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Impact of a simulation-based training in hand hygiene with alcohol-based hand rub in emergency departments

Ghazali, A. D. et al |2018|  Impact of a simulation-based training in hand hygiene with alcohol-based hand rub in emergency departments| Infection Control & Hospital Epidemiology| 39|11| P. 1347-1352.

The journal of Infection Control and Epidemiology has published an article that assesses hand hygiene before and following simulation-based training.



Hand hygiene is the primary measure for reducing nosocomial infections based on 7 steps recommended by the WHO. The aim of this study was to assess the duration and the quality of hand hygiene before and after simulation-based training (SBT).

The study took place in a University Hospital Pediatric Department among its residents and nurses. In assessment A, 10 hand-rubbing procedures per participant during a work day were scored by observers using a validated, anatomically based assessment scale. Two weeks later, all participants received a didactic course and SBT, followed 1 month later by assessment B, observation of 10 hand-rubbing procedures. Assessments were performed by 2 independent observers. Before-and-after testing was used to evaluate the demonstration of theoretical knowledge.


In total, 22 participants were included, for whom 438 hand hygiene procedures were assessed: 218 for assessment A and 220 for assessment B. The duration of hand rubbing increased from 31.16 seconds in assessment A to 35.75 seconds in assessment B. In assessment A, participants averaged 6.33 steps, and in assessment B, participants averaged 6.03 steps (difference not significant). Significant improvement in scores was observed between assessments A and B, except for the dorsal side of the right hand. The wrist and interdigital areas were the least-cleaned zones. A difference between assessments A and B was observed for nail varnish but not for long nails or jewelry. Theoretical scores increased from 2.83 to 4.29.


This study revealed that an optimal number of steps were performed during hand-rubbing procedures and that SBT improved the duration and quality of hand hygiene, except for the dorsal right side. Emphasis should be placed on the specific hand areas that remained unclean after regular hand-rubbing procedures.

Rotherham NHS staff can request this article here 

Association of Corticosteroid Treatment With Outcomes in Adult Patients With Sepsis A Systematic Review and Meta-analysis

Fang, F. et al| 2018| Association of Corticosteroid Treatment With Outcomes in Adult Patients With SepsisA Systematic Review and Meta-analysis|  JAMA Intern Med| Published online December 21, 2018|  doi:10.1001/jamainternmed.2018.5849

This systematic review with meta-analysis of 37 RCTs considers the research question: Are corticosteroids associated with a reduction in 28-day mortality in patients with sepsis? 

It reports in its study of over 9500 patients with sepsis, that the administration of arteriosclerosis was  associated with reduced 28-day mortality. Administration of corticosteroids were also linked to a increased shock reversal at day 7, as well as vasopressor-free days and with decreased intensive care unit length of stay. 


The authors of the research suggest that administration of corticosteroid treatment in patients with sepsis is associated with significant improvement in health care outcomes and thus with reduced 28-day mortality.


Importance  Although corticosteroids are widely used for adults with sepsis, both the overall benefit and potential risks remain unclear.

Objective  To conduct a systematic review and meta-analysis of the efficacy and safety of corticosteroids in patients with sepsis.

Data Sources and Study Selection  MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception until March 20, 2018, and updated on August 10, 2018. The terms corticosteroidssepsisseptic shockhydrocortisonecontrolled trials, and randomized controlled trialwere searched alone or in combination. Randomized clinical trials (RCTs) were included that compared administration of corticosteroids with placebo or standard supportive care in adults with sepsis.

Data Extraction and Synthesis  Meta-analyses were conducted using a random-effects model to calculate risk ratios (RRs) and mean differences (MDs) with corresponding 95% CIs. Two independent reviewers completed citation screening, data abstraction, and risk assessment.

Main Outcomes and Measures  Twenty-eight–day mortality.

Results  This meta-analysis included 37 RCTs (N = 9564 patients). Eleven trials were rated as low risk of bias. Corticosteroid use was associated with reduced 28-day mortality  and intensive care unit (ICU) mortality. Corticosteroids were significantly associated with increased shock reversal at day 7 and vasopressor-free days ( and with ICU length of stay, the sequential organ failure assessment score at day 7, and time to resolution of shock. However, corticosteroid use was associated with increased risk of hyperglycemia  and hypernatremia.

Conclusions and Relevance  The findings suggest that administration of corticosteroids is associated with reduced 28-day mortality compared with placebo use or standard supportive care. More research is needed to associate personalized medicine with the corticosteroid treatment to select suitable patients who are more likely to show a benefit.

This article is available to Rotherham NHS staff through NHS Athens (one month embargo) or a paper copy of this article is available in the Library

Environmental contamination by bacteria in hospital washrooms according to hand-drying method: a multi-centre study

Best, E., |2018|  Environmental contamination by bacteria in hospital washrooms according to hand-drying method: a multi-centre study|  Journal of Hospital Infection| 100| 4| P. 469-475.

A new article in the Journal of Hospital Infection considers the importance of hand- drying, it is the largest study of its type to examine whether hand-drying method, in healthcare settings, affects the extent of environmental contamination by potential bacterial pathogens. 




Hand hygiene is a fundamental component of infection prevention, but few studies have examined whether hand-drying method affects the risk of dissemination of potential pathogens.


To perform a multi-centre, internal-crossover study comparing bacterial contamination levels in washrooms with hand-drying by either paper towels (PT) or jet air dryer (JAD; Dyson).


