Trial of Universal Gloving with Emollient-Impregnated Gloves to Promote Skin Health and Prevent the Transmission of Multidrug-Resistant Organisms in a Surgical Intensive Care Unit

2010 ◽  
Vol 31 (05) ◽  
pp. 491-497 ◽  
Author(s):  
Gonzalo Bearman ◽  
Adriana E. Rosato ◽  
Therese M. Duane ◽  
Kara Elam ◽  
Kakotan Sanogo ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Phase 1 ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Phase 2 ◽  
Surgical Intensive Care ◽  
Contact Precautions ◽  
Hygiene Compliance ◽  
Device Associated Infection

Objective.To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health.Design.Prospective before-after trial.Setting.An 18-bed surgical intensive care unit.Methods.During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistantEnterococcus(VRE) and methicillin-resistantStaphylococcus aureus(MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection andClostridium difficileinfection (CDI) were determined.Results.The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P= .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters;P= .001; after patient care, 63% vs 51% of encounters;P< .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P= .10), 8.9 and 7.8 for urinary tract infection (P= .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P= .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P= .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P= .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P= .16). Hand skin health improved during phase 2.Conclusions.Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.

scholarly journals Hand hygiene and the sequence of patient care

2021 ◽  
pp. 1-6
Author(s):  
Nai-Chung Chang ◽  
Michael Jones ◽  
Heather Schacht Reisinger ◽  
Marin L. Schweizer ◽  
Elizabeth Chrischilles ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hand Hygiene ◽  
Patient Care ◽  
Intensive Care Units ◽  
Healthcare Workers ◽  
Hand Hygiene Compliance ◽  
Resistant Bacteria ◽  
Surgical Intensive Care ◽  
Hygiene Compliance ◽  
Hand Hygiene Opportunity

Abstract Objective: To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. Design: For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. Setting: The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. Participants: HCWs in the STAR*ICU study units. Results: HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). Conclusions: HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.

scholarly journals Identifying the World Health Organization’s fifth moment for hand hygiene: Infection prevention in the operating room

2019 ◽  
Vol 21 (1) ◽  
pp. 28-34
Author(s):  
Fiona Smith ◽  
Karen Lee ◽  
Eleanor Binnie-McLeod ◽  
Mark Higgins ◽  
Elizabeth Irvine ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Operating Room ◽  
Direct Contact ◽  
Phase 1 ◽  
World Health ◽  
Phase 2 ◽  
Frontline Staff ◽  
The World ◽  
Hygiene Compliance ◽  
Health Organization

Background: The World Health Organization have designed the fifth of their ‘5 moments’ for hand hygiene to account for microbial transfer from patients to equipment in a narrow area around that patient, known as the patient zone. The study was prompted by emerging local confusion about application of the patient zone in the operating room (OR). Aim/Objectives: In two phases, we aimed to create a ‘5 moments’ style poster displaying an OR patient zone: phase 1, quantify equipment, in direct contact with the patient and, touched by non-scrubbed staff immediately after touching the patient; and phase 2, categorise equipment identified in phase 1 into patient zone and healthcare zone. An objective is to produce a ‘5 moments’ poster for the OR. Methods: The first phase used non-participant direct overt observation. In phase 2, phase 1 data were collaboratively assigned to patient zone or healthcare zone. Photography and graphic design were used to produce the OR ‘5 moments’ poster. Results: In 11 full-length surgeries, 20 pieces of equipment were in direct contact with the patient and 57 pieces of equipment were touched. In phase 2, a ‘5 moments’ poster showing an OR patient zone was designed. Discussion: Content of the patient zone was identified and displayed in a novel resource. Having shared understanding of the patient zone has potential to sustain hand hygiene compliance and equipment cleaning in the OR. Conclusion: Limitations in methods were balanced by collaboration with frontline staff. The study has been used as a teaching tool in the OR and similar settings.

Factors Associated with Hand Hygiene Compliance at a Tertiary Care Teaching Hospital

2013 ◽  
Vol 34 (11) ◽  
pp. 1146-1152 ◽  
Author(s):  
Benjamin Kowitt ◽  
Julie Jefferson ◽  
Leonard A. Mermel
Keyword(s):  
Hand Hygiene ◽  
Teaching Hospital ◽  
Hand Hygiene Compliance ◽  
Tertiary Care ◽  
Support Staff ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
Factors Associated ◽  
Contact Precautions ◽  
Hygiene Compliance

