1887

Abstract

The hands of healthcare workers (HCWs) are the most common vehicle for the transmission of micro-organisms from patient to patient and within the healthcare environment. The aim of this study was to evaluate the impact of a multimodal campaign on the type and amount of resident and transient flora and the presence of potential risk factors for hand contamination during routine care. A before–after (PRE and POST periods) interventional study was carried out in medical wards of a tertiary care hospital. Eighty-nine samples were analysed. Samples were cultured immediately before patient contact using a glove-juice method. Data collected included socio-demographic and risk factors for hand contamination. Flora was measured as log c.f.u. ml and evaluated by comparing median values in the PRE and POST periods. Transient flora was isolated from the hands of 67.4 and 46.1 % of HCWs in the PRE and POST periods, respectively (<0.001). , spp. and meticillin-sensitive were the predominant contaminants. Resident flora was isolated from 92.1 % of HCWs in the PRE period and from 70.8 % in the POST period (<0.001). The meticillin-resistant coagulase-negative staphylococci log c.f.u. count ml decreased from 1.96±1.2 to 0.89±1.2 (mean±; <0.001), and the global flora count decreased from 2.77±1.1 to 1.56±1.4 (<0.001). In the POST period, the wearing of fewer rings (<0.001), shorter fingernail length ( = 0.008), a shorter time since recent hand hygiene (HH) ( = 0.007) and an increased use of alcohol-based hand rub instead of soap (<0.001) were documented. The HH multimodal strategy reduced the number of risk factors and the level of HCW hand contamination.

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2013-04-01
2019-12-13
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References

