Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-28T04:55:18.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Shortening the Application Time of Alcohol-Based Hand Rubs to 15 Seconds May Improve the Frequency of Hand Antisepsis Actions in a Neonatal Intensive Care Unit

Published online by Cambridge University Press:  30 October 2017

Axel Kramer ,
Didier Pittet ,
Romana Klasinc ,
Stefan Krebs ,
Torsten Koburger ,
Christoph Fusch  and
Ojan Assadian
Axel Kramer
Affiliation:
Institute of Hygiene and Environmental Medicine, University Hospital of Greifswald, Greifswald, Germany
Didier Pittet
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Romana Klasinc*
Affiliation:
Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
Stefan Krebs
Affiliation:
Institute of Hygiene and Environmental Medicine, University Hospital of Greifswald, Greifswald, Germany
Torsten Koburger
Affiliation:
Hygiene North GmbH, Greifswald, Greifswald, Germany
Christoph Fusch
Affiliation:
Department of Pediatrics, University Hospital of Greifswald, Greifswald, Germany Center for the Newborn, Children, and Adolescents, General Hospital, Paracelsus Medical School, Nuremberg, Germany
Ojan Assadian
Affiliation:
Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria Institute for Skin Integrity & Infection Prevention, School of Human & Health Sciences, University of Huddersfield, Queensgate, Huddersfield, United Kingdom
*
Address correspondence to Romana Klasinc, MD, Department for Infection Control and Hospital Epidemiology, Medical University of Vienna, General Hospital of Vienna Waehringer Guertel 18-20, 1090 Vienna, Austria (romana.klasinc@meduniwien.ac.at).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

For alcohol-based hand rubs, the currently recommended application time of 30 seconds is longer than the actual time spent in clinical practice. We investigated whether a shorter application time of 15 seconds is microbiologically safe in neonatal intensive care and may positively influence compliance with the frequency of hand antisepsis actions.

METHODS

We conducted in vitro experiments to determine the antimicrobial efficacy of hand rubs within 15 seconds, followed by clinical observations to assess the effect of a shortened hand antisepsis procedure under clinical conditions in a neonatal intensive care unit (NICU). An independent observer monitored the frequency of hand antisepsis actions during shifts.

RESULTS

All tested hand rubs fulfilled the requirement of equal or even significantly higher efficacy within 15 seconds when compared to a reference alcohol propan-2-ol 60% (v/v) within 30 seconds. Microbiologically, reducing the application time to 15 seconds had a similar effect when compared to 30-second hand rubbing, but it resulted in significantly increased frequency of hand antisepsis actions (7.9±4.3 per hour vs 5.8±2.9 per hour; P=.05).

CONCLUSION

Time pressure and workload are recognized barriers to compliance. Therefore, reducing the recommended time for hand antisepsis actions, using tested and well-evaluated hand rub formulations, may improve hand hygiene compliance in clinical practice.

Infect Control Hosp Epidemiol 2017;38:1430–1434

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 12 , December 2017 , pp. 1430 - 1434
Copyright
© 2017 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

