1
|
Chen N, Li Y, He W, Chen X, Cheng F, Cheng X, Zhou W, Tan Y, Wu W, Wu L, Qiao F, Feng B, Wang Y. Clinical Effectiveness of a 3-Step Versus a 6-Step Hand Hygiene Technique: A Randomized Controlled Cross-over Study. Open Forum Infect Dis 2024; 11:ofae534. [PMID: 39411223 PMCID: PMC11475017 DOI: 10.1093/ofid/ofae534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 09/12/2024] [Indexed: 10/19/2024] Open
Abstract
Background The aim of this study is to assess the clinical effectiveness of the 3-step hand hygiene (HH) technique (3-HT) compared with the 6-step HH technique (6-HT; World Health Organization 6-step technique) using an alcohol-based hand rub. Methods A randomized controlled crossover trial was conducted from November to December 2023 in 10 wards of a tertiary A-level hospital according to CONSORT guidelines. The 240 healthcare workers (HCWs) were randomly divided into the 3-HT intervention group or the 6-HT control group. The trial was conducted in 2 stages, and the effectiveness of each indicator in the 2 groups was compared after a washout period of 2 weeks. Results Compared with the 6-HT, the 3-HT has demonstrated significant superiority in all indicators of HH compliance as well as the accuracy rate of HH practices. The total HH median times for the 3-HT and 6-HT were 16.00 (interquartile range, 15.00-20.00) and 32.50 (30.00-40.00) seconds, respectively (P < .05). The reduction factors for bacterial colony-forming unit counts did not differ and the colony-forming unit counts were not significantly different. Bacillus, Staphylococcus, and Micrococcus were detected before and after the use of hand rubs. HCWs preferred the 3-HT over the 6-HT. There were no significant difference in healthcare-associated infections rate between the 2 techniques. Conclusions The 3-HT was significantly superior to the 6-HT in terms of the HH eligibility rate, compliance, and HH time. The safety and feasibility of the 3-HT were verified by assessing microorganism count.
Collapse
Affiliation(s)
- Nuo Chen
- School of Public Health, Hubei University of Medicine, Shiyan, Hubei, China
- Department of Healthcare-associated Infection Prevention and Control, Zhongnan Hospital of Wuhan University, Hubei, China
| | - Yan Li
- Department of Healthcare-associated Infection Prevention and Control, Zhongnan Hospital of Wuhan University, Hubei, China
| | - Wenbin He
- Nursing Department of Zhongnan Hospital of Wuhan University, Hubei, China
| | - Xiaoyan Chen
- Nursing Department of Zhongnan Hospital of Wuhan University, Hubei, China
| | - Fan Cheng
- Department of Healthcare-associated Infection Prevention and Control, Zhongnan Hospital of Wuhan University, Hubei, China
| | - Xiaolin Cheng
- Department of Healthcare-associated Infection Prevention and Control, Zhongnan Hospital of Wuhan University, Hubei, China
| | - Weilong Zhou
- Department of Infection Prevention and Control, West China Women's and Children's Hospital, Chengdu, China
| | - Yibin Tan
- Department of Healthcare-associated Infection Prevention and Control, Zhongnan Hospital of Wuhan University, Hubei, China
| | - Wenwen Wu
- School of Public Health, Hubei University of Medicine, Shiyan, Hubei, China
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei University of Medicine, Shiyan, Hubei, China
| | - Lingling Wu
- Department of Information, Zhongnan Hospital of Wuhan University, Hubei, China
| | - Fu Qiao
- Infection Prevention and Control Department, West China Hospital, Sichuan University, Chengdu, China
| | - Bilong Feng
- Nursing Department of Zhongnan Hospital of Wuhan University, Hubei, China
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Hubei, China
| | - Ying Wang
- Department of Healthcare-associated Infection Prevention and Control, Zhongnan Hospital of Wuhan University, Hubei, China
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Hubei, China
| |
Collapse
|
2
|
Knol CWJ, Stob PH, Woerdenbag HJ. Development and Implementation of an Ultraviolet-Dye-Based Qualification Procedure for Hand Washing and Disinfection to Improve Quality Assurance of Pharmacy Preparations and Compounding, Especially in Cleanrooms: A Pilot Study. PHARMACY 2024; 12:73. [PMID: 38804465 PMCID: PMC11130823 DOI: 10.3390/pharmacy12030073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/18/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Even though, nowadays, most medicines are manufactured industrially, patients may have medical needs that can only be met by a tailor-made approach. This requires the availability of pharmacy preparations made under Good Manufacturing Practice (GMP) conditions. An efficient hand hygiene practice is essential herewith, especially if sterile products that are prepared in a cleanroom are concerned. The effectiveness of hand washing and hand disinfection procedures greatly relies on adequate training. We carried out an observational cross-sectional pilot study aimed at optimizing hand hygiene training with objective and measurable quality assessments using an ultraviolet (UV) dye. Practical acceptance criteria for qualifying personnel through this method were set and evaluated. In total, 25 GMP-qualified cleanroom operators washed and disinfected their hands with UV dye hand wash lotion and UV dye hand alcohol, respectively. To obtain a proof-of-concept, the results were judged based on adherence to the WHO six-step protocol and associated acceptance criteria. Commonly missed areas were brought to light, and the influence of procedure duration was investigated. UV-dye-based assessments appeared to be more valuable in hand disinfection than in hand washing. In both procedures, the back of the hands and the thumbs were frequently missed. This underpins the need for enhanced and repeated education on hand washing and disinfection. Additionally, a dry skin gave rise to extra cleaning challenges. From this pharmacy practice pilot study with a focus on pharmaceutical product care, it may be concluded that the application of UV-dye-based assessments offers valuable insights for pharmacists to optimize hand hygiene, thereby increasing the safety of tailor-made medicines and on-site preparations.
