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Frequency of Use of Alcohol-Based Hand Rubs by Nurses: A Systematic Review

  • John M. Boyce (a1), Philip M. Polgreen (a2), Mauricio Monsalve (a3) (a4), David R. Macinga (a5) and James W. Arbogast (a5)...

Abstract

BACKGROUND

Recently, the US Food and Drug Administration requested that a “maximal use” trial be conducted to ensure the safety of frequent use of alcohol-based hand rubs (ABHRs) by healthcare workers.

OBJECTIVE

To establish how frequently volunteers should be exposed to ABHR during a maximal use trial.

DESIGN

Retrospective review of literature and analysis of 2 recent studies that utilized hand hygiene electronic compliance monitoring (ECM) systems.

METHODS

We reviewed PubMed for articles published between 1970 and December 31, 2015, containing the terms hand washing, hand hygiene, hand hygiene compliance, and alcohol-based hand rubs. Article titles, abstracts, or text were reviewed to determine whether the frequency of ABHR use by healthcare workers was reported. Two studies using hand hygiene ECM systems were reviewed to determine how frequently nurses used ABHR per shift and per hour.

RESULTS

Of 3,487 citations reviewed, only 10 reported how frequently individual healthcare workers used ABHR per shift or per hour. Very conservative estimates of the frequency of ABHR use were reported owing to shortcomings of the methods utilized. The greatest frequency of ABHR use was recorded by an ECM system in a medical intensive care unit. In 95% of nursing shifts, individual nurses used ABHR 141 times or less per shift, and 15 times or less per hour.

CONCLUSIONS

Hand hygiene ECM systems established that the frequency of exposure to ABHRs varies substantially among nurses. Our findings should be useful in designing how frequently individuals should be exposed to ABHR during a maximal use trial.

Infect Control Hosp Epidemiol 2017;38:189–195

Copyright

Corresponding author

Address correspondence to John M. Boyce, MD, J. M. Boyce Consulting, 62 Sonoma Ln, Middletown, CT 06457 (jmboyce69@gmail.com).

References

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1. Boyce, JM, Pittet, D, Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for hand hygiene in health-care settings. MMWR Recomm Rep 2002;51:145.
2. World Health Organization. WHO Guidelines for Hand Hygiene in Health Care. Geneva: World Health Organization; 2009.
3. US Food and Drug Administration. Proposed rule: safety and effectiveness of health care antiseptics. Fed Regist 2015;80:84.
4. Boyce, JM, Cooper, T, Lunde, A, Yin, J, Arbogast, J. Impact of an electronic hand hygiene monitoring system trial on hand hygiene compliance in a surgical intensive care unit and general medical ward. In: Program and abstracts of 2012 IDWeek; October 19, 2012; San Diego, CA. Abstract 1008.
5. Monsalve, MN, Pemmaraju, SV, Thomas, GW, et al. Do peer effects improve hand hygiene adherence among healthcare workers? Infect Control Hosp Epidemiol 2014;35:12771285.
6. Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med 1999;130:126130.
7. Hugonnet, S, Perneger, TV, Pittet, D. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Intern Med 2002;162:10371043.
8. Cohen, B, Hyman, S, Rosenberg, L, Larson, E. Frequency of patient contact with health care personnel and visitors: implications for infection prevention. Jt Comm J Qual Patient Saf 2012;38:560565.
9. Westbrook, JI, Li, L, Georgiou, A, Paoloni, R, Cullen, J. Impact of an electronic medication management system on hospital doctors’ and nurses’ work: a controlled pre-post, time and motion study. J Am Med Inform Assoc 2013;20:11501158.
10. Westbrook, JI, Duffield, C, Li, L, Creswick, NJ. How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interactions with health professionals. BMC Health Serv Res 2011;11:319.
11. Meengs, MR, Giles, BK, Chisholm, CD, Cordell, WH, Nelson, DR. Hand washing frequency in an emergency department. Ann Emerg Med 1994;23:13071312.
12. Levchenko, AI, Boscart, VM, Fernie, GR. The feasibility of an automated monitoring system to improve nurses’ hand hygiene. Int J Med Inform 2011;80:596603.
13. Witterick, P, Stuart, R, Gillespie, E, Buist, M. Hand hygiene during the intensive care unit ward round: how much is enough? An observational study. Crit Care Resusc 2008;10:285287.
14. Koff, MD, Loftus, RW, Burchman, CC, et al. Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device. Anesthesiology 2009;110:978985.
15. Krediet, AC, Kalkman, CJ, Bonten, MJ, Gigengack, AC, Barach, P. Hand-hygiene practices in the operating theatre: an observational study. Br J Anaesth 2011;107:553558.
16. Larson, E, Silberger, M, Jakob, K, et al. Assessment of alternative hand hygiene regimens to improve skin health among neonatal intensive care unit nurses. Heart Lung 2000;29:136142.
17. Winnefeld, M, Richard, MA, Drancourt, M, Grobb, JJ. Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br J Dermatol 2000;143:546550.
18. Boyce, JM, Kelliher, S, Vallande, N. Skin irritation and dryness associated with two hand hygiene regimens: soap and water handwashing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol 2000;21:442448.
19. Visser, MJ, Behroozy, A, Verberk, MM, Semple, S, Kezic, S. Quantification of wet-work exposure in nurses using a newly developed wet-work exposure monitor. Ann Occup Hyg 2011;55:810816.
20. Storey, SJ, FitzGerald, G, Moore, G, et al. Effect of a contact monitoring system with immediate visual feedback on hand hygiene compliance. J Hosp Infect 2014;88:8488.
21. Muller, MP, Levchenko, AI, Ing, S, Pong, SM, Fernie, GR. Electronic monitoring of individual healthcare workers’ hand hygiene event rate. Infect Control Hosp Epidemiol 2014;35:11891192.
22. Radhakrishna, K, Waghmare, A, Ekstrand, M, et al. Real-time feedback for improving compliance to hand sanitization among healthcare workers in an open layout ICU using radiofrequency identification. J Med Syst 2015;39:68.
23. Monsalve, M, Pemmaraju, S, Polgreen, PM. Interactions in an intensive care unit: experiences pre-processing sensor network data. In: Program and abstracts of the 4th Conference on Wireless Health; November 1-3, 2013; Baltimore, MD.
24. Steed, C, Kelly, JW, Blackhurst, D, et al. Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 Benchmark Study. Am J Infect Control 2011;39:1926.
25. Fries, J, Segre, AM, Thomas, G, et al. Monitoring hand hygiene via human observers: how should we be sampling? Infect Control Hosp Epidemiol 2012;33:689695.
26. Marra, AR, Moura, DF Jr, Paes, AT, dos Santos, OF, Edmond, MB. Measuring rates of hand hygiene adherence in the intensive care setting: a comparative study of direct observation, product usage, and electronic counting devices. Infect Control Hosp Epidemiol 2010;31:796801.
27. Morgan, DJ, Pineles, L, Shardell, M, et al. Automated hand hygiene count devices may better measure compliance than human observation. Am J Infect Control 2012;40:955959.
28. Magnus, TP, Marra, AR, Camargo, TZ, et al. Measuring hand hygiene compliance rates in different special care settings: a comparative study of methodologies. Int J Infect Dis 2015;33:205208.
29. Kinsella, G, Thomas, AN, Taylor, RJ. Electronic surveillance of wall-mounted soap and alcohol gel dispensers in an intensive care unit. J Hosp Infect 2016;66:3439.

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