Use Of Alcohol-based Solutions Research Articles

Lavado de manos: experiencias de dos comunidades autónomas

The Spanish Ministry of Health in accordance with WHO guidelines, promotes hand washing in hospitals, with the objective of reinforcing the commitment of health care workers to hand washing. In this study we described the results of the actions implemented in two communities, which were aimed at increasing hand-washing compliance among health care workers by means of a multimodal improvement programme. Cantabrian and Murcian health services. The project was carried out in three phases. Phase I: analysis of preimplantation situation by means of an observational study in open care units, and a cross study of self-perceived compliance to hand hygiene with a questionnaire. Phase II: Implementing of training plan and promoting the use of alcohol-based solutions. Phase III: Reassessment of the results achieved by means of a post- intervention observational study. There has been a significant increase in frequency of hand washing adherence in both communities. 40.5% 95% CI [38.2-42.4] vs. 46.2% 95% CI [44.0-48.4] (p < .001) in Cantabria, and 43% vs. 54% in Murcia. The need to implement recommendations must continue to be emphasized and new interventions developed to increase health workers compliance, as well as promote educational policies and ease of access to alcohol-based solutions.

Antimicrobial drug use and infection control practices associated with the prevalence of methicillin-resistant Staphylococcus aureus in European hospitals

Major regional variations in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) are observed across Europe. This study investigated hospital MRSA prevalence in relation to patterns of antimicrobial use and infection control policies in an observational, cross-sectional study that used retrospective data from 2001 and linear regression to model relationships. MRSA prevalence (median 20.8%, n = 173 hospitals) and antimicrobial consumption (median 55.2 defined daily doses/100 bed-days, n = 140 hospitals) both varied significantly according to geographical region (p <0.001). MRSA prevalence and antimicrobial consumption data were provided by 128 hospitals, and showed a strong statistical relationship between macrolide use and MRSA prevalence. Use of (i) third-generation cephalosporins, (ii) all antimicrobial agents, and (iii) all antimicrobial agents except glycopeptides was also associated with MRSA prevalence. Up to 146 hospitals provided data on MRSA prevalence and key infection control parameters. Adjusted linear regression modelling provided strong evidence that infection control policy recommendations associated with lower MRSA prevalence rates were (i) use of alcohol-based solutions for hand hygiene (mean difference 10.3%, 99% CI 1.2-10.3), and (ii) placement of MRSA patients in single rooms (mean difference 11.2%, 99% CI 1.4-20.9). Hospitals with problems in implementing isolation policies had higher resistance levels (mean difference 12%, 99% CI 3.8-20.1). Additional recommendations showed less evidence of association with a low MRSA prevalence. Overall, this study highlighted significant associations between MRSA prevalence, antimicrobial use and various key infection control parameters, all of which showed significant individual variations according to geographical region.

Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study

Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals from 32 European countries, categorised by five geographical regions. A formal IC programme existed in 72% of hospitals, and a multidisciplinary IC committee was operational in 90%. Trained IC nurses (ICNs) were present in 80% of hospitals (ranging from 54% in south-east and central-eastern Europe, to 100% in northern Europe), whereas 74% had one or more trained IC doctors (ICDs) (ranging from 46% in south-east Europe to 84% in western Europe). Median staffing levels were 2.33 ICNs/1,000 beds and 0.94 ICDs/1,000 beds. The intensity of IC programmes scored higher in centres from northern and western Europe than from other European regions. Written guidelines promoted hand hygiene for healthcare workers in 89% of hospitals, education in 85%, and audit in 46%. Guidelines recommended use of alcohol-based solutions (70%) and/or medicated/antiseptic soap (43%) for decontamination of non-soiled hands. Use of alcohol-based solutions varied according to region, from 41% in southern Europe to 100% in northern Europe, compared with use of medicated soap from 77% in southern Europe to 11% in northern Europe (p < 0.01). These findings showed that IC programmes in European hospitals suffer from major deficiencies in human resources and policies. Staffing levels for ICNs were below recommended standards in the majority of hospitals. Education programmes were incomplete and often not supported by audit of performance. Hand hygiene procedures were sub-standard in one-third of centres. Strengthening of IC policies in European hospitals should be a public health priority.

