Improvement of Hand Hygiene Quality and Compliance Using Bioburden Measurement and Online Feedback in Germany

Tailored positioning and number of hand rub dispensers: the fundamentals for optimized hand hygiene compliance

BACKGROUND

Availability of alcohol-based hand rub (ABHR) dispensers at positions adapted to the work flow of healthcare workers (HCWs) is decisive in order to carry out indication-based hand rubbing. Although requirements and guidelines regarding the positioning of ABHR dispensers are in place, scientific evidence is often lacking.

METHODS

In order to analyse the impact of the location and number of ABHR dispensers on hand hygiene performance, additional dispensers were systematically placed in patient rooms in a surgical 38-bed ward at Marburg University Hospital, Germany to complement the existing dispenser locations. ABHR use was monitored continuously before and after complementation using the NosoEx hand hygiene monitoring system. The ward had 53 dispensers before the intervention and 82 dispensers after the intervention.

RESULTS

The addition of dispensers increased ABHR consumption across the entire ward. Before the intervention, mean consumption was 20.6 mL/patient-day, whereas mean consumption after the intervention was 25.3 mL/patient-day. Depending on the combination of dispenser locations, consumption increased through targeted supplementation in patient rooms. The presence of two or three dispensers per patient room resulted in significantly greater ABHR consumption compared with one dispenser per patient room. The preferred location combinations were entrance-front bed-back bed and entrance-foot end.

CONCLUSION

ABHR consumption can be increased significantly by optimizing the position and number of dispensers. The outstanding factors are visibility and integrability of dispenser use into the work flow; in particular, a dispenser should be positioned in the entrance area. Recommendations should be optimized with regard to the required number and location of dispensers in patient rooms.

Alteration of antibiotic regimen as an additional control measure in suspected multi-drug-resistant Enterobacter cloacae outbreak in a neonatal intensive care unit

BACKGROUND

Increased occurrence of a particular species of Gram-negative bacteria (GNB), especially when multi-drug-resistant (MDR), in routine screening surveillance in neonatal intensive care units (NICUs) can be evoked by selection pressure.

AIM

To evaluate adaptation of the empiric antibiotic regimen for its usefulness as a control measure in suspected outbreaks in the NICU.

METHODS

In a retrospective outbreak analysis, cases between 1^st December 2017 and 31^st March 2018 were identified through microbiology and hygiene surveillance records. Furthermore, risk factors for MDR-GNB colonization were collected. Whole-genome sequencing (WGS) was performed on all isolates. Control measure documentations and interviews were employed to define interventions. As well as infection control measures, administration of third-generation cephalosporins was avoided and replaced whenever clinically acceptable as part of the intervention bundle.

FINDINGS

In total, nine patients were found to have rectal colonization with third-generation cephalosporin-resistant Enterobacter cloacae in routine screening surveillance in the pre-intervention period. After implementation of an infection control bundle, the incidence declined rapidly. WGS analysis revealed that two MDR E. cloacae were transmitted, and the majority were new cases. The incidence density of MDR-GNB colonization was 7.94/1000 patient-days (PD) before the intervention and 1.68/1000 PD during the altered antibiotic regimen. No infections with MDR-GNB occurred during the study.

CONCLUSIONS

Altering the antibiotic regimen with regard to selection pressure may be considered as part of an intervention bundle to rapidly control the emergence of MDR-GNB in suspected outbreak situations in the NICU.

Training to Proficiency in the WHO Hand Hygiene Technique

OBJECTIVES

Hand hygiene is critical to patient safety, but low performance in terms of the quantity and quality of hand hygiene is often reported. Training-to-proficiency is common for other clinical skills, but no proficiency-based training program for hand hygiene has been reported in the literature. This study developed a proficiency-based training program to improve hand hygiene quality in line with World Health Organization (WHO) guidelines and assessed the amount of training required to reach proficiency. The training was delivered as part of a 5-day induction for students on the Physician Assistant online program.

METHODS

A total of 42 students used a simulator to objectively measure hand hygiene technique over a 5-day period. Proficiency was achieved when students demonstrated all 6 steps of the WHO technique in less than 42 seconds. The students also completed a postintervention questionnaire.

RESULTS

The average training episode lasted 2.5 minutes and consisted of 4.5 hand hygiene exercises. The average student completed 5 training episodes (1 per day) taking a total of 17 minutes. A total of 40% (17) of the students achieved proficiency within the 5 days. Proficiency was strongly correlated with the number of training exercises completed (r = 0.79, P < .001) and the total time spent training (r = 0.75, P < .001). Linear regression predicted that the 32 hand hygiene exercises or a total of 23-minute training were required to achieve proficiency.

CONCLUSIONS

This is the first study to develop a train-to-proficiency program for hand hygiene quality and estimate the amount of training required. Given the importance of hand hygiene quality to preventing health care-associated infections (HAIs), medical education programs should consider using proficiency-based training in hand hygiene technique.

The method used to dry washed hands affects the number and type of transient and residential bacteria remaining on the skin

BACKGROUND

Widespread antibiotic resistance has led to fears that we are entering a post-antibiotic era and the relatively simple premise of hand washing to reduce transfer of bacteria and viruses has never been more important. Much of the emphasis has been on hand-washing technique, type of soap, and maintaining compliance but effective drying of the hands is just as important.

AIM

To compare the efficacy of drying washed hands with a jet air dryer or paper towels to remove transient bacterial contamination and to determine the effect on residential flora.

METHODS

Eighty volunteers were recruited. The entire surfaces of volunteers' hands were artificially contaminated with Escherichia coli before being washed and dried; then bacteria remaining on the skin were recovered and enumerated. In the second part of the study the number and types of bacteria comprising the natural flora remaining on washed and dried hands were determined.

FINDINGS

Significantly fewer transient and residential bacteria remained on the skin if hands were dried with a jet air dryer (P < 0.001). Drying hands with paper towels increased the number of resident bacteria, including potentially pathogenic species, released from the volunteers' skin, compared to a jet air dryer.

CONCLUSION

The number and types of bacteria remaining on washed hands were affected by the drying method. Hands dried with a jet air dryer harboured fewer viable bacteria, reducing the risk of infection transmission via touch. This could be especially important for healthcare workers who are constantly in contact with large numbers of vulnerable patients.