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Table III.1.1: Advantages and disadvantages of direct and indirect monitoring of hand hygiene compliance Advantages Disadvantages Observation Accurate assessment of compliance Resource-intensive Direct monitoring Patient assessment Can give some information on compliance Patients may be reluctant to carry out this task Patients are not trained to observe Self-assessment Not resource-intensive Studies have shown that this is not always accurate Indirect monitoring Monitoring of soap or alcohol use Electronic monitoring Less resource-intensive than direct monitoring Less resource-intensive than direct monitoring Studies have shown that this form of monitoring does not correlate with direct observation Does not cover all opportunities for washing hands
Table III.2.1: Quality indicators related to hand hygiene in health-care settings * = outside the ward: at ward entrance, at the nursing station; inside the unit/ward: at 2 m from the patient. ** = safe storage, concerning contamination risks and security risks. *** = organized management of provision, with regular provision of products. Structure Handrub at bedside/point of care – percentage of beds served by handrub – should a benchmark be proposed? Handrub dispensers working Sink adequately placed* – percentage of beds served by sinks – percentage of beds served by sinks adequately equipped (paper towel, liquid soap) – should a benchmark be proposed? Automatic sink Taps/faucets not manipulated by hands Liquid soap available Liquid soap dispensers working No hand-operated liquid soap dispensers Availability of paper towels Availability of gloves at point of care Availability of skin care products Adequate storage of products** Adequate provision of hand hygiene products*** Written hand hygiene guidelines or recommendations available Process Promotion of institutional climate (posters, award, etc.) Extensive and complete education programmes A product selection process has been implemented Feedback performance to staff No staff downsizing or understaffing No overcrowding Active participation at individual and institutional level Senior management support Institutional/corporate commitment to the use of alcohol-based handrub and the monitoring of its use Outcome Monitor adherence of staff to hand hygiene practices Monitor adherence at time of outbreak Monitor appropriate use of gloves Monitor adherence to nail and artificial nail policies Monitor regular presence of hand hygiene products in the units Monitor the amount of handrub used (surrogate marker) Count used paper hand towels (surrogate marker; value could decrease with time) Reduction in infection rates Reduction in cross-transmission rates (i.e. MRSA, VRE) Reduction in antimicrobial resistance spread Cost implications of hand hygiene promotion
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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
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23. Lee YL et al. Colonization by S
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Interscience Conference on Antimicr
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122. Vicca AF. Nursing staff worklo
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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 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: Table I.21.2: Unsolved issues for 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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