Failure of Bland Soap Handwash to Prevent Hand Transfer of Patient Bacteria to Urethral Catheters

1991 ◽  
Vol 12 (11) ◽  
pp. 654-662 ◽  
Author(s):  
N. Joel Ehrenkranz ◽  
Blanca C. Alfonso
Keyword(s):  
Confidence Interval ◽  
Risk Ratio ◽  
Healthcare Workers ◽  
Isopropyl Alcohol ◽  
Gram Negative Bacteria ◽  
Patient Contact ◽  
Urinary Catheters ◽  
Gram Negative ◽  
High Burden ◽  
Direct Patient Contact

AbstractObjective:The study was designed to compare the efficacies of bland soap handwash and isopropyl alcohol hand rinse in preventing transfer of aerobic gram-negative bacilli to urinary catheters via transient hand colonization acquired from direct patient contact. Glove juice recovery of gram-negative bacteria was considered transient colonization; catheter recovery was considered transfer colonization.Design:The contact source for gram-negative bacteria was a single “high burden” groin skin carrier ( ≥ 104/ml cup scrub fluid). Using a two-period cross-over design, 6 healthcare workers had 2 15-second contacts for each hand followed by either soap handwash or alcohol hand rinse (12 experiments with each treatment). Between 4 to 5 minutes after contact, each hand manipulated a catheter; the catheter was then cultured and the hand was glove juice tested.Results:Soap handwash failed to prevent gram-negative bacteria transfer to the catheter in 11 of 12 (92%) experiments; alcohol hand rinse in 2 of 12 (17%) (p< .001). Soap handwash failed to prevent transient colonization in 12 of 12 (100%) experiments; alcohol in 5 of 12 (42%) (risk ratio 2.4,95% confidence interval 1.2-4.7). Single gram-negative bacteria species carried at source levels ≥ 5.5 × 103/ml (heavy contamination) established transient colonization in 23 of 30 (77%) exposures following soap handwash; single gram-negative bacteria species carried at levels ≤ 3.5 × 103/ml established colonization in 1 of 22 (5%) similar exposures (p<.001).Conclusions:Bland soap handwash was generally ineffective in preventing hand transfer of gram-negative bacteria to catheters following brief contact with a heavy-contamination patient source; alcohol hand rinse was generally effective.

Description of an Influenza Vaccination Campaign and Use of a Randomized Survey to Determine Participation Rates

2010 ◽  
Vol 31 (2) ◽  
pp. 151-157 ◽  
Author(s):  
Xuguang (Grant) Tao ◽  
Janine Giampino ◽  
Deborah A. Dooley ◽  
Frances E. Humphrey ◽  
David M. Baron ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Healthcare Workers ◽  
Vaccination Campaign ◽  
Vaccination Rate ◽  
Patient Contact ◽  
Participation Rates ◽  
Immunization Program ◽  
Influenza Immunization ◽  
Direct Patient Contact ◽  
Johns Hopkins University

Objectives.To describe the procedures used during an influenza immunization program and the use of a randomized survey to quantify the vaccination rate among healthcare workers with and without patient contact.Design.Influenza immunization vaccination program and a randomized survey.Setting.Johns Hopkins University and Health System.Methods.The 2008/2009 Johns Hopkins Influenza Immunization Program was administered to 40,000 employees, including 10,763 healthcare workers. A 10% randomized sample (1,084) of individuals were interviewed to evaluate the vaccination rate among healthcare workers with direct patient contact.Results.Between September 23, 2008, and April 30, 2009, a total of 16,079 vaccinations were administered. Ninety-four percent (94.5%) of persons who were vaccinated received the vaccine in the first 7 weeks of the campaign. The randomized survey demonstrated an overall vaccination rate of 71.3% (95% confidence interval, 68.6%-74.0%) and a vaccination rate for employees with direct patient contact of 82.8% (95% confidence interval, 80.1%-85.5%). The main reason (25.3%) for declining the program vaccine was because the employee had received documented vaccination elsewhere.Conclusions.The methods used to increase participation in the recent immunization program were successful, and a randomized survey to assess participation was found to be an efficient means of evaluating the workforce's level of potential immunity to the influenza virus.