Collapse
Affiliation(s)
- Catharina W. J. Knol
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
- Fagron Sterile Services Nederland, Dieselstraat 3, 7903 AR Hoogeveen, The Netherlands;
| | - Paul H. Stob
- Fagron Sterile Services Nederland, Dieselstraat 3, 7903 AR Hoogeveen, The Netherlands;
| | - Herman J. Woerdenbag
- Department of Pharmaceutical Technology and Biopharmacy, Groningen Research Institute of Pharmacy (GRIP), University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands;
| |
Collapse
|
3
|
Tartari E, Bellissimo-Rodrigues F, Pires D, Fankhauser C, Lotfinejad N, Saito H, Suchomel M, Kramer A, Allegranzi B, Boyce J, Sax H, Stewardson AJ, Pittet D. Updates and future directions regarding hand hygiene in the healthcare setting: insights from the 3rd ICPIC alcohol-based handrub (ABHR) task force. Antimicrob Resist Infect Control 2024; 13:26. [PMID: 38424571 PMCID: PMC10905912 DOI: 10.1186/s13756-024-01374-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) pose threats to global health. Effective hand hygiene is essential for preventing HAIs and the spread of AMR in healthcare. We aimed to highlight the recent progress and future directions in hand hygiene and alcohol-based handrub (ABHR) use in the healthcare setting. In September 2023, 42 experts in infection prevention and control (IPC) convened at the 3rd International Conference on Prevention and Infection Control (ICPIC) ABHR Taskforce in Geneva, Switzerland. The purpose of this meeting was to provide a synthesis of recent evidence and formulate a research agenda on four critical areas for the implementation of effective hand hygiene practices: (1) ABHR formulations and hand rubbing techniques, (2) low-resource settings and local production of ABHR, (3) hand hygiene monitoring and technological innovations, and (4) hand hygiene standards and guidelines.
Collapse
Affiliation(s)
- Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | | | - Daniela Pires
- National Institute of Health and Care Research, Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | - Nasim Lotfinejad
- Infection Control Program and WHO Collaborating Centre, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine. Faculty of Medicine, Institute of Global Health, . Mariana University Yokohama Seibu Hospital, University of Geneva, Geneva, Switzerland
| | - Miranda Suchomel
- Institute of Hygiene and Applied Immunology, Medical University of Vienna, Vienna, Austria
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
| | - John Boyce
- J.M. Boyce Consulting, LLC, Hyde Park, NY, USA
| | - Hugo Sax
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrew J Stewardson
- Department of Infectious Diseases, Central Clinical School, The Alfred Hospital, Monash University, Melbourne, Australia
| | - Didier Pittet
- Clean Hospitals, Geneva, Switzerland.
- Faculty of Medicine & Clean Hospitals, University of Geneva, Geneva, Switzerland.
| |
Collapse
|
4
|
Ozen N, Sis Celik A, Terzioglu F, Ozen V, Ozmen O, Kose S, Tosun B, Dogan N, Ardic B, Atabeyoglu Cimen B, Kilic D, Uslu H. Prevention of microbial colonization of feeding tubes in the intensive care unit. Nurs Crit Care 2023; 28:1087-1096. [PMID: 35702975 DOI: 10.1111/nicc.12812] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Various microorganisms which increase the mortality rate in the intensive care unit (ICU) cause microbial colonization of the nasogastric tube (NGT) and use the NGT as a reservoir. AIM To detect the colonization on the NGT and to determine the effect that training regarding hand hygiene, NGT management, and enteral feeding (EF) provided to ICU nurses and auxiliary service staff (ASS) has on the level of NGT colonization. STUDY DESIGN A quasi-experimental pre-test and post-test control design was used in this study. Microbial samples were taken from the outer and inner parts of NGT. The microorganisms were categorized as: group 1, no risk; group 2, low risk pathogenic; group 3, high-risk pathogenic group. The training was given to nurses (n = 15) and ASS (n = 7). Hand hygiene, NGT, and EF care training are provided to nurses and ASS by researchers. A total of three training sessions were scheduled to be held in 3 weeks so that all health care staff members were trained. Each session lasted 2 h in total. Patients were assigned to a group if one of the microorganisms presented on the outer surface of the patient's feeding tube and/or on the hub. The hand hygiene compliance was evaluated by direct observation according to the World Health Organization hand hygiene indications. RESULTS The study was conducted with 46 patients. Evaluating the patients for the presence of microorganisms before education revealed that 4.3% were in group 1, 21.8% were in group 2, and 73.9% were in group 3. After the education, evaluating the samples for the presence of microorganisms revealed that 39.1% were in group 1, 13% were in group 2, and 47.8% were in group 3. A statistically significant difference was found between the number of samples included in the groups after the participants had received training (H = 8.186; p = .017). CONCLUSIONS An NGT could act as a reservoir of microbial colonization and high-risk microorganisms could be on the tube. Providing training not only to nurses but also to ASS will help reduce the risk of colonization. RELEVANCE TO CLINICAL PRACTICE Eliminating such colonization with effective hand hygiene during NGT feeding is a cost-effective method. Providing training not only to nurses but also to ASS will help obtain the optimum benefit from patient care.
