Use Of Alcohol-based Hand Rubs Research Articles

Promoting hand hygiene and prudent use of antimicrobials in long-term care facilities

A multidisciplinary team visited all long-term care facilities (n = 123) for elderly persons in the Central Finland health care district (population, 265,000) during 2004-2005. Use of alcohol-based hand rubs and ongoing systematic antimicrobials were assessed. Thereafter, regional guidelines for prudent use of antimicrobials were published. One year after the visits, a significant increase in the mean amount of alcohol-based hand rubs used was detected while usage of antimicrobials for the prevention of urinary tract reinfections had decreased.

Adoption of Alcohol-Based Handrub by United States Hospitals: A National Survey

The extent to which the use of alcohol-based handrub for hand hygiene has been adopted by US hospitals is unknown. A survey of infection control coordinators (response rate, 516 [72%] of 719) revealed that most hospitals (436 [84%] of 516) have adopted alcohol-based handrub. Leadership support and staff receptivity play a significant role in its adoption.

Religion and culture: Potential undercurrents influencing hand hygiene promotion in health care

BackgroundHealth care–associated infections affect hundreds of millions of patients worldwide each year. The World Health Organization's (WHO) First Global Patient Safety Challenge, “Clean Care is Safer Care,” is tackling this major patient safety problem, with the promotion of hand hygiene in health care as the project's cornerstone. WHO Guidelines on Hand Hygiene in Healthcare have been prepared by a large group of international experts and are currently in a pilot-test phase to assess feasibility and acceptability in different health care settings worldwide.MethodsAn extensive literature search was conducted and experts and religious authorities were consulted to investigate religiocultural factors that may potentially influence hand hygiene promotion, offer possible solutions, and suggest areas for future research.ResultsReligious faith and culture can strongly influence hand hygiene behavior in health care workers and potentially affect compliance with best practices. Interesting data were retrieved on specific indications for hand cleansing according to the 7 main religions worldwide, interpretation of hand gestures, the concept of “visibly dirty” hands, and the use of alcohol-based hand rubs and prohibition of alcohol use by some religions.ConclusionsThe impact of religious faith and cultural specificities must be taken into consideration when implementing a multimodal strategy to promote hand hygiene on a global scale.

Has the Time Come to Recommend the Use of Alcohol-Based Hand Rub to Hospitalized Patients?

Has the Time Come to Recommend the Use of Alcohol-Based Hand Rub to Hospitalized Patients?

Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile

The aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (ABHRs) and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. An interventional time-series analysis was performed to evaluate the impact of two promotion campaigns on the consumption of ABHRs and to assess their effect on the incidence of non-duplicate clinical isolates of MRSA and C. difficile from February 2000 through September 2006. This analysis was combined with a transfer function model of aggregated data on antibiotic use. Consumption of ABHRs correlated with MRSA, but not with C. difficile. The final model demonstrated the immediate effect of the second hand hygiene promotion campaign and an additional temporal effect of fluoroquinolone (time lag, 1 month; i.e. antibiotic effect delayed for 1 month), macrolide (lag 1 and 4 months), broad-spectrum cephalosporins (lag 3, 4 and 5 months) and piperacillin/tazobactam (lag 3 months) use. The final model explained 57% of the MRSA variance over time. In contrast, the model for C. difficile showed only an effect for broad-spectrum cephalosporins (lag 1 month). We observed an aggregate-level relation between the monthly MRSA incidence and the use of different antibiotic classes and increased consumption of ABHR after a successful hand hygiene campaign, while no association with ABHR use was detected for C. difficile.

Hand Rub–Associated Fire Incidents During 25,038 Hospital-Years in Germany

Fire incidents in German hospitals related to the use of alcohol-based hand rubs were analyzed. Seven nonsevere fire incidents were identified, occurring during 25,038 hospital-years, which were caused by individual human actions and not by technical failure. The results underline the safety of using alcohol-based hand rubs in hospitals.

