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P10.10 Room for Improvement: Two Third of Hospital Staff do not use Proper Hand Disinfection Technique
S54
Abstracts, 6th Int. Conf. of the Hospital Infection Society, 15–18 October 2006, Amsterdam, The Netherlands
P10.10 Room for Improvement: Two Third of Hospital Staff do not use Proper Hand Disinfection Technique H. Kolmos *, A. Petersen, P. Hilsberg, H. Holmgren, L. Andersen. Odense University Hospital, Denmark Background: Compliance studies in hand hygiene (HH) usually focus on frequencies, whereas much less attention is being paid to the technical quality of procedures. Aim: To investigate the ability of hospital staffs to perform proper alcoholic hand rub (AHR) after theoretical and practical instruction. The audit was part of a pilot study preparing for the implementation of new infection control standards. Methods: 98 staff members from intensive care and nephrology participated in the study. Both units used AHR routinely. 63 were nurses, 12 medical doctors, and 23 from other staff categories. The instruction programme consisted of a state of the art lecture and a practical instruction in AHR by an experienced infection control nurse. Immediately afterwards participants were asked to perform AHR using a fluorescent alcoholic test solution. Results were visualised in an ultraviolet light box provided with a camera. Photos of palms and backs of each pair of hands were taken for documentation. Evaluation of photos took place blinded. Results: 32 participants (33%) performed a correct procedure, i.e. full coverage of hands and wrists with a suitable amount of alcohol. 21 obtained full coverage, but with an insufficient amount. 45 had defects on fingers (42), backs of hands (7), and/ or around wrists (14). There were no demonstrable differences in performance between staff categories. Discussion: The low technical performance is remarkable, since participants were familiar with AHR and focused on HH. Taking into consideration that compliance with HH in daily routine may be as low as 50%, our results suggest that correct hand disinfection is performed after less than 20% of patient contacts. Conclusion: Proper HH technique cannot be taken for granted, but must be trained even with experienced staff. Ultraviolet light boxes are a good training tool, which should be made available to all clinical staff for training and self-assessment on a routine basis. P10.11 Efficacy of Three Hand-Rub Antiseptics Against Escherichia Coli Urinary Tract Isolates J.Y. Maillard1 *, B. Edwards1 , I. Hosein2 . 1 Cardiff University, UK, 2 University Hospital of Wales, UK Background: The prevention and control of hospital acquired infections are challenging and failures have been linked to non-compliance with disinfection and antiseptic regimens. The introduction of alcoholic hand-rubs has improved hand-hygiene compliance but there are still questions as to their in-use antimicrobial efficacy. Aims: This study aims to determine the susceptibility of urinary tract isolates of E. coli to hand-rubs used at the University Hospital of Wales. Methods: Two alcoholic (Soft Care Med H5 and Spirigel) and one alcohol-free (NO-GERMS) hand-rubs were tested for their efficacy against six E. coli urinary tract isolates using a suspension and a non-porous surface efficacy tests. Results: All 3 hand-rubs produced >5 log reduction within 15 s with the suspension test. However, the efficacy of both alcoholic based hand-rubs was significantly lower with the surface test. Spirigel and Soft Care Med H5 achieved 5 log reduction in 30 and 60 s, respectively. The QAC based rub was effective (>6.2 log reduction within 15 s) with both tests. There was a difference in susceptibility between the isolates to short exposures to the alcoholic hand-rubs when tested with the surface test. Discussion: The use of pathogenic isolates remains a challenge since “in vivo” efficacy tests cannot be used for ethical reasons.
Here, the surface test allowed discriminating between the different rubs. This confirms previous observations that surface tests present a more appropriate challenge to biocides and represents better in-use conditions. Our results also showed differences in susceptibility between the clinical isolates. This leads to some interesting questions as to why some isolates are less susceptible and more importantly about the risks associated with non-compliance to manufacturers’ instructions. Conclusion: These results confirm the efficacy of the 3 handrubs against the E. coli isolates. However, some differences were observed when the surface test was used. P10.12 Detection of Staphylococcus aureus on the Hands of Health Care Workers E. Lingaas1 *, M. Fagernes2 , P. Bjark2 . 1 RikshospitaletRadiumhospitalet, Department of Infection Prevention, Norway, 2 Sykehuset Vestfold i Tønsberg, Norway Background: Staphylococcus aureus is one of the most common etiologic agents in nosocomial infections, and the hands of health care workers (HCWs) are considered to be important vehicles for transmission of exogenous S. aureus infections. There are, however, few studies on the occurrence of S. aureus on the hands of HCWs during ordinary clinical work and on the sensitivity of different detection methods. Aims: The aims of this study were to examine the hands of a large number of HCWs for S. aureus during ordinary daily clinical practice and to compare two different culture methods for their ability to detect S. aureus. Methods: HCWs from two different hospitals participated in the study. They were invited to participate without prior notice after having been at work for at least two hours. Samples were taken between job tasks, and they should therefore have been able to wash or disinfect hands when indicated, but no extra hand hygiene was allowed before sampling. Sampling was performed by rubbing each hand in a standardised manner in a sterile bag with 100 ml sterile tryptic soy broth with neutralizers for skin antiseptics. The broth was spread on a blood agar plate and a mannitol salt agar plate as well as in salt mannitol broth and incubated at 36ºC for 48 hours. S. aureus was identified with conventional microbiological methods. Results: A total of 265 HCWs volunteered to participate (530 hands). S. aureus was detected i a total of 96 samples from 68 (25.7%) HCWs. Incubation in broth turned out to be more than three times as sensitive as the spread plate method. Among the 96 positive specimens 93 (96.9%) were detected by broth incubation and only 30 (31.2%) with agar plates. Conclusion: The prevalence of S. aureus on the hands of HCW was surprisingly high as detected with a broth incubation method. This method probably detects small numbers of S. aureus, and the significance of these findings remains to be determined. P10.13 What Gets Up Your Nose? R. Soliman, I. McKay, G. Phillips *. Ninewells Hospital, UK Background: Nosocomial acquisition of Methicillin Resistant Staphylococcus aureus (MRSA) has been an increasing problem, with the UK having one of the highest rates in Europe. Various data are available on the prevalence of MRSA carriage among Health care workers (HCWs) but locally we have seen an increase of MRSA infections in staff. Objective: Assess the prevalence of transient MRSA nasal colonisation among staff. Method: It was anonymous, voluntary, self screening, done in all of the surgical, medical, and orthopaedic wards where the MRSA in endemic. Posters and book marks were distributed for information. Demographic data (ward/occupation) and the timing of the nasal swab (before/during or after working shift)
Abstracts, 6th Int. Conf. of the Hospital Infection Society, 15–18 October 2006, Amsterdam, The Netherlands
P10.10 Room for Improvement: Two Third of Hospital Staff do not use Proper Hand Disinfection Technique H. Kolmos *, A. Petersen, P. Hilsberg, H. Holmgren, L. Andersen. Odense University Hospital, Denmark Background: Compliance studies in hand hygiene (HH) usually focus on frequencies, whereas much less attention is being paid to the technical quality of procedures. Aim: To investigate the ability of hospital staffs to perform proper alcoholic hand rub (AHR) after theoretical and practical instruction. The audit was part of a pilot study preparing for the implementation of new infection control standards. Methods: 98 staff members from intensive care and nephrology participated in the study. Both units used AHR routinely. 63 were nurses, 12 medical doctors, and 23 from other staff categories. The instruction programme consisted of a state of the art lecture and a practical instruction in AHR by an experienced infection control nurse. Immediately afterwards participants were asked to perform AHR using a fluorescent alcoholic test solution. Results were visualised in an ultraviolet light box provided with a camera. Photos of palms and backs of each pair of hands were taken for documentation. Evaluation of photos took place blinded. Results: 32 participants (33%) performed a correct procedure, i.e. full coverage of hands and wrists with a suitable amount of alcohol. 21 obtained full coverage, but with an insufficient amount. 45 had defects on fingers (42), backs of hands (7), and/ or around wrists (14). There were no demonstrable differences in performance between staff categories. Discussion: The low technical performance is remarkable, since participants were familiar with AHR and focused on HH. Taking into consideration that compliance with HH in daily routine may be as low as 50%, our results suggest that correct hand disinfection is performed after less than 20% of patient contacts. Conclusion: Proper HH technique cannot be taken for granted, but must be trained even with experienced staff. Ultraviolet light boxes are a good training tool, which should be made available to all clinical staff for training and self-assessment on a routine basis. P10.11 Efficacy of Three Hand-Rub Antiseptics Against Escherichia Coli Urinary Tract Isolates J.Y. Maillard1 *, B. Edwards1 , I. Hosein2 . 1 Cardiff University, UK, 2 University Hospital of Wales, UK Background: The prevention and control of hospital acquired infections are challenging and failures have been linked to non-compliance with disinfection and antiseptic regimens. The introduction of alcoholic hand-rubs has improved hand-hygiene compliance but there are still questions as to their in-use antimicrobial efficacy. Aims: This study aims to determine the susceptibility of urinary tract isolates of E. coli to hand-rubs used at the University Hospital of Wales. Methods: Two alcoholic (Soft Care Med H5 and Spirigel) and one alcohol-free (NO-GERMS) hand-rubs were tested for their efficacy against six E. coli urinary tract isolates using a suspension and a non-porous surface efficacy tests. Results: All 3 hand-rubs produced >5 log reduction within 15 s with the suspension test. However, the efficacy of both alcoholic based hand-rubs was significantly lower with the surface test. Spirigel and Soft Care Med H5 achieved 5 log reduction in 30 and 60 s, respectively. The QAC based rub was effective (>6.2 log reduction within 15 s) with both tests. There was a difference in susceptibility between the isolates to short exposures to the alcoholic hand-rubs when tested with the surface test. Discussion: The use of pathogenic isolates remains a challenge since “in vivo” efficacy tests cannot be used for ethical reasons.
