Use Of Hand Hygiene Products Research Articles

689. Significant Improvement in Hand Hygiene Compliance and Decline in Clostridioides difficile Infections with Implementation of Infection Prevention Interventions

Abstract Background Per CDC, C. difficile is an urgent microbial threat. Despite use of CDC diagnostic criteria, 2-step testing protocol and antimicrobial stewardship interventions limiting broad spectrum antimicrobial use, we witnessed an increase in infections in 2022, therefore, additional interventions were implemented. Methods A multifaceted QI intervention program to improve IPC (infection prevention and control) practices was implemented in July 2022 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Interventions included: auditing and real time observations for health care personnel (HCP) hand hygiene compliance; monitoring soap/sanitizer usage; educational interventions including posters posted throughout the hospital emphasizing hand hygiene, “A clean in and clean out” approach and contact precautions reminders posted in patient rooms/nursing stations, weekly nursing huddles focused on nursing and ancillary staff education, provider counseling and continued coaching. Pre-intervention period (P1: 1/10/2021- 6/30/2022) was compared with Intervention period (P2: 07/01/2022-3/31/2023) for hand hygiene compliance and C. difficile infection rates. Results Overall adequate hand hygiene compliance rates for all health care personnel (HCP) increased from 71% during P1 to 85% during P2 (P< 0.05). All categories of HCP showed a significant improvement in hand hygiene compliance from P1 to P2, with rates for physicians increasing from 74% to 92% (p< 0.05), nurses from 68% to 94% (p< 0.001); nurse practitioners/physician assistants from 75% to 90% (p< 0.05), ancillary staff (chaplain, medical technicians, social workers) from 60% to 89% (p< 0.01)]. Hand hygiene product use increased significantly and soap usage alone increased from 45% to 75% in P2 (p< 0.05). C. difficile infections declined significantly from a mean of 1.9 infections per 1000 patient days during P1 to 0.5 infections per 1000 patient days during P2 (p< 0.001); SIR (Standardized infection ratio) decreased from 1.14 during P1 to 0.4 during P2 (p< 0.01). No C. difficile related mortality was observed. Conclusion With implementation of multifaceted IPC interventions, significantly improved hand hygiene rates and a significant decline in C. difficile infections were observed. Disclosures All Authors: No reported disclosures

The covid-19 pandemic led to an upsurge of irritant contact hand dermatitis

The COVID-19 Pandemic has brought about a transition in hand hygiene practices since the disease has no cure. WHO recommends frequent hand washing for at least 20 seconds each time or the use of alcohol-based hand rubs to prevent infection. This change has led to a variety of skin changes over hands including dryness, redness, irritation, etc. Dermatitis is a medical term for skin inflammation (irritation). Contact dermatitis is an allergic or irritant reaction that causes a painful or itchy skin rash. Frequent use of hand hygiene products, particularly soaps, and other detergents, is one of the leading causes of irritant contact dermatitis among health workers in this Covid pandemic era. : To know the impact of change in hand hygiene practices after the start of the COVID-19 pandemic, an online survey was conducted using google forms. Participants included only medical students and professionals aged 18 and above till 35 years. Informed consent was obtained from all individual participants included in the study. Information was recorded and analyzed.: The study included a total of 151 participants including medical students and professionals out of which 71 (47%) were male, 79(53%), and female, all aged between 18-35 years. 136 (90.1%) of the total participants agreed with an increase in hand hygiene practices brought about by the pandemic, using various means for the same including soap, alcohol-based gels, rubs, and wipes. 51 participants (33.8 %) noticed explicit changes in the skin of their hands after the switch in their respective hand hygiene practices.: This study highlights the changes in hand hygiene practices due to the pandemic and the prevalence of dermatitis due to the same in medical students and professionals. The study will highlight the awareness about the prevention of skin changes in hand due to frequent sanitation and the need to seek a dermatologist if and when required

Hand hygiene product use by food employees in casual dining and quick-service restaurants

