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Nosocomial infections; hand-washing compliance; comparing hand hygiene protocols; sensor-operator faucets - Evidence For Practice

AORN Journal, March, 2003 by Suzanne C. Beyea

Reducing nosocomial Infections Infection Control and Hospital Epidemiology, February 2002

This prospective, controlled study was conducted in eight medium-sized hospitals and examined the effect of appropriate quality management activities on nosocomial infection rates during a 26-month period. (1) The study focused on surgical departments. Intensive care units (ICUs) were included to capture data for patients requiring this type of treatment after surgery. The intervention group comprised four hospitals, and the control group comprised four hospitals.

More Articles of Interest: Nosocomial Infections : Measures for Prevention and Control; Hand washing: First defense against infection; Knocking out nosocomial infections; Nosocomial Infections; Handwashing in critical care

There were three observation periods--one before intervention and two after intervention. The main interventions included the introduction of quality circles and surveillance activities. Infection control nurses were trained in diagnosing nosocomial infections using definitions from the Centers for Disease and Control and Prevention:

Findings. A total of 11,295 patients received follow-up during the three observation periods. Patient days equaled 116,057. Before intervention, all hospitals had nearly equal infection rates. Hospitals in the intervention group experienced an overall decrease in the incidence of nosocomial infections. Between the two groups, 781 nosocomial infections were found. Of these, 32.3% were surgical site infections, 31.9% urinary tract infections, 18.8% lower respiratory tract infections, and 3.6% blood stream infections.

Clinical implications. Clinicians should be aware of opportunities to use quality improvement and surveillance activities as strategies to reduce the risks of infection. In this study, clinicians from the units involved were instrumental in evaluating infection control measures and relating and implementing strategies to reduce the risk of infection.

Improving nurses' hand-washing compliance

Journal of Hospital Infection, May 2002

This study explored the effectiveness of teaching strategies and the availability of additional hand-carried alcohol dispensers on nurses' compliance with hand disinfection. (2) Registered nurses and nurse assistants (n = 480) received standardized instruction on alcohol hand disinfection. To determine the amount of disinfectant used, the volume of the solution was measured before and after each study period.

Findings. Use of the alcohol disinfectant increased by 78% on units that received the teaching intervention and additional hand-carried dispensers. The researchers later reevaluated the overall use of the alcohol disinfectant and reported that the level of improvement was maintained over time.

Clinical implications. Hand disinfection is a critical step in minimizing nosocomial infections. This study supports the premise that nurses and nursing assistants improve compliance with hand washing when teaching is provided. It also supports the importance of having hand-washing supplies in adequate supply and readily available at the point of care.

Comparison of hand-hygiene protocols

Journal of Hospital Infection, April 2002

This randomized, controlled study examined the efficacy of various hand-hygiene techniques, including hand rubbing with an alcohol-based compound and hand washing with antiseptic agents and unmedicated soap, for reducing bacteria. (3) The study was conducted in two medical ICUs, a surgical ICU, a cardiac surgery ICU, a surgical recovery unit, and two medical units in a Parisian hospital. On each unit, five to seven health care workers volunteered to use one of six hand-hygiene techniques, in random order, immediately after participating in a health care procedure. Volunteers included at least one physician, one nurse assistant, and two nurses.

Hand-hygiene protocols were standardized for volume of product, duration of application, and method of drying hands. Cultures were obtained from all five fingertips of each volunteer's dominant hand before and after he or she followed the protocol.

Findings. Forty-three health care workers participated in the study, and all used each of the six protocols. There were no significant differences in hand contamination before hand-hygiene protocols were used. Hand contamination was highest among health care workers who worked on medical units, physicians, and health care workers who have no direct patient contact. Glove use significantly reduced contamination.

As expected, compliance with hand-hygiene protocol significantly reduced bacterial counts. Hand washing with antiseptic soap or hand rubbing with alcohol-based disinfectant significantly reduced bacterial counts compared to hand washing with unmedicated soap. The researchers concluded that hand rubbing with an alcohol-based disinfectant and hand washing with antiseptic soap are more effective in reducing bacterial counts on hands than hand washing with unmedicated-soap.

Clinical implications. These researchers conclude that hand rubbing with an alcohol-based disinfectant could replace hand washing with either unmedicated or antiseptic soap for hand hygiene in many clinical situations. Clinicians should heed advice about the importance of regular hand washing after patient contact and use agents that will decrease bacterial counts significantly. The findings of this study also suggest that it is important for health care workers who have no direct patient contact to wash their hands regularly.

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Nosocomial infections; hand-washing compliance; comparing hand hygiene protocols; sensor-operator faucets - Evidence For Practice

AORN Journal, March, 2003 by Suzanne C. Beyea

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