Impact of Finger Rings on Transmission of Bacteria During Hand Contact

2009 ◽  
Vol 30 (5) ◽  
pp. 427-432 ◽  
Author(s):  
Mette Fagernes ◽  
Egil Lingaas
Keyword(s):  
Confidence Interval ◽  
Odds Ratio ◽  
Healthcare Workers ◽  
Bacterial Load ◽  
Analysis Of Covariance ◽  
Control Group ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
The Impact ◽  
Hand Contact

Objective.To investigate the impact of finger rings on the transmission of bacteria from the hands of healthcare workers and the impact on the microflora on the hands of healthcare workers in clinical practice.Design.Our study had a nonequivalent control group posttest-only design (pre-experimental). Healthcare workers who wore finger ring(s) on 1 hand and no ring on the other hand (n = 100) and a control group of healthcare workers who did not wear any rings (n = 100) exchanged standardized hand shakes with an investigator wearing sterile gloves. Samples from the gloved hands of the investigators and the bare hands of the healthcare workers were thereafter obtained by the glove juice technique.Setting.Two Norwegian acute care hospitals.Participants.Healthcare workers (n = 200) during ordinary clinical work.Results.A significantly higher bacterial load (odds ratio, 2.63 [95% confidence interval, 1.28-5.43]; P = .009) and a significantly higher number of bacteria transmitted (odds ratio, 2.43 [95% confidence interval, 1.44-4.13]; P = .001) were associated with ringed hands, compared with control hands. However, a multiple analysis of covariance revealed no statistically significant effect of rings alone. The prevalence of nonfermentative gram-negative bacteria (42% vs 26%) and Enterobacteriaceae (26% vs 13%) was also significantly higher among persons who wore rings than among persons who did not wear rings. However, no statistically significant differences in the incidence of transmission of these pathogens were detected after hand contact. The prevalence of Staphylococcus aureus and incidence of transmission of S. aureus were the same in both groups.Conclusions.Wearing finger rings increases the carriage rate of nonfermentative gram-negative bacteria and Enterobacteriaceae on the hands of healthcare workers. However, no statistically significant differences in the incidence of transmission of nonfermentative gram-negative bacteria or Enterobacteriaceae were detected between the healthcare workers who wore rings and those who did not.

Impact of a Single Plain Finger Ring on the Bacterial Load on the Hands of Healthcare Workers

2007 ◽  
Vol 28 (10) ◽  
pp. 1191-1195 ◽  
Author(s):  
Mette Fagernes ◽  
Egil Lingaas ◽  
Per Bjark
Keyword(s):  
Healthcare Workers ◽  
Paired Comparison ◽  
Bacterial Load ◽  
Physical Contact ◽  
Gram Negative Bacteria ◽  
Quantitative Culture ◽  
Control Groups ◽  
Gram Negative ◽  
The Impact ◽  
Paired Analysis

Objective.To investigate the impact of a single plain finger ring on the number and types of bacteria on the hands of healthcare workers (HCWs).Design.Nonequivalent control groups, posttest only (preexperimental).Methods.A total of 121 HCWs wearing 1 plain ring and 113 HCWs wearing no rings had both hands sampled by the “glove juice” technique. Quantitative culture of the samples was performed and microorganisms were identified.Setting.Two Norwegian acute care hospitals.Participants.A total of 234 HCWs who had physical contact with patients.Results.Total bacterial counts did not differ when hands with rings and hands without rings were compared, both according to nonpaired analysis (which compared the ring-bearing hands of ring-wearing HCWs to the hands of HCWs who did not wear rings [P= .661]) and according to paired analysis (which compared the ring-bearing and ring-free hands of ring-wearing HCWs [P= .071]).Staphylococcus aureuswas recovered from 18.6% of the hands sampled, belonging to 26.9% of the HCWs, but neither paired nor nonpaired analysis showed any association with ring wearing. Gram-negative bacteria were recovered from 20.3% of the hands sampled, belonging to 28.6% of the HCWs. Ring-wearing HCWs were significantly more likely to be carriers of Enterobacteriaceae (P= .006), but paired comparison of the ring-bearing and ring-free hands of these HCWs did not show significant differences (P= .180). Carriage of nonfermentative gram-negative rods did not differ between the 2 groups, by either paired or nonpaired analysis.Conclusions.Wearing a single plain finger ring did not increase the total bacterial load on the hands, nor was it associated with an increased rate of carriage ofS. aureusor nonfermentative gram-negative rods. However, plain rings were associated with an increased rate of Enterobacteriaceae carriage.

scholarly journals Comparable Efficacy and Better Safety of Double β-Lactam Combination Therapy versus β‑Lactam plus Aminoglycoside in Gram-Negative Bacteria in Randomized, Controlled Trials