Collapse
Affiliation(s)
- Nurten Ozen
- Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
| | - Aslı Sis Celik
- Department of Birth, Women Health and Gynecology Nursing, Nursing Faculty, Ataturk University, Erzurum, Turkey
| | | | - Volkan Ozen
- Department of Anesthesiology and Reanimation, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Ozgur Ozmen
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Sema Kose
- Department of Nursing, Faculty of Health Sciences, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Betul Tosun
- Department of Nursing, Faculty of Health Sciences, Hasan Kalyoncu University, Gaziantep, Turkey
| | - Nazim Dogan
- Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey
| | - Busra Ardic
- Department of Medical Biology and Microbiology, Kackar City Hospital, Rize, Turkey
| | | | - Dilek Kilic
- Department of Public Health Nursing, Nursing Faculty, Ataturk University, Erzurum, Turkey
| | - Hakan Uslu
- Department of Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| |
Collapse
|
5
|
Boyce JM. Current issues in hand hygiene. Am J Infect Control 2023; 51:A35-A43. [PMID: 37890952 DOI: 10.1016/j.ajic.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Multiple aspects of hand hygiene have changed in recent years. METHODS A PubMed search was conducted to identify recent articles about hand hygiene. RESULTS The COVID-19 pandemic caused temporary changes in hand hygiene compliance rates and shortages of alcohol-based hand sanitizers (ABHSs), and in marketing of some products that were ineffective or unsafe. Fortunately, ABHSs are effective against SARS-CoV-2 and other emerging pathogens including Candida auris and mpox. Proper placement, maintenance, and design of ABHS dispensers have gained additional attention. Current evidence suggests that if an adequate volume of ABHS has been applied to hands, personnel must rub their hands together for at least 15 seconds before hands feel dry (dry time), which is the primary driver of antimicrobial efficacy. Accordingly, practical methods of monitoring hand hygiene technique are needed. Direct observation of hand hygiene compliance remains a challenge in many healthcare facilities, generating increased interest in automated hand hygiene monitoring systems (AHHMSs). However, several barriers have hindered widespread adoption of AHHMSs. AHHMSs must be implemented as part of a multimodal improvement program to successfully improve hand hygiene performance rates. CONCLUSIONS Remaining gaps in our understanding of hand hygiene warrant continued research into factors impacting hand hygiene practices.
Collapse
Affiliation(s)
- John M Boyce
- J.M. Boyce Consulting, LLC, Middletown, CT, USA.
| |
Collapse
|
6
|
Kim J, Yu SN, Jeong YS, Kim JH, Jeon MH, Kim T, Choo EJ, Lee E, Kim TH, Park SY. Hand hygiene knowledge, attitude, barriers and improvement measures among healthcare workers in the Republic of Korea: a cross-sectional survey exploring interprofessional differences. Antimicrob Resist Infect Control 2023; 12:93. [PMID: 37674241 PMCID: PMC10483734 DOI: 10.1186/s13756-023-01296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Hand hygiene (HH) is a fundamental component of infection prevention and control in healthcare settings. This study aimed to identify knowledge, attitude, and barriers to HH according to occupational groups and strategies to increase the rate of HH compliance among healthcare workers (HCWs). METHODS This cross-sectional survey was conducted in July 2018 at four university-affiliated hospitals. The survey comprised seven parts with 49 items, including self-reported HH compliance, knowledge, attitudes, behaviours, barriers to HH, and improvement strategies. RESULTS A total of 1046 HCWs participated in the survey. The nursing group's self-reported HH compliance rate was the highest, followed by other HCWs and physicians. The scores regarding knowledge, attitudes, and behaviours regarding HH were the highest in the nursing group. The nursing group also had higher internal and emotional motivation scores. Physicians and nurses found HH the most challenging in emergencies, while other HCWs considered skin problems caused by HH products the most significant barrier. Among 12 improvement measures, approximately 20% of the respondents ranked "diversify types of hand sanitisers," "install soap and paper towels in each hospital room," and "change perception through various HH campaigns" as the top three priorities. The physician group deemed the timely reminder of HH compliance as the second most critical improvement measure. CONCLUSION Differences in knowledge, attitude and barriers hindering HH compliance and improvement plans were identified for each group. The findings suggest that targeted interventions tailored to the specific needs of different occupational groups may effectively improve HH compliance in healthcare settings.
Collapse
Affiliation(s)
- Jaewoong Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
- Yongin Severance Hospital, Centers for Digital Health, Yonsei University Health System, Yongin, Republic of Korea
| | - Shi Nae Yu
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Yeon Su Jeong
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Jin Hwa Kim
- Infection Control Team, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea
| | - Min Hyok Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Tark Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Eun Ju Choo
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Department of Internal Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea.
| |
Collapse
|
7
|
Comparison of two alcohol hand rubbing techniques regarding hand surface coverage among hospital workers: a quasi-randomized controlled trial. Antimicrob Resist Infect Control 2022; 11:132. [PMID: 36329519 PMCID: PMC9635155 DOI: 10.1186/s13756-022-01172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The adapted 6-step without interlock (A6Sw/oI) hand rub technique, commonly practiced in Japan, adds the "wrist" but omits the "interlock" step compared to the WHO 6-step technique (WHO6S). The first objective of this study was to assess the differences of the two techniques regarding surface coverage. The second objective was to analyze the coverage differences between hand sizes. METHODS Hospital workers went under stratified quasi-randomization by glove size. The overall mean coverage, and the coverage of the sections of the hands were evaluated by fluorescent dye-based coverage assessment using a digital device with artificial intelligence technology. RESULTS Total of 427 workers were randomly allocated to WHO6S (N = 215) or the A6Sw/oI (N = 212). The overall mean dorsum coverage by WHO6S and A6Sw/oI was 90.6% versus 88.4% (p < 0.01), and the percentage of the participants with insufficient coverage of the backs of the four fingers ranged from 0.0-7.4% versus 28.2-51.4% (p < 0.001). Dorsum coverage varied largely between hand size for both techniques, and significant differences were found between small and large hands. CONCLUSION The WHO6S was superior to the locally adapted technique regarding hand surface coverage. Hand size should be considered when assessing coverage differences between procedures. No trial registrations or fundings.
