Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-14T04:32:55.581Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of a simulation-based training in hand hygiene with alcohol-based hand rub in emergency departments

Published online by Cambridge University Press:  15 October 2018

Aiham Daniel Ghazali Open the ORCID record for Aiham Daniel Ghazali [Opens in a new window] ,
Elsa Deilhes ,
Julie Thomas ,
Catherine Laland ,
Sarah Thévenot ,
Jean Pierre Richer  and
Denis Oriot
Aiham Daniel Ghazali*
Affiliation:
Simulation Center, University of Paris-Diderot, Paris, France Emergency Department and EMS, University Hospital of Bichat, Paris, France
Elsa Deilhes
Affiliation:
Pediatric Department, Hospital of Niort, France
Julie Thomas
Affiliation:
Emergency Department, University Hospital of Poitiers, Poitiers, France
Catherine Laland
Affiliation:
Hygiene Department, University Hospital of Poitiers, Poitiers, France
Sarah Thévenot
Affiliation:
Hygiene Department, University Hospital of Poitiers, Poitiers, France
Jean Pierre Richer
Affiliation:
Anatomy and Simulation Laboratory, University of Poitiers, Poitiers, France
Denis Oriot
Affiliation:
Anatomy and Simulation Laboratory, University of Poitiers, Poitiers, France Pediatric Emergency Department, University Hospital of Poitiers, Poitiers, France
*
Author for correspondence: Dr Daniel Aiham Ghazali MD, PhD, Emergency Department and EMS, University Hospital of Bichat, 46 rue Henri Huchard, 75018 Paris, France and Simulation Center, University Paris Diderot, 20 rue du Département, 75018 Paris, France. E-mail: aiham@hotmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Hand hygiene is the primary measure for reducing nosocomial infections based on 7 steps recommended by the WHO. The aim of this study was to assess the duration and the quality of hand hygiene before and after simulation-based training (SBT).

Methods

The study took place in a University Hospital Pediatric Department among its residents and nurses. In assessment A, 10 hand-rubbing procedures per participant during a work day were scored by observers using a validated, anatomically based assessment scale. Two weeks later, all participants received a didactic course and SBT, followed 1 month later by assessment B, observation of 10 hand-rubbing procedures. Assessments were performed by 2 independent observers. Before-and-after testing was used to evaluate the demonstration of theoretical knowledge.

Results

In total, 22 participants were included, for whom 438 hand hygiene procedures were assessed: 218 for assessment A and 220 for assessment B. The duration of hand rubbing increased from 31.16 seconds in assessment A to 35.75 seconds in assessment B (P=.04). In assessment A, participants averaged 6.33 steps, and in assessment B, participants averaged 6.03 steps (difference not significant). Significant improvement in scores was observed between assessments A and B, except for the dorsal side of the right hand. The wrist and interdigital areas were the least-cleaned zones. A difference between assessments A and B was observed for nail varnish (P=.003) but not for long nails or jewelry. Theoretical scores increased from 2.83 to 4.29 (scale of 0–5; P<.001).