2019 ◽  
Vol 63 (7) ◽  
Author(s):  
Yuanyuan Jiao ◽  
Bartolome Moya ◽  
Mong-Jen Chen ◽  
Alexandre P. Zavascki ◽  
Hsinyin Tsai ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Response ◽  
Risk Ratio ◽  
Sensitivity Analyses ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Content Type ◽  
Randomized Controlled

ABSTRACTThere is a great need for efficacious therapies against Gram-negative bacteria. Double β-lactam combination(s) (DBL) are relatively safe, and preclinical data are promising; however, their clinical role has not been well defined. We conducted a metaanalysis of the clinical and microbiological efficacy of DBL compared to β-lactam plus aminoglycoside combinations (BLAG). PubMed, Embase, ISI Web of Knowledge, and Cochrane Controlled Trials Register database were searched through July 2018. We included randomized controlled clinical trials that compared DBL with BLAG combinations. Clinical response was used as the primary outcome and microbiological response in Gram-negative bacteria as the secondary outcome; sensitivity analyses were performed forPseudomonas aeruginosa,Klebsiellaspp., andEscherichia coli. Heterogeneity and risk of bias were assessed. Safety results were classified by systems and organs. Thirteen studies evaluated 2,771 cases for clinical response and 665 cases for microbiological response in various Gram-negative species. DBL achieved slightly, but not significantly, better clinical response (risk ratio, 1.05; 95% confidence interval [CI], 0.99 to 1.11) and microbiological response in Gram-negatives (risk ratio, 1.11; 95% CI, 0.99 to 1.25) compared with BLAG. Sensitivity analyses by pathogen showed the same trend. No significant heterogeneity across studies was found. DBL was significantly safer than BLAG regarding renal toxicity (6.6% versus 8.8%,P = 0.0338) and ototoxicity (0.7 versus 3.1%,P = 0.0137). Other adverse events were largely comparable. Overall, empirically designed DBL showed comparable clinical and microbiological responses across different Gram-negative species, and were significantly safer than BLAG. Therefore, DBL should be rationally optimized via the latest translational approaches, leveraging mechanistic insights and newer β-lactams for future evaluation in clinical trials.

Epidemiology of Sepsis in the Valencian Community (Spain), 1995–2004

2008 ◽  
Vol 29 (7) ◽  
pp. 630-634 ◽  
Author(s):  
Juan Carlos Andreu Ballester ◽  
Ferran Ballester ◽  
Antonio González Sánchez ◽  
Amadeo Almela Quilis ◽  
Enrique Colomer Rubio ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Organ Failure ◽  
Incidence Rates ◽  
Public Hospitals ◽  
Polymicrobial Sepsis ◽  
Gram Negative Bacteria ◽  
Gram Negative

Objective.To study the incidence of sepsis in the Valencian Community (Spain) during a period of 10 years (1995–2004).Methods.We downloaded data on discharge diagnoses of septicemia in all 26 public hospitals in the Valencian Community during the 10-year study period, as well as the additional discharge diagnoses of each patient.Results.We identified 33,767 cases of sepsis during the study period. The age-standardized incidence rates among men increased from 64.11 (95% confidence interval [CI], 60.37–67.85) cases per 100,000 population in 1995 to 114.02 (95% CI, 109.02–118.50) cases per 100,000 population in 2004 (P < .001), and those among women increased from 45.08 (95% CI, 42.01–48.15) cases per 100,000 population in 1995 to 83.62 (95% CI, 79.85–87.39) cases per 100,000 population in 2004 (P < .001). Gram-negative bacteria were the most frequently involved microorganisms (in 21.4% of cases), and there was a significant increase in the number of sepsis cases caused by these organisms from 1999 onward. The mortality rate was approximately 42.5% among patients hospitalized for sepsis, and mortality was associated with organ failure. In addition, mortality was associated with the microorganism responsible not being known, with infection due to fungi, and with polymicrobial sepsis.Conclusions.The rates of hospitalization both for sepsis overall and for severe sepsis in the Valencian Community (Spain) are lower than those in other countries but are increasing, by 5% each year. The increase in the number of cases in which gram-negative bacteria are the cause of sepsis is notable.

scholarly journals Relationship between Triclosan and Susceptibilities of Bacteria Isolated from Hands in the Community

