2%-34.0%) use of soap and water, and 37.0% (95% CI, 31.8%-42.4%) use of no hand hygiene. These findings support the need for ongoing infection prevention quality improvement initiatives in outpatient settings and underscore the importance of assessing both self-report and observed behavior of infection prevention compliance.

Perception of health-care workers about hand hygiene and its resources at King Fahad Hospital of University

Background: Transmission of pathogens via health-care workers’ hands is one of the most frequent means of spreading multiresistant organisms and the occurrence of health-care–associated infections. Hand hygiene is the simplest, most effective method to prevent cross-infections. Hand hygiene perception plays an important role in determining hand hygiene compliance. Objective: To assess physicians’ perceptions and the available resources for hand hygiene at King Fahad Hospital of University. Materials and Method: A cross-sectional study was used on 209 physicians. Data were collected using a Word Health Organization Self-Report Questionnaire and a checklist for availability of hand hygiene resources. Result: More than half of the sample was male subjects (55.5%), with a mean age of (30 ± 6.5 years). About 44% showed positive perception, and 38% were neutral about the importance of hand hygiene. The frequent use of alcohol-based handrub was significantly associated with positive perception of importance of hand hygiene (P = 0.031). Nonhuman resources of hand hygiene were available in all the departments, except for hand cream or lotion. Conclusion: Accordingly, we recommend raising the patients’ awareness about their right to remind health-care workers to clean their hands. Moreover, during training of health-care workers, the trainer should remind the health-care workers that the patient has the right to ask them to wash their hands.

Control of extended-spectrum β-lactamase–producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis

This study was undertaken to determine the temporal relationship between implementation of different interventions in an intensive care unit (ICU) and control of endemic nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE). This was a prospective observational study with time-series analysis of the monthly incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline period, an intervention consisting of restriction of third-generation cephalosporins (3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008, an increased health care worker (HCW):patient ratio was also implemented. In March 2010, the ICU was closed, and patients were moved to a clean ICU. The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based hand rub. A significant change in ESBLE incidence was observed in a full segmented univariate regression analysis (mean change in level, -0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition. According to the multivariate model, the ICU closure was the main protective factor. Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence interval, 0.06-1.25; P = .09). This study shows that ICU closure was associated with, but not necessarily the reason for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE sources may play a role in cross-transmission.

Understanding barriers to the provision of hand hygiene products in Africa – a WHO POPS/APPS project

The availability of alcohol-based handrub (ABHR) and its component parts to enable reliable use in health care are variable around the globe. Three initiatives from the World Health Organisation (WHO) have addressed this inequity. The WHO guidelines on hand hygiene (2009) promote the use of ABHR as an easy and effective way to ensure clean safe hands at the point of care. WHO Private Organisations for Patient Safety (POPS) harnesses industry strengths to align and improve implementation of WHO recommendations, to hand hygiene in the first instance. WHO African Partnerships for Patient Safety (APPS) focuses on supporting safer healthcare delivery in hospitals with hand hygiene as a linchpin for safe quality care. In 2013, a one-off project was launched through POPS to provide empty bottles to APPS hospitals so that operational barriers to implementation of locally produced ABHR could be addressed.

Using feedback with adenosine triphosphate (ATP) bioluminescence assay improved the cleanliness of computerized nursing cart

Purpose: The Centers for Disease Control (CDC) recommends hand hygiene as the simplest, most effective method to prevent health care-associated infections. The purpose of this study was to review of literature on effectiveness with hand hygiene strategies in Taiwan medical institution. Methods: A review for relevant published literature in 2004-2014 was undertaken using electronic databases. Databases searched included: Medline, CINAHL, EMBASE, Chinese electronic periodical Service (CEPS), National Digital Library of Theses and Dissertations in Taiwan. Eight studies met the inclusion criteria. Results: Results showed that 8 hand hygiene programs were effective. Hand hygiene strategies such as:Use of alcohol-based hand rubs at the points of patient care. Education program, posters, slogans, revised hand hygiene standard, online self-learning materials, established a monitoring mechanism and enforcement of reward-punishment regulations. To improvement of hand hygiene compliance can effectively transform to the healthcare quality and patient safety in medical centers. Conclusions: These review shows that hand hygiene strategies can increase the medical staff hand hygiene compliance rate and the correction rate of hand hygiene.

