Skip to main content Accessibility help
×
Home

The Role of Handwashing in Prevention of Endemic Intensive Care Unit Infections

  • Bryan Simmons (a1), Jerri Bryant (a2), Kim Neiman (a3), Linda Spencer and Kris Arheart (a4)...

Abstract

Handwashing is believed to be the most important means of preventing nosocomial infections. Previous studies of healthcare workers (HCWs) have shown that handwashing practices are poor. No one has shown that handwashing practices can be easily improved and that this prevents endemic (non-epidemic) nosocomial infection. Handwashing and infection rates were studied in two intensive care units (ICUs) of a community teaching hospital. Handwashing rates were monitored secretly throughout the study. After six months of observation, we started interventions to increase handwashing. Handwashing increased gradually, but overall rates before (22.0%) and after (29.9%) interventions were not significantly different (p = .071). Handwashing never occurred before intravenous care, whereas it occurred 67.5% for all other indications (p<.0001). When questioned, nurses felt they were washing appropriately nearly 90% of the time. Infection rates seemed unrelated to handwashing throughout the study, and no clusters of infection were detected. We conclude that handwashing rates, when measured against arbitrary but reasonable standards, are suboptimal, difficult to change and not closely related to evidence of cross-infection. Further, nurses wash hands selectively, depending on the indication for handwashing, and generally believe they are washing much more frequently than an objective observer believes they are.

Copyright

Corresponding author

188 S. Bellevue, Suite 419, Memphis, TN 38104

References

Hide All
1.Daschner, FD. The transmission of infections in hospitals by staff carriers, methods of prevention and control. Infect Control. 1985;6:9799.
2.Larson, E. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control Hosp Epidemiol. 1988;9:2836.
3.Haley, RW, Tenney, JH, Lindsey, JO, Gamer, JS, Bennett, JV. How frequent are outbreaks of nosocomial infection in community hospitals? Infect Control. 1985;6:223226.
4.Wenzel, RP, Thompson, RL, Landry, SM, et al. Hospital-acquired infections in intensive care unit patients: an overview with emphasis on outbreaks. Infect Control. 1983;4:371375.
5.Schaberg, DR, Haley, RW, Highsmith, AK, et al. Nosocomial bacteriuria, a prospective study of case clustering and antimicrobial resistance. Ann Intern Med. 1980;93:420424.
6.Albert, RK, Condie, F. Handwashing patterns in medical intensive care units. N Engl J Med. 1981;304:14651466.
7.Kaplan, LM, McGuckin, M. Increasing handwashing compliance with more accessable sinks. Infect Control. 1986;7:408410.
8.Preston, GA, Larson, EL, Stamm, WE. The effect of private isolation rooms on patient care practices, colonization, and infection in an intensive care unit. Am J Med. 1981;70:641645.
9.Mayer, JA, Dubbert, PM, Miller, M, et al. Increasing handwashing in an intensive care unit. Infect Control. 1986;7:259262.
10.Centers for Disease Control. National Nosocomial Infections Study Site Definitions Manual. Atlanta, Ga: Centers for Disease Control; 1975.
11.Simmons, BP, Hooton, TM, Mallison, GF. Antiseptics, handwashing, and handwashing facilities. Guideline for environmental control, part I. Znfect Control. 1981;2:131146.
12.Steere, AC, Mallison, GF. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med. 1975;83:683690.
13.Geller, ES, Eason, SL, Phillips, JA, et al. Interventions to improve sanitation during food preparation. Journal of Organizational Behaviorial Mangement. 1980;2:229240.
14.Maki, D. The use of antiseptics for handwashing by medical personnel. J Chemother. 1989;1(suppl 1):311.
15.Centers for Disease Control. Recommendations for precautions of HIV transmission in health care settings. MMWR. 1987;36:S3S18.
16.Gamer, J, Simmons, BP. Guidelines for isolation precautions in hospitals. Infect Control. 1983;4:245325.
1'7.Doebbehng, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove: implications for glove reuse and handwashing. Ann Intern Med. 1988;109:394398.
18.Reingold, AL, Kane, MA, Hightower, AW. Failure of gloves and other protective devices to prevent transmission of hepatitis B virus to oral surgeons. JAMA. 1988;259:25582560.
19.Klein, BS, Perloff, WH, Maki, DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med. 1989;320:17141721.
20.Raven, BH, Haley, RW. Social influence and compliance of hospital nurses with infection control policies. In: Esner, JR, ed. Social Psychology and Behavioral Medicine. Chichester, England: John Wiley & Sons Ltd.; 1982.
21.Larson, E, McGinley, KJ, Grove, CL, et al. Physiologic, microbiologic, and seasonal effects of handwashing on the skin of healthcare personnel. Am J Infect Control. 1986;14:5159.

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed