New method for assessing hand disinfection shows that pre-operative alcohol/chlorhexidine rub is as effective as a traditional surgical scrub

A Randomized Controlled Trial of Animal-assisted Activities for Pediatric Oncology Patients: Psychosocial and Microbial Outcomes

INTRODUCTION

Evidence about the effectiveness and safety of dog visits in pediatric oncology is limited.

METHOD

We conducted a randomized controlled trial (n=26) of dog visits versus usual care among pediatric oncology inpatients. Psychological functioning and microbial load from hand wash samples were evaluated. Parental anxiety was a secondary outcome.

RESULTS

We did not observe a difference in the adjusted mean present functioning score (-3.0; 95% confidence interval [CI], -12.4 to 6.4). The difference in microbial load on intervention versus control hands was -0.04 (95% CI, -0.60 to 0.52) log10 CFU/mL, with an upper 95% CI limit below the prespecified noninferiority margin. Anxiety was lower in parents of intervention versus control patients.

DISCUSSION

We did not detect an effect of dog visits on functioning; however, our study was underpowered by low recruitment. Visits improved parental anxiety. With hand sanitization, visits did not increase hand microbial levels.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov NCT03471221.

Sustainable Hand Surgery: Incorporating Water Efficiency Into Clinical Practice

Introduction Public health and well-being outcomes are intimately connected with the health of our planet. Climate change has numerous far-reaching effects. Managing and mitigating these risks to human health presents one of the next challenges to global healthcare. The current usage of planetary resources is unsustainable. Surgical procedures are particularly resource-intensive, often utilising vast amounts of single-use consumables, like water. In the last 100 years global usage of fresh water has increased six-fold and continues to rise by 1% year on year. It is well established that initial hand sterilization and maintenance of hand sterility during the surgical list are essential for preventing hospital-acquired infections and associated morbidity and mortality. This study aims to estimate the current daily water usage of two typical hand surgery lists from a District General Hospital in North Wales, to determine potential water savings by switching exclusively to an alcohol-based hand rub for subsequent scrubs, in line with current national guidelines. Methods Observational study estimation of water consumption from a temperature-controlled manual tap required using a 1 litre volumetric jug where the time taken to fill was recorded. Three separate observational samples were taken, and a mean was calculated. This mean determined the amount of water dispensed from the tap in a standard 3 min scrub and subsequent 1 min scrub. Two different theatre schedules were analysed: 1. A trauma list (five cases) and 2. A higher volume minor elective procedure schedule (16 cases), in this case a wide-awake local anaesthetic no tourniquet (WALANT) carpal tunnel release (CTR). Results Each case regardless of procedure had approximately three persons scrubbed. 20.57L of water is used for one person to scrub for 3 mins and an extra 6.8574L for each subsequent 1 min scrub. Therefore, current daily water consumption could reach 143.99L during the major hand trauma list and 411.4L during a high-volume carpal tunnel release list. Conclusion Simply following current guidelines by switching to alcohol-based hand rub just for subsequent scrubs could reduce water consumption by 57.2% for hand trauma lists and 70.2% for high-volume CTR lists.

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update

The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

Surgical hand rubbing versus surgical hand scrubbing: Systematic review and meta-analysis of efficacy

BACKGROUND

Surgical hand rubbing (SHR) and surgical hand scrubbing (SHS) are two common methods used by surgeons to reduce surgical site infections. To date, the optimal method that can effectively reduce these infections remains unknown. In this study, we performed a comprehensive statistical analysis to compare the efficacy of these two methods in effectively controlling surgical site infections.

METHODS

A systemic review and meta-analysis was performed by mining literature from major databases, including Pubmed, Embase, Cochrane library, Ovid and Google Scholar, and recruiting studies published between 1980 and 1st April 2019. Analysis was performed using Revman, version 5.3, software, and focused on primary outcomes that included colony-forming unit (CFU) counts and logarithmic reduction of CFU after hand antisepsis and after surgery.

RESULTS

Seven clinical trials met our inclusion criteria, with a total of 764 healthcare workers analyzed. We found no statistically significant differences between the two methods with regards to CFU counts and logarithmic reduction of CFU after hand antisepsis and surgery, as well as antisepsis and surgery times.

CONCLUSION

From the literature, it was evident that SHR had similar efficacy to SHS, without necessarily increasing costs. Owing to advantages such as ease of application, exposure to less dermal irritation, and less time consumption, SHR is recommended as a cost-effective alternative for management of surgical site infections.

Association Between Eliminating Water From Surgical Hand Antisepsis at a Large Ophthalmic Surgical Hospital and Cost

Importance

Alcohol-based surgical scrub is recommended for presurgical antisepsis by leading health organizations. Despite this recommendation, water-based scrub techniques remain common practice at many institutions.