Collapse
|
8
|
Price L, Gozdzielewska L, Matuluko A, Pittet D, Allegranzi B, Reilly J. Comparing the effectiveness of hand hygiene techniques in reducing the microbial load and covering hand surfaces in healthcare workers: Updated systematic review. Am J Infect Control 2022; 50:1079-1090. [PMID: 35167898 DOI: 10.1016/j.ajic.2022.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND This review, commissioned by the World Health Organization (WHO), examined the effectiveness of the WHO 6-step hand hygiene (HH) technique in reducing microbial load on hands and covering hand surfaces, and compared its effectiveness to other techniques. METHODS Medline, CINAHL, ProQuest, Web of Science, Mednar, and Google Scholar were searched for primary studies, published in English (1978-February 2021), evaluating the microbiological effectiveness or hand surface coverage of HH techniques in healthcare workers. Reviewers independently performed quality assessment using Cochrane tools. The protocol for the narrative review was registered (PROSPERO 2021: CRD42021236138). RESULTS Nine studies were included. Evidence demonstrated that the WHO technique reduced microbial load on hands. One study found the WHO technique more effective than the 3-step technique (P = .02), while another found no difference between these 2 techniques (P = .08). An adapted 3-step technique was more effective than the WHO technique in laboratory settings (P = .021), but not in clinical practice (P = .629). One study demonstrated that an adapted 6-step technique was more effective than the WHO technique (P = .001). Evidence was heterogeneous in application time, product, and volume. All studies were high risk of bias. CONCLUSIONS Eight studies found that the WHO 6-step technique reduced microbial load on healthcare workers' hands; but the studies were heterogeneous and further research is required to identify the most effective, yet feasible technique.
Collapse
Affiliation(s)
- Lesley Price
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| | - Lucyna Gozdzielewska
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK.
| | - Ayodeji Matuluko
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Center on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Jacqui Reilly
- SHIP Research Group, Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
9
|
Saveanu CI, Anistoroaei D, Todireasa S, Saveanu AE, Bobu LI, Bamboi I, Boronia O, Balcos C. Evaluation of the Efficiency of Hand Hygiene Technique with Hydroalcoholic Solution by Image Color Summarize. Medicina (B Aires) 2022; 58:medicina58081108. [PMID: 36013575 PMCID: PMC9413243 DOI: 10.3390/medicina58081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: The HH (hand hygiene) technique is relatively simple. Even so, in practice there are still non-conformities regarding this aspect. Lack of knowledge or lack of compliance can be reasons for non-adherence with HH techniques. In this context, the purpose of this study was to follow the realization of the hand-washing technique with hydroalcoholic solution, applied before and after receiving the HH recommendations. Materials and Methods: A descriptive, cross-sectional study was conducted from May 2022 to June 2022. Students from a second year dental medicine class teaching in French 2021/22 “Grigore T. Popa” University of Medicine and Pharmacy in Iasi were included in the study. The approval of the ethics commission was received: No. 184/05.05.2022. The study was conducted in two stages. In the first stage, HH was performed without any recommendation. In the second stage, the antiseptic hand rubbing technique was presented following the WHO recommendations. The fluorescent Fluo-Add solution, Wood lamp for dermatology (4 × 5.5 W ultraviolet tubes with a wavelength of 360 nm), and photo camera were used. Subjects performed their HH movement before and after receiving instructions according to WHO. Images were initially taken from the backhand and palm and were finally analyzed with Image Color Summarizer. The data were analyzed by the Mann–Whitney U Test, t-test paired samples using IBM-SPSS version 26 (IBM, Armonk, NY, USA), and p ≤ 0.05 was considered statistically significant. Results: After analyzing the images, there were 70 subjects, 45.7% (32) female and 54.33% (38) male. Final average covered area of backhand was 60.89% (±17.17), 28.84:86.11, compared to 52.07% (±17.04), 9:85.23. Final average covered area for palm was 69.91% (±13.5), 31.61:93.41 compared to 59.74% (±16.64), 26.13:92.72. No statistical significance was obtained by gender. Conclusions: The study showed an improvement in hand hygiene technique without highlighting gender differences.
Collapse
Affiliation(s)
| | - Daniela Anistoroaei
- Correspondence: (D.A.); (A.E.S.); Tel.: +40-721-377-269 (D.A.); +40-0755569120 (A.E.S.)
| | | | | | | | | | | | | |
Collapse
|
10
|
Gould D, Purssell E, Jeanes A, Drey N, Chudleigh J, McKnight J. The problem with 'My Five Moments for Hand Hygiene'. BMJ Qual Saf 2022; 31:322-326. [PMID: 34261814 PMCID: PMC8938669 DOI: 10.1136/bmjqs-2020-011911] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 04/09/2021] [Indexed: 01/03/2023]
Affiliation(s)
| | | | | | - Nicolas Drey
- School of Health Sciences, City University, London, UK
| | | | - Jacob McKnight
- The Health Systems Collaborative, Nuffield Department of Clinical Medicine, Oxford, UK
| |
Collapse
|
11
|
Kalaiselvan P, Yasir M, Vijay AK, Willcox MD, Tummanapalli S. Longevity of hand sanitisers on fingers. Clin Exp Optom 2022; 106:436-442. [PMID: 35263547 DOI: 10.1080/08164622.2022.2040334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CLINICAL RELEVANCE Hand hygiene is important to reduce the spread of microbes in clinical settings. Hand sanitisers that last longer may be beneficial. BACKGROUND Longevity of hand sanitisation products on fingers and hands may be important to help reduce microbial transmission. The current study evaluated the persistence of disinfection of three hand sanitisers. METHODS Initially the minimum inhibitory concentrations of the hand sanitisers were determined using strains of Staphylococcus epidermidis and S. aureus. Then a cross-over study with participants randomly assigned to use three different hand sanitisers for 30 seconds was undertaken. The number of bacteria and fungi on fingers was assessed 10 and 20 minutes and 4 hours after use. The type of microbial inhibition of the capric acid sanitiser was studied by examining the effects of adding Tween 80 and lecithin to microbial agar. RESULTS The minimum inhibitory concentration of an alcohol-based sanitiser (AS) was 10%, for the capric acid-based (CS) sanitiser was 70%, and for the quaternary ammonium-based (QS) sanitiser was < 10%. AS significantly reduced the number of microbes on fingers 10 minutes after hand washing (18.2 cfu/mL) compared to CS (59.7 cfu/mL; p < 0.0001) or QS (64.5 cfu/mL; p < 0.0001). Twenty minutes after use, microbes on fingers after AS (23 cfu/mL) or CS (16.7 cfu/mL) were significantly reduced compared to QS (72.2 cfu/mL; p < 0.0001) and the numbers on fingers after CS was significantly less than after AS (p = 0.002). Four hours after use of any hand sanitiser, the number of microbes increased to near baseline levels. The reduction in bacterial numbers was not affected by the use of neutralisers in agar (48 ± 28% reduction with, 47 ± 49% reduction without; p = 0.876). CONCLUSIONS Hand sanitisers containing capric acid or alcohol out-performed one containing quaternary ammonium in the clinical trial and may help reduce the spread of microbes.