2004 ◽  
Vol 48 (8) ◽  
pp. 2973-2979 ◽  
Author(s):  
Allison E. Aiello ◽  
Bonnie Marshall ◽  
Stuart B. Levy ◽  
Phyllis Della-Latta ◽  
Elaine Larson
Keyword(s):  
Confidence Interval ◽  
Antibiotic Susceptibility ◽  
Community Setting ◽  
Consumer Products ◽  
Hand Washing ◽  
Gram Negative Bacteria ◽  
Odds Ratios ◽  
Gram Negative ◽  
Increasing Trend

ABSTRACT The possible association between triclosan and bacterial susceptibility to antibiotic was examined among staphylococci and several species of gram-negative bacteria (GNB) isolated from the hands of individuals in a community setting. Hand cultures from individuals randomized to using either antibacterial cleaning and hygiene products (including a hand soap containing 0.2% triclosan) or nonantibacterial cleaning and hygiene products for a 1-year period were taken at baseline and at the end of the year. Although there was no statistically significant association between triclosan MICs and susceptibility to antibiotic, there was an increasing trend in the association the odds ratios (ORs) for all species were compared at baseline (OR = 0.65, 95% confidence interval [95%CI] = 0.33 to 1.27) versus at the end of the year (OR = 1.08, 95%CI = 0.62 to 1.97) and for GNB alone at baseline(OR = 0.66, 95%CI = 0.29 to 1.51) versus the end of year (OR = 2.69, 95%CI = 0.78 to 9.23) regardless of the hand-washing product used. Moreover, triclosan MICs were higher in some of the species compared to earlier reports on household, clinical, and industrial isolates, and some of these isolates had triclosan MICs in the range of concentrations used in consumer products. The absence of a statistically significant association between elevated triclosan MICs and reduced antibiotic susceptibility may indicate that such a correlation does not exist or that it is relatively small among the isolates that were studied. Still, a relationship may emerge after longer-term or higher-dose exposure of bacteria to triclosan in the community setting.

scholarly journals Improving Antibacterial and Anti-biofilmic properties of urological catheters with Eucalyptus, Rosemary, Green tea and Ziziphora extracts by impregnation method

2021 ◽  
Author(s):  
Najme Akhlaghi-Ardekani ◽  
Davod Mohebbi-Kalhori ◽  
Abdolreza samimi ◽  
Reza Karazhyan
Keyword(s):  
Green Tea ◽  
Biofilm Formation ◽  
Antibacterial Agents ◽  
Antibacterial Properties ◽  
Polymer Materials ◽  
Gram Negative Bacteria ◽  
Impregnation Method ◽  
Herbal Extracts ◽  
Urinary Catheters ◽  
Gram Negative

Abstract The main complications of urinary catheters are the bacteria's biofilm formation and the urinary tract infection caused by gram-positive and gram-negative bacteria. In the recent years, the attention has changed its direction toward the antimicrobial, anti-biofilmic, and hydrophobicity effects of herbal extracts. Some of these extracts can inhibit the colonization of the two bacteria Staphylococcus aureus and Escherichia coli which are resistant to antibiotics. These bacteria can stick to the surface of polymer materials due to their hydrophobicity. Thus, antibacterial hydrophilic herbal extracts are supposed to help reduce the risk of the surficial infection if they are used to impregnate the urinary catheters. In this research, the extracts of these four plants eucalyptus, rosemary, green tea and ziziphora were used as the antibacterial agents. After the impregnation and modification of the sample catheters, they were tested by AFM, FE-SEM, ATR-FTIR methods to measure their mechanical, chemical, and hydrophilic properties, during the 21-day experiment period, compared to non-impregnated ones. The tests showed the silicone catheters impregnated by the herbal extracts have some significant anti-biofilmic and antibacterial properties (P˂0.0001) due to the increase in their hydrophilic property. The impregnated catheters could be release the extracts and killed bacteria in 21 days Therefore; some herbal extracts can be good alternatives to chemical drugs.

