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Nosocomial infections; hand-washing compliance; comparing hand hygiene protocols; sensor-operated faucets
MARCH 2003, VOL 77, NO 3 E V I D E N C E FOR P H A < ’ I I C E
Nosocomial infections; hand- washing compliance; comparing hand hygiene protocols; sensor-operated faucets Reducing nosocomiai 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.’ 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. There were three observation periods-ne 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 1 1,295 patients received follow-up during the three observation periods. Patient days equaled 1 16,057. 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, 78 1 nosocomial infections were found. Of these, 32.3% were surgical site infections, 3 1.9% urinary tract infections, 18.8% lower respiratory tract infections, and 3.6%
blood stream infections. Clinical implicafions. 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 handcarried alcohol dispensers on nurses’ compliance with hand disinfection.’ 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 handcarried dispensers. The researchers later reevaluated the overall use of SUZANNE C. BEYEA RN, PHD, FAAN, is director of nursing research, Dartmouth-Hitchcock Medical Center;Lebanon, NH. She was director of research at AORN, Denver: at the time this article was written. 671 AORN JOURNAL
the alcohol disinfectant and reported that the level of improvement was maintained over time. Clinical implicutions. 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.j 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 handhygiene 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
MARCH 2003, VOL 77, NO 3
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 alcoholbased 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.
Faucets as transmitters of nosocomial infection Infection Control and Hospital Epidemiology, January 2002 The purpose of this study was to examine the level of P.yeudomonas aeruginosa contamination on sensor-operated faucets compared to handle-operated faucets in an Austrian hospitaLJ This casecontrol study examined 18 randomly selected sensor-operated faucets and I8 handle-operated faucets. Samples were collected in a standardized manner, and cultures were obtained. Findings. Researchers found no Pseudomonas aeruginosa on the
18 sensor-operated faucets examined. They did find Pseudomonas aeruginosa on one of the 18 handle-operated faucets. They conclude that sensor-operated faucets prevent contact transmission of nosocomial pathogens. They also state that elbow-operated handle faucets are equivalent in this respect as long as they are operated correctly. The researchers also found that regular use of faucets may be important in avoiding colonization of faucets and water pipes and that newly installed faucets that are not used regularly are at higher risk of being colonized with potentially pathogenic bacteria. C/inicu/imp/icutions. Clinicians and infection control practitioners should consider and monitor water quality whenever they install new faucets. It also appears that clinicians should consider factors such as frequency of use when using sinks. Further research is needed to understand the role of water delivery devices in the development of nosocomial infections. Clinicians should be aware of any new evidence related to bacterial contamination associated with certain types of faucets. A
NOTES 1. P Gastmeier et al, “A quality management project in 8 selected hospitals to reduce nosocomial infections: A prospective, controlled study,” In#ection Control und Hospital Epidemiology 23 (February 2002) 9 1-97. 2. C Colombo et al, “Impact of teaching interventions on nurse compliance with hand disinfection,” Jout-nu/ of Hospital Inftction 51 (May 2002) 69-72.
3. J C Lucet et al, “Hand contamination before and after different hand hygiene techniques: A randomized clinical trial,” Journal of Hospital lnfection 50 (April
This information is intended for general use only. The clinicol implications ore specific to the abstracted article only. Those intending to
put these findings into procfice are strongly encouraged to review the originol article to defernine its applicobiliiy to their sefting.
2002) 276-280. 4. 0 Assadian et al, “Sensor-operated faucets: A possible source of nosocomial infection‘?’’Infiction Control and Hospitctl Epidemiology 23 (January 2002) 44-46.
672 AORN JOURNAL
Nosocomial infections; hand- washing compliance; comparing hand hygiene protocols; sensor-operated faucets Reducing nosocomiai 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.’ 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. There were three observation periods-ne 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 1 1,295 patients received follow-up during the three observation periods. Patient days equaled 1 16,057. 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, 78 1 nosocomial infections were found. Of these, 32.3% were surgical site infections, 3 1.9% urinary tract infections, 18.8% lower respiratory tract infections, and 3.6%
blood stream infections. Clinical implicafions. 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 handcarried alcohol dispensers on nurses’ compliance with hand disinfection.’ 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 handcarried dispensers. The researchers later reevaluated the overall use of SUZANNE C. BEYEA RN, PHD, FAAN, is director of nursing research, Dartmouth-Hitchcock Medical Center;Lebanon, NH. She was director of research at AORN, Denver: at the time this article was written. 671 AORN JOURNAL
the alcohol disinfectant and reported that the level of improvement was maintained over time. Clinical implicutions. 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.j 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 handhygiene 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
MARCH 2003, VOL 77, NO 3
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 alcoholbased 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.
Faucets as transmitters of nosocomial infection Infection Control and Hospital Epidemiology, January 2002 The purpose of this study was to examine the level of P.yeudomonas aeruginosa contamination on sensor-operated faucets compared to handle-operated faucets in an Austrian hospitaLJ This casecontrol study examined 18 randomly selected sensor-operated faucets and I8 handle-operated faucets. Samples were collected in a standardized manner, and cultures were obtained. Findings. Researchers found no Pseudomonas aeruginosa on the
18 sensor-operated faucets examined. They did find Pseudomonas aeruginosa on one of the 18 handle-operated faucets. They conclude that sensor-operated faucets prevent contact transmission of nosocomial pathogens. They also state that elbow-operated handle faucets are equivalent in this respect as long as they are operated correctly. The researchers also found that regular use of faucets may be important in avoiding colonization of faucets and water pipes and that newly installed faucets that are not used regularly are at higher risk of being colonized with potentially pathogenic bacteria. C/inicu/imp/icutions. Clinicians and infection control practitioners should consider and monitor water quality whenever they install new faucets. It also appears that clinicians should consider factors such as frequency of use when using sinks. Further research is needed to understand the role of water delivery devices in the development of nosocomial infections. Clinicians should be aware of any new evidence related to bacterial contamination associated with certain types of faucets. A
NOTES 1. P Gastmeier et al, “A quality management project in 8 selected hospitals to reduce nosocomial infections: A prospective, controlled study,” In#ection Control und Hospital Epidemiology 23 (February 2002) 9 1-97. 2. C Colombo et al, “Impact of teaching interventions on nurse compliance with hand disinfection,” Jout-nu/ of Hospital Inftction 51 (May 2002) 69-72.
3. J C Lucet et al, “Hand contamination before and after different hand hygiene techniques: A randomized clinical trial,” Journal of Hospital lnfection 50 (April
This information is intended for general use only. The clinicol implications ore specific to the abstracted article only. Those intending to
put these findings into procfice are strongly encouraged to review the originol article to defernine its applicobiliiy to their sefting.
2002) 276-280. 4. 0 Assadian et al, “Sensor-operated faucets: A possible source of nosocomial infection‘?’’Infiction Control and Hospitctl Epidemiology 23 (January 2002) 44-46.
672 AORN JOURNAL