Diarrhea at the Hajj and Umrah.

This systematic review aims to summarize the incidence and etiology of diarrheal illness among pilgrims attending the Hajj and Umrah. Gastroenteritis and diarrhea have been potential threats during previous Hajj pilgrimages. The last cases of Hajj related cholera were reported in 1989. Currently, respiratory tract infections account for the majority of health problems during the Hajj. This shift in epidemiology reflects the improvement of sanitary conditions in Saudi Arabia in general, and at religious sites in particular. Nevertheless, gastrointestinal diseases, food-poisoning outbreaks, and diarrhea continue to occur among pilgrims. Available studies about diarrhea among Hajj pilgrims indicate a mean prevalence of 2% with the highest prevalence of 23% among a group of French pilgrims in 2013. There is an obvious lack of information about the etiology of diarrheal disease at the Hajj. Further studies addressing this issue in hospitalized patients as well as prospective cohort studies would be of interest. During the Hajj, hand washing is regularly carried out by pilgrims under a ritual purification, often called ablution. We recommend implementation of effective hand hygiene practices focusing on the regular use of alcohol-based hand rubs, as they require less time than traditional hand washing, act more rapidly, and contribute to sustained improvement in compliance associated with decreased infection rates.

Health care worker hand hygiene in the pediatric special care unit at Mulago National Referral Hospital in Uganda: a best practice implementation project.

The hands of a health care worker are a common vehicle of pathogen transmission in hospital settings. Health care worker hand hygiene is therefore critical for patients' well being. Whilst failure of health care workers to comply with the best hand hygiene practice is a problem in all health care settings, issues of lack of access to adequate cleaning equipment and in some cases even running water make practicing good hand hygiene particularly difficult in low-resource developing country settings. This study reports an audit and feedback project that focused on the hand hygiene of the health care worker in the pediatric special care unit of the Mulago National Referral Hospital, which is a low-resource setting in Uganda. To improve hand hygiene among health care workers in the pediatric special care unit and thereby contribute to reducing transmission of health care worker-associated pathogens. The Joanna Briggs Institute three-phase Practical Application of Clinical Evidence System audit and feedback tool for promoting evidence utilization and change in health care was used. In phase one of the project, stakeholders were engaged and seven evidence-based audit criteria were developed. A baseline audit was then conducted. In phase two, barriers underpinning areas of noncompliance found in the baseline audit were identified and three strategies - education, reminders and provision of hand cleaning equipment - were implemented to overcome them. In phase three, a follow-up audit was conducted. Compliance with best practice hygiene was found to be poor in the baseline audit for all but one of the audit criteria. Following the implementation of the strategies, hand hygiene improved. The compliance rate increased substantially across all criteria. Staff education achieved 100%, whilst criterion 4 increased to 70%. However, use of alcohol-based hand-rub for hand hygiene only improved to 66%, and for six of the seven audit criteria, compliance remained below 74%. The project provides another example of how audit can be used as a tool to improve health practice, even in a low-resource setting. At the same time, it showed how difficult it is to achieve compliance with best hand hygiene practice in a low-resource hospital. The project highlights the importance of continued education/awareness raising on the importance of good hand hygiene practice as well as investment in infrastructure and cleaning supplies for achieving and sustaining good hand hygiene among workers in a low-resource hospital setting. A key contribution of the project was the legacy it left in the form of knowledge about how to use audit and feedback as a tool to promote the best practice. A similar project has been implemented in the maternity ward at the hospital and further audits are planned.

Screening and isolation to control meticillin-resistant Staphylococcus aureus: sense, nonsense, and evidence

Screening and isolation to control meticillin-resistant Staphylococcus aureus: sense, nonsense, and evidence

Video observation of hand hygiene practices during routine companion animal appointments and the effect of a poster intervention on hand hygiene compliance.

BackgroundHand hygiene is considered one of the most important infection control measures in human healthcare settings, but there is little information available regarding hand hygiene frequency and technique used in veterinary clinics. The objectives of this study were to describe hand hygiene practices associated with routine appointments in companion animal clinics in Ontario, and the effectiveness of a poster campaign to improve hand hygiene compliance.ResultsObservation of hand hygiene practices was performed in 51 clinics for approximately 3 weeks each using 2 small wireless surveillance cameras: one in an exam room, and one in the most likely location for hand hygiene to be performed outside the exam room following an appointment. Data from 38 clinics were included in the final analysis, including 449 individuals, 1139 appointments before and after the poster intervention, and 10894 hand hygiene opportunities. Overall hand hygiene compliance was 14% (1473/10894), while before and after patient contact compliance was 3% (123/4377) and 26% (1145/4377), respectively. Soap and water was used for 87% (1182/1353) of observed hand hygiene attempts with a mean contact time of 4 s (median 2 s, range 1-49 s), while alcohol-based hand rub (ABHR) was used for 7% (98/1353) of attempts with a mean contact time of 8 s (median 7 s, range 1-30 s). The presence of the posters had no significant effect on compliance, although some staff reported that they felt the posters did increase their personal awareness of the need to perform hand hygiene, and the posters had some effect on product contact times.ConclusionsOverall hand hygiene compliance in veterinary clinics in this study was low, and contact time with hand hygiene products was frequently below current recommendations. Use of ABHR was low despite its advantages over hand washing and availability in the majority of clinics. The poster campaign had a limited effect on its own, but could still be used as a component of a multimodal hand hygiene campaign. Improving the infection control culture in veterinary medicine would facilitate future campaigns and studies in this area, as well as overall patient and staff safety.

A Quality Improvement Project on Hand Hygiene Compliance and Its Impact on Central Line Associated Blood Stream Infections

The risk of developing Central Line-Associated Bloodstream Infection (CLABSI) depends on several factors. Emphasis on hand hygiene and proper use of alcohol-based hand rubs is a critical intervention in minimizing healthcare associated infections (HAI) that is supported by the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) guidelines. The objective of this Quality Improvement Project was to improve the hand hygiene compliance among all health care workers and decrease the rate of CLABSI.

Secular trends in the epidemiology of Clostridium difficile infection (CDI): relationship with alcohol gel and antimicrobial usage in a hospital

Clostridium difficile-associated diarrhea (CDAD) has shown increasing incidence, morbidity, and mortality in recent years. We assessed the number of CDAD tests requested, CDAD positivity rates, the use of alcohol-based hand rubs, and antimicrobial utilization. We collected information on every adult patient (>18 years) who developed diarrhea and had a positive stool test for C. difficile toxin from June 2005 to December 2009 at a tertiary care hospital. A time-series analysis was performed using monthly data on the incidence of C. difficile infection (CDI) (i.e., cases of infection per 1000 patient-days), as well as the consumption of alcohol-based hand rubs (in liters/1000-patient days) and antibiotics (in defined daily doses per 1000 patient-days). The mean number of annual requests for C. difficile tests was 1031, and the rates per 1000 patient-days for each year from 2005 to 2009 were 0.30, 0.46, 0.39, 0.31, and 0.40 overall in the hospital, and 0.18, 0.10, 0.53, 0.38, and 0.37 in the intensive care unit (ICU). The use of alcohol-based hand rubs per 1000 patient-days increased from 37.4 to 73.0, and from 41.5 to 129.4 in the hospital and in the ICU, respectively. The incidence of CDI in the hospital and ICU remained low, despite the increased use of alcohol-based hand rubs and antimicrobials.

VOC Contamination in Hospital, from Stationary Sampling of a Large Panel of Compounds, in View of Healthcare Workers and Patients Exposure Assessment

BackgroundWe aimed to assess, for the first time, the nature of the indoor air contamination of hospitals.Methods and FindingsMore than 40 volatile organic compounds (VOCs) including aliphatic, aromatic and halogenated hydrocarbons, aldehydes, alcohols, ketones, ethers and terpenes were measured in a teaching hospital in France, from sampling in six sampling sites – reception hall, patient room, nursing care, post-anesthesia care unit, parasitology-mycology laboratory and flexible endoscope disinfection unit – in the morning and in the afternoon, during three consecutive days. Our results showed that the main compounds found in indoor air were alcohols (arithmetic means ± SD: 928±958 µg/m3 and 47.9±52.2 µg/m3 for ethanol and isopropanol, respectively), ethers (75.6±157 µg/m3 for ether) and ketones (22.6±20.6 µg/m3 for acetone). Concentrations levels of aromatic and halogenated hydrocarbons, ketones, aldehydes and limonene were widely variable between sampling sites, due to building age and type of products used according to health activities conducted in each site. A high temporal variability was observed in concentrations of alcohols, probably due to the intensive use of alcohol-based hand rubs in all sites. Qualitative analysis of air samples led to the identification of other compounds, including siloxanes (hexamethyldisiloxane, octamethyltrisiloxane, decamethylcyclopentasiloxane), anesthetic gases (sevoflurane, desflurane), aliphatic hydrocarbons (butane), esters (ethylacetate), terpenes (camphor, α-bisabolol), aldehydes (benzaldehyde) and organic acids (benzoic acid) depending on sites.ConclusionFor all compounds, concentrations measured were lower than concentrations known to be harmful in humans. However, results showed that indoor air of sampling locations contains a complex mixture of VOCs. Further multicenter studies are required to compare these results. A full understanding of the exposure of healthcare workers and patients to complex mixtures of chemical compounds can then be related to potential health outcomes.

Assessment of exposure to ethanol vapors released during use of Alcohol-Based Hand Rubs by healthcare workers

Despite the increasing use of Alcohol-Based Hand Rub solutions, few studies have quantified the concentrations of inhaled ethanol. The aim of this study was to assess ethanol exposure during hygienic and surgical hand disinfection practices. Ethanol concentrations were measured at the nose level of a wooden dummy and human volunteers. Two systems were used in parallel to determine short-term ethanol vapor exposures: activated charcoal tubes followed by gas chromatography analysis and direct reading on a photoionization detector (PID). Exposure was assessed for 4 different sequences (N=10) reproducing hand rubs for simple surgery, nursing care, intensive care and surgical scrub. The ethanol concentrations measured were of a similar order between the dummy and volunteers. The concentrations obtained by PID were higher than the gas chromatography values for the simple care (45%) and nursing care (27%) sequences and reflected specific exposure peaks of ethanol, whereas ethanol concentrations were continuously high for intensive care (440 mg m(-3)) or surgical scrub (650 mg m(-3)). Ethanol concentrations were similar for these two exposure assessment methods and demonstrated a relationship between handled doses and inhaled doses. However, the ethanol vapors released during hand disinfection were safe for the healthcare workers.