Implementing Alcohol-Based Hand Rub on an Ambulatory Dementia Unit

ISSUE: The use of alcohol-based hand rubs (AHR) are a popular and scientifically-accepted method of hand hygiene for many health care settings. Their use can improve compliance with optimal staff hand hygiene practice, and improve infection prevention efforts for both resident and employee safety. These products however, contain ingredients which are potentially harmful if ingested or placed into eyes. For this reason, the use of AHR in environments of clients with impaired judgement is controversial, and may be limited due to perceived risk by the staff in such a setting. This situation provides a challenge to Infection Control professionals: to provide caregivers with convenient AHR in a manner that does not compromise resident safety.

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

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

Lack of Association Between the Increased Incidence ofClostridium difficile–Associated Disease and the Increasing Use of Alcohol-Based Hand Rubs

To determine whether there is an association between the increasing use of alcohol-based hand rubs (ABHRs) and the increased incidence of Clostridium difficile-associated disease (CDAD). A 500-bed university-affiliated community teaching hospital. Use of ABHRs during the period 2000-2003 was expressed as the number of liters of ABHR used per 1000 patient-days. The proportion of hand hygiene episodes performed by using an ABHR was determined by periodic observational surveys. CDAD was defined as a physician-ordered stool assay positive for C. difficile toxin A or A/B. The incidence of CDAD was expressed as the number of unique patients who had 1 or more positive CDAD test results per 1,000 patient-days. During 2000-2003, the use of ABHR increased 10-fold, from 3 to greater than 30 L/1,000 patient-days (P<.001). The proportion of hand hygiene episodes performed using an ABHR increased from 10% to 85% (P<.001). The incidence of CDAD in 2000, 2001, 2002, and 2003 was 1.74, 2.33, 1.14, and 1.18 cases/1,000 patient-days, respectively. Despite a significant and progressive increase in the use of ABHRs in our facility during a 3-year period, there was no evidence that the incidence of CDAD increased. These findings suggest that factors other than the increased use of ABHRs are responsible for the increasing incidence of CDAD noted since 2000 in other facilities.

Improving Patient Safety: Resource Availability and Application for Reducing the Incidence of Healthcare-Associated Infection

VHA Mountain States conducted a survey and analysis of infection control (IC) staffing resources, organizational structures, and clinical processes related to reducing the incidence of healthcare-associated infections (HAIs) in community healthcare facilities. Member participation was solicited for 2 study components. The first was a survey of demographic characteristics regarding the type and size of the facility and the structure and functions of IC departments. The second was an observational study of infection prevention practices related to general hand hygiene (GHH), ventilator-associated pneumonia (VAP), catheter-related bloodstream infection (CRBSI), and catheter-related urinary tract infection (CRUTI). A total of 31 not-for-profit community healthcare facilities submitted data; the number of beds in participating centers ranged from less than 50 beds (1 facility) to more than 500 beds (7 facilities). IC department staffing ranged from 0.3 to 5.0 full-time equivalents. There was a positive correlation between average daily census and IC staffing (r = .879; P < .001). Observational studies revealed that compliance with the use of alcohol-based hand rubs (77%) was significantly better than compliance with the use of soap and water (64%; P < .001). Seven (30%) of 23 organizations observed 90% or better compliance with VAP process measures; 7 of 27 (26%) observed 90% or better compliance with guidelines for preventing CRBSI; and 14 (56%) demonstrated proper placement of urinary drainage bags at least 90% of the time. There was variation in IC department structure and processes among the participating organizations. Infection prevention practices were inconsistent. These findings emphasize the need for more-effective implementation of current evidence-based recommendations for preventing HAIs and reducing the risk of harm to patients.

