Group Members Santana Suckra Sashonie Taylor Natasha-Lee Roache Tressan Ritchie Tameka Stewart Althea Walker
Clinical question: Is antiseptic hand washing as effective as alcohol sanitizer in reducing the rates of hospital acquired infections?
Patient: • Hospitalized patients • Intervention: • Hand washing • Comparison: • Alcohol sanitizer • Outcome: • Reducing the rates of hospital acquired infections.
Introduction In a health-care setting certain procedures and guidelines are essential and the implementation of hand hygiene is one such requirement. Hand hygiene involves general hand washing with the use of soap and water and the use of antiseptic agents such as antiseptic hand rubs or antiseptic hand wash (Rosenthal, Guzman & Safdar, 2005).
Introduction Cont’d According to the World Health Organization (WHO) a hospital acquired infection is “An infection acquired in hospital by a patient who was admitted for a reason other than that infection.” or “An infection occurring in a patient in a hospital or other health care facility in whom the infection was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility.”
Antiseptic hand washing versus the alcohol hand sanitizer/rubs It has been noted by that both antiseptic hand washing and alcohol sanitizers contribute to a reduction of nosocomial infections during hospitalization. However, some studies concluded that alcohol hand rubs are more effective in reducing bacterial contamination during patient care routine compared to antiseptic hand washing (Girou et al., 2003).
Antiseptic hand washing versus the alcohol hand sanitizer/rubs Another study suggest that antiseptic hand washing is more effective at removing the Clostridium Difficile bacteria that result is a nosocomial infection (Jabbar et al., 2010). There are also studies saying that there is no difference between the effectiveness of the antiseptic hand washing versus the alcohol hand rubs (Larson et al., 2005).
Study 1: In a randomized qualitative study conducted by Girou et al. in 2003, twenty-three (23) patients, permanent and temporary nurses and nursing assistants volunteered to participate. Twelve (12) health care workers were allocated to hand rubbing with a waterless alcohol based solution and eleven (11) were allocated to hand washing with antiseptic soap. Patient care activities were monitored during daily sessions of 2–3 hours until a predetermined number of eligible activities had been performed. The conclusion was that hand rubbing with an alcohol based solution reduced bacterial contamination of healthcare workers’ hands more than hand washing with antiseptic soap during routine patient care activities.
Study 2: Larson et al. (2005) conducted study using a crossover design in two (2) neonatal intensive care units inclusive 2932 neonatal hospital admissions and 119 nurse participants. Larson et al. compared the effects of two (2) hand hygiene regimens in infection rates between the traditional antiseptic hand wash and an alcohol hand sanitizer. Each product was used for 11 consecutive months in each neonatal intensive care unit in random order. The study concluded that there was no difference seen on the nurses’ hands during the hand washing and alcohol phase. However, assessment of infection rates in a single intervention was limited because of multiple contributory factors such as patient risk, unit design, and staff behavior. Other practices such as frequency and quality of hand hygiene are likely to be as important as product in reducing risk of cross-transmission.
Study 3: This study was a comparison of alcohol based hand rubs (ABHRs) as an effective means of decreasing the transmission of bacterial pathogens. Even though alcohol is not effective against the bacteria known as Clostridium Difficile (C. Difficile) spores. The study was conducted by Jabbar et al. in 2010 with ten (10) persons volunteering for C. Difficile to be spread on their bare palms. The use of three (3) ABRRs and hand washing with chlorhexidine (antiseptic) soap were compared with plain water rubbing alone for removal of C. Difficile. The result of the study stated that there were no statistically significant differences in the reductions achieved by the ABHRs. Therefore it was concluded that hand washing with soap and water is significantly more effective at removing C. Difficile spores than ABHRs and after the use of ABHRs with a single handshake the residual spores are readily transferred.
STUDY 1 This study was conducted with 23 participants in three intensive care units in a University Hospital in France. 12 participants were assigned to use a hand rubbing agent with a waterless alcohol based solution and 11 were assigned to hand washing with antiseptic soap. The participants had already been instructed on the use of alcohol based solution as there was a policy that had been implemented 1 year previously in the hospital. Each ICU had copies of the policies.
The study zeroed in on the effectiveness of antiseptic hand washing over hand rubbing with a sanitizer. This article was helpful in formulating a generalized conclusion. The results of the study were formulated by testing the participants hand after hand hygiene with any products was done. Researchers did this by taking an imprint of the fingertips and palm of participant’s dominant hand 1 minute before and after the procedure, to count the amount of bacteria present.
Limitations Some participants were reported to have washed hands under the recommended 30 second time limit, which would have been inadequate time for decontamination to be at an optimal level. Also, there was no suggestion in the article how they differentiated normal flora from infection-causing bacteria.
STUDY 2 This study was centred in two (2) Neonatal Intensive care units in Manhattan New York which included 119 nurse participants. The participants were oriented to the study products and procedures. Also a comparison was done on two hand hygiene products; they were antiseptic hand wash and an alcohol hand sanitizer. Both agents were used for 11 consecutive months, where both were alternated following random order.
A six-point scale was used to examine the hand at magnification x 3. A special technique known as the glove-juice technique used for sampling was done to differentiate between normal flora and microbes. The outcome variable in the model was the presence or absence of any infection in each neonate. The sample size was adequate for the type of research being conducted as there is a greater sample size fit for comparison.
Limitations In the study, there was no indication that hand washing procedures were performed within the 30 second time interval. Infections that were not yet diagnosed (i.e. infections arising after study was conducted) may have gone undetected.
References Girou ??? . (2003). Efficacy of handrubbing with alcohol based solution versus standard handwashingwith antiseptic soap: randomised clinical trial. ??? Retrieved from: http://ebn.bmj.com/content/6/2/54.full.html Jabbar, U., Leischner, J., Kasper, D., Gerber, R., Sambol, S. P., Parada, J. P., ... & Gerding, D. N. (2010). Effectiveness of Alcohol‐Based Hand Rubs for Removal of Clostridium difficile Spores from Hands. infection control and hospital epidemiology, 31(6), 565-570. Retrieved from: http://www.jstor.org/stable/10.1086/652772 Larson, E. L., Cimiotti, J., Haas, J., Parides, M., Nesin, M., Della-Latta, P., & Saiman, L. (2005). Effect of antiseptic handwashingvs alcohol sanitizer on health care-associated infections in neonatal intensive care units. Archives of pediatrics & adolescent medicine, 159(4), 377. Retrieved from: http://archpedi.jamanetwork.com/article.aspx?articleid=485991 Moralejo, D., & Jull, A. (2003). Handrubbing with an alcohol based solution reduced healthcare workers’ hand contamination more than handwashing with antiseptic soap. Evidence Based Nursing, 6(2), 54-54. Retrieved from: http://ebn.bmj.com/content/6/2/54.short
References Cont’d Rocha, L. A., Nunes, M. J., & GontijoFilho, P. P. (2012). Low Compliance to Handwashing Program and High Nosocomial Infection in a Brazilian Hospital.Interdisciