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

Reducing the Risk of Mouth to Mouth Transmission of Pathogens Via Parking Tickets.

In the initial phase of our study 598 staff members were observed entering the carpark. 21.6% of them put their parking ticket in their mouth | Journal of Hospital Infection

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Using UV dye we successfully demonstrated card-to-card cross-contamination. Swabs of the ticket machine yielded commensal bacteria: coagulase negative staphylococci and a Bacillus species.

After placing a poster on the ticket-reading machine highlighting this potential infection risk, a further 1366 observations resulted in a statistically significant and persistent decline in the proportion of staff putting their carpark tickets in their mouths (p<0.001).

Full reference: Groves, J. et al. (2017) Reducing the Risk of Mouth to Mouth Transmission of Pathogens Via Reusable, Machine-read, Parking Tickets. An observational cohort study. Journal of Hospital Infection. Published online: June 08, 2017

Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit

Price, J.R. et al. (2017) The Lancet Infectious Diseases. 17(2) pp. 207–214

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Background: Health-care workers have been implicated in nosocomial outbreaks of Staphylococcus aureus, but the dearth of evidence from non-outbreak situations means that routine health-care worker screening and S aureus eradication are controversial. We aimed to determine how often S aureus is transmitted from health-care workers or the environment to patients in an intensive care unit (ICU) and a high-dependency unit (HDU) where standard infection control measures were in place.

Interpretation: In the presence of standard infection control measures, health-care workers were infrequently sources of transmission to patients. S aureus epidemiology in the ICU and HDU is characterised by continuous ingress of distinct subtypes rather than transmission of genetically related strains.

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Smartphone text message service to foster hand hygiene compliance in health care workers

Kerbaj, J. et al. American Journal of Infection Control. Published online 9 December 2016

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Background: Health care-associated infections are a major worldwide public health issue. Hand hygiene is a major component in the prevention of pathogen transmission in hospitals, and hand hygiene adherence by health care workers is low in many studies. We report an intervention using text messages as reminders and feedback to improve hand hygiene adherence.

Conclusions: Text message feedback should be incorporated into multimodal approaches for improving hand hygiene compliance.

Read the full abstract here

Utilizing the Surgical “Time-out” and Hand-off Protocols to Deter High-Risk Needlesticks

Katsevman, G.V. et al. Journal of Hospital InfectionPublished online: November 3 2016

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About 35.7 million healthcare workers face sustaining a needlestick injury worldwide and an estimated 384,000 percutaneous injuries occur annually in United States hospitals alone.1,2 Although needlestick injuries continue to pose a major occupational hazard for healthcare workers, underreporting and a “culture of silence” persist.3 Few papers suggest solutions. We propose a novel solution that will help deter high-risk (i.e., history of human immunodeficiency virus (HIV), bloodborne hepatitis virus, or intravenous (IV) drug abuse) needlesticks in the operating room (OR) and the wards.

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Effects of an Intervention on Hand Hygiene Compliance in a Radiography Unit

O’Donoghue, M. et al. Antimicrobial Resistance & Infection Control. Published online: 19 October 2016

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Background: Whilst numerous studies have investigated nurses’ compliance with hand hygiene and use of alcohol-based hand rub (ABHR), limited attention has been paid to these issues in allied health staff. Reports have linked infections to breaches in infection control in the radiography unit (RU). With advances in medical imaging, a higher proportion of patients come into contact with RU staff increasing the need for good hand hygiene compliance. This study aimed to evaluate effectiveness on compliance of an intervention to improve awareness of hand hygiene in the RU of a district hospital.

Methods: A quasi-experimental study design including questionnaires assessing knowledge and attitudes of hand hygiene and direct observation of participants was used to evaluate an educational programme on hand hygiene of the RU of a large district hospital. All healthcare workers (HCW), comprising 76 radiographers, 17 nurses, and nine healthcare assistants (HCA), agreed to participate in the study. Of these, 85 completed the initial and 76 the post-test anonymous questionnaire. The hand hygiene compliance of all 102 HCW was observed over a 3-week period prior to and after the intervention. The 2-month intervention consisted of talks on hand hygiene and benefits of ABHR, provision of visual aids, wall-mounted ABHR dispensers, and personal bottles of ABHR.

Results: Before the intervention, overall hand hygiene compliance was low (28.9 %). Post-intervention, compliance with hand hygiene increased to 51.4 %. This improvement was significant for radiographers and HCA. Additionally, knowledge and attitudes improved in particular, understanding that ABHR can largely replace handwashing and there is a need to perform hand hygiene after environmental contact. The increased use of ABHR allowed HCW to feel they had enough time to perform hand hygiene.

Conclusions: The educational intervention led to increased awareness of hand hygiene opportunities and better acceptance of ABHR use. The reduced time needed to perform hand rubbing and improved access to dispensers resulted in fewer missed opportunities. Although radiographers and other allied HCW make frequent contact with patients, these may be mistakenly construed as irrelevant with respect to healthcare associated infections. Stronger emphasis on hand hygiene compliance of these staff may help reduce infection risk.

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Promoting health workers’ ownership of infection prevention and control: using Normalisation Process Theory as an interpretive framework

Gould, D.J. et al. Journal of Hospital Infection. Published online: October 13 2016

boy-1299626_960_720Background: All health workers should take responsibility for infection prevention and control (IPC). Recent reduction in key reported healthcare-associated infections in the United Kingdom is impressive but determinants of success are unknown. It is imperative to understand how IPC strategies operate as new challenges arise and threats of antimicrobial resistance increase.

Methods: We undertook a retrospective, independent evaluation of an action plan to enhance IPC and ‘ownership’ (individual accountability) for IPC introduced throughout a healthcare organisation. Twenty purposively selected informants were interviewed. Data were analysed inductively. Normalisation Process Theory (NPT) was applied to interpret the findings and explain how the action plan was operating.

Findings: Six themes emerged through inductive analysis. Theme 1: ‘Ability to make sense of ownership’ provided evidence of the first element of NPT (Coherence). Regardless of occupational group or seniority, informants understood the importance of IPC ownership and described what it entailed. They identified three prerequisites: ‘Always being vigilant’ (Theme 2), ‘The importance of access to information’ (Theme 3) and ‘Being able to learn together in a no blame culture’ (Theme 4) Data relating to each theme provided evidence of the other elements of NPT that are required to embed change: planning implementation (cognitive participation), undertaking the work necessary to achieve change (collective action) and reflection on what else is needed to promote change as part of continuous quality improvement (reflexive monitoring). Informants identified barriers (e.g. workload) and facilitators (clear lines of communication and expectations for IPC).

Conclusion: Eighteen months after implementing the action plan incorporating IPC ownership there was evidence of continuous service improvement and significant reduction in infection rates. Applying a theory that identifies factors that promote/inhibit routine incorporation (‘normalisation’) of IPC into everyday healthcare can help explain success of IPC initiatives and inform implementation.

Read the abstract here