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Table I.14.2: Hand hygiene adherence by health-care workers (1981–2004) Reference Year Setting 476 501 502 480 475 503 504 745 506 507 508 509 510 511 512 500 513 151 150 482 514 515 516 517 518 519 520 Before/ after contact Adherence baseline (%) Adherence after intervention (%) Intervention 1981 ICU A 16 30 More convenient sink locations 1981 ICU A 41 -- ICU A 28 -- 1983 All wards A 45 -- 1986 SICU A 51 -- MICU A 76 -- 1986 ICU A 63 92 Performance feedback 1987 PICU A 31 30 Wearing overgown 1989 MICU B/A 14/28 * 73/81 Feedback, policy reviews, memo, posters MICU B/A 26/23 38/60 1989 NICU A/B 75/50 -- 1990 ICU A 32 45 Alcohol rub introduced 1990 ICU A** 81 92 In-service first, then group feedback 1990 ICU B/A** 22 30 1991 SICU A 51 -- 1991 Pedi OPDs B 49 49 Signs, feedback, verbal reminders to doctors Feedback, dissemination 1991 Nursery & NICU B/A *** 28 63 of literature, results of environmental cultures 1992 NICU/others A 29 -- 1992 ICU N.S. 40 -- 1993 ICUs A 40 -- 1994 Emerg Room A 32 -- 1994 All wards A 32 -- 1994 SICU A 22 38 Automated handwashing machines available 1994 NICU A 62 60 No gowning required 1994 ICUs A 30 Wards A 29 -- 1995 ICU Oncol Ward A 56 -- 1995 ICU N.S. 5 63 Lectures, feedback, demonstrations 1996 PICU B/A 12/11 68/65 Overt observation, followed by feedback 1996 MICU A 41 58 Routine wearing of gowns and gloves 1996 Emerg Dept A 54 64 Signs/distributed review paper
Table I.14.2: Hand hygiene adherence by health-care workers (1981–2004) (Cont.) Reference Year Setting 526 521 522 523 262 359 360 524 459 527 261 528 530 529 499 531 263 525 533 534 Before/ after contact Adherence baseline (%) Adherence after intervention (%) Intervention 1997 ICU B/A** 56 83 Lectures based on previous questionnaire on HCWs’ beliefs, feedback, administrative support, Automated handwashing machines available 1998 All wards A 30 -- 1998 Paediatric wards B/A 52/49 74/69 Feedback, films, posters, brochures 1999 MICU B/A 12/55 -- 2000 All wards B/A** Posters, feedback, administrative support, alcohol rub 48 67% and *** 2000 MICU A 42 61% Alcohol handrub made available 2000 MICU B/A 10/22 23%/48% Education, feedback, alcohol gel made available CTICU B/A 4/13 7%/14% 2000 Medical wards A*** 60 52% Education, reminders, alcohol gel made available 2001 All wards B/A 62 67% Education, alcohol gel made available 2002 ICU B/A** 15 -- 2002 MICU/ SICU B/A** Posters, feedback, administrative support, alcohol rub 38 55% NICU and *** 2002 PICU / NICU B/A** and *** 33 37% Posters, feedback, alcohol rub 2003 All wards Education, reminders, more B/A 17 58% 3 hospitals sinks made available 2003 NICU B/A** Education, feedback, alcohol gel made available 44 48% and *** 2003 PACU B/A** and *** 19.6 -- 2004 NICU B/A*** 40 53 Education, reminders 2004 Doctors in B/A** all wards and *** 57 -- 2005 All wards B/A** and *** 39 -- -- 2005 Haemodialysis B/A B 13.8 units and *** Ar 35.6 -- -- 2005 Haemodialysis units* B/A 26 -- ICU = intensive care unit; SICU = surgical ICU; MICU = medical ICU; PICU = paediatric ICU; NICU = neonatal ICU; Emerg = emergency; Oncol = oncology; CTICU = cardiothoracic ICU; PACU = post-anaesthesia care unit: OPD = outpatient department; N.S = not stated. * Percentage compliance before/after patient contact; ** Hand hygiene opportunities within the same patient also counted; *** After contact with inanimate objects; **** Use of gloves almost universal (93%) in all activities.
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The WHO Guidelines on Hand Hygiene
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CONTENTS INTRODUCTION . ...........