REFERENCES

1. Kampf, G. State-of-the-art hand hygiene in community medicine. Int J Hyg Environ Health 2003;206:465–472.CrossRefGoogle ScholarPubMed
2. Boyce, JM, Pittet, D. 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. 2002;51(No. RR-16):1–45.CrossRefGoogle Scholar
3. Pittet, D, Allegranzi, B, Boyce, J, for the World Health Organization World Alliance for Patient Safety First Global Patient Safety Challenge Core Group of Experts. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30:611–622.CrossRefGoogle ScholarPubMed
4. Rotter, ML, Kampf, G, Suchomel, M, Kundi, M. Population kinetics of the skin flora on gloved hands following surgical hand disinfection with 3 propanol-based hand rubs: a prospective, randomized, double-blind trial. Infect Control Hosp Epidemiol 2007;28:346–350.CrossRefGoogle ScholarPubMed
5. Tavolacci, MP, Pitrou, I, Merle, V, Haghighat, S, Thillard, D, Czernichow, P. Surgical hand rubbing compared with surgical hand scrubbing: comparison of efficacy and costs. J Hosp Infect 2006;63:55–59.CrossRefGoogle ScholarPubMed
6. Kramer, A, Bernig, T, Kampf, G. Clinical double-blind trial on the dermal tolerance and user acceptability of six alcohol-based hand disinfectants for hygienic hand disinfection. J Hosp Infect 2002;51:114–120.CrossRefGoogle ScholarPubMed
7. Larson, EL, Aiello, AE, Bastyr, J, et al. Assessment of two hand hygiene regimens for intensive care unit personnel. Crit Care Med 2001;29:944–951.CrossRefGoogle ScholarPubMed
8. Pittet, D, Boyce, JM. Revolutionising hand hygiene in health-care settings: guidelines revisited. Lancet Infect Dis 2003;3:269–270.CrossRefGoogle ScholarPubMed
9. Boyce, JM. Using alcohol for hand antisepsis: dispelling old myths. Infect Control Hosp Epidemiol 2000;21:438–441.CrossRefGoogle ScholarPubMed
10. Pittet, D, Allegranzi, B, Sax, H, Chraiti, M-N, Griffiths, W, Richet, H. Double-blind, randomized, crossover trial of 3 hand rub formulations: fast-track evaluation of tolerability and acceptability. Infect Control Hosp Epidemiol 2007;28:1344–1351.CrossRefGoogle ScholarPubMed
11. Kampf, G, Löffler, G. Dermatological aspects of a successful introduction and continuation of alcohol-based hand rubs for hygienic hand disinfection. J Hosp Infect 2003;55:1–7.CrossRefGoogle ScholarPubMed
12. Souweine, B, Lautrette, A, Aumeran, C, et al. Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study. Intensive Care Med 2009;35:1216–1224.CrossRefGoogle ScholarPubMed
13. Voss, A, Widmer, AF. No time for handwashing!? Handwashing versus alcoholic rub can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205–208.CrossRefGoogle ScholarPubMed
14. Rotter, ML. Arguments for alcoholic hand disinfection. J Hosp Infect 2001;48:4–8.CrossRefGoogle ScholarPubMed
15. Pittet, D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21:381–386.CrossRefGoogle ScholarPubMed
16. Boyce, JM. Hand hygiene compliance monitoring: current perspectives from the USA. J Hosp Infect 2008;70(Suppl 1):2–7.CrossRefGoogle ScholarPubMed
17. De Wandel, D, Maes, L, Labeau, S, Vereecken, C, Blot, S. Behavioral determinants of hand hygiene compliance in intensive care units. Am J Crit Care 2010;19:230–239.CrossRefGoogle ScholarPubMed
18. Barrett, R, Randle, J. Hand hygiene practices: nursing students’ perceptions. J Clin Nurs 2008;17:1851–1857.CrossRefGoogle ScholarPubMed
19. Longtin, Y, Sax, H, Leape, LL, Sheridan, SE, Donaldson, L, Pittet, D. Patient participation: current knowledge and applicability to patient safety. Mayo Clin Proc 2010;85:53–62.CrossRefGoogle ScholarPubMed
20. Dunn-Navarra, A-M, Cohen, B, Stone, PW, Pogorzelska, M, Jordan, S, Larson, E. Relationship between systems-level factors and hand hygiene adherence. J Nurs Care Qual 2011;26:30–38.CrossRefGoogle ScholarPubMed
21. Takahashi, I, Turale, S. Evaluation of individual and facility factors that promote hand washing in aged-care facilities in Japan. Nurs Health Sci 2010;12:127–134.CrossRefGoogle ScholarPubMed
22. Buffet-Bataillon, S, Leray, E, Poisson, M, Michelet, C, Bonnaure-Mallet, M, Cormier, M. Influence of job seniority, hand hygiene education, and patient-to-nurse ratio on hand disinfection compliance. J Hosp Infect 2010;76:32–35.CrossRefGoogle ScholarPubMed
23. Korniewicz, DM, El-Masri, M. Exploring the factors associated with hand hygiene compliance of nurses during routine clinical practice. Appl Nurs Res 2010;23:86–90.CrossRefGoogle ScholarPubMed
24. Allegranzi, B, Pittet, D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect 2009;73:305–315.CrossRefGoogle ScholarPubMed
25. Kramer, A, Rudolph, P, Kampf, G, Pittet, D. Limited efficacy of alcohol-based hand gels. Lancet 2002;359:1489–1490.CrossRefGoogle ScholarPubMed
26. World Health Organization. WHO Guidelines on Hand Hygiene in Health Care. First global patient safety challenge clean care is safer care. World Alliance for Patient Safety. Geneva: World Health Organization Press; 2009.Google Scholar
27. Pittet, D. Hand hygiene: it’s all about when and how. Infect Control Hosp Epidemiol 2008;29:957–959.CrossRefGoogle Scholar
28. EN 13727. Chemical disinfectants and antiseptics. Quantitative suspension test for the evaluation of bactericidal activity in the medical area. Test method and requirements (phase 2, step 1). Brussels: European Committee for Standardization; 2003.Google Scholar
29. EN 13624. Chemical disinfectants and antiseptics. Quantitative suspension test for the evaluation of fungicidal activity of chemical disinfectants for instruments used in the medical area. Test method and requirements (phase 2, step 1). Brussels: European Committee for Standardization; 2003.Google Scholar
30. EN 1500. Chemical disinfectants and antiseptics—hygienic handrub—test method and requirements (Phase 2/Step 2). Brussels: European Committee for Standardization; 1997.Google Scholar
31. Sax, H, Allegranzi, B, Chraïti, M-N, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37:827–834.CrossRefGoogle ScholarPubMed
32. Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Infection control program. Ann Intern Med 1999;130:126–130.CrossRefGoogle Scholar
33. Pires, D, Soule, H, Bellissimo-Rodrigues, F, Gayet-Ageron, A, Pittet, D. Hand hygiene with alcohol-based handrub: how long is long enough? Infect Control Hosp Epidemiol 2017;38:547–552.CrossRefGoogle Scholar
34. Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
35. Dharan, S, Hugonnet, S, Sax, H, Pittet, D. Comparison of waterless hand antisepsis agents at short application times: raising the flag of concern. Infect Control Hosp Epidemiol 2003;24:160–164.CrossRefGoogle ScholarPubMed
36. Pittet, D, Donaldson, L. Clean care is safer care: the first global challenge of the WHO World Alliance for Patient Safety. Infect Control Hosp Epidemiol 2005;26:891–894.CrossRefGoogle ScholarPubMed