Is hand washing really needed in an intensive care unit?

1995 ◽  
Vol 23 (7) ◽  
pp. 1211-1216 ◽  
Author(s):  
Leonard J. Rossoff ◽  
Michael Borenstein ◽  
Henry D. Isenberg
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Washing

Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project

2018 ◽  
Vol 8 (5) ◽  
pp. 408-413 ◽  
Author(s):  
Arunava Biswas ◽  
Sangeeta Das Bhattacharya ◽  
Arun Kumarendu Singh ◽  
Mallika Saha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care Unit ◽  
Conceptual Framework ◽  
Neonatal Intensive Care ◽  
Hand Hygiene Compliance ◽  
Hand Washing ◽  
Root Cause ◽  
Hygiene Compliance

Abstract Objective Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit. Materials and Methods We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively. Results A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9–5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36–16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities. Conclusions Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.

Limited Impact of Sustained Simple Feedback Based on Soap and Paper Towel Consumption on the Frequency of Hand Washing in an Adult Intensive Care Unit

2002 ◽  
Vol 23 (3) ◽  
pp. 120-126 ◽  
Author(s):  
Marvin J. Bittner ◽  
Eugene C. Rich ◽  
Paul D. Turner ◽  
William H. Arnold
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prospective Trial ◽  
Hand Washing ◽  
Surgical Intensive Care Unit ◽  
Control Group ◽  
Surgical Intensive Care ◽  
Adult Intensive Care Unit ◽  
Paper Towel

Objective:To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption.Design:Prospective trial with a nonequivalent control group.Setting:Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU).Subjects:Unit staff.Intervention:Every weekday from May 26 through December 8,1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks.Results:Directly counted hand washing fell in the SICU from a baseline of 2.68 ± 0.72 (mean ± standard deviation) episodes per occupied bed per hour to 1.92 ± 1.35 in the follow-up period. In the MICU, episodes fell from 2.58 ± 0.95 (baseline) to 1.74 ± 0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36 ± 0.49 at baseline to 1.01 ± 0.36, with a return to 1.16 ± 0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r= -0.35 for the MICU,r= -0.46 for the SICU).Conclusions:Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.

Video surveillance audit of hand-washing practices in a neonatal intensive care unit

2015 ◽  
Vol 52 (5) ◽  
pp. 409-411 ◽  
Author(s):  
Rutvi Shah ◽  
Dipen V. Patel ◽  
Kushal Shah ◽  
Ajay Phatak ◽  
Somashekhar Nimbalkar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Video Surveillance ◽  
Neonatal Intensive Care ◽  
Hand Washing

Increasing ICU Staff Handwashing: Effects of Education and Group Feedback

1990 ◽  
Vol 11 (4) ◽  
pp. 191-193 ◽  
Author(s):  
Patricia M. Dubbert ◽  
Jeffrey Dolce ◽  
William Richter ◽  
Mary Miller ◽  
Stanley W. Chapman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Educational Intervention ◽  
Hand Washing ◽  
Group Feedback ◽  
Infection Control Nurse

AbstractThis study provides an evaluation of the effectiveness of methods to increase hand-washing (HW) by nurses working in an intensive care unit. After baseline observations, two interventions were implemented in sequence: three series of classes conducted by the infection control nurse (ICN); and feedback to staff about handwashing errors on the previous day. Staff were aware that handwashing was being observed throughout the study. The educational intervention produced an immediate increase in HW that was followed by a decline to baseline rates over four weeks. Feedback produced an improvement to 97% compliance that was sustained until completion of the study. Improvement in HW compliance following specified critical procedures was also observed following interventions.

scholarly journals Epidemiology and Prevention of Pseudomonas Aeruginosa Chest Infection in an Intensive Care Unit

1981 ◽  
Vol 9 (3) ◽  
pp. 260-265 ◽  
Author(s):  
D. V. Seal ◽  
Janet M. Strangeways
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Systemic Disease ◽  
Hand Washing ◽  
Epidemiological Investigation ◽  
Chest Infection ◽  
Bacterial Filters ◽  
Spread Of Infection

An epidemiological investigation of Pseudomonas aeruginosa in an Intensive Care Neurosurgical Unit has shown that there were epidemic, endemic and endogenous types present simultaneously. These pseudomonads were cultured from purulent sputa postoperatively and sometimes caused systemic disease. The epidemic type was traced to a ventilator and a nebulizer whilst the endemic and endogenous types were not found in environmental sites. Effective decontamination of equipment and the use of bacterial filters where possible are essential in preventing the spread of infection. Staff hygiene remains important, particularly hand washing with antiseptic soap preparations.

scholarly journals Molecular epidemiology ofPseudomonas aeruginosain an intensive care unit

1993 ◽  
Vol 110 (3) ◽  
pp. 427-436 ◽  
Author(s):  
G. Döring ◽  
M. Hörz ◽  
J. Ortelt ◽  
H. Grupp ◽  
C. Wolz
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hand Washing ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Aerosol Generation ◽  
Air Sampler ◽  
Route Of Transmission ◽  
Hygienic Measures ◽  
Hospital Acquired

SUMMARYGenotyping was used to analysePseudomonas aeruginosaisolates from sink drains and 15 intubated patients as part of a 3-month prospective study of strain transmission in a medical-surgical intensive care unit. Ninety percent of all washbasin drains were persistently contaminated with severalP. aeruginosagenotypes. In 60% (9/15) of the patients,P. aeruginosacolonization or infection was hospital-acquired:P. aeruginosastrains isolated from these patients were present in hospital sinks or in other patients before their admission. Since all patients were immobile, personnel were the probable route of transmission ofP. aeruginosain the hospital. The mechanism of strain transmission from sinks to hands during hand washing was investigated in a children's hospital. WhenP. aeruginosawas present at densities of > 105/c.f.u. per ml in sink drains, hand washing resulted in hand contamination withP. aeruginosavia aerosol generation in the majority of experiments orP. aeruginosawas detected using an air sampler above the washing basin. HighP. aeruginosacfu were present at 4.30 h in the eight sinks (5.4 × 105−7.0 × 1010c.f.u./ml), whereas at 13.00 hP. aeruginosac.f.u. were significantly lower (3.1 × 102−8.0 × 105c.f.u. / ml). These data reveal that the danger of bacterial contamination of hands during hand washing is highest in the morning. The identified transmission routes demand more effective hygienic measures in hospital settings particularly concerning personnel hands and sink drains.

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