Infection control precautions

Standard infection control precautions: national hand hygiene and personal protective equipment policy | NHS Improvement

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This national policy is a practice guide for NHS healthcare staff of all disciplines in all care settings. It covers responsibilities for organisations, staff and infection prevention and control teams. It also sets out how and when to decontaminate hands.

The national policy aims to:

  • support a common understanding (making the right thing easy to do for every patient, every time)
  • reduce variation in practice and standardise care processes
  • improve how knowledge and skills are applied in infection prevention and control
  • help reduce the risk of healthcare-associated infection
  • help to align practice, education, monitoring, quality improvement and scrutiny

Full document: Standard infection control precautions: national hand hygiene and personal protective equipment policy

 Compliance with hand hygiene in emergency medical services: an international observational study

Vikke, H.S. et al | 2019| Compliance with hand hygiene in emergency medical services: an international observational study |

An observational study, published in the Emergency Medicine Journal, identified sub-optimal levels of hand hygiene compliance among emergency medical service indications. 

The study’s results indicate a tendency to self-protection and over-reliance on gloves among emergency medical service providers (less than or equal to 15 per cent).

The research team found average hand hygiene compliance was low (3 per cent) before touching the patient and less than a fifth (19 per cent)  after having touched the patient. Gloves were worn  in more than half (54 per cent) of all hand hygiene indications.

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Abstract

Introduction Healthcare-associated infection caused by insufficient hygiene is associated with mortality, economic burden, and suffering for the patient. Emergency medical service (EMS) providers encounter many patients in different surroundings and are thus at risk of posing a source of microbial transmission. Hand hygiene (HH), a proven infection control intervention, has rarely been studied in the EMS.

Methods A multicentre prospective observational study was conducted from December 2016 to May 2017 in ambulance services from Finland, Sweden, Australia and Denmark. Two observers recorded the following parameters: HH compliance according to WHO guidelines (before patient contact, before clean/aseptic procedures, after risk of body fluids, after patient contact and after contact with patient surroundings). Glove use and basic parameters such as nails, hair and use of jewellery were also recorded.

Results Sixty hours of observation occurred in each country, for a total of 87 patient encounters. In total, there were 1344 indications for HH. Use of hand rub or hand wash was observed: before patient contact, 3%; before clean/aseptic procedures, 2%; after the risk of body fluids, 8%; after patient contact, 29%; and after contact with patient-related surroundings, 38%. Gloves were worn in 54% of all HH indications. Adherence to short or up done hair, short, clean nails without polish and no jewellery was 99%, 84% and 62%, respectively. HH compliance was associated with wearing gloves, but not associated with gender.

Conclusion HH compliance among EMS providers was remarkably low, with higher compliance after patient contacts compared with before patient contacts, and an over-reliance on gloves. We recommend further research on contextual challenges and hygiene perceptions among EMS providers to clarify future improvement strategies.

The full open-access article is available to download from the BMJ

Improving infection control practices of nurse anesthetists

Plemmons, Molly M. et al. | Improving infection control practices of nurse anesthetists in the anesthesia workspace | American Journal of Infection Control | published online January 18th 2019

Abstract
Background
Anesthesia providers commonly cross-contaminate their workspace and subsequently put patients at risk for a health care-acquired infection. The primary objective of this project was to determine if education and implementation of standardized infection control guidelines that address evidence-based best practices would improve compliance with infection control procedures in the anesthesia workspace.

Methods
Patient care-related hand hygiene of nurse anesthetists was observed in 3 areas of anesthesia practice before and 3 weeks and 3 months after staff education, placement of visual reminders, and the implementation of infection control guidelines. After the observation periods, the percent compliance on the part of the providers was calculated for each of the 3 areas of anesthesia practice, and the results were compared using the Fisher exact test.

Results
There were a total of 95 observations performed during the 3 observation periods. When compared with preimplementation baseline data, there was a 26.2% increase in the number of providers compliant with hand hygiene practices after airway instrumentation (P = .029) and a 71.9% increase in the number of providers who separated clean from contaminated items in the workspace (P = .0001).

Conclusions
Education, visual reminders, and standardized infection control guidelines were shown to improve compliance with infection control best practices in a group of nurse anesthetists.

 

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.

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Abstract 

Background
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).

Methods
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.

Results

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.

Conclusion

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 

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. 

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Summary

Background

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.

Aim

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).

Methods

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.

Findings

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.

Conclusion

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 

Jet-air dryers should not be used in hospital toilets

University of Leeds | September 2018 | Jet-air dryers should not be used in hospital toilets

A new study from researchers at Leeds University and Leeds Teaching Hospital Trust investigated whether the way people dried their hands (using paper towels or jet-air dryers) has an impact on the spread of bacteria. 

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The academics argue that official guidance about how to prevent bacterial contamination in hospital buildings needs to be strengthened. Currently, the official Department of Health guidance states that air dryers can be placed in toilets in the public areas of a hospital but not in clinical areas: but this due to the noise they create rather than due to any potential  risks they pose for cross contamination (via University of Leeds).

Over 12 weeks at three hospitals in the UK, Italy and France levels of bacterial contamination from two toilets at each hospital were measured, allowing comparisons to be made when either paper towels or jet-air dryers were in use. Samples were taken from the floors, air and surfaces in each of the toilets.

The researchers found that across the three hospitals, bacterial counts were significantly higher in the toilets on the days that jet-air dryers were in use.

Professor Wilcox, Professor of Medical Microbiology at the University of Leeds supervised the study. He said:

“We found multiple examples of greater bacterial contamination on surfaces, including by faecal and antibiotic-resistant bacteria, when jet-air dryers rather than paper towels were in use. Choice of hand drying method affects how likely microbes can spread, and so possibly the risk of infection.” (Source: University of Leeds)

The study has been published in The Journal of Hospital Infection. 

Summary

Background

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.

Aim

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).

Methods

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.

Findings

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 (median: 100–300 vs 0–10 cfu; all P < 0.0001). In the UK and France, significantly more bacteria were recovered from JAD washroom floors. UK meticillin-susceptible Staphylococcus aureus recovery was three times more frequent and six-fold higher for JAD vs PT surfaces. UK meticillin-resistant S. aureus recovery was three times more frequent 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. In France, ESBL-producing bacteria were recovered from dust twice as often during JAD versus PT use.

Conclusion

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.

 

The full article can be downloaded from the Journal of Hospital Infection  

Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center?

Highlights: 

  • An educational intervention study was completed to improve patient hand hygiene opportunities for patients at a large academic medical center.
  • After the intervention, it was possible to study the effects of improved patient hand hygiene on health care facility–onset Clostridium difficile infection events.
  • C difficile infection events decreased significantly (P ≤ .05) for 6 months after the intervention.
  • Patient hand hygiene may be an underused prevention measure for C difficile disease; successful implementation requires staff to engage the patient with opportunities, reminders, and encouragement to keep their hands clean

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Full reference: Pokrywka, M. et al. (2017) Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center? American Journal of Infection Control. Vol. 45 (Issue 9) pp. 959–963