Hand hygiene product usage characteristics by food employees when hand sanitizers are made available are not well understood. To investigate hand hygiene product usage in casual dining and quick-service restaurants, we placed automated monitoring soap and sanitizer dispensers side-by-side at handwash sinks used by food employees in seven restaurants. Dispenses were monitored, and multiple dispenses that occurred within 60 s of each other were considered a single hand hygiene event. This resulted in 186,998 events during the study (149,779 soap only, 21 985 sanitizer only, and 15,234 regimen [defined as soap followed by sanitizer at the same sink within 60 s]) over 15,447 days of use. Soap was the most frequently used hand hygiene method by food employees in both restaurant types. Regimen use, despite being the preferred hand hygiene method by both restaurant chains, was the least used hand hygiene method. When pooled over restaurant types, the median daily usage for soap was statistically significantly highest of all methods at 23.5 dispenses per sink per day (p < 0.0001), the sanitizer median daily usage was 4.27 dispenses per sink per day, and regimen use was statistically significantly lowest of all methods at 4.02 dispenses per sink per day (p < 0.0001). When hand hygiene event types were pooled, casual dining restaurants had similar median hand hygiene event rates (11.4 dispenses per sink per day) compared to quick-service restaurants (11.9 dispenses per sink per day; p = 0.890). The number of events by sink location varied, with sinks located at a warewash station having the highest number of events (19.3 dispenses per sink per day; p < 0.0001), while sinks located by a ready-to-eat food preparation area had the lowest number of events (6.8 dispenses per sink per day; p < 0.0001). These data provide robust baseline benchmarks for future hand hygiene intervention studies in these settings.

Hand eczema prevalence among healthcare workers during COVID-19 pandemic – a systematic review

Introduction The globe is currently experiencing a new pandemic due to the introduction of the SARS-CoV-2 strain of the human coronavirus. The virus infects people and causes COVID-19, a lung condition that can be fatal in susceptible people and is characterized by fever, pneumonia, and shortness of breath. The prevalence of hand eczema among healthcare professionals working in COVID-19 units has grown, and it has been linked to increased hand sanitation habits. Aim of the study The purpose of the study was to examine the prevalence of hand eczema as a consequence of more intensive hand hygiene among healthcare workers during COVID-19 pandemic. Materials and methods A search was conducted using PubMed and Google Scholar databases. Articles were searched in English using the following key words: hand eczema; hand dermatitis; atopic dermatitis; COVID-19; SARS-CoV-2. Results Healthcare workers developed hand eczema more frequently in COVID-19 outbreak. The risk of hand eczema was raised by frequent use of hand hygiene products, alcohol-based hand sanitizers, wearing gloves, previous atopic dermatitis history and female sex gender. Due to excessive hand hygiene the natural skin barrier function was impaired, leading to hand eczema. The use of preventive skincare products can lower the risk of hand eczema development. Conclusion Findings demonstrated positive correlation between hand eczema prevalence among healthcare professionals and COVID-19 pandemic. Hand washing and the use of disinfectants disrupt the natural skin barrier function, leading to allergic and irritating hand eczema. In order to continue practicing hand hygiene during the continuing pandemic, proper prevention strategies and education should be implemented.

Antimicrobial Resistance Following Prolonged Use of Hand Hygiene Products: A Systematic Review.

Background: This systematic review aimed to establish whether antimicrobial resistance (AMR) occurs following prolonged use of antimicrobial hand hygiene (HH) products, and, if so, in what magnitude. Methods: Key bibliographic databases were searched to locate items on HH use and AMR development from database inception to December 2020. Records were screened and full texts of all potentially eligible articles were retrieved and checked for inclusion. The following data from the included studies were abstracted: type of HH product used, including the name of antimicrobial agent, study setting, country, study year, duration of use and development of AMR including the organisms involved. Quality assessment was done using the Newcastle-Ottawa Scale (NOS). Results: Of 339 full-text articles assessed for eligibility, only four heterogeneous United States (US) studies conducted in the period between 1986 and 2015 were found eligible, and included. One hospital-based study showed evidence of AMR following long term use of HH products, two studies conducted in household settings showed no evidence of AMR, and another experimental study showed partial evidence of AMR. The overall certainty of the evidence was moderate. Conclusion: Prolonged use of HH products may cause AMR in health care settings, but perhaps not in other settings.

