Hand hygiene compliance in a universal gloving setting

The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions | American Journal of Infection Control

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Image source: Michael Coghlan – Flickr // CC BY-SA 2.0

Background: The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting.

Methods: This nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital.

Results: A total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus.

Conclusion: It is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.

Full reference: Kuruno, N. et al. (2017) Hand hygiene compliance in a universal gloving setting. American Journal of Infection Control. Vol. 45 (Issue 8) pp. 830–834

Beyond hand hygiene: preventing cross-contamination on hospital wards

Hospital-acquired infections are the most common adverse event for inpatients worldwide | BMJ Quality & Safety

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Background: Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice.

Results: We found that healthcare workers’ routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving ‘from clean to dirty’ when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning.

Conclusions: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.

Full reference: Hor, S. et al. (2017) Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ Quality & Safety. 26:552-558.

 

Disinfection of gloved hands for multiple activities with indicated glove use on the same patient

Most hand hygiene guidelines recommend that gloves should be changed during patient care when an indication for hand disinfection occurs | The Journal of Hospital Infection

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Observational studies indicate that the majority of healthcare workers (HCWs) do not disinfect their hands at all during continued glove wear. The aim of this narrative review is to assess the potential benefits and risks for disinfecting gloved hands during patient care for multiple activities with indicated glove use on the same patient.

Continued glove wear for multiple activities on the same patient often results in performing procedures, including aseptic procedures with contaminated gloves, especially in a setting where there are many indications in a short time, e.g. anaesthetics or accident and emergency departments. Of further note is that hand hygiene compliance is often lower when gloves are worn. To date, three independent studies have shown that decontamination is at least as effective on gloved hands as on bare hands and that puncture rates are usually not higher after up to 10 disinfections. One study on a neonatal intensive care unit showed that promotion of disinfecting gloved hands during care on the same patient resulted in a significant reduction in the incidence of late-onset infections and of necrotizing enterocolitis.

We conclude that disinfection of gloved hands by HCWs can substantially reduce the risk of transmission when gloves are indicated for the entire episode of patient care and when performed during multiple activities on the same patient.

Full reference: Kampf, G. & Lemmen, S. (2017) Disinfection of gloved hands for multiple activities with indicated glove use on the same patient. The Journal of Hospital Infection. Published online: June 22 2017

Are alcohol-based dispensers fomites for C difficile?

The purpose of this study was to evaluate alcohol-based dispensers as potential fomites for Clostridium difficile | American Journal of Infection Control

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A convenience sample of 120 alcohol-based dispensers was evaluated for the presence of C difficile either by culture or polymerase chain reaction for C difficile toxin. The results demonstrated that C difficile was not cultured, and C difficile toxin was not detected using polymerase chain reaction; however, gram-positive rods, Clostridium perfringens, Pantoea agglomerans, coagulase-negative Staphylococcus, Peptostreptococcus, Bacillus spp, and microaerophilic Streptococcus were present within the overflow basins of the alcohol-based dispensers.

Full reference: Hall, J.A. et al. (2017) Dipping into the Clostridium difficile pool: Are alcohol-based dispensers fomites for C difficile? American Journal of Infection Control. DOI: 10.1016/j.ajic.2017.04.284

Washing hands in cold water ‘as good as hot’

A US study says there is no benefit in terms of hygiene from washing in hot water rather than cold. | BBC Health

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A small study of 20 people found using water at 15C (59F) left hands as clean as water heated to 38C (100F) . The report is published in the Journal of Food Protection,

In the UK, NHS experts say people can use cold or hot water to wash their hands. They say hands should be washed for at least 20 seconds and stress the importance of using enough soap to cover the whole surface of the hands.

Their guidance focuses on rubbing hands together in various ways to make sure each surface of each hand is clean.

Jensen DA, Macinga DR, Shumaker DJ, et al. Quantifying the Effects of Water Temperature, Soap Volume, Lather Time, and Antimicrobial Soap as Variables in the Removal of Escherichia coli ATCC 11229 from Hands. Journal of Food Protection. Published online May 15 2017

Patients’ Hand Washing and Reducing Hospital-Acquired Infection

Stacy Haverstick et al. | Patients’ Hand Washing and Reducing Hospital-Acquired Infection
Critical Care Nurse | June 2017 | 37:e1-e8;

Background:  Hand hygiene is important to prevent hospital-acquired infections. Patients’ hand hygiene is just as important as hospital workers’ hand hygiene. Hospital-acquired infection rates remain a concern across health centers.

Objectives: To improve patients’ hand hygiene through the promotion and use of hand washing with soap and water, hand sanitizer, or both and improve patients’ education to reduce hospital-acquired infections.

Methods: In August 2013, patients in a cardiothoracic postsurgical step-down unit were provided with individual bottles of hand sanitizer. Nurses and nursing technicians provided hand hygiene education to each patient. Patients completed a 6-question survey before the intervention, at hospital discharge and 1, 2, and 3 months after the intervention. Hospital-acquired infection data were tracked monthly by infection prevention staff.

Results: Significant correlations were found between hand hygiene and rates of infection with vancomycin-resistant enterococci (P = .003) and methicillin-resistant Staphylococcus aureus (P = .01) after the intervention. After the implementation of hand hygiene interventions, rates of both infections declined significantly and patients reported more staff offering opportunities for and encouraging hand hygiene.

Conclusion: This quality improvement project demonstrates that increased hand hygiene compliance by patients can influence infection rates in an adult cardiothoracic step-down unit. The decreased infection rates and increased compliance with hand hygiene among the patients may be attributed to the implementation of patient education and the increased accessibility and use of hand sanitizer.

 

Monitoring the hand hygiene compliance of health care workers

Brotfein, E. et al. American Journal of Infection Control | Published online: 4 May 2017

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Highlights:

  • CCTV is a new and reliable method for observation of hand hygiene.
  • CCTV methodology records a different performing hand hygiene compared to overt observation.
  • Covert observations using CCTV can replace direct overt observation for hand hygiene of HCWs.

Read the full abstract here