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At least 127 records · Page 7Linked to original sources
PubMed2006

Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador.

In developing countries, continuing education for healthcare staff may be limited by staff shortages and lack of sophisticated means of delivery. These limitations have implications for compliance with an important infection control practice, namely good hand hygiene. A comparison was made between the efficacy of two educational tools commonly used in healthcare and practical sanitation settings in developing countries, i.e. videotapes and flipcharts, in delivering hand hygiene education to 67 nurses in a paediatric hospital in El Salvador. Efficacy was measured on the basis of scores obtained in pre- and post-training tests consisting of 10 multiple-choice questions. Half of the nurses received video-based instruction and half received instruction via flipcharts. Both methods of instruction increased participants' knowledge of good hand hygiene, and the extent of knowledge acquisition by the two methods was similar. Feedback obtained from flipchart users six months after training indicated that most of the respondents used the flipchart to teach hand hygiene to patients' families (62.5%), patients (50%) and healthcare workers (43.8%). Flipchart users ranked flipcharts as their favourite educational tool. Flipcharts offer an economical, easy-to-use, non-technological yet effective alternative to videotapes for delivering education in developing countries. Although the use of flipcharts requires a skilled and well-trained instructor, flipcharts could be used more widely to deliver education in resource-poor settings.

Audiovisual Aids↗
PubMed1971

Hygienic hands.

Explore the source record for details and available documents.

Antisepsis↗
PubMedDate not supplied

Hand hygiene: promoting compliance among nurses and health workers.

Around 10% of hospital patients acquire a healthcare-associated infection and it has been estimated that around one-third of these could be prevented. This article discusses the causal link between hand hygiene and infection and the reasons why healthcare workers (HCW) fail to comply with hand-hygiene policies. The action of hand hygiene is discussed in terms of the removal of transient micro-organisms and the agents used. Reasons for non-compliance and some measures for achieving compliance, such as education and patient empowerment, are discussed alongside the difficulties that these present. In order to move forward, it is suggested that the problem has to be managed through cultural change, making it easier for HCWs to comply by improving hand-cleansing facilities and materials and providing feedback to personnel on local infection rates so that high-priority areas can be targeted. This may be facilitated by locally based action research.

Guideline Adherence↗
PubMed2005

Prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among obstetrics and gynaecology workers in rural China.

This study identified the prevalence of and risk factors for non-compliance with glove utilization and hand hygiene among rural obstetrics and gynaecology workers in two poor counties in Anhui, China. A cross-sectional survey was conducted using a self-administered anonymous semi-structured questionnaire. The study population included all health workers in the departments of obstetrics and gynaecology in township hospitals and county health facilities. Among the 137 participants, the rate of non-compliance with glove utilization was 61%, the rate of non-compliance with hand hygiene was 40%, and the rate of non-compliance with both was 67%. 'Unnecessary and inconvenient' accounted for 66% of the reasons for not always using gloves and 71% for not always washing hands. 'Short of gloves or water' accounted for 15% and 22% of reasons, respectively. Two variables were associated with non-compliance: county [odds ratio (OR)=11.56, P<0.001] and knowledge (OR=0.10, P=0.033). After removing county from the regression model, institutional level (OR=2.34, P=0.059), institutional support (OR=3.85, P=0.009) and knowledge (OR=0.05, P=0.007) were associated with non-compliance. The prevalence of non-compliance with glove utilization and hand hygiene was high. The risk factors for non-compliance were institutional level, institutional support and knowledge. These variables incorporated both subjective and objective reasons for non-compliance.

Adult↗
PubMed2006

Effect of education on hand hygiene beliefs and practices: a 5-year program.

To evaluate infection control and hand hygiene understanding at 3 public hospitals, we surveyed 4,345 healthcare workers (HCWs) 3 times during a 5-year infection control intervention. The preference for the use of alcohol hand rub for hand hygiene increased dramatically; in nurses, it increased from 14% to 34%; in physicians, 4.3% to 51%; and in allied HCWs, 12% to 44%. Study year, infection control interactive education-session attendance, infection control knowledge, and being a physician or allied HCW independently predicted a preference for alcohol hand rub.