Collapse
Affiliation(s)
- Parthasarathi Kalaiselvan
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Muhammad Yasir
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Ajay Kumar Vijay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Dp Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Shyam Tummanapalli
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
12
|
Ackermann L, Thum A, Meagher K, Molyneaux D, Neff R, Zabriskie K, Shimada A, Riggio J. Video engagement to improve handwashing duration: A longitudinal study assessing creative and messaging fatigue. Am J Infect Control 2022; 50:295-299. [PMID: 35125216 DOI: 10.1016/j.ajic.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/12/2021] [Accepted: 11/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Poor hand hygiene can contribute to increased rates of health care and community-acquired infections. Effective hand hygiene involves both a washer's technique and the duration of their wash. METHODS The purpose of this longitudinal study was 2-fold: to improve the ability of hand-washers to meet the recommended handwashing duration of ≥20 seconds and to assess the effect of washer fatigue with the intervention. An innovative system of smart connected soap and towel dispensers synchronized to engaging video content was implemented to meet this objective. RESULTS The intervention increased mean handwashing duration by 7.5 seconds (95% CI: 6.6, 8.4) and improved handwashing duration ≥20 seconds by 39.3% (P < .001). Using a similar cohort of hand-washers over 26 months, the video content had peak effect in month 1, and declined to a new steady state at month 11. DISCUSSION Handwashing for the recommended time can be difficult to achieve. Most hand hygiene studies examine the rate of completion without measuring duration. CONCLUSIONS Video engagement can improve and sustain handwashing duration. To mitigate creative and messaging fatigue, video content refresh for this intervention should be considered at 3 months for optimal effect or at 11 months prior to full decline to new steady state.
Collapse
Affiliation(s)
- Lily Ackermann
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Andrew Thum
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA.
| | - Kristine Meagher
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Donna Molyneaux
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Robert Neff
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Kelly Zabriskie
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Ayako Shimada
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jeffrey Riggio
- Departments of Medicine, Infection Control, Nursing, Pharmacology & Experimental Therapeutics, Thomas Jefferson University Hospital, Philadelphia, PA
| |
Collapse
|
13
|
Wang C, Jiang W, Yang K, Yu D, Newn J, Sarsenbayeva Z, Goncalves J, Kostakos V. Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology. J Med Internet Res 2021; 23:e27880. [PMID: 34821565 PMCID: PMC8663600 DOI: 10.2196/27880] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 09/04/2021] [Accepted: 10/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Hand hygiene is one of the most effective ways of preventing health care-associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality. OBJECTIVE This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems. METHODS A systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author. RESULTS In total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7%), camera-assisted observation (10/73, 14%), sensor-assisted observation (29/73, 40%), and real-time locating system (32/73, 44%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33%). CONCLUSIONS Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene-related issues.
Collapse
Affiliation(s)
- Chaofan Wang
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Weiwei Jiang
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Kangning Yang
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Difeng Yu
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Joshua Newn
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Zhanna Sarsenbayeva
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Jorge Goncalves
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| | - Vassilis Kostakos
- School of Computing and Information Systems, The University of Melbourne, Carlton, Australia
| |
Collapse
|
14
|
Bella A, Akbar MT, Kusnadi G, Herlinda O, Regita PA, Kusuma D. Socioeconomic and Behavioral Correlates of COVID-19 Infections among Hospital Workers in the Greater Jakarta Area, Indonesia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5048. [PMID: 34064580 PMCID: PMC8151868 DOI: 10.3390/ijerph18105048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/23/2022]
Abstract
(1) Background: because of close contacts with COVID-19 patients, hospital workers are among the highest risk groups for infection. This study examined the socioeconomic and behavioral correlates of COVID-19 infection among hospital workers in Indonesia, the country hardest-hit by the disease in the Southeast Asia region. (2) Methods: we conducted a cross-sectional study, which collected data from 1397 hospital staff from eight hospitals in the Greater Jakarta area during April-July 2020. The data was collected using an online self-administered questionnaire and Reverse Transcription-Polymerase Chain Reaction (RT-PCR) tests. We employed descriptive statistics and adjusted and unadjusted logistic regressions to analyze the data of hospital workers as well as the subgroups of healthcare and non-healthcare workers. (3) Results: from a total of 1397 hospital staff in the study, 22 (1.6%) were infected. In terms of correlates, being a healthcare worker (adjusted odds ratio (AOR) = 8.31, 95% CI 1.27-54.54) and having a household size of more than five (AOR = 4.09, 1.02-16.43) were significantly associated with a higher risk of infection. On the other hand, those with middle- and upper-expenditure levels were shown to have a lower risk of infection (AOR = 0.06, 0.01-0.66). Behavioral factors associated with COVID-19 infection among healthcare and non-healthcare workers included knowledge of standard personal protective equipment (PPE) (AOR = 0.08, 0.01-0.54) and application of the six-step handwashing technique (AOR = 0.32, 0.12-0.83). (4) Conclusion: among hospital staff, correlates of COVID-19 infection included being a healthcare worker, household size, expenditure level, knowledge and use of PPE, and application of appropriate hand washing techniques.
