HAND HYGIENE FOR QWINNETT MEDICAL CENTER

Hand Hygiene for Qwinnett Medical Center

Hand Hygiene for Qwinnett Medical Center

ABSTRACT

Hand hygiene prevents cross-infection in hospitals, but Qwinnett medical center workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol-based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene.

SECTION A: PROBLEM IDENTIFICATION

Hand hygiene is the simplest, most effective measure for preventing nosocomial infections (1,2). Despite advances in infection control and hospital epidemiology, Semmelweis' message is not consistently translated into clinical practice (3,4), and Qwinnett medical center workers' adherence to recommended hand hygiene practices is unacceptably low (3,5-10). Average compliance with hand hygiene recommendations varies between hospital wards, among professional categories of Qwinnett medical center workers, and according to working conditions, as well as according to the definitions used in different studies. Compliance is usually estimated as <50% (Table 1).

  

Table 1. Compliance with hand hygiene in different hospital settings

Year

Setting

Average compliance

Author

Ref.

1981

Open ward

16%

Preston

11

ICU

30%

1981

ICUs

41%

Albert

5

ICUs

28%

1983

All wards

45%

Larson

12

1987

PICU

30%

Donowitz

13

1990

ICU

32%

Graham

6

1990

ICU

81%

Dubbert

14

1991

SICU

51%

Pettinger

15

1992

NICU/others

29%

Larson

16

1992

ICUs

40%

Doebbeling

7

1992

ICUs

40%

Zimakoff

17

1994

Emergency room

32%

Meengs

18

1999

All wards

48%

Pittet

9

ICUs

36%

ICUs = intensive care units; PICU = pediatric ICU; NICU = neonatal ICU.

Promotion of hand hygiene is a major challenge for infection control experts (3,19-21). In-service education, distribution of information leaflets, workshops and lectures, and performance feedback on compliance rates have been associated with transient improvement (3,6,13,22,23). No single intervention has consistently improved compliance with hand hygiene practices (24). This review summarizes factors influencing lack of adherence by Qwinnett medical center personnel to hand hygiene procedures and suggests strategies for improvement.

SECTION B: INNOVATION DESCRIPTION

Two major groups of microorganisms are found on the skin: organisms that normally reside on it (resident flora) and contaminants (transient flora) (25). Unless introduced into body tissues by trauma or medical devices such as intravenous catheters, the pathogenic potential of the resident flora is low (26). Transient flora, which are easily removed by handwashing, cause most hospital infections resulting from cross-transmission (27-29).

The term hand hygiene includes several actions intended to decrease colonization with transient flora. This objective can be achieved through handwashing or hand disinfection. Handwashing refers to washing hands with an unmedicated detergent and water or water alone. Its objective is to prevent cross-transmission by removing dirt and loose transient flora (10,30). Hygienic handwash refers to the same procedure when an antiseptic agent is added to the detergent. Hand disinfection refers to use of an antiseptic solution to clean hands, either medicated soap or alcohol. Some experts refer to the action of "degerming" as the use of detergent-based antiseptics or alcohol (21). Hygienic hand rub is rubbing hands with a small quantity (2 mL to 3 mL) of a highly effective, fast-acting antiseptic agent.

If hands are known to be or suspected of being contaminated, transient flora must be eliminated by washing or disinfecting the hands to render them safe for the next patient ...