Use patterns and frequency of hand hygiene in healthcare facilities: Analysis of electronic surveillance data

Healthcare workers perform hand hygiene much more frequently than workers in other fields. As a result, healthcare workers have a higher exposure to topical antiseptic products. Five tertiary care facilities were equipped with an electronic hand hygiene compliance monitoring system. Alcohol-based handrub (ABHR) and handwash use was recorded on a worker-specific basis for 6 months. Total hand hygiene product use and total hours worked were calculated for each worker to determine use frequency. A detailed, descriptive analysis of hand hygiene practices was performed. All facilities demonstrated high hand hygiene compliance rates (>85%). ABHR use was more frequent (9.1 uses/hour, 95th percentile) than handwashing (2.1 uses/hour, 95th percentile). This study identified a relationship between hand hygiene frequency and job function. Nursing and nonclinical support staff demonstrated higher usage rates than other healthcare workers. For these workers with high hand hygiene frequency, 95th percentile usage rates for ABHR use and handwashing were 9.6 and 2.2 uses/hour, respectively. This extensive dataset, monitoring nearly 4000 healthcare workers and more than 6 million data points, provides a detailed description of current hand hygiene practices of hospital staff. ABHR was used more frequently than handwashing. Job function was found to affect hand hygiene frequency, with nonclinical staff and nursing staff demonstrating elevated rates of hand hygiene.

Microbial Characteristics of Nosocomial Infections and Their Association with the Utilization of Hand Hygiene Products: A Hospital-Wide Analysis of 78,344 Cases.

Nosocomial infections are the main adverse events during health care delivery. Hand hygiene is the fundamental strategy for the prevention of nosocomial infections. Microbial characteristics of nosocomial infections in the Asia-Pacific region have not been investigated fully. Correlation between the use of hand hygiene products and the incidence of nosocomial infections is still unknown. This study investigates the microbial characteristics of nosocomial infections in the Asia-Pacific region and analyzes the association between the utilization of hand hygiene products and the incidence of nosocomial infections. A total of 78,344 patients were recruited from a major tertiary hospital in China. Microbial characteristics of major types of nosocomial infections were described. The association between the utilization of hand hygiene products and the incidence of nosocomial infections was analyzed using correlation and regression models. The overall incidence of nosocomial infections was 3.04%, in which the incidence of surgical site infection was 1%. Multi-drug resistance was found in 22.8% of all pathogens, in which multi-drug-resistant Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus were 56.6% and 54.9%, respectively. The utilization of hand hygiene products (including hand sanitizer, soap and paper towel) was associated negatively with the incidence of surgical site infection in surgical departments and the incidence of nosocomial infections in non-intensive care unit (ICU) departments (especially in surgical departments). Regression analysis further identified that higher utilization of hand hygiene products correlated with decreased incidence of major types of nosocomial infections. Multi-drug-resistant organisms are emerging in Asia-Pacific health care facilities. Utilization of hand hygiene products is associated with the incidence of nosocomial infections.

Increase in hospital purchase of hand hygiene products: The importance of focusing on the right product

Alcohol-based handrub (AHR) consumption is positively correlated with increases in hand hygiene (HH) compliance. In our 2,000-bed hospital in India, multiple awareness drives have been conducted to promote HH. This study aimed to determine the quantitative effect of these campaigns on use of HH products (soap and AHR) in the hospital. Over the last 6 years, bar soap consumption has increased by 389.15%, whereas that of AHR increased by 146.7%. We also evaluated microbial contamination of 99bar soap and 60 liquid soap samples in our hospital for a year. Of the samples, 61 (61.6%) of the bar soaps and 2 (3.3%) of the liquid soaps were found to be contaminated with various organisms (P<.0002). To conclude, the focus should be to increase the right kind of HH product so that hospitals in developing countries procure liquid soaps instead of bar soaps for handwashing purposes.