Skin antiseptics and the risk of operating theatre fires

Following press reports of patients catching fire or receiving chemical burns in the operating theatre, a review was conducted on the flammability of skin antiseptics. The purpose of the paper was to clarify confusion regarding povidine-iodine (Betadine), which had been reported as being flammable, and also to determine the use of alcohol-based solutions in the Hunter Area Health Service. A risk assessment was conducted and risk reduction strategies outlined. Risk assessment was made following a literature review and an audit of 10 operating theatres in the Hunter Area Health Service. Risk for operating room fires from alcohol-based skin antiseptics was confirmed. Antiseptics in aqueous solutions only smoulder. The Hunter Health survey indicated that although alcohol-based solutions were not used in operating theatres, they were used in anaesthetic bays for insertion of epidural and central line catheters. Strategies to reduce the risk of fire include discontinuation of use of alcohol-based skin antiseptics in operating theatres; using fire retardant surgical drapes; installing over-current protection devices on electrical equipment; minimizing flammable conditions by avoiding nitrous oxide and using the lowest required concentration of inspired oxygen; use of non-flammable cuffed endotracheal tubes; education and training of operating theatre personnel in fire hazards. Operating theatre fires continue to be a major risk for patient safety. In order to reduce this risk, the strategies outlined here should be followed.

A systematic review on the effectiveness of alcohol-based solutions for hand hygiene.

The use of alcohol has been proposed as an option for hand hygiene. A systematic review was conducted to evaluate the clinical evidence supporting the use of alcohol-based solutions in hospitals as an option for hand hygiene. Studies published between January 1992 and April 2002 in English and Thai, related to the effectiveness of alcohol-based solutions, were reviewed. The databases searched included Medline, DARE, CINAHL and Dissertation Abstracts International. All studies were assessed as having adequate methodological quality. Results of this systematic review supported that alcohol-based hand rubbing removes microorganisms effectively, requires less time and irritates hands less often than does handwashing with soap or other antiseptic agents and water. Furthermore, the availability of bedside alcohol-based solutions increases compliance with hand hygiene among health care workers.

Effectiveness of Alcohol-based solutions for Hand Hygiene: A Systematic Review.

To conduct a systematic review to determine the best available evidence related to effectiveness of alcohol-based solutions for hand hygiene. The specific review questions addressed were: the effectiveness in reducing microorganisms, compliance with hand hygiene, and the incidence of skin problems. Application time (consumption) addressed efficiency. This review considered all studies that included alcohol-based solutions that related to the objectives of the review. Outcomes included measures for the reduction of organisms, compliance with hand hygiene, the types of skin problems, and application time. The review primarily considered any intra-individual trials (IITs), randomised controlled trials (RCTs) and controlled clinical trials (CCTs) relating to the effectiveness of alcohol-based solutions but also included quasi-experimental designs. The search sought to find published and unpublished studies. The databases searched included: Medline, CINAHL, ProQuest and Dissertation Abstracts International. Studies were additionally identified from reference lists of all studies retrieved. All studies were checked for methodological quality by two reviewers and data were extracted using a tool. The study results were pooled in statistical meta-analysis using Review Manager software and summarized in narrative form where statistical pooling was not appropriate or possible. This systematic review included thirty seven studies that supports the use of alcohol-based solutions for routine hand hygiene and surgical hand scrub. Alcohol-based hand rub removes microorganisms from hands of personnel more effectively, requires less time, and irritates hands less often than traditional handwashing with nonmedicated soap or other antiseptic agents and water. The combination of 61% ethanol and 1% chlorhexidine gluconate (CHG) is even more effective in producing residual antibacterial properties on the skin. Furthermore, the availability of bedside alcohol-based solutions increased compliance with hand hygiene among HCWs. Rubbing hands with alcohol-based agents has been proved to be effective in the reduction of microorganisms from hands. Alcohols are effective for preoperative cleaning of the hands of surgical personnel. Addition of CHG to alcohol-based solution can produce residual antibacterial properties on the skin. The use of alcohol-based solutions containing emollients causes less skin irritation and dryness and requires less time than washing hands with soap or other disinfectants. The promotion of bedside, alcohol-based hand rubs contributes to the increase in compliance with hand hygiene by HCWs.