  1. Bandura A. . ( 1982; ). Self-efficacy mechanism in human agency. . Am Psychol 37:, 122–147. [CrossRef]
    [Google Scholar]
  2. Barbut F. , Maury E. , Goldwirt L. , Boëlle P. Y. , Neyme D. , Aman R. , Rossi B. , Offenstadt G. . ( 2007; ). Comparison of the antibacterial efficacy and acceptability of an alcohol-based hand rinse with two alcohol-based hand gels during routine patient care. . J Hosp Infect 66:, 167–173. [CrossRef] [PubMed]
    [Google Scholar]
  3. Boyce J. M. , Pittet D. . the Healthcare Infection Control Practices Advisory Committee the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force ( 2002; ). Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. . MMWR Recomm Rep 51: (RR-16), 1–45, quiz CE1–CE4.[PubMed]
    [Google Scholar]
  4. Cardoso C. L. , Pereira H. H. , Zequim J. C. , Guilhermetti M. . ( 1999; ). Effectiveness of hand-cleansing agents for removing Acinetobacter baumannii strain from contaminated hands. . Am J Infect Control 27:, 327–331. [CrossRef] [PubMed]
    [Google Scholar]
  5. Edmonds S. L. , Mann J. , McCormack R. R. , Macinga D. R. , Fricker C. M. , Arbogast J. W. , Dolan M. J. . ( 2010; ). SaniTwice: a novel approach to hand hygiene for reducing bacterial contamination on hands when soap and water are unavailable. . J Food Prot 73:, 2296–2300.[PubMed]
    [Google Scholar]
  6. Girou E. , Loyeau S. , Legrand P. , Oppein F. , Brun-Buisson C. . ( 2002; ). Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. . BMJ 325:, 362. [CrossRef] [PubMed]
    [Google Scholar]
  7. Guilhermetti M. , Hernandes S. E. , Fukushigue Y. , Garcia L. B. , Cardoso C. L. . ( 2001; ). Effectiveness of hand-cleansing agents for removing methicillin-resistant Staphylococcus aureus from contaminated hands. . Infect Control Hosp Epidemiol 22:, 105–108. [CrossRef] [PubMed]
    [Google Scholar]
  8. Herruzo-Cabrera R. , García-Caballero J. , Fernandez-Aceñero M. J. . ( 2001; ). A new alcohol solution (N-duopropenide) for hygienic (or routine) hand disinfection is more useful than classic handwashing: in vitro and in vivo studies in burn and other intensive care units. . Burns 27:, 747–752. [CrossRef] [PubMed]
    [Google Scholar]
  9. Hobson D. W. , Woller W. , Anderson L. , Guthery E. . ( 1998; ). Development and evaluation of a new alcohol-based surgical hand scrub formulation with persistent antimicrobial characteristics and brushless application. . Am J Infect Control 26:, 507–512. [CrossRef] [PubMed]
    [Google Scholar]
  10. Kac G. , Podglajen I. , Gueneret M. , Vaupré S. , Bissery A. , Meyer G. . ( 2005; ). Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study. . J Hosp Infect 60:, 32–39. [CrossRef] [PubMed]
    [Google Scholar]
  11. Kampf G. , Höfer M. , Wendt C. . ( 1999; ). Efficacy of hand disinfectants against vancomycin-resistant enterococci in vitro. . J Hosp Infect 42:, 143–150. [CrossRef] [PubMed]
    [Google Scholar]
  12. Larson E. L. , Aiello A. E. , Bastyr J. , Lyle C. , Stahl J. , Cronquist A. , Lai L. , Della-Latta P. . ( 2001; ). Assessment of two hand hygiene regimens for intensive care unit personnel. . Crit Care Med 29:, 944–951. [CrossRef] [PubMed]
    [Google Scholar]
  13. Lucet J. C. , Rigaud M. P. , Mentre F. , Kassis N. , Deblangy C. , Andremont A. , Bouvet E. . ( 2002; ). Hand contamination before and after different hand hygiene techniques: a randomized clinical trial. . J Hosp Infect 50:, 276–280. [CrossRef] [PubMed]
    [Google Scholar]
  14. Monistrol O. , Calbo E. , Riera M. , Nicolás C. , Font R. , Freixas N. , Garau J. . ( 2012; ). Impact of a hand hygiene educational programme on hospital-acquired infections in medical wards. . Clin Microbiol Infect 18:, 1212–1218.[PubMed] [CrossRef]
    [Google Scholar]
  15. Pessoa-Silva C. L. , Dharan S. , Hugonnet S. , Touveneau S. , Posfay-Barbe K. , Pfister R. , Pittet D. . ( 2004; ). Dynamics of bacterial hand contamination during routine neonatal care. . Infect Control Hosp Epidemiol 25:, 192–197. [CrossRef] [PubMed]
    [Google Scholar]
  16. Picheansathian W. . ( 2004; ). A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. . Int J Nurs Pract 10:, 3–9. [CrossRef] [PubMed]
    [Google Scholar]
  17. Pittet D. , Dharan S. , Touveneau S. , Sauvan V. , Perneger T. V. . ( 1999; ). Bacterial contamination of the hands of hospital staff during routine patient care. . Arch Intern Med 159:, 821–826. [CrossRef] [PubMed]
    [Google Scholar]
  18. Pittet D. , Hugonnet S. , Harbarth S. , Mourouga P. , Sauvan V. , Touveneau S. , Perneger T. V. . ( 2000; ). Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. . Lancet 356:, 1307–1312. [CrossRef] [PubMed]
    [Google Scholar]
  19. Pittet D. , Allegranzi B. , Sax H. , Dharan S. , Pessoa-Silva C. L. , Donaldson L. , Boyce J. M. . WHO Global Patient Safety Challenge, World Alliance for Patient Safety ( 2006; ). Evidence-based model for hand transmission during patient care and the role of improved practices. . Lancet Infect Dis 6:, 641–652. [CrossRef] [PubMed]
    [Google Scholar]
  20. Rotter M. L. . ( 2004; ). Hand Washing and Hand Disinfection, , 3rd edn., pp. 1728–1746. Edited by Mayhall G. . . Baltimore, MD:: Lippincott, Williams & Wilkins;.
    [Google Scholar]
  21. Rotter M. L. , Koller W. . ( 1992; ). Test models for hygienic handrub and hygienic handwash: the effects of two different contamination and sampling techniques. . J Hosp Infect 20:, 163–171. [CrossRef] [PubMed]
    [Google Scholar]
  22. Rupp M. E. , Fitzgerald T. , Puumala S. , Anderson J. R. , Craig R. , Iwen P. C. , Jourdan D. , Keuchel J. , Marion N. . & other authors ( 2008; ). Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. . Infect Control Hosp Epidemiol 29:, 8–15. [CrossRef] [PubMed]
    [Google Scholar]
  23. Tenorio A. R. , Badri S. M. , Sahgal N. B. , Hota B. , Matushek M. , Hayden M. K. , Trenholme G. M. , Weinstein R. A. . ( 2001; ). Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant Enterococcus species by health care workers after patient care. . Clin Infect Dis 32:, 826–829. [CrossRef] [PubMed]
    [Google Scholar]
  24. Trick W. E. , Vernon M. O. , Hayes R. A. , Nathan C. , Rice T. W. , Peterson B. J. , Segreti J. , Welbel S. F. , Solomon S. L. , Weinstein R. A. . ( 2003; ). Impact of ring wearing on hand contamination and comparison of hand hygiene agents in a hospital. . Clin Infect Dis 36:, 1383–1390. [CrossRef] [PubMed]
    [Google Scholar]
  25. Tvedt C. , Bukholm G. . ( 2005; ). Alcohol-based hand disinfection: a more robust hand-hygiene method in an intensive care unit. . J Hosp Infect 59:, 229–234. [CrossRef] [PubMed]
    [Google Scholar]
  26. Waterman T. R. , Smeak D. D. , Kowalski J. , Hade E. M. . ( 2006; ). Comparison of bacterial counts in glove juice of surgeons wearing smooth band rings versus those without rings. . Am J Infect Control 34:, 421–425. [CrossRef] [PubMed]
    [Google Scholar]
  27. Whitby M. , Pessoa-Silva C. L. , McLaws M. L. , Allegranzi B. , Sax H. , Larson E. , Seto W. H. , Donaldson L. , Pittet D. . ( 2007; ). Behavioural considerations for hand hygiene practices: the basic building blocks. . J Hosp Infect 65:, 1–8. [CrossRef] [PubMed]
    [Google Scholar]
  28. WHO ( 2006; ). WHO Multimodal Hand Hygiene Improvement Strategy. Manual for Observers. Geneva:: World Health Organization;.
    [Google Scholar]
  29. WHO ( 2009a; ). Guide to Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy. Geneva:: World Health Organization;.
    [Google Scholar]
  30. WHO ( 2009b; ). WHO Guidelines on Hand Hygiene in Health Care. Geneva:: World Health Organization;.
    [Google Scholar]
  31. Zaragoza M. , Sallés M. , Gomez J. , Bayas J. M. , Trilla A. . ( 1999; ). Handwashing with soap or alcoholic solutions? A randomized clinical trial of its effectiveness. . Am J Infect Control 27:, 258–261. [CrossRef] [PubMed]
    [Google Scholar]
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