Here, the surface test allowed discriminating between the different rubs. This confirms previous observations that surface tests present a more appropriate challenge to biocides and represents better in-use conditions. Our results also showed differences in susceptibility between the clinical isolates. This leads to some interesting questions as to why some isolates are less susceptible and more importantly about the risks associated with non-compliance to manufacturers’ instructions. Conclusion: These results confirm the efficacy of the 3 handrubs against the E. coli isolates. However, some differences were observed when the surface test was used. P10.12 Detection of Staphylococcus aureus on the Hands of Health Care Workers E. Lingaas1 *, M. Fagernes2 , P. Bjark2 . 1 RikshospitaletRadiumhospitalet, Department of Infection Prevention, Norway, 2 Sykehuset Vestfold i Tønsberg, Norway Background: Staphylococcus aureus is one of the most common etiologic agents in nosocomial infections, and the hands of health care workers (HCWs) are considered to be important vehicles for transmission of exogenous S. aureus infections. There are, however, few studies on the occurrence of S. aureus on the hands of HCWs during ordinary clinical work and on the sensitivity of different detection methods. Aims: The aims of this study were to examine the hands of a large number of HCWs for S. aureus during ordinary daily clinical practice and to compare two different culture methods for their ability to detect S. aureus. Methods: HCWs from two different hospitals participated in the study. They were invited to participate without prior notice after having been at work for at least two hours. Samples were taken between job tasks, and they should therefore have been able to wash or disinfect hands when indicated, but no extra hand hygiene was allowed before sampling. Sampling was performed by rubbing each hand in a standardised manner in a sterile bag with 100 ml sterile tryptic soy broth with neutralizers for skin antiseptics. The broth was spread on a blood agar plate and a mannitol salt agar plate as well as in salt mannitol broth and incubated at 36ºC for 48 hours. S. aureus was identified with conventional microbiological methods. Results: A total of 265 HCWs volunteered to participate (530 hands). S. aureus was detected i a total of 96 samples from 68 (25.7%) HCWs. Incubation in broth turned out to be more than three times as sensitive as the spread plate method. Among the 96 positive specimens 93 (96.9%) were detected by broth incubation and only 30 (31.2%) with agar plates. Conclusion: The prevalence of S. aureus on the hands of HCW was surprisingly high as detected with a broth incubation method. This method probably detects small numbers of S. aureus, and the significance of these findings remains to be determined. P10.13 What Gets Up Your Nose? R. Soliman, I. McKay, G. Phillips *. Ninewells Hospital, UK Background: Nosocomial acquisition of Methicillin Resistant Staphylococcus aureus (MRSA) has been an increasing problem, with the UK having one of the highest rates in Europe. Various data are available on the prevalence of MRSA carriage among Health care workers (HCWs) but locally we have seen an increase of MRSA infections in staff. Objective: Assess the prevalence of transient MRSA nasal colonisation among staff. Method: It was anonymous, voluntary, self screening, done in all of the surgical, medical, and orthopaedic wards where the MRSA in endemic. Posters and book marks were distributed for information. Demographic data (ward/occupation) and the timing of the nasal swab (before/during or after working shift)