M L Earl, in M M Jackson, L s Rickm...

M L Earl, in M M Jackson, L s Rickman American Journal of Nursing Vol 101 (March 2001) 26-33

Hand washing is the single principally effective means of preventing nosocomial infection; however, health care providers frequently neglect the practice. Approximately brace million patients annually acquire a potentially life-threatening nosocomial infection. Although various rinse-free, alcohol-based gel issues have been developed as an alternative to traditional hand washing systems they have yet to pass through large-scale testing in the clinical arena. The plan of this study was to determine if making hand antisepsis (ie, degerming with an alcohol-based gel) quicker and more convenient would increase compliance with the hand antisepsis guidelines of the Association of Professionals in Infection superintendence and Epidemiology (APIC).

Methodology. This was a three-phase observational investigation conducted in two intensive care units (ie, 13-bed medical and 20-bed surgical) between January and May 1999 at an academic medical center Although the managers of the units being studied were informed of the project those being observed were not. When data collectors were questioned, they told those in subordination to observation that they were conducting an infection command study. Five public health graduate bookish mans observed and recorded episodes of patient contact that would necessitate hand antisepsis and noted whether it actually occurred

Phase single in kind determined the baseline frequency of staff member performance of hand antisepsis when it was required. Dispensers of alcohol-based gel then were installed the pair inside and outside patient plays Phase two examined the rates of hand antisepsis pair to six weeks after installation of the dispensers. Phase three measured hand antisepsis compliance 10 to 14 weeks after installation of the dispensers.

conclusions There were 402 total hours of observation for all phases of the meditation A 49% (1,481 of 3015) compliance rate was observ for those situations where APIC guidelines commend hand antisepsis.

During phase united of the study, in 432 instances where washing with soap and water should have occurr hand antisepsis occurr 396% of the time. In phase sum of two units a 52.6% compliance rate was observ indicating the rate of hand antisepsis had increased from 32.8%. Employment status was a significant factor. During phase sum of two units the compliance rate among ancillary personnel (42%) improved the principally from baseline, followed by physicians (392%) and nursing personnel (316%) The location of dispensers was a factor in in what way often alcohol-based gel was used. Those identified as nursing personnel were greatest in quantity likely to use alcohol-based gel antisepsis (628%) During phase three 475 instances of hand antisepsis were observ indicating an 84% increase from phase two

Overall, nursing personnel followed hand antisepsis 569% of the time, a 5% increase from phase sum of two units and 38.1% from baseline. Physicians followed guidelines 437% of the time, an increase of 71% from phase brace and 49.2% from baseline.

Discussion. This consideration supports the notion that the availability of alcohol-based gel consequences in conveniently located places (eg wall soared in patient care areas or rooms) conclusions in an increase in hand antisepsis rates by way of all personnel. Hand antisepsis increased 328% pair to six weeks after the alcohol-based gel outcomes were made available and continued to increase at 10 to 14 weeks after the intervention. The greatest in quantity interesting finding is that although all providers were noted to increase compliance, personnel in technical and ancillary positions had the highest horizontals of compliance. This study establish that the introduction of a rinse-free, alcohol-based gel in strategically placed dispensers was effective in increasing compliance with APIC hand antisepsis guidelines.

Limitations. First, in this close attention the Hawthorne effect (ie, subjects' awareness that they are being observed) may have accounted for the increased compliance with hand antisepsis. The mean duration of hand antisepsis was 94 secondarys (standard deviation = [+ or -] 4/9) which is too short for soap and water to be effective in preventing microbial carriage. secondary these findings may not be representative of other facilities because of differences in staff members, demographics, physical plant, and the measure to which hand antisepsis is emphasized. Third, researchers did not account for the impact of this intervention onward the rate of nosocomial infection. It, therefore, is unknown whether instituting alcohol-based gel as an alternative to soap and water had an impact upon patient outcomes (eg, nosocomial infections). Although this meditation found an increase in hand antisepsis initially, it is unknown if compliance with hand antisepsis will continue.

Perioperative Implications. Many members of the surgical team may comply with standard precautions on the other hand not wash their hands routinely after patient contact or glove removal. At my facility, we freshly began using an alcohol-based gel as an alternative to soap and water when the hands of care providers are not visibly soiled because of the complaint that soap and water are not always easily accessible in the patient care area. This is authentic in the OR, where common would have to leave the sweep to access soap and water. Perhaps the introduction of a rinse-free, alcohol-based gel in convenient locations would be an effective means of increasing hand antisepsis rates in the OR.