Collapse
Affiliation(s)
- Adrianna Bella
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Mochamad Thoriq Akbar
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Gita Kusnadi
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Olivia Herlinda
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Putri Aprilia Regita
- Center for Indonesia’s Strategic Development Initiatives (CISDI), Jakarta 10350, Indonesia; (A.B.); (M.T.A.); (G.K.); (O.H.); (P.A.R.)
| | - Dian Kusuma
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London SW7 2AZ, UK
| |
Collapse
|
15
|
Zorrilla-Vaca A, Marmolejo-Posso D, Caballero-Lozada AF, Miño-Bernal JF. Sterility and Infection Prevention Standards for Anesthesiologists in LMICs: Preventing Infections and Antimicrobial Resistance. CURRENT ANESTHESIOLOGY REPORTS 2021. [DOI: 10.1007/s40140-021-00441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
Gould DJ, McKnight J, Leaver M, Keene C, Gaze S, Purssell E. Qualitative interview study exploring frontline managers' contributions to hand hygiene standards and audit: Local knowledge can inform practice. Am J Infect Control 2020; 48:480-484. [PMID: 32334724 DOI: 10.1016/j.ajic.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/29/2020] [Accepted: 02/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Frontline managers promote hand hygiene standards and adherence to hand hygiene protocols. Little is known about this aspect of their role. METHODS Qualitative interview study with frontline managers on 2 acute admission wards in a large National Health Service Trust in the United Kingdom. RESULTS Managers reported that hand hygiene standards and audit were modeled on World Health Organization guidelines. Hand hygiene outside the immediate patient zone was not documented but managers could identify when additional indications for hand hygiene presented. They considered that audit was worthwhile to remind staff that hand hygiene is important but did not regard audit findings as a valid indicator of practice. Managers identified differences in the working patterns of nurses and doctors that affect the number and types of hand hygiene opportunities and barriers to hand hygiene. Ward managers were accepted as the custodians of hand-hygiene standards. CONCLUSIONS Frontline managers identified many of the issues currently emerging as important in contemporary infection prevention practice and research and could apply them locally. Their views should be represented when hand hygiene guidelines are reviewed and updated.
Collapse
|
17
|
Mohd Rani MD, Mohamed NA, Tengku Jamaluddin TZM, Ismail Z, Ramli S, Faroque H, Abd Samad FN, Ariffien AR, Che Amir Farid AAR, Isahak I. Effectiveness of comprehensive hand hygiene module on preschool children in Klang Valley, Malaysia. Clin Exp Pediatr 2020; 63:115-116. [PMID: 32023401 PMCID: PMC7073378 DOI: 10.3345/cep.2019.01277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/31/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Nurul Azmawati Mohamed
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | | | - Zarini Ismail
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Shalinawati Ramli
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Habibah Faroque
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Farishah Nur Abd Samad
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | - Abdul Rasyid Ariffien
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| | | | - Ilina Isahak
- Faculty of Medicine & Health Sciences, Universiti Sains Islam Malaysia, Kuala Lumpur, Malaysia
| |
Collapse
|
18
|
Lacey G, Zhou J, Li X, Craven C, Gush C. The impact of automatic video auditing with real-time feedback on the quality and quantity of handwash events in a hospital setting. Am J Infect Control 2020; 48:162-166. [PMID: 31358419 DOI: 10.1016/j.ajic.2019.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor quality handwashing contributes to the spread of nosocomial infections. We investigate the impact of automatic video auditing (AVA) with feedback on the quality and quantity of handwashing in a hospital setting. METHODS AVA systems were mounted over all handwash sinks in a surgical unit. Phase 1 established baseline handwashing quality and quantity. Phase 2 examined the impact of real-time performance feedback, and phase 3 examined the incremental impact of weekly team performance reports. Phase 4 remeasured the baseline without feedback. RESULTS A total of 3,606 handwash events were audited. During phase 2 and 3, compliance with the World Health Organization technique improved from 15.7%-46% (P < .0001), and the average number of handwash events per patient per day increased from 0.91-2.25 (P < .0001). Performance returned to baseline in phase 4. CONCLUSIONS AVA with real-time feedback significantly improved the quality and quantity of handwashing. The combination of AVA with electronic monitoring will allow simultaneous auditing of hand hygiene quantity and quality. The impact of cognitive offloading onto the technology may have contributed to the return to baseline at the end of the study, and suggests further research is required in this area.
Collapse
|
19
|
Affiliation(s)
- Nisha Thampi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Yves Longtin
- Department of Medicine, Jewish General Hospital, Montreal, Canada
| |
Collapse
|
20
|
Riutort KT, Brull SJ, Prielipp RC. Hand Hygiene and Relearning Lessons From the Past. Anesth Analg 2019; 129:1446-1449. [DOI: 10.1213/ane.0000000000004303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
21
|
Abstract
AbstractBackground:The effectiveness of alcohol-based hand rub (ABHR) is correlated with drying time, which depends on the volume applied. Evidence suggests that there is considerable variation in the amount of ABHR used by healthcare providers.Objective:We sought to identify the volume of ABHR preferred for use by nurses.Methods:A prospective observation study was performed in 8 units at a tertiary-care hospital. Nurses were provided pocket-sized ABHR bottles with caps to record each bottle opening. Nurses were instructed to use the volume of ABHR they felt was best. The average ABHR volume used per hand hygiene event was calculated using cap data and changes in bottle mass.Results:In total, 53 nurses participated and 140 nurse shifts were analyzed. The average ABHR dose was 1.09 mL. This value was greater for non-ICU nurses (1.18 mL) than ICU nurses (0.96 mL), but this difference was not significant. We detected no significant association between hand surface area and preferred average dose volume. The ABHR dose volume was 0.006 mL less per use as the number of applications per shift increased (P = .007).Conclusions:The average dose of ABHR used was similar to the dose provided by the hospital’s automated dispensers, which deliver 1.1 mL per dose. The volume of ABHR dose was inversely correlated with the number of applications of ABHR per shift and was not correlated with hand size. Further research to understand differences and drivers of ABHR volume preferences and whether automated ABHR dosing may create a risk for people with larger hands is warranted.