Alcohols↗
PubMedDate not supplied

Infection control audit of hand hygiene facilities.

BACKGROUND: The socio-economic costs of healthcare associated infections (HCAIs) are continually rising. The focus for reducing the incidence of HCAIs should be on maintaining a microbiologically safe environment Hand hygiene is of paramount importance in preventing the transmission of infection, as it is a low-tech, low-cost, effective intervention. Hand hygiene is as important in the non-acute care setting as in the acute setting, as community or non-acute patients are often admitted to acute facilities. CONCLUSION: This audit, conducted in 2000-2001, examined hand hygiene facilities at one non-acute trust. The results confirmed that although handwashing is considered the most important factor in preventing the spread of infection, it cannot always be carried out successfully if facilities are inadequate. Recommendations were made that will encourage safe practice, improve service delivery and raise clinical standards.

Hand Disinfection↗
PubMed2001

The influence of hand hygiene prior to insertion of peripheral venous catheters on the frequency of complications.

In a prospective multi-centre study involving 1132 peripheral venous catheters in three hospitals, the relationship between various measures of hand hygiene before insertion of peripheral venous catheters and the frequency of infectious complications', such as local reddening, swelling, pain, purulence and fever of unknown origin, were analysed. For documentation of the relevant data, special protocol forms, one for each catheter, were filled in at the time of insertion and removal of catheters. In comparison with simple hand washing, disinfection of hands before the insertion or wearing of gloves resulted in significantly fewer complications (relative risk 0.59 and 0.66, respectively). Normal hand washing was no better than no hand hygiene (relative risk 1.13), with regard to reduction of complications. This underlines the necessity of employing more effective measures of hand hygiene. The frequency of complications was dependent on the duration of peripheral venous catheterization. Catheters inserted in the operating room had a significantly lower risk of complications than catheters inserted on the ward or in the outpatient unit.

Aged↗
PubMed2006

An examination of covert observation and solution audit as tools to measure the success of hand hygiene interventions.

BACKGROUND: Many studies have examined hand hygiene (HH) frequency and adherence in response to various interventions. This study used 2 methods to determine HH frequency and adherence to see how well the outcomes correlated. METHODS: HH frequency was measured over 4, 1-month periods (phases 1-4), using 2 methods: an audit of HH solution used during each phase adjusted for patient-days and covert observation of HH adherence. The number of x-ray technician contacts with patients (a known quantity) across the study period was retrospectively compared with the number of observations made of x-ray technicians' HH behavior to see what proportion of contacts were observed. RESULTS: HH solution use doubled in phase 2 and was 65% and 55% higher than the baseline level in phases 3 and 4, respectively. Observed HH adherence fell from 51% to 37% in phase 2 and then rose to 58% in phases 3 and 4. Three percent of x-ray technicians' patient contacts were observed across the 4 phases. CONCLUSION: Observation of HH may not adequately sample patient contacts to provide an accurate measure of HH adherence. Further studies are needed to confirm this finding.

Australia↗
PubMed2006

Hand hygiene among laboratory workers.

We performed a study to measure the compliance of laboratory personnel with different components of hand hygiene. The level of compliance at the end of duty was 100%; however, 36.7% of subjects wore a ring, 46.9% wore a watch, and 6.1% wore a bracelet. Pathogenic microorganisms were exclusively found on hands of laboratory personnel who wore jewelry. After interventions, the level of compliance with the no-jewelry policy among laboratory personnel showed sustained improvement. Efforts to improve hand hygiene should be directed not only at healthcare workers but also at laboratory personnel.

Female↗
PubMed2005

Focus group data as a tool in assessing effectiveness of a hand hygiene campaign.

