Hand washing; craniotomy and meningitis; contaminated rinse water; trauma and infection - Evidence For Practice - Brief Article

AORN Journal,  Jan, 2003  by Suzanne C. Beyea

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Encouraging physicians to comply with hand-washing guidelines

Infection Control and Hospital Epidemiology, January 2002

This study examined the motivating and behavioral factors that improve physicians' compliance with hand-washing guidelines. (1) The design involved five observational, unobtrusive studies examining hand-washing behaviors after direct patient contact. Study observations were conducted in an 18-bed medical-surgical intensive care unit (ICU) and a 12-bed cardiac care unit in a 450-bed hospital. After data were collected and analyzed, an infection control physician met individually with participants. During that meeting, participants learned of the study results and agreed to follow hand-washing guidelines. Subsequently, interviews were conducted to evaluate behavioral factors and educational programs.

Findings. Rates of physician compliance in the five studies conducted were 19%, 85%, 76%, 74%, and 68% respectively. Seventy-one initial interviews and 55 follow-up interviews were conducted with participating physicians. During the interviews, physicians rated the knowledge that hand washing prevents nosocomial infections as the most important factor for complying with hand-washing guidelines. Researchers found that personal commitment and meeting with an infection control physician had the most influence on hand-washing behavior. Direct inservice programs, presented live or via videotape, had more influence than e-mail messages about hand-washing practices.

Clinical implications. Washing hands remains one of the cornerstones in infection control and disease prevention. Increasing and maintaining compliance with hand-washing guidelines is an extremely complex issue. In this study, a focused approach and face-to-face interaction were effective for a select group of physicians, and live education presentations and videotapes were helpful as well. Researchers and clinicians must continue to work together to identify the necessary prompts, reminders, and educational programs that will ensure ongoing compliance with this simple but critical task.

Risk for developing meningitis in patients undergoing craniotomy

American Journal of Infection Control, May 2002

This study examined the incidence of postcraniotomy meningitis in patients in a tertiary university hospital surgical unit, the etiologic factors involved, the impact on mortality and length of stay, and the risk factors associated with postcraniotomy meningitis. (2) The study was conducted in Brazil during a two and one-half year period. The sample included nontraumatic craniotomy patients. Patients were tracked prospectively from the date of surgery to death or discharge and up to 30 days postoperatively. A total of 50 patients developed meningitis. The risk factor analysis was performed using a case-control methodology. Meningitis was defined using the Centers for Disease Control and Prevention definition.

Findings. Researchers found that in the study population of 559 patients, only 8.9% (50) developed meningitis. In 70% of those patients who developed meningitis, the infection developed two to 10 days after surgery. Patients who developed meningitis were hospitalized an average of 23.9 days longer than patients who did not develop meningitis. Fifteen (30%) of the infected patients died. Gram-negative bacilli accounted for 77.8% of the 16 positive cerebral spinal fluid cultures. Repeat surgery was the one risk factor that predicted postcraniotomy meningitis. Data did not support assumptions regarding risk factors, including postoperative external ventricular shunt or remote site infection.

Clinical implications. In this study population, the risk of developing meningitis after craniotomy was quite high, resulting in prolonged hospitalization and increased mortality. Clinicians working with patients undergoing neurosurgery need to understand the risk factors for postoperative infections, including meningitis. This study provides what may be a helpful methodology for collecting postoperative outcomes data. It also indicates the need for further epidemiological research about postoperative neurological infections.

Contaminated rinse water and endoscopy equipment

Journal of Hospital Infection, May 2002

This paper is a report from a joint working group of the Hospital Infection Society and the Public Health Laboratory Service in the United Kingdom. (3) It is not a true research paper but one that uses literature and research to make recommendations about monitoring rinse water and providing high-quality rinse water for heat labile endoscopy equipment. This paper was developed because of the increased use of automated washer disinfection systems.

Findings. The authors of this paper state that when automated systems are used, the following issues must be addressed:

* adequate manual precleaning,

* ensuring compatibility of auto-disinfector fittings, and

* regular and adequate maintenance.

They also state that the most significant problem is the use of rinse water that might not be sterile and, thus, might have the ability to recontaminate an endoscope.