Genotyping and Preemptive Isolation to Control an Outbreak of Vancomycin-Resistant Enterococcus faecium

Control of vancomycin-resistant Enterococcus faecium (VRE) in European hospitals is hampered because of widespread asymptomatic carriage of VRE by healthy Europeans. In 2000, our hospital (The University Medical Center Utrecht, Utrecht, The Netherlands) was confronted with a large outbreak of VRE. On the basis of genotyping (by pulsed-field gel electrophoresis), epidemic and nonepidemic VRE strains were distinguished, and infection-control measures were exclusively targeted toward epidemic VRE. The outbreak was retrospectively divided into 3 periods of different infection-control measures. Compliance with use of alcohol-based hand rubs was enforced during all periods. Period I involved active surveillance, isolation of carriers, and cohorting (duration, 4 months); preemptive isolation of high-risk patients for VRE colonization was added in period II (7 months); and cohorting and preemptive isolation were abandoned in period III (18 months). When the outbreak was identified, 27 patients in 6 wards were colonized; 93% were colonized with an epidemic VRE strain. Detection rates of nonepidemic VRE were 3.5%, 3.0%, and 2.9% among 683, 810, and 977 screened patients in periods I, II, and III, respectively, comparable to a prevalence of 2% (95% confidence interval [CI], 1%-3.5%) among 600 nonhospitalized persons. The relative risks of detecting epidemic VRE in periods II and III, compared with period I, were 0.67 (95% CI, 0.41-1.10) for period II and 0.02 (95% CI, 0.002-0.6) for period III. Infection-control measures were withheld for patients colonized with nonepidemic VRE (76 [54%] of 140 patients with a test result positive for VRE). Use of alcohol-based hand rubs increased by 31%-275% in outbreak wards. Genotyping-targeted infection control, isolation of VRE carriers, enhancement of hand-hygiene compliance, and preemptive isolation successfully controlled nosocomial spread of epidemic VRE infection.

Using the Six Sigma Process to Implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 Intensive Care Units

The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC's emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement. To use the Six Sigma process to examine hand hygiene practices and increase compliance with the CDC hand hygiene recommendations required by JCAHO. Six Sigma Project with pre-post design. Physicians, nurses, and other staff working in 4 intensive care units at 3 hospitals. Observed compliance with 10 required hand hygiene practices, mass of ABHR used per month per 100 patient-days, and staff attitudes and perceptions regarding hand hygiene reported by questionnaire. Observed compliance increased from 47% to 80%, based on over 4,000 total observations. The mass of ABHR used per 100 patient-days in 3 intensive care units (ICUs) increased by 97%, 94%, and 70%; increases were sustained for 9 months. Self-reported compliance using the questionnaire did not change. Staff reported increased use of ABHR and increased satisfaction with hand hygiene practices and products. The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC's evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use.

Using the six sigma process to implement the centers for disease control and prevention guideline for hand hygiene in 4 intensive care units

BACKGROUND: The Centers for Disease Control and Prevention (CDC) Guideline for Hand Hygiene in Health Care Settings was issued in 2002. In 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) established complying with the CDC Guideline as a National Patient Safety Goal for 2004. This goal has been maintained through 2006. The CDC’s emphasis on the use of alcohol-based hand rubs (ABHRs) rather than soap and water was an opportunity to improve compliance, but the Guideline contained over 40 specific recommendations to implement. OBJECTIVE: To use the Six Sigma process to examine hand hygiene practices and increase compliance with the CDC hand hygiene recommendations required by JCAHO. DESIGN: Six Sigma Project with pre-post design. PARTICIPANTS: Physicians, nurses, and other staff working in 4 intensive care units at 3 hospitals. MEASUREMENTS: Observed compliance with 10 required hand hygiene practices, mass of ABHR used per month per 100 patient-days, and staff attitudes and perceptions regarding hand hygiene reported by questionnaire. RESULTS: Observed compliance increased from 47% to 80%, based on over 4,000 total observations. The mass of ABHR used per 100 patient-days in 3 intensive care units (ICUs) increased by 97%, 94%, and 70%; increases were sustained for 9 months. Self-reported compliance using the questionnaire did not change. Staff reported increased use of ABHR and increased satisfaction with hand hygiene practices and products. CONCLUSIONS: The Six Sigma process was effective for organizing the knowledge, opinions, and actions of a group of professionals to implement the CDC’s evidence-based hand hygiene practices in 4 ICUs. Several tools were developed for widespread use.