Strategies to prevent healthcare-associated infections through hand hygiene.

Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Strategies to prevent healthcare-associated infections through hand hygiene.

Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

Clean Hands for Life™: results of a large, multicentre, multifaceted, social marketing hand-hygiene campaign

A year-long multifaceted hand-hygiene campaign entitled Clean Hands for Life targeting individual, environmental and organisational factors that influence healthcare worker (HCW) hand-hygiene behaviour was implemented in 36 acute and long-term care facilities in Vancouver Coastal Health region. The campaign involved rotation of ten novel posters, two poster contests, and distribution of multiple promotional items. A social marketing approach was used to implement and monitor the effectiveness of the campaign. Evaluation included quality assurance surveys, staff surveys (baseline, mid- and post-campaign), and focus groups. A total of 141 poster contest submissions was received, 5452 staff surveys completed and 14 focus groups conducted. Overall knowledge of the importance of hand-hygiene and intention to clean hands was high at baseline. No significant differences were observed when mid- and post-campaign scores were compared to baseline. The majority (89.5%) of HCWs reported that they preferred soap and water over alcohol hand gel. A significant increase in the self-reported use of hand-hygiene products was observed particularly among HCWs not providing direct patient care. Barriers to hand-hygiene included inappropriate placement of sinks, traffic flow issues, inadequately stocked washrooms, workload and time constraints. Organisational support was visible throughout the campaign. The results showed that social marketing is an effective approach in engaging HCWs. Hand-hygiene campaigns that focus almost exclusively on increasing awareness among HCWs may not be as successful as multifaceted campaigns or campaigns that target identified barriers to hand-hygiene.

Watching Them Wash: Description of a Hand Hygiene Observation Program

An essential but difficult element of an effective hospital handhygiene program is assessing compliance with hand hygiene.Currently, there is no generally accepted standardized methodto assess compliance with hand hygiene in hospitals, andmultiple approaches have been tried, including direct obser-vation, self-reporting by healthcare workers, and surrogatemeasurements, such as electronic counting devices on soapdispensers or hand hygiene product use.

Availability and Use of Hand Hygiene Products, by Visitors, at the Entry Points of Hospitals

Availability and Use of Hand Hygiene Products, by Visitors, at the Entry Points of Hospitals

Association between use of hand hygiene products and rates of health care–associated infections in a large university hospital in Norway

An association between use of hand hygiene products and health care-associated infection rates was investigated in a large Norwegian university hospital. We conducted an ecologic study by combining data from purchasing and admission systems with data from 32 point prevalence surveys (27,248 patients) in 1998-2005. Data on purchase of hand disinfectants and soap, and patient-days, were collected for 20 bed wards similar to those of the prevalence surveys. The prevalence of infections was 7.1%. We found no significant decline in overall infections (P = .19), but use of hand hygiene products significantly increased from 28.5 L per 1000 patients-days in 1998 to 43.3 L per 1000 patient-days in 2005 (P < .001). After examining a linear dose-response relation between use and infection rates, we observed a borderline significant decline in infections from 8% to 6% with increased use of hand hygiene products (P = .05). This association appeared stronger for wards that were registered with infections >9% at study start in 1998 (P < .001). These data suggests that infection rates may be reflected by amount of hand hygiene products used. Quantification of such products over time may serve as an indicator for hand hygiene performance in hospitals.