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17. Organizing an education program
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INTRODUCTION The WHO Advanced Draft
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Handwashing. Washing hands with pla
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still considered the standard of ca
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treatment selectively removes glyce
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of the organism on their hands. Mak
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6. MODELS OF HAND TRANSMISSION 6.1
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In the 1960s, a prospective, contro
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for its ability to reduce the relea
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8.2 SHORTCOMINGS OF TRADITIONAL TES
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tions of short-chain aliphatic alco
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9.1.3 WATER QUALITY The physical, c
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Case study: experience of Egypt The
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and both reduced viral counts on ha
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activity of chlorhexidine is not se
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protein synthesis and alteration of
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in micelle structures formed by sur
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In all the studies that included pl
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isopropyl alcohol) were applied to
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3) Glycerol is added using a measur
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in 2005 the costs of an alcohol-bas
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infection, risk factors that are la
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11.4.4 SIDE-EFFECTS OF THE SURGICAL
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• Repeat the process on the other
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12.2 ALLERGIC CONTACT DERMATITIS RE
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particularly when resources are lim
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Handrubs are available as gels, sol
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14. HAND HYGIENE PRACTICES AMONG HE
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quantified in observational studies
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According to behavioural theories (
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of water with special leaves) outsi
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Furthermore, according to Phra Depv
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16. BEHAVIOURAL CONSIDERATIONS 16.1
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and community factors must be consi
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i. ii. iii. iv. v. vi. a) b) Educat
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tion precautions 580 . There are al
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follow the intent 588 . Studies hav
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18. FORMULATING STRATEGIES FOR HAND
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18.2 DEVELOPING A STRATEGY FOR GUID
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1998 (P
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HCWs routinely to wear vinyl gloves
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quality gloves, reuse, shortage of
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• To test for holes, gloves shoul
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Figure l.20.2: Blood safety: crucia
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Consensus recommendations are that
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D. Wash hands with either plain or
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5. SKIN CARE A. B. C. Include infor
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PART III. OUTCOME MEASUREMENTS 1. M
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2. HAND HYGIENE AS A QUALITY INDICA
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can be seen during routine work. Da
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Case study: United Kingdom national
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PART IV. PROMOTING HAND HYGIENE ON
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ated to reinforce its principles (t
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6. PRINCIPLES OF COUNTRYWIDE HAND H
Page 122 and 123: As many international and national
Page 124: debate that resulted in increasing
Page 128 and 129: 23. Lee YL et al. Colonization by S
Page 130 and 131: Interscience Conference on Antimicr
Page 132 and 133: 122. Vicca AF. Nursing staff worklo
Page 134 and 135: 171. Kauppinen J et al. Hospital wa
Page 136 and 137: 224. Krilov LR et al. Inactivation
Page 138 and 139: 276. Thomas L et al. Development of
Page 140 and 141: 326. Johnson S et al. Prospective,
Page 142 and 143: 34th Interscience Conference on Ant
Page 144 and 145: 423. Kampf G, et al. Influence of a
Page 146 and 147: 474. West DP et al. Evaluation of a
Page 148 and 149: 524. Muto C et al. Hand hygiene rat
Page 150 and 151: 578. Babcock HM et al. An education
Page 152 and 153: Interscience Conference on Antimicr
Page 154 and 155: 679. Hirschmann H et al. The influe
Page 156: 729. Martin LS, McDougal JS, Loskos
Page 161 and 162: Table I.8.1: Basic experimental des
Page 163 and 164: Table I.9.1: Waterborne pathogens a
Page 165 and 166: Table I.9.3: Virucidal activity of
Page 167 and 168: Table I.9.4: Studies comparing the
Page 169 and 170: Table I.9.6: Studies comparing the
Page 171: Table I.14.1: Hand hygiene frequenc
Page 175 and 176: Table I.15.1: Hand hygiene indicati
Page 177 and 178: Table I.18.1: Strategies for succes
Page 179 and 180: Table l.20.1: Possible problems and
Page 181 and 182: Table I.21.1. Hand hygiene research
Page 183 and 184: Table I.21.1: Hand hygiene research
Page 185 and 186: Table I.21.2: Unsolved issues for r
Page 187 and 188: Table III.2.1: Quality indicators r
Page 189 and 190: Table V.3.1: Examples of public inf
Page 191 and 192: Table V.4.1: Examples of national p
Page 193: Table V.5.1: The public information
Page 197 and 198: APPENDIX 1. DEFINITIONS OF HEALTH-C
Page 199: APPENDIX 2. HAND AND SKIN SELF-ASSE
Page 202: Data in coloured cells can be chang
Page 206: NHS NICU n-P NPSA NA NS OPD PACU PA
Page 211 and 212: AUTHORS: John Boyce Saint Raphael H
Page 213 and 214: Garance Upham People’s Health Mov
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