BACKGROUND: Routine handwashing has been proven to decrease incidence of health care-associated infections, including methicillin-resistant Staphylococcus aureus (MRSA), spawning numerous attempts to "advertise" its importance. However, most control measures fail to evaluate systematically the efficacy of handwashing initiatives. The purpose of this study was to implement a hand hygiene program in an academic medical center, utilizing visual cues developed with periodic input from hospital personnel. METHODS: After estimation of baseline compliance (20%), visual cues in the form of 11'' x 17'' posters were developed in a sequential fashion, based on suggestions from participants. The stepwise approach was supported by data collected via focus groups. These data were used to design target-specific messages and to understand better the benefits of utilizing participant input. RESULTS: Postexposure compliance rates indicated a modest improvement over baseline, increasing to 37% during the 12-month study. In addition, the stepwise design proved to be highly useful in guiding the intervention process. Analysis of qualitative data also elucidated numerous routes through which effective hand hygiene campaigns could be implemented. CONCLUSIONS: Through diligent observation and participant feedback, the research team was able to develop and market educational cues to meet service demands of health care professionals in a unified effort to control health care-associated infections. Future interventions should employ incremental evaluation designs supported by participant input to develop effective hand hygiene initiatives.

Cross Infection↗
PubMed1985

Studies on the use of povidone-iodine with the 'hygienic hand disinfection' test.

The DGHM test for hygienic hand disinfection is based on that of Rotter et al. (1980), and compares the ability of a test agent with 60% isopropanol to reduce Escherichia coli counts on artificially contaminated fingers using 15 volunteers. The test was performed seven times--three with 10% povidone-iodine (PVP-I) scrub, three with 10% PVP-I solution and once with 5% PVP-I solution. Initial tests with PVP-I scrub ('Betadine') gave comparable results with the iso-propanol, but the latter gave an activity below that normally expected, and specified in the Austrian standard (but not in the DGHM test). A repeat test with greater attention to detail gave similar activity with the scrub, but markedly greater activity from the iso-propanol so that the PVP-I scrub failed the test. Subsequent tests with four aqueous PVP-I solutions showed that all passed the tests with activity marginally greater than that of iso-propanol. Interestingly enough, two German formulations of PVP-I solution showed almost identical activity.

1-Propanol↗
PubMed2003

Hand hygiene and skin health.

The high rate of hand problems associated with the hand hygiene of medical professions is due to a combination of damaging factors: (1) the removal of barrier lipids by detergent cleaning and alcohol antisepsis followed by a loss of moisturizers and stratum corneum water and (2) the overhydration of the stratum corneum by sweat trapped within gloves. Together the facilitate the invasion of irritants and allergens which elicit inflammatory responses in the dermis. Among the lipids and water-soluble substances removed are natural antibacterials. Their loss leads to increased growth of transient and pathogenic micro-organisms which jeapordizes the very intention of skin hygiene. The kinetics of damage and its repair, and epidemiological evidence suggest that modern synthetic detergents as used in foaming liquid cleansers are the major offender. Conversely, the replacement of detergents with non-detergent emulsion cleansers has been shown to be effective in reducing the prevalence of hand problems among hospital staff. Presently recommended hand antisepsis reduces the risks to patients, but puts the burden on the health care provider. Rather than fighting micro-organisms at the expense of the skin's health, the skin and its own defences should be considered a collaborator in combating infectious diseases.

Detergents↗
PubMed1988

A laboratory model for testing agents for hygienic hand disinfection: handwashing and chlorhexidine for the removal of klebsiella.

A model for the laboratory assessment of hygienic hand disinfection is described which closely reproduces handwashing in a ward setting. The model uses a clinically relevant test organism and takes into account the natural antibacterial action of the skin. It also provides a means of measuring any residual antibacterial action after hand disinfection. Using an epidemic multiply-resistant strain of Klebsiella aerogenes K21, 0.5% chlorhexidine in iso-propyl alcohol yielded sterile post-disinfection finger washings more often than 4% chlorhexidine digluconate. Both preparations were more effective than soap and water, and with each residual action was demonstrable. The model is applicable to the laboratory evaluation of hygienic hand procedures and for agents of potential use in defined clinical settings.