Objective

To calculate the potential financial savings that a large, subspecialty ophthalmic surgical center can achieve with a conversion to waterless surgical hand preparation.

Design, Setting, and Participants

A review of accounting records associated with the purchase of scrubbing materials and water company invoices was conducted to assess direct costs attributable to water consumption and scrub materials for brushless, alcohol-based surgical scrub and water-based presurgical scrub. The flow rate of scrub sinks to estimate water consumption per year was tested. Savings associated with operating room (OR) and personnel time were calculated based on the prescribed scrub times for waterless techniques vs traditional running-water techniques. The study was conducted from January 5 to March 1, 2019.

Main Outcomes and Measures

The primary outcomes for this study were the quantity of water consumed by aqueous scrubbing procedures as well as the cost differences between alcohol-based surgical scrub and water-based scrub procedures per OR per year.

Results

Scrub sinks consumed 15.9 L of water in a 2-minute period, projecting a savings of 61 631 L and $277 in water and sewer cost per operating room per year. Alcohol-based surgical scrub cost $1083 less than aqueous soap applied from wall-mounted soap dispensers and $271 less than preimpregnated scrub brushes per OR per year in supply costs. The decrease in scrub time from adopting waterless scrub technique could save between approximately $280 000 and $348 000 per OR per year.

Conclusions and Relevance

Adopting waterless scrub techniques has the potential for economic savings attributable to water. Savings may be larger for surgical facilities performing more personnel-intensive procedures.

Effectiveness of Surgical hand Washing with Chlorhexidine, Providone iodine and Alcohol on Reducing the Microorganisms on the Hands: A Systematic Review

Background: Postoperative infection is one of the causes of mortality and the hands of the surgical team are the most common cause. According to the The Center for Disease Control and Prevention (CDC), proper hand washing can reduce the occurrence of nosocomial infections by up to 30%. The aim of this study is to determine the effectiveness of surgical hand washing using chlorhexidine, providone iodine and alcohol in reducing the microorganisms on the hand.Method: The data was collected from the following electronic databases: Science Direct, Springer link, Scopus and ProQuest. The search obtained 11 articles in accordance with the inclusion criteria and we obtained the literature in full text form.Result: The results of the study found three articles that mentioned hand washing with an alcohol hand rub as being more effective than iodine and chlorhexidine providone. There was one article described that both alcohol hand rub and chlorhexidine are more effective than iodine providone, Another article mentioned that chlorhexidine, providone iodine and alcohol hand rub were equally effective at reducing microorganisms contaminating the hand.Conclusion: The conclusion of the study is that surgical hand washing using chlorhexidine, providone iodine and alcohol are all effective at reducing microorganisms.

Adherence to surgical hand antisepsis: Barriers and facilitators in a tertiary care hospital

Although surgical hand antisepsis is paramount to surgical infection prevention, adherence to correct technique may be suboptimal. We conducted direct observations and semistructured interviews to identify barriers and facilitators to appropriate surgical hand antisepsis in a tertiary care hospital. Only 18% (9 out of 50) surgical hand antisepsis observations were fully compliant with the recommended application techniques. Most surgical staff members considered lack of organizational oversight, monitoring, and direct hands-on training as important barriers to adherence.

Adherence to surgical hand rubbing directives in a hospital district of Southwest Finland

BACKGROUND

The primary objective was to measure the compliance with alcohol-based surgical hand rubbing (SHR) among operation room personnel. The secondary objective was to evaluate the effect of feedback sessions on compliance.

METHODS

This was a prospective observational before-after intervention study. Between October 2010 and June 2012 the hygiene nurses observed SHR among operation room personnel in the hospital district of Southwest Finland. After feedback sessions a second observation round was conducted in the main operation room of Turku University Hospital. The first observation round comprised 477 observations: 259 (54%) were doctors, 190 (40%) nurses and 28 (5%) other personnel. In the second observation round a total of 210 observations were made.

RESULTS

During the first round in 42% of observations the 3 min SHR time recommended by WHO was used. Median times for SHR were 1 min 50 s (range 0 min to 5 min 44 s) for doctors and 3 min 25 s (range 1 min 1 s to 8 min 15 s) for nurses, respectively (p < 0.0001). In 40% of observations hands were not properly dried after a wash before applying SHR and in 45% hands were not allowed to dry properly after SHR before donning surgical gloves. After feedback, time for SHR did not significantly improve but technique did.

CONCLUSIONS

SHR was performed incorrectly in most observations even after feedback. The results stress the importance of more effective education, helping techniques and positive role models for operation room personnel to promote SHR.