Objective.To identify factors associated with hand hygiene compliance during a multiyear period of intervention.Design.Observational study.Setting.A 719-bed tertiary care teaching hospital.Participants.Nursing, physician, technical, and support staff.Methods.Light-duty staff performed hand hygiene observations during the period July 2008-December 2012. Infection control implemented hospital-wide hand hygiene initiatives, including education modules; posters and table tents; feedback to units, medical directors and the executive board; and an increased number of automated alcohol hand hygiene product dispensers.Results.There were 161,526 unique observations; overall compliance was 83%. Significant differences in compliance were observed between physician staff (78%) and support staff (69%) compared with nursing staff (84%). Pediatric units (84%) and intensive care units (84%) had higher compliance than did medical (82%) and surgical units (81%). These findings persisted in the controlled multivariate model for noncompliance. Additional factors found to be significant in the model included greater compliance when healthcare workers were leaving patient rooms, when the patient was under contact precautions, and during the evening shift. The overall rate of compliance increased from 60% in the first year of observation to a peak of 96% in the fourth year, and it decreased to 89% in the final year, with significant improvements occurring in each of the 4 professional categories.Conclusions.A multipronged hand hygiene initiative is effective in increasing compliance rates among all categories of hospital workers. We identified a variety of factors associated with increased compliance. Additionally, we note the importance of continuous interventions in maintaining high compliance rates.

Inverse Correlation Between Level of Professional Education and Rate of Handwashing Compliance in a Teaching Hospital

2008 ◽  
Vol 29 (6) ◽  
pp. 534-538 ◽  
Author(s):  
Joan M. Duggan ◽  
Sandra Hensley ◽  
Sadik Khuder ◽  
Thomas J. Papadimos ◽  
Lloyd Jacobs
Keyword(s):  
Hand Hygiene ◽  
Healthcare Worker ◽  
Teaching Hospital ◽  
Hand Hygiene Compliance ◽  
Compliance Rate ◽  
Inverse Correlation ◽  
Hand Washing ◽  
Surgical Intensive Care Unit ◽  
Hygiene Compliance ◽  
Attending Physicians

Objective.To evaluate educational level as a contributing factor in handwashing compliance.Design.Observation of hand washing opportunities was performed for approximately 12 weeks before an announced Joint Commission on Accreditation of Healthcare Organizations (JCAHO) visit and for approximately 10 weeks after the visit. Trained observers recorded the date, time, and location of the observation; the type of healthcare worker or hospital employee observed; and the type of hand hygiene opportunity observed.Setting.University of Toledo Medical Center, a 319-bed teaching hospital.Results.A total of 2,373 observations were performed. The rate of hand washing compliance among nurses was 91.3% overall. Medical attending physicians had the lowest observed rate of compliance (72.4%; P < .001). Nurses showed statistically significant improvement in their rate of hand hygiene compliance after the JCAHO visit (P = .001), but no improvement was seen for attending physicians (P = .117). The compliance rate in the surgical intensive care unit was more than 90%, greater than that in other hospital units (P = .001). Statistically, the compliance rate was better during the first part of the week (Monday, Tuesday, and Wednesday) than during the latter part of the week (Thursday and Friday) (P = .002), and the compliance rate was better during the 3 PM-1 1 PM shift, compared with the 7 AM-3 PM shift (P < .001). When evaluated by logistic regression analysis, non-physician healthcare worker status and observation after the JCAHO accreditation visit were associated with an increased rate of hand hygiene compliance.Conclusion.An inverse correlation existed between the level of professional educational and the rate of compliance. Future research initiatives may need to address the different motivating factors for hand hygiene among nurses and physicians to increase compliance.

Improved hand hygiene compliance after eliminating mandatory glove use from contact precautions—Is less more?

2015 ◽  
Vol 43 (9) ◽  
pp. 922-927 ◽  
Author(s):  
Alexia Cusini ◽  
Doris Nydegger ◽  
Tanja Kaspar ◽  
Alexander Schweiger ◽  
Rolf Kuhn ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Contact Precautions ◽  
Hygiene Compliance

The effect of contact precautions on hand hygiene compliance

2013 ◽  
Vol 41 (6) ◽  
pp. 558-559 ◽  
Author(s):  
Sátiro Ribeiro Franca ◽  
Alexandre R. Marra ◽  
Rejane Augusta de Oliveira Figueiredo ◽  
Oscar Fernando Pavão dos Santos ◽  
Júlio Cesar Teodoro Ramos ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Hand Hygiene Compliance ◽  
Contact Precautions ◽  
Hygiene Compliance

Hand hygiene compliance in patients under contact precautions and in the general hospital population

2013 ◽  
Vol 41 (11) ◽  
pp. 976-978 ◽  
Author(s):  
Martín Almaguer-Leyva ◽  
Lidia Mendoza-Flores ◽  
Ana Gabriela Medina-Torres ◽  
Ana Gabriela Salinas-Caballero ◽  
Jose Antonio Vidaña-Amaro ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
General Hospital ◽  
Hand Hygiene Compliance ◽  
Contact Precautions ◽  
Hospital Population ◽  
Hygiene Compliance
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