1-Propanol↗
PubMed2005

Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study.

The aim of this study was to evaluate the comparative microbiological efficacy of hand rubbing and handwashing in healthcare workers from different wards, with particular emphasis on transient flora, and to assess predisposing factors for hand contamination after patient care in everyday practice. Over a six-month period, 50 healthcare workers were randomly assigned, using a crossover design, to perform handwashing with unmedicated soap and hand rubbing with an alcoholic solution following a healthcare procedure. Imprints of palms and fingertips were taken separately before and after each hand hygiene procedure. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Hand rubbing produced a significantly greater reduction in microbiological load than handwashing (P<0.0001 for palms and P=0.0003 for fingertips). In multivariate analysis, working in a medical ward rather than in an intensive care unit was significantly associated with increased hand contamination (P=0.03 for palms and P=0.02 for fingertips). Transient pathogens were found on 15% of healthcare workers' hands before hand hygiene. The only factor associated with hand contamination by transient pathogens was the absence of gloving during the healthcare procedure (odds ratio 4.8; 95% confidence interval 1.2-19; P=0.03). After hand rubbing, no transient pathogens were recovered, while these were found in two cases after handwashing. Hand rubbing is more efficacious than handwashing for the decontamination of healthcare workers' hands following contact with patients and patients' environments. Gloving may reduce microbiological hand contamination by transient pathogens.

2-Propanol↗
PubMedDate not supplied

A cost comparison of hand hygiene regimens.

The cost and quality of two hand hygiene regimens were compared. A waterless alcohol-based rub was significantly less costly than traditional handwashing because of reduced time required, and was associated with significantly better quality.

Anti-Infective Agents, Local↗
PubMed2003

Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit.

BACKGROUND: Hand hygiene (HH) is critical to infection control, but compliance is low. Alcohol-based antiseptics may improve HH. HH practices in Russia are not well described, and facilities are often inadequate. SETTING: Four 6-bed units in a neonatal intensive care unit in St. Petersburg, Russia. METHODS: Prospective surveillance of HH compliance, nosocomial colonization, and antibiotic administration was performed from January until June 2000. In February 2000, alcohol-based hand rub was provided for routine HH use. Eight weeks later, a quality improvement intervention was implemented, consisting of review of interim data, identification of opinion leaders, posting of colonization incidence rates, and regular feedback. Means of compliance, colonization, and antibiotic use were compared for periods before and after each intervention. RESULTS: A total of 1,027 events requiring HH were observed. Compliance was 44.2% before the first intervention, 42.3% between interventions, and 48% after the second intervention. Use of alcohol rose from 15.2% of HH indications to 25.2% between interventions and 41.5% after the second intervention. The incidence of nosocomial colonization (per 1,000 patient-days) with Klebsiella pneumoniae was initially 21.5, decreased to 4.7, and then was 3.2 in the final period. Rates of antibiotic and device use also decreased. CONCLUSIONS: HH may have increased slightly, but the largest effect was a switch from soap and water to alcohol which may have been associated with decreased cross-transmission of Klebsiella, although this may have been confounded by lower device use. Alcohol-based antiseptic may be an improvement over current practices, but further research is required.

Adult↗
PubMed2005

Hand hygiene posters: selling the message.

This literature review was undertaken to determine the established theory and research that might be utilized to inform the construction of persuasive messages on hand hygiene posters. It discusses the principles of message framing and the use of fear appeals. Current theory suggests that the most effective messages for health promotion behaviours should be framed in terms of gains rather than losses for the individual. However, as clinical hand hygiene is largely for the benefit of others (i.e. patients), messages should also invoke a sense of personal responsibility and appeal to altruistic behaviour. The use of repeated minimal fear appeals have their place. Posters that simply convey training messages are not effective persuaders.

Fear↗