Technique is important for alcohol-based surgical hand antisepsis

Dear Editor, Surgical hand antisepsis (‘surgical scrubbing’) has been the topic of a recent article in this journal, as well as of several recent posts on the Australasian College for Infection Prevention and Control (ACIPC) email list ‘Infexion Connexion’. The article and the list discussion focused on the use of alcohol-based hand rubs for this purpose, which is a relatively new development in the Australian setting as opposed to ‘traditional’ surgical hand antisepsis with water and detergent-based antiseptics such as chlorhexidine or povidone–iodine antiseptic soaps. I would like to add another aspect to the discussion; this is the issue of correct technique, including appropriate hand and arm surface coverage, when using alcohols for surgical hand antisepsis. Alcohols for surgical hand antisepsis have three main advantages. First, they create far greater microbial reduction on hands and arms than is possible with any detergent-based antiseptics. In particular, products that meet the stringent European standard EN 12791, whereby an agent is compared to the reference of 60% (v/v) n-propanol, typically produce logarithmic (log) reductions between 2 and 3, with sustained values at 3 h under surgical gloves of around 2, where the baseline is normal resident hand flora before antisepsis. Second, alcohols with added emollients are generally better tolerated on hands and skin than detergents, particularly when frequent antisepsis is necessary. Third, the time requirements for alcohol-based antisepsis are shorter; most products require only 3min (this is also the time specified in standard EN 12791), and there are now newer products that achieve equivalent microbial reduction in only 1.5min of application. However, although microbiological principles and biological plausibility strongly support greater rather than lesser microbial reduction, so far there are no clinical trials showing that this translates into fewer surgical site infections. Alcohol-based as well as detergent-based surgical hand antisepsis has been incorporated into recent guidelines by the USCenters for Disease Control and Prevention (CDC), the Association of periOperative Registered Nurses (AORN) and the World Health Organization (WHO). There are two types of settings with regard to surgical hand antisepsis: (1) settings where alcohol-based agents have been predominantly or exclusively used for many decades, such as countries in central Europe, and (2) settings where detergentbased antisepsis has been the predominant method, such as Australia or the USA. In settings where something is frequently practised, in particular in the operating room environment, a practice becomes highly ritualised and is taught to new personnel and supervised (often fiercely) by experienced senior nurses or surgeons. Such practices then become engrained and assume elements that are not easily conveyed by textbooks or the scientific literature. In my own surgical internship in Germany, surgical hand antisepsis (termed ‘surgical hand disinfection’) was practised as follows. For the first procedure of the day, we did a hand and forearm wash with soap and water, including brushing or scraping only under the fingernails. Then, hands and forearms were dried using a sterile standard towel (remaining water on hands would compromise the efficacy of alcohol). This was followed by a 5-min alcohol hand rub (with a liquid product) whereby the alcohol was repeatedly and liberally dispensed from a wall-mounted, elbow-driven dispenser and rubbed onto hands and forearms, such that they were literally kept wet with alcohol and all surfaces covered for the entire period. The alcohol was then left to dry by evaporation. Current recommendations no longer require washing hands before using alcohol, and the application times have become shorter. The WHO guidelines state that prior hand washing is only necessary when hands are visibly dirty and that for most products, 3min of application are sufficient. The guidelines recommend approximately 3 5mL (total 15mL) for the procedure, but they emphasise that it is important to keep hands and arms wet during the entire procedure. In any case, this technique is fundamentally different from regular ward-based hand antisepsis according

Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility

Alcohol-based hand rubs play a key role in reducing the transmission of pathogens in acute care settings, especially as part of a comprehensive hand hygiene program. However, their use in long-term care facilities (LTCFs) has been virtually unstudied. Infection data, including those meeting McGeer etal and the Pennsylvania Patient Safety Authority's surveillance definitions, for lower respiratory tract infections (LRTIs) and skin and soft-tissue infections (SSTIs), as well as hospitalization data were collected in a 174-bed LTCF for 22 months (May 2009 to February 2011). In March 2010, a comprehensive hand hygiene program including increased product availability, education for health care personnel (HCP) and residents, and an observation tool to monitor compliance, was implemented. Infection rates for LRTIs were reduced from 0.97 to 0.53 infections per 1,000 resident-days(P=.01) following the intervention, a statistically significant decline. Infection rates for SSTIs were reduced from 0.30 to 0.25 infections per 1,000 resident-days (P= .65). A 54% compliance rate was observed among HCP. This study demonstrates that the use of alcohol-based hand rubs, as part of a comprehensive hand hygiene program for HCP and residents, can decrease infection rates in LTCFs.