Intensive care unit environmental cleaning: an evaluation in sixteen hospitals using a novel assessment tool

Despite isolation precautions and enhanced hand hygiene product use, the transmission of healthcare-associated pathogens remains a major problem. Recent studies have confirmed that microbial contamination of the environment in intensive care units (ICUs) can lead to colonisation and infection of patients. Although environmental disinfectants have been used to minimise the spread of microbial pathogens, suboptimal cleaning may limit the effectiveness of such activities. In order to evaluate the thoroughness of cleaning near-patient surfaces, a transparent, easily cleanable and environmentally stable solution was developed that fluoresces when exposed to UV light. The solution was used to mark a standardised group of frequently touched objects in ICU patient rooms following discharge cleaning. These sites were then evaluated after at least two patients had occupied the room and at least two terminal cleanings had been completed. Evaluation of 2320 objects in 197 patient areas disclosed that 57.1% of the standardised sites were cleaned following discharge of the room's occupant in the 16 ICUs studied. Although high rates of cleaning (>80%) were found for toilet seats, sinks and tray tables, consistently low rates of cleaning (<30%) were documented for several objects at high risk of becoming contaminated with nosocomial pathogens, including bedpan cleaners, toilet area handholds, doorknobs and light switches.

Identifying Opportunities To Enhance Environmental Cleaning in Twelve Acute Care Hospitals

BACKGROUND/OBJECTIVES: Despite activities aimed at enhancing isolation practices and promoting increased use of hand hygiene products, the spread of health care associated pathogens continues to be a major problem. While clearly not an independent factor, environmental contamination with these resistent and resiliant pathogens in combination with suboptimal cleaning/disinfection activities has been shown to play a role in perpetuating the transmission of these pathogens in many settings. In this context we undertook a multi-institutional prospective evaluation of cleaning/disinfecting activities to determine if opportunities to enhance these activities could be identified. METHODS: An evaluation of the thoroughness of cleaning of the near patient environment using a non-biological targeting method was undertaken in twelve acute care hospitals ranging in size from 46 to 568 beds. The proportion of frequently touched objects cleaned as part of terminal room cleaning/disinfecting activities was calculated for between 30 and 52 rooms in each facility in a confidential manner. The results were analyzed to determine how specific interventions could be developed to enhance such cleaning activities. RESULTS: Substantial opportunites for improving terminal room cleaning were identified in all hospitals. While the overall thoroughness of cleaning of objects in the near patient environment was quite similar in this cohort of hospitals (mean % of objects cleaned=45.3, SD=3.4), wide differences in how well specific objects were cleaned both within and between institutions were noted. Analysis of these results disclosed a range of institutional specific opportunities for a) educational interventions, b) the re-assessment of environmental services personnel allocation and c) the identification of possible motivational issues as well as inter-institutional analyses of issues for which highly specific interventions could be implemented and their impact objectively measured. CONCLUSIONS: The programmatic use of a simple user-friendly targeting method to evaluate the thoroughness of terminal patient room cleaning identified many specific opportunities for improving cleaning/disinfecting activities in each of the twelve acute care hospitals studied.

La consommation de produits d'hygiène des mains dans les établissements de soins dans l'interrégion Ouest

The study had for aim to investigate hand hygiene product use in French hospitals between 2000 and 2003. A questionnaire was sent in 2002 and 2 more in 2003 and 2004 (for 2000 to 2003) requiring data on type of hospital, number of beds, staff members, admissions and patient-day, litres of mild soap, antiseptic soap and alcohol-based rub used and price per litre. Indices were calculated accordingly. 574 hospitals answered over the 4 year period (average 143 per year) representing an average of 50 000 beds/year, 80 000 full-time staff positions, 1.2 million admissions and 16 millions patient-days. The median consumption of mild soap was 3.8 l per bed, 2.7 l per staff member, 2.4 l per 100 admissions, and 10.6 ml per patient-day. The median consumption of antiseptic soap was 1 l per bed, 0.8 l per staff member, 4.8 l per 100 admissions, and 3.2 ml per patient-day. The median consumption of alcohol-based rub (HAS) was 0.3 l per bed, 0.3 l per staff-member, 1.5 l per admission, and 0.9 l per patient-day. Between 2000 and 2003, HAS use significantly increased from 69 to 88% (a relative increase of 31%) and the median consumption increased from 0.5 ml to 1.5 ml per patient-day. 370 fully completed grids gave a number of 7 opportunities per patient-day with less than 1 for HAS. The best indicator for an infection control practitioners is the quantity of alcohol-based solution in ml/patient-day and HAS per patient-day is the reference.