Cost Analysis of Hand Hygiene Using Antimicrobial Soap and Water Versus an Alcohol-Based Hand Rub

Proper hand hygiene is acknowledged as the most critical element of an adequate infection control program in the oral healthcare setting. However, adherence to proper hand hygiene protocols is often lacking. Poor compliance with hand hygiene protocols has been attributed to such factors as lack of time, hand irritation, hand dryness, forgetfulness, skepticism over importance, understaffing, perceived low risk of cross-infection, inconvenience, and the belief gloves alone offer protection. In the medical environment the use of alcohol-based hand rubs now represent the preferred method of performing hand hygiene when delivering non-surgical care. In this study we compared the costs associated with traditional hand washing against an alcohol-based hand rub protocol in the dental setting. The results indicate an alcohol-based hand rub protocol is less costly and less time consuming when compared to traditional handwashing in the dental setting, creating a new paradigm for hand hygiene in the dental office.

Extent and Predictors of Microbial Hand Contamination in a Tertiary Care Ophthalmic Outpatient Practice

To measure the extent of microbial hand contamination among ophthalmologists during routine clinic practice and examine its association with hand cleansing practices and beliefs, glove use, and patient load. This was a single-masked analysis of resident and transient flora of ophthalmologists before and after patient examination and after handwashing by agar imprints of the dominant hand. Standardized questionnaires were used to collect information concerning subjects' hand cleansing practices and patient load. Of the 108 cultures, 107 (99.1%) were culture positive, yielding 15 separate organisms. Gram-negative bacilli were the most common transient flora, followed by Gram-positive cocci and fungi. Thirty-five (97.2%) ophthalmologists were culture positive for at least one resident and 8 (22.2%) ophthalmologists were culture positive for at least one transient organism, before patient contact. Regression models showed alcohol-based hand rub use, transient and resident floral load before patient contact, and patient load collectively accounted for 58.7% of the variance in resident floral load after patient contact. Use of alcohol-based hand rubs was associated with a mean resident floral reduction of 324.4 CFUs (95% confidence interval [CI] = 185.4 to 463.5; P < 0.01) and 31.6 CFUs (95% CI = 1.2 to 62.0; P < 0.05) after patient contact and handwashing, respectively. Handwashing with chlorhexidine was a significant predictor for transient floral load after handwashing (unstandardized beta = -17.2; 95% CI = -10.2 to -24.2; P < 0.01). The extent of contamination with pathogenic organisms after contact with eye outpatients, who have traditionally been perceived as relatively "clean," was of concern. Previously identified risk factors for hand contamination in inpatient settings, such as patient load, only explained a small proportion of variance in microbial load in the ophthalmic outpatient setting.

Low rates of cutaneous adverse reactions to alcohol-based hand hygiene solution during prolonged use in a large teaching hospital.

We assessed cutaneous adverse reactions (CARs) to alcohol-based hand rub (ABHR) after the introduction of a hand hygiene culture change program at our institution. CARs were infrequent among exposed health care workers (HCWs) (13/2,750; 0.47%; 1 CAR per 72 years of HCW exposure) and were not influenced by the duration or intensity of ABHR use but were associated with the presence of irritant contact dermatitis.

Reduction in Nosocomial Transmission of Drug-Resistant Bacteria After Introduction of an Alcohol-Based Handrub