Indications for Alcohol or Bland Soap in Removal of Aerobic Gram-Negative Skin Bacteria: Assessment by a Novel Method

1989 ◽  
Vol 10 (7) ◽  
pp. 306-311 ◽  
Author(s):  
Debra G. Eckert ◽  
N. Joel Ehrenkranz ◽  
Blanca C. Alfonso
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Complete Removal ◽  
Contact Model ◽  
Patient Contact ◽  
Gram Negative ◽  
High Burden ◽  
Skin Bacteria ◽  
Care Workers ◽  
Novel Method

AbstractA patient contact model was devised for health care workers (HCWs) to define heavy hand contamination with aerobic gram-negative bacilli (AGNB) that requires alcohol for complete removal. In patients, AGNB quantitation was per ml cup scrub fluid; in HCWs, per ml glove juice. Following 15-second contact, two Proteeae groin carriers yielding ≥ 4 log10AGNB (high burden) transmitted ≥ 3 log10in 67% of 24 tests of six HCWs, and ≤ 2 log10in 29%. Two carriers yielding ≤ 3 log10(low burden) transmitted ≥ 3 log10in 8% and ≤ 2 log10in 38%. At ≤ 2 log10HCW acquisitions, soap eliminated all AGNB in six of seven tests; alcohol in nine of nine (p > 0.05). At ≥ 3 log10acquisitions, soap eliminated all AGNB in three of 10; alcohol in eight of eight Contacteight (p= 0.009). Contact with densely colonized patient skin may cause heavy AGNB contamination of HCWs' hands that generally necessitates alcohol for complete removal.

Correlation Between Respiratory Colonization With Gram-Negative Bacteria and Development of Gram-Negative Bacterial Infection After Cardiac Surgery

2008 ◽  
Vol 29 (6) ◽  
pp. 546-548 ◽  
Author(s):  
Pranavi V. Sreeramoju ◽  
Sylvia Garcia-Houchins ◽  
Judith Bova ◽  
Cynthia C. Kelly ◽  
Jan E. Patterson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Relative Risk ◽  
Observational Study ◽  
Confidence Interval ◽  
Bacterial Infection ◽  
Gram Negative Bacteria ◽  
Subsequent Infection ◽  
Gram Negative

This pilot, observational study involving 286 patients who underwent cardiac surgery found that patients who had endotracheal colonization with gram-negative bacteria at 1 week after surgery were more likely to develop subsequent infection compared to those without colonization (8 of 23 vs. 4 of 40; relative risk 2.3 [95% confidence interval, 1.3–4.1;Pvalue < .05]).

scholarly journals 515. Acquisition of Antibiotic-Resistant Gram-Negative Bacteria in the Benefits of Universal Glove and Gown (BUGG) Cluster Randomized Trial

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S248-S249
Author(s):  
Anthony Harris ◽  
Daniel Morgan ◽  
Lisa Harris ◽  
Laurence S Magder ◽  
Lyndsay M O’Hara ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Effect Sizes ◽  
Gram Negative Bacteria ◽  
Patient Contact ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Secondary Outcomes ◽  
Cluster Randomized

Abstract Background The Benefits of Universal Gloves and Gowns (BUGG) randomized trial found a decrease in MRSA acquisition, no effect on VRE acquisition and no increase in adverse events with the intervention of wearing gloves and gowns for all patient contact in the intensive care unit (ICU). The objective of the study was to assess whether wearing gloves and gowns for all patient contact in the ICU decreases the acquisition of antibiotic-resistant Gram-negative bacteria. Methods Design: Secondary study of the BUGG cluster-randomized trial. Participants: 20 medical and surgical ICUs in 20 US hospitals. Intervention: Healthcare workers were required to wear gloves and gowns when entering any patient room compared with standard care. Main outcomes and measures: The primary composite outcome was acquisition of any antibiotic-resistant Gram-negative bacteria based on surveillance cultures collected on admission and discharge. Secondary outcomes were acquisition of carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriaceae, or ESBL-producing Enterobacteriaceae. Results For the primary outcome, the intervention had a RR of 0.90 (95% CI 0.71 to 1.12, P = 0.34). Effects on the secondary outcomes were: carbapenem-resistant Enterobacteriaceae [RR 0.86 (95% CI, 0.60 to 1.24), P = 0.43], carbapenem-resistant Acinetobacter [RR 0.81 (95% CI, 0.52 to 1.27) P = 0.36], carbapenem-resistant Pseudomonas [RR 0.88 (95% CI, 0.55 to 1.42) P = 0.62], ESBL producing bacteria [RR 0.94, (95% CI, 0.71 to 1.24) P = 0.67]. Conclusion The association of universal glove and gown use in the ICU with acquisition of antibiotic-resistant Gram-negative bacteria was inconclusive. The observed rate ratios for all five outcomes suggest that the intervention was protective, however, none were statistically significant. The study was likely underpowered to detect statistical significance for the effect sizes found. Individual hospitals should consider implementing the intervention based on the importance of these organisms at their hospital, effect sizes, confidence intervals, and cost. Disclosures All authors: No reported disclosures.

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