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Rates of hand disinfection associated with glove use, patient isolation, and changes between exposure to various body sites*,**

https://doi.org/10.1067/mic.2003.32Get rights and content

Abstract

Background: Handwashing is the most effective and economic intervention shown to reduce nosocomial infection rates. However, studies have consistently documented low hand disinfection compliance. Literature regarding the roles that concomitant glove use and isolation precautions play in health care worker compliance with hand disinfection is limited. It is unclear whether workers change gloves and disinfect hands adequately between exposures to different body sites/secretions while caring for a patient. Methods: This was an observational study in which hand disinfection compliance and glove use among workers was evaluated in 2 intensive care units at a tertiary care hospital. Results: Five hundred eighty-nine opportunities for hand disinfection were recorded in 40 hours of observation. Overall compliance was 22.1%. We found a statistically significant, positive association between glove use and subsequent hand disinfection (relative risk [RR], 3.9 [95% CI, 2.5–6.0]; P <.0001). Isolation precautions did not significantly increase disinfection compliance. Only 4.8% (3/63) of workers appropriately complied with disinfection when hands were exposed to multiple body sites/secretions while caring for a patient. Conclusions: Glove use increases compliance with hand disinfection. Isolation precautions do not increase compliance. Workers do not appropriately comply with disinfection guidelines when attending to multiple body sites/secretions on the same patient. Compliance with hand disinfection remains low. (Am J Infect Control 2002;31:97-103.)

Section snippets

Definitions

It is important at this time to define terms relevant to hand hygiene as described by the literature.32, 39, 40, 41Handwashing (not including surgical hand scrub) refers to the action of washing hands with an unmedicated detergent and water or water alone to remove dirt and loose, transient flora to prevent cross-transmission. Hygienic handwashing refers to the same procedure with an antiseptic agent added to the detergent. This includes the chlorhexidine-based soap used in both the medical ICU

Results

Five hundred eighty-nine opportunities for hand disinfection were observed in the MICU and SICU. Two hundred ninety-eight opportunities occurred in the MICU and 291 in the SICU. Overall, compliance with hand disinfection guidelines was 22.1% (ie, 130/589 opportunities for hand disinfection resulted in appropriate disinfection by health care workers). Compliance with hand disinfection in the MICU was 64/298 opportunities, or 21.5%, whereas in the SICU, compliance was 66/291 opportunities, or

Discussion

The findings of this study would suggest the following: (1) health care workers who wear gloves are more likely to wash their hands than those who do not wear gloves, (2) worker hand disinfection compliance is not significantly improved during care for patients for whom contact isolation precautions have been prescribed, and (3) health care workers do not change gloves or wash their hands adequately between exposures to multiple body sites on the same patient. This study confirms previous

Conclusions

In summary, we have demonstrated the following: (1) glove use increases compliance with hand disinfection, (2) contact isolation precautions do not significantly increase worker compliance with hand disinfection, and (3) health care workers do not appropriately comply with hand disinfection when attending to multiple body sites/secretions on the same patient. Overall compliance with hand disinfection among health care workers remains unacceptably low. Hopefully the information presented in this

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      World Health Organization (WHO) 2009 guidelines recommend using alcohol-based hand rub or washing hands with soap and water during five moments of HH to minimize risk of health care-associated infections: 1) before touching a patient; 2) before a clean/aseptic procedure; 3) after body fluid exposure risk; and 4) after touching a patient or 5) patient surroundings [11]. Previous studies evaluating compliance with WHO guidelines have shown that HH opportunities are frequent, sometimes over 44 HH opportunities per patient per hour, and are associated with low compliance (22 to 60%) suggesting that strict adherence to the guidelines may not be feasible [12–23]. In time sensitive conditions, like emergent care, time is of the essence.

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    *

    This research was supported by National Institutes of Health grant K23AI01752-01A1.

    **

    Reprint requests: Anthony D. Harris, MD, MPH, Veterans Affairs Medical Center, Room 5D 151 [DT111], 10 N Greene St, Baltimore, MD 21201.

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