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Table I.19.1: Association between improved adherence with hand hygiene practice and health care-associated infection rates Year 1977 Authors Casewell & Phillips Hospital setting Adult ICU 1982 Maki & Hecht Adult ICU 1984 Massanari & Hierholzer Adult ICU 1989 Conly et al. Adult ICU 1990 1992 Simmons et al. Doebbeling et al. Adult ICU Adult ICU 1994 Webster et al. NICU 1995 Zafar et al. Newborn nursery 2000 Larson et al. MICU/NICU 2000 Pittet et al. Hospital-wide 2003 2004 MacDonald et al. Swoboda et al. Hospital-wide Adult intermediate care unit 2004 Lam et al. NICU 2004 Won et al. NICU Significant results Reduction in Klebsiella spp. health careassociated infections Reduction in health care-associated infection rates Reduction in health care-associated infection rates Reduction in health care-associated infection rates No effect (hand hygiene improvement did not reach statistical significance) Significant difference in health careassociated infection rates between two different hand hygiene agents Elimination of MRSA, when combined with multiple other infection control measures. Reduction of vancomycin use Elimination of MRSA, when combined with multiple other infection control measures Significant (85%) relative reduction of VRE rate in the intervention hospital; no significant change in MRSA Significant reduction in the overall prevalence of health care-associated infections and MRSA rates. Active surveillance cultures and contact precautions were implemented during the same time period Significant reduction in hospitalacquired MRSA cases Reduction in health care-associated infection rates did not reach statistical significance No significant reduction in health careassociated infection rates Significant reduction of health careassociated infection rates Duration of follow-up 2 years N.S. N.S. N.S. 11 months 8 months 9 months 3.5 years 8 months 5 years N.S. 2.5 months 6 months 3 years Ref 67 750 133 504 508 500 119 120 535 262 363 489 531 536 ICU = intensive care unit; NICU = neonatal ICU; MRSA = methicillin-resistant S. aureus; MICU = medical ICU; N.S. = not stated.
Table l.20.1: Possible problems and recommended solutions during the reprocessing of gloves Problem: sticky gloves Problem: excess tearing and rupturing Probable cause Residual liquid soap or detergent Heated to high temperature for too long Gloves sterilized with other items Gloves not allowed to dry completely after steaming Surfaces of gloves touching each other Deterioration of rubber (latex) gloves (used, unused) while stored Gloves used too soon following sterilization Recommended solution Reduce amount of liquid soap or detergent used when washing gloves Rinse gloves at least three times in clean (running) water Use 30 minutes sterilizing time at 121°C and remove gloves from sterilizer as soon as cycle is completed Sterilize gloves separately Wear “wet” within 30 minutes or allow to dry for 4 to 6 hours before using Gauze or paper wicks should be inserted between palm and back of each glove and between the hand of the glove and the turned-back cuff (allows steam to contact all surfaces and prevents surfaces from adhering to each other) Store in a dry, cool place away from direct sunlight Do not use gloves for 24–48 hours after sterilization (allows gloves to regain their elasticity before use) Source: 641 .
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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
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As many international and national
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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 and 172: Table I.14.1: Hand hygiene frequenc
Page 173 and 174: Table I.14.2: Hand hygiene adherenc
Page 175 and 176: Table I.15.1: Hand hygiene indicati
Page 177: Table I.18.1: Strategies for succes
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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