A total of 120 sampling sessions occurred over 12 weeks in each of three hospitals (UK, France, Italy). Bacteria were cultured from air, multiple surfaces, and dust. Washroom footfall (patients/visitors/staff) was monitored externally.


Footfall was nine times higher in UK washrooms. Bacterial contamination was lower in PT versus JAD washrooms; contamination was similar in France and the UK, but markedly lower in Italian washrooms. Total bacterial recovery was significantly greater from JAD versus PT dispenser surfaces at all sites. In the UK and France, significantly more bacteria were recovered from JAD washroom floors (median: 24 vs 191 cfu, P less than 0.00001). UK meticillin-susceptible Staphylococcus aureus recovery was three times more frequent and six-fold higher for JAD vs PT surfaces (both P less than  0.0001). UK meticillin-resistant S. aureus recovery was three times more frequent (21 vs 7 cfu) from JAD versus PT surfaces or floors. Significantly more enterococci and extended-spectrum β-lactamase (ESBL)-producing bacteria were recovered from UK JAD versus PT washroom floors (P less than 0.0001). In France, ESBL-producing bacteria were recovered from dust twice as often during JAD versus PT use.


Multiple examples of significant differences in surface bacterial contamination, including by faecal and antibiotic-resistant bacteria, were observed, with higher levels in JAD versus PT washrooms. Hand-drying method affects the risk of (airborne) dissemination of bacteria in real-world settings.

Read the full article at the Journal of Hospital Infection or download 

Wiping out MRSA

Garvey, M. et al. | Wiping out MRSA: effect of introducing a universal disinfection wipe in a large UK teaching hospital | Antimicrobial Resistance & Infection Control | 2018 7:155 | published: 19 December 2018


Contamination of the inanimate environment around patients constitutes an important reservoir of MRSA. Here we describe the effect of introducing a universal disinfection wipe in all wards on the rates of MRSA acquisitions and bacteraemias across a large UK teaching hospital.


A segmented Poisson regression model was used to detect any significant changes in the monthly numbers per 100,000 bed days of MRSA acquisitions and bacteraemias from April 2013 – December 2017 across QEHB.


From April 2013 to April 2016, cleaning of ward areas and multi-use patient equipment by nursing staff consisted of a two-wipe system. Firstly, a detergent wipe was used, which was followed by a disinfection step using an alcohol wipe. In May 2016, QEHB discontinued the use of a two-wipe system for cleaning and changed to a one wipe system utilising a combined cleaning and disinfection wipe containing a quaternary ammonium compound. The segmented Poisson regression model demonstrated that the rate of MRSA acquisition/100,000 patient bed days was affected by the introduction of the new wiping regime (20.7 to 9.4 per 100,000 patient bed days).


Using a Poisson model we demonstrated that the average hospital acquisition rate of MRSA/100,000 patient bed days reduced by 6.3% per month after the introduction of the new universal wipe.


We suggest that using a simple one wipe system for nurse cleaning is an effective strategy to reduce the spread and incidence of healthcare associated MRSA.

Full article available here

Antimicrobial resistance (AMR)

Department for Environment, Food & Rural Affairs, Department of Health and Social Care, Public Health England, and Veterinary Medicines Directorate | December 2018 |Antimicrobial resistance (AMR)

The Department for Environment, Food & Rural Affairs, Department of Health and Social Care, Public Health England, and Veterinary Medicines Directorate  have updated  information and resources on the government’s plans to slow the growth of antimicrobial resistance.

Full details here

‘The gloves are off’ campaign [Shared Atlas of Learning Case Study]

NHS England | December 2018 | ‘The gloves are off’ campaign’

The use of non-sterile gloves has been associated with a significant potential for cross-contamination and transmission of healthcare-associated infections (HAIs). This is because they are often used when they aren’t needed, put on too early, taken off too late or not changed at critical points (Source: NHS England)

A case study recently added to NHS England’s Shared Atlas of Learning, addresses the over-use of non-sterile gloves through education and training. The Lead Nurse for Infection Prevention and Control and two Lead Practice Educators at Great Ormond Street Hospital NHS Foundation Trust (GOSH).


Actions included establishing a working group to develop an educational awareness programme for staff. This included an updated educational package for when gloves should be worn generally in practice and a risk assessment strategy for use of gloves when preparing intravenous medication.


Staff were asked to risk assess when they would wear gloves for giving medication. Gloves were only needed for:

  • any medication where you could be in contact with a bodily fluid. e.g. eye drops, nose drops
  • any therapeutically active cream
  • any liquid hormones or cytotoxic medications.

As a result of the nurses’ actions, the case study reports:

Better outcomes – There has been a reduction in staff attendances to occupational health for hand or skin related problems. The CVL infection rate remains within normal parameters and there has been no adverse rise in hospital acquired infections including Vancomycin-resistant Enterococci (VRE), viral respiratory and enteric infections.

Better experience – The father of a child with learning disabilities gave feedback that his child is hospital and gloves phobic and the project has improved the quality of their life.

The main focus of the project was to provide education and training so that staff felt empowered to risk assess when they used gloves, which has been achieved.

Better use of resources – There has been a significant reduction in the amount of gloves ordered into the hospital. The most recent mean for gloves ordered is 163,125 per week, which is taken from the baseline period between the weeks beginning 15 April 2018 and 29 July 2018, which is a significant reduction on the previous mean of 199,733 units per week a difference of 36,608.

The outcomes of the project are continuing to be monitored and are reported quarterly to staff across the Trust and Nursing Board.

Read the case study at NHS England