A cluster-randomized controlled trial of handrubs for prevention of infectious diseases among children in Colombia

To evaluate the effectiveness of alcohol-based handrubs (ABH) in reducing acute diarrheal diseases (ADD) and acute respiratory infections (ARI) among children 1-5 years of age in childcare centers with limited tap water. This was the first cluster-randomized controlled trial in a developing country. The study took place at 42 childcare centers with sporadic and limited water availability in six towns in Colombia. Participants were randomly assigned to use ABH as a complement to handwashing (intervention arm: 21 centers/794 children); or to continue existing handwashing practices (control arm: 21 centers/933 children). ADD and ARI cases were identified through teacher-reported signs and symptoms of illness. Adverse events were monitored. Hazard ratios (HR) were obtained using Cox proportional hazards multivariate regression shared frailty models. Child-days of surveillance totaled 336 038. Loss to follow up was 14.5%. For both ADD and ARI, there were no differences in hazard ratios during the first trimester of the study. In the second and third trimesters, significant reductions in the risk of ADD were found in the intervention compared to control arm (HR = 0.55, P < 0.001 and HR = 0.44, P < 0.001, respectively). There were also significant risk reductions for ARI in the second trimester (HR = 0.80, P < 0.05) and in the third trimester (HR = 0.69, P < 0.001). No adverse events occurred. ABH effectively prevent ADD and ARI, and are safe. Colombia's national public health policies for prevention of these diseases should include use of ABH, especially in settings where handwashing with soap and water is limited by water availability.

Is hand-rub consumption correlated with hand hygiene and rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE)-acquired infections?

A retrospective investigation was conducted to determine whether the consumption of alcohol-based hand rub (ABHR) used was correlated with the incidence of acquired nosocomial infection due to meticillin-resistant Staphylococcus aureus or to extended-spectrum beta lactamase (ESBL)-producing strains. Between 2005 and 2008, the use of ABHRs increased significantly by 8L per 1000 patient-days of hospitalization per year. During the same period, adherence to hand hygiene increased significantly from 55.6% to 70.9% (P<0.0001). Despite these improvements there was a steady increase in the incidence of ESBL-producing strains in the past three years and no correlation was found between ABHR consumption and either nosocomially acquired ESBL or adherence to hand hygiene.

Sustained increase in the use of alcohol-based hand rubs in Finnish long-term care facilities

Long-term care facilities (LTCFs) may serve as a reservoir for multi-resistant bacteria. Hand disinfection with alcohol-based rubs is a simple tool for controlling cross-contamination between patients and preventing healthcare-associated infections. Our aim was to promote the use of alcohol-based hand rubs. A multidisciplinary team (an infectious disease consultant, an infection control nurse, and a geriatrician) visited all LTCFs (n=123) for elderly persons in the Central Finland Healthcare District (population 265 000) between September 2004 and October 2005. In each unit, head nurses and often also general practitioners answered structured questions concerning the monthly amount of alcohol-based hand rubs used in liters and patient days. The facility environment was evaluated, especially the opportunities for hand disinfection and new locations for additional hand rub containers were proposed. During 2006-2008, three postal surveys including feedback were conducted annually. A total of 119 units with around 3500 residents participated in all four steps (a site visit and three postal surveys). The total amount of hand rub used increased by 70%, from the mean (SD) of 7.3 (5.1) liters/1000 patient days on the baseline visit to 12.4 liters (14.9) in 2008. The multidisciplinary team succeeded in promoting hand hygiene in LTCFs, which was sustained over the three-year follow-up. Continuous training is needed to preserve the positive trend and direct observations to assess whether hand hygiene is performed correctly and at the right time.