Collapse
|
22
|
Interventions to improve healthcare workers' hand hygiene compliance: A systematic review of systematic reviews. Infect Control Hosp Epidemiol 2019; 39:1449-1456. [PMID: 30526716 DOI: 10.1017/ice.2018.262] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). METHODS PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. RESULTS Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. CONCLUSIONS This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.
Collapse
|
23
|
Abstract
Although substantial improvements in hand hygiene practices have occurred in recent years, many health care facilities continue to encounter challenges in achieving and maintaining high levels of hand hygiene compliance. Issues of current interest include the optimum dose of alcohol-based handrub (ABHR) that should be applied, the impact of hand size and alcohol-based handrub dry times have on efficacy, and ideal hand hygiene technique. There is a need to determine which additional promotional activities can augment improvements in hand hygiene that are achieved by implementing the multimodal improvement strategy recommended by the World Health Organization. Monitoring hand hygiene performance and providing personnel with feedback on their performance are essential elements of successful improvement programs. Further research is needed to establish the most effective methods of providing feedback. Additional studies are needed to optimize strategies for performing direct observation of hand hygiene compliance, and to determine the role of supplementing direct observations using automated monitoring systems.
Collapse
|
24
|
Lacey G, Showstark M, Van Rhee J. Training to Proficiency in the WHO Hand Hygiene Technique. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2019; 6:2382120519867681. [PMID: 31428680 PMCID: PMC6683317 DOI: 10.1177/2382120519867681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
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.
Collapse
Affiliation(s)
- Gerard Lacey
- School of Computer Science and Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Mary Showstark
- Physician Assistant Online Program, Yale School of Medicine, New Haven, CT, USA
| | - James Van Rhee
- Physician Assistant Online Program, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
25
|
Price L, Melone L, Cutajar E, Blane L, Gozdzielewska L, Young M, McAloney-Kocaman K, Reilly J. Investigating the effect of preparation for and participation in a hand-sanitizing relay on nursing students' ability to recall the WHO 6-step hand hygiene technique. Am J Infect Control 2018; 46:1304-1306. [PMID: 29805058 DOI: 10.1016/j.ajic.2018.04.222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 10/16/2022]
Abstract
This study explored whether preparation for a hand-sanitizing relay affected nursing students' ability to recall, 12 months later, the World Health Organization 6-step hand hygiene technique. No significant difference was observed in recall between those who participated in the relay and those who did not (P = .736). The most frequently missed step was Step 3 (palm to palm with fingers interlaced). Our results suggest that regular feedback may be an important additional component in future interventions.
Collapse
|
26
|
Pires D, Soule H, Bellissimo-Rodrigues F, de Kraker MEA, Pittet D. Antibacterial efficacy of handrubbing for 15 versus 30 seconds: EN 1500-based randomized experimental study with different loads of Staphylococcus aureus and Escherichia coli. Clin Microbiol Infect 2018; 25:851-856. [PMID: 31203871 DOI: 10.1016/j.cmi.2018.10.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/16/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Compliance with the World Health Organization 'how to handrub' action is suboptimal. Simplifying the hand-hygiene action may improve practice. However, it is crucial to preserve antibacterial efficacy. We tested the non-inferiority of 15 versus 30 seconds handrubbing for Staphylococcus aureus and Escherichia coli contamination at different loads, using hand-size customized alcohol-based handrub (ABHR) volumes. METHODS In an EN1500-based study, 18 health-care workers (HCWs) with extensive experience in hand hygiene rubbed hands with a hand-size customized volume of isopropanol 60% v/v. They repeated the following sequence: hand contamination (E. coli or S. aureus; broth containing 108 or 106 CFU/mL); baseline fingertips sampling; handrubbing (15 or 30 seconds); re-sampling. The main outcome was log10 CFU corrected reduction factor (cRF) on HCWs' hands, applying a generalized linear mixed model with a random intercept for subject. RESULTS The median cRF was 2.1 log10 (interquartile range 1.50-3.10). After fitting the model, cRF was significantly higher for S. aureus compared with E. coli but there was no significant effect for duration of handrubbing or contamination fluid concentration. Fifteen seconds of handrubbing was non-inferior to 30 (-0.06 log10, 95% CI -0.34 to 0.22; EN1500 0.60 log10 non-inferiority margin). This was confirmed in all pre-specified subgroups. CONCLUSION Among experienced HCWs using a hand-size customized volume of ABHR, handrubbing for 15 seconds was non-inferior to 30 seconds in reducing bacterial load, irrespective of type of bacteria or contamination fluid concentration. This provides further support for a shorter, 15-seconds, hand-hygiene action.
Collapse
Affiliation(s)
- D Pires
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Department of Infectious Diseases, Centro Hospitalar Lisboa Norte and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - H Soule
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - F Bellissimo-Rodrigues
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - M E A de Kraker
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - D Pittet
- Infection Control Programme, WHO Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| |
Collapse
|
27
|
Price L, Melone L, McLarnon N, Bunyan D, Kilpatrick C, Flowers P, Reilly J. A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers. Am J Infect Control 2018; 46:814-823. [PMID: 29602496 DOI: 10.1016/j.ajic.2018.01.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Effective hand hygiene prevents healthcare-associated infections. This systematic review evaluates the evidence for the World Health Organization's (WHO) technique in reducing the microbial load on the hands of healthcare workers (HCWs). METHODS This study was conducted in accordance with Joanna Briggs Protocol 531. Index and free-text terms for technique, HCW, and microbial load were searched in CINAHL, Medline, Web of Science, Mednar, Proquest, and Google Scholar. Inclusion criteria were articles in English that evaluated the WHO 6-step hand hygiene technique for healthcare staff. Two reviewers independently performed quality assessment and data extraction. RESULTS All 7 studies found that the WHO technique reduced bacterial load on HCW hands, but the strongest evidence came from 3 randomized controlled trials, which reported conflicting evidence. One study found no difference in the effectiveness of the WHO 6-step technique compared to the Centers for Disease Control and Prevention's 3-step technique (P = .08); another study found the WHO 6-step technique to be more effective (P = .02); and the third study found that a modified 3-step technique was more effective than the 6-step technique (P = .021). CONCLUSIONS This review provides evidence of the effectiveness of the WHO technique but does not identify the most effective hand hygiene technique. Questions to be addressed by further research are identified. Meanwhile, current practices should continue.