Conclusion

This study revealed that an optimal number of steps were performed during hand-rubbing procedures and that SBT improved the duration and quality of hand hygiene, except for the dorsal right side. Emphasis should be placed on the specific hand areas that remained unclean after regular hand-rubbing procedures.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 11 , November 2018 , pp. 1347 - 1352
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Haidegger, T, Nagy, M, Lehotsky, Á, Szilágyi, L. Digital imaging for the education of proper surgical hand disinfection. Med Image Comput Assist Interv 2011;14:619–626.Google Scholar
2. WHO guidelines on hand hygiene in health care. WHO library cataloguing-in-publication data, p. 155. World Health Organization website. http://www.who.int/gpsc/5may/tools/9789241597906/en/. Published 2009. Accessed April 10, 2018.Google Scholar
3. Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 2000;356:1307–1312.Google Scholar
4. Dicko-Traore, F, Gire, C, Brevaut Malaty, V, et al. Évaluation des connaissances et des pratiques d’hygiène des mains au niveau de l’unité de néonatologie et soins intensifs du service de médecine infantile et néonatologie de l’hôpital Nord, Marseille. J Pédiatr Puér 2011;24:172–177.Google Scholar
5. Girard, R, Amazian, K, Fabry, J. Better compliance and better tolerance in relation to a well-conducted introduction to rub-in hand disinfection. J Hosp Infect 2001;47:131–137.Google Scholar
6. Edmonds-Wilson, S, Campbell, E, Fox, K, et al. Comparison of 3 in vivo methods for assessment of alcohol-based hand rubs. Am J Infect Control 2015;43:506–509.Google Scholar
7. Gould, DJ, Moralejo, D, Drey, N, el al. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2010;9:CD005186.Google Scholar
8. French Society of Hospital Hygiene (Société française d’hygiène hospitalière). Recommandation for hand hygiene (Recommandations pour l’hygiène des mains). http://nosobase.chu-lyon.fr/recommandations/sfhh/2009_mains_SFHH.pdf. Published 2009. Accessed April 10, 2018.Google Scholar
9. Ng, PC, Wong, HL, Lyon, DJ, et al. Combined use of alcohol hand rub and gloves reduces the incidence of late onset infection in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2004;89:F336–F340.Google Scholar
10. WHO guidelines on hand hygiene in health care. WHO library cataloguing-in-publication data p. 72–77. World Health Organization website. http://www.who.int/gpsc/5may/tools/9789241597906/en/. Published 2009. Accessed April 10, 2018.Google Scholar
11. Pittet, D, Simon, A, Hugonnet, S, et al. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Intern Med 2004;141:1–8.Google Scholar
12. Kuzu, N, Ozer, F, Aydemir, S, et al. Compliance with hand hygiene and glove use in a university-affiliated hospital. Infect Control Hosp Epidemiol 2005;26:312–315.Google Scholar
13. Pan, A, Mondello, P, Posfay-Barbe, K, et al. Hand hygiene and glove use behavior in an Italian hospital. Infect Control Hosp Epidemiol 2007;28:1099–1102.Google Scholar
14. Pessoa-Silva, CL, Hugonnet, S, Pfister, R, et al. Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics 2007;120:e382–e390.Google Scholar
15. Pittet, D, Stephan, F, Hugonnet, S, et al. Hand-cleansing during postanesthesia care. Anesthesiology 2003;99:530–535.Google Scholar
16. Dedrick, RE, Sinkowitz-Cochran, RL, Cunningham, C, et al. Hand hygiene practices after brief encounters with patients: an important opportunity for prevention. Infect Control Hosp Epidemiol 2007;28:341–345.Google Scholar
17. Suchitra, JB, Lakshmi Devi, N. Impact of education on knowledge, attitudes and practices among various categories of healthcare workers on nosocomial infections. Indian J Med Microbiol 2007;25:181–187.Google Scholar
18. Sax, H, Uçkay, I, Richet, H, et al. Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns. Infect Control Hosp Epidemiol 2007;28:1267–1274.Google Scholar
19. Lehotsky, Á, Szilágyi, L, Bánsághi, S, et al. Towards objective hand hygiene technique assessment: validation of the ultraviolet-dye-based hand-rubbing quality assessment procedure. J Hosp Infect 2017;97:26–29.Google Scholar
20. Vanyolos, E, Peto, K, Viszlai, A, et al. Usage of ultraviolet test method for monitoring the efficacy of surgical hand rub technique among medical students. J Surg Educ 2015;72:530–535.Google Scholar
21. Garnier, L, Burger, S, Salles, F, et al. Quantifier la qualité de la friction des mains. Hygienes 2014;22:211–217.Google Scholar
22. Girou, E, Loyeau, S, Legrand, P, et al. Efficacy of hand rubbing with alcohol-based solution versus standard hand hygiene with antiseptic soap: randomised clinical trial. BMJ 2002;325:362.Google Scholar
23. Laustsen, S, Lund, E, Bibby, BM, et al. Cohort study of adherence to correct hand antisepsis before and after performance of clinical procedures. Inf Control Hosp Epidemiol 2009;30:172–178.Google Scholar
24. Ghazali, DA, Thomas, J, Deilhes, E, et al. Design and validation of an anatomically based assessment scale for hand hygiene with alcohol-based hand rub. Inf Control Hosp Epidemiol 2018. doi:10.1017/ice.2018.119.Google Scholar
25. Macdonald, DJM, McKillop, ECA, Trotter, S, et al. Improving hand-washing performance—a crossover study of hand-washing in the orthopaedic department. Ann R Coll Surg Engl 2006;88:289–291.Google Scholar
26. Zanni, GR. Hand hygiene: more than just hands. Consult Pharm 2008;23:438–444.Google Scholar
27. Ramón-Cantón, C, Boada-Sanmartín, N, Pagespetit-Casas, L. Evaluation of a hand hygiene technique in healthcare workers. Rev Calid Asist 2011;26:376–379.Google Scholar
28. Rubanprem Kumar, SA, Aruna, S, Sasikala, M. Effectiveness of hand hygiene teaching on knowledge and compliance of hand washing among the students at a selected school in Mugalivakkam village, Kancheepuram District. J Nurs Health Sci 2014;3:56–60.Google Scholar
29. Alex-Hart, BA, Opara, PI. Hand hygiene practices amongst health workers in a Teaching Hospital. Am J Infect Dis 2011;7:8–15.Google Scholar
30. Kennedy, M, Burnett, E. Hand hygiene, knowledge and attitudes: comparison between student nurses. J Infec Prev 2011;12:246–250.Google Scholar
31. Sibiya, JE, Gumbo, JR. Knowledge, attitude and practices (KAP) survey on water, sanitation and hygiene in selected schools in Vhembe District, Limpopo, South Africa. Int J Environ Res Public Health 2013;10:2282–2295.Google Scholar
32. Martín-Madrazo, C, Soto-Díaz, S, Cañada-Dorado, A, et al. Cluster randomized trial to evaluate the effect of a multimodal hand hygiene improvement strategy in primary care. Inf Control Hosp Epidemiol 2012;33:681–688.Google Scholar
33. Zil-E-Ali, A, Cheema, MA, Wajih Ullah, M, et al. A survey of hand hygiene knowledge and attitudes among the healthcare professionals in Lahore, Pakistan. Cureus 2017;9:e1089.Google Scholar
34. Ward, DJ. Hand adornment and infection control. Br J Nurs 2007;16:654–656.Google Scholar
35. Fagernes, M, Lingaas, E. Factors interfering with the microflora on hands: a regression analysis of samples from 465 healthcare workers. J Adv Nurs 2011;67:297–307.Google Scholar
36. Carbonne, A, Veber, B, Ajjar, J. Evaluation des pratiques en anesthésie exposant au risque de transmission croisée. French Society of Anesthesiology and French Society of Hygiene. http://www.cpias-ile-de-france.fr/ACTU_DIVERS/RapportAnesth06.pdf. Published 2006. Accessed February 10, 2018.Google Scholar
37. Vandenbos, F, Gal, J, Dandine, M, et al. Assessing the wearing of jewelry by French healthcare professionals. Med Mal Infect 2011;41:192–196.Google Scholar
38. Kawalec, A, Kawalec, A, Pawlas, K. Compliance with hygiene procedures among medical faculty students. Med Pr 2014;65:593–599.Google Scholar
39. Nabavi, M, Alavi-Moghaddam, M, Gachkar, L, et al. Knowledge, attitudes, and practices study on hand hygiene among Imam Hossein hospital’s residents in 2013. Iran Red Crescent Med J 2015;17:e19606.Google Scholar
40. Guilbert, JJ. Vers une formation pertinente des personnels de santé. Pourquoi cela prend-il du temps? Que faire? Pédagog Méd 2003;4:35–41.Google Scholar
Supplementary material: File

Ghazali et al. supplementary material

Appendix 1

Download Ghazali et al. supplementary material(File)
File 438.5 KB
Supplementary material: File

Ghazali et al. supplementary material

Appendix 2

Download Ghazali et al. supplementary material(File)
File 538.5 KB
Supplementary material: File

Ghazali et al. supplementary material

Appendix 3

Download Ghazali et al. supplementary material(File)
File 75 KB