To assess quantitatively the clinical impact of using an alcohol-based handrub (ABHR) in the hospital environment, measuring impact as the incidence of new, nosocomial isolates of drug-resistant organisms. An observational survey from 1998 to 2003 comparing the first 3 years of no ABHR use with the 3 years following, when an ABHR was provided for hand hygiene. An inner-city, tertiary-care medical center. At baseline, an antimicrobial soap with 0.3% triclosan was provided for staff hand hygiene. The intervention was placement in all inpatient and all outpatient clinic rooms of wall-mounted dispensers of an ABHR with 62.5% ethyl alcohol. Data were collected on change in the incidence of three drug-resistant bacteria. During the 6 years of the survey, all new, nosocomially acquired isolates of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile-associated diarrhea were recorded. On comparison of the first 3 years with the final 3 years, there was a 21% decrease in new, nosocomially acquired MRSA (90 to 71 isolates per year; P = .01) and a 41% decrease in VRE (41 to 24 isolates per year; P < .001). The incidence of new isolates of C. difficile was essentially unchanged. In the 3 years following implementation of an ABHR, this hospital experienced the value of reductions in the incidence of nosocomially acquired drug-resistant bacteria. These reductions provide clinical validation of the recent CDC recommendation that ABHRs be the primary choice for hand decontamination.

The “Don't Catch the Flu Bear Blues” educational campaign to increase hand hygiene awareness during the flu vaccine shortage in an orthopedic specialty hospital

ISSUE: On October 5, 2004, there was news from the Centers for Disease Control and Prevention (CDC) that due to problems in manufacturing of the influenza vaccine for the 2004-2005 season, the expected supply was reduced. Because of the situation, persons who were not included in one of the priority groups were asked to forego or defer vaccination. In an effort to prevent the transmission and acquisition of the influenza virus, an educational campaign was designed to increase awareness to the importance of hand hygiene and respiratory etiquette. PROJECT: The theme of the educational program was “Don't Catch the Flu Bear Blues” and involved the distribution of wicker baskets filled with a teddy bear with a pediatric mask on its face, bottles of alcohol-based hand rub, respiratory etiquette flyers, an educational poster, and candy kisses. The baskets were distributed to each of the infection control liaisons from the following departments: inpatient nursing units, radiology, acute care unit, intensive care unit, patient access, laboratory, rehab unit, prescreening unit, operating room, post anesthesia care unit, and induction room area. Baskets were re-filled with alcohol hand rub and candy over a 4-week period. The project cost was approximately $700, which included the baskets, bears, candy, and hand rub. Four cases of hand rub were donated by the pharmacy department to contribute to reducing influenza transmission from the reduction in vaccine supplies. RESULTS: Fifteen baskets were distributed the week before the holidays in the spirit of a gift basket to the liaisons. They were instructed to keep the basket and teddy bear after the campaign was completed. Staff was delighted to receive the individual bottles of hand rub, as were the patients who received bottles in patient access. LESSONS LEARNED: Unique, creative hand hygiene campaigns heighten awareness of the importance of handwashing and the use of alcohol-based hand rubs in patient care areas. It was a great way to market the infection control program and boost staff morale during an unusual flu vaccine season. A turnkey approach to setting up the educational campaign, including sources for vendors and a detailed budget, will be presented.

Cost analysis of hand hygiene using antimicrobial soap and water versus an alcohol-based hand rub

Proper hand hygiene is acknowledged as the most critical element of an adequate infection control program in the oral healthcare setting. However, adherence to proper hand hygiene protocols is often lacking. Poor compliance with hand hygiene protocols has been attributed to such factors as lack of time, hand irritation, hand dryness, forgetfulness, skepticism over importance, understaffing, perceived low risk of cross-infection, inconvenience, and the belief gloves alone offer protection. In the medical environment the use of alcohol-based hand rubs now represent the preferred method of performing hand hygiene when delivering non-surgical care. In this study we compared the costs associated with traditional hand washing against an alcohol-based hand rub protocol in the dental setting. The results indicate an alcohol-based hand rub protocol is less costly and less time consuming when compared to traditional handwashing in the dental setting, creating a new paradigm for hand hygiene in the dental office.

Low frequency of fires from alcohol-based hand rub dispensers in healthcare facilities.

We administered a web-based questionnaire to SHEA, APIC, and EIN members to assess the frequency of fires associated with alcohol-based hand rub (ABHR) dispensers in healthcare settings. None of the 798 responding facilities using ABHRs reported a dispenser-related fire; 766 facilities had accrued an estimated 1,430 hospital-years of ABHR use.