Collapse
|
28
|
Thirkell G, Chambers J, Gilbart W, Thornhill K, Arbogast J, Lacey G. Pilot study of digital tools to support multimodal hand hygiene in a clinical setting. Am J Infect Control 2018; 46:261-265. [PMID: 29079136 DOI: 10.1016/j.ajic.2017.08.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Digital tools for hand hygiene do not share data, limiting their potential to support multimodal programs. The Christie NHS Foundation Trust, United Kingdom, worked with GOJO (in the United States), MEG (in Ireland), and SureWash (in Ireland) to integrate their systems and pilot their combined use in a clinical setting. METHODS A 28-bed medical oncology unit piloted the system for 5 weeks. Live data from the tools were combined to create a novel combined risk status metric that was displayed publicly and via a management Web site. RESULTS The combined risk status reduced over the pilot period. However, larger and longer duration studies are required to reach statistical significance. Staff and especially patient reaction was positive in that 70% of the hand hygiene training events were by patients. The digital tools did not negatively impact clinical workflow and received positive engagement from staff and patients. The combined risk status did not change significantly over the short pilot period because there was also no specific hand hygiene improvement campaign underway at the time of the pilot study. CONCLUSIONS The results indicate that integrated digital tools can provide both rich data and novel tools that both measure impact and provide feedback to support the implementation of multimodal hand hygiene campaigns, reducing the need for significant additional personnel resources.
Collapse
|
29
|
McGoldrick M. Hand Hygiene in the Home Setting: Technique Matters. Home Healthc Now 2017; 35:454-455. [PMID: 28857872 DOI: 10.1097/nhh.0000000000000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Mary McGoldrick
- Mary McGoldrick, MS, RN, CRNI, is a Home Care and Hospice Consultant, Home Health Systems, Inc., Saint Simons Island, Georgia
| |
Collapse
|
30
|
Lehotsky Á, Szilágyi L, Bánsághi S, Szerémy P, Wéber G, Haidegger T. Towards objective hand hygiene technique assessment: validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure. J Hosp Infect 2017; 97:26-29. [PMID: 28579470 DOI: 10.1016/j.jhin.2017.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/26/2017] [Indexed: 11/30/2022]
Abstract
Ultraviolet spectrum markers are widely used for hand hygiene quality assessment, although their microbiological validation has not been established. A microbiology-based assessment of the procedure was conducted. Twenty-five artificial hand models underwent initial full contamination, then disinfection with UV-dyed hand-rub solution, digital imaging under UV-light, microbiological sampling and cultivation, and digital imaging of the cultivated flora were performed. Paired images of each hand model were registered by a software tool, then the UV-marked regions were compared with the pathogen-free sites pixel by pixel. Statistical evaluation revealed that the method indicates correctly disinfected areas with 95.05% sensitivity and 98.01% specificity.
Collapse
Affiliation(s)
- Á Lehotsky
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - L Szilágyi
- Department of Control Engineering and Information Technology, Budapest University of Technology and Economics, Budapest, Hungary; Computational Intelligence Research Group, Department of Electrical Engineering, Sapientia University of Transylvania, Tîrgu Mureş, Romania.
| | - S Bánsághi
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - P Szerémy
- Institute of Biochemistry, Faculty of Medicine, University of Szeged, Hungary
| | - G Wéber
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - T Haidegger
- Antal Bejczy Centre for Intelligent Robotics, Óbuda University, Budapest, Hungary; Austrian Centre for Medical Innovation and Technology, Wiener Neustadt, Austria
| |
Collapse
|
31
|
Hand Hygiene With Alcohol-Based Hand Rub: How Long Is Long Enough? Infect Control Hosp Epidemiol 2017; 38:547-552. [PMID: 28264743 DOI: 10.1017/ice.2017.25] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Hand hygiene is the core element of infection prevention and control. The optimal hand-hygiene gesture, however, remains poorly defined. OBJECTIVE We aimed to evaluate the influence of hand-rubbing duration on the reduction of bacterial counts on the hands of healthcare personnel (HCP). METHODS We performed an experimental study based on the European Norm 1500. Hand rubbing was performed for 10, 15, 20, 30, 45, or 60 seconds, according to the WHO technique using 3 mL alcohol-based hand rub. Hand contamination with E. coli ATCC 10536 was followed by hand rubbing and sampling. A generalized linear mixed model with a random effect on the subject adjusted for hand size and gender was used to analyze the reduction in bacterial counts after each hand-rubbing action. In addition, hand-rubbing durations of 15 and 30 seconds were compared to assert non-inferiority (0.6 log10). RESULTS In total, 32 HCP performed 123 trials. All durations of hand rubbing led to significant reductions in bacterial counts (P<.001). Reductions achieved after 10, 15, or 20 seconds of hand rubbing were not significantly different from those obtained after 30 seconds. The mean bacterial reduction after 15 seconds of hand rubbing was 0.11 log10 lower (95% CI, -0.46 to 0.24) than after 30 seconds, demonstrating non-inferiority. CONCLUSIONS Hand rubbing for 15 seconds was not inferior to 30 seconds in reducing bacterial counts on hands under the described experimental conditions. There was no gain in reducing bacterial counts from hand rubbing longer than 30 seconds. Further studies are needed to assess the clinical significance of our findings. Infect Control Hosp Epidemiol 2017;38:547-552.
Collapse
|
32
|
Subjective Qualitative Hand Hygiene Compliance Observation: A Feasibility Trial. Infect Control Hosp Epidemiol 2017; 38:251-252. [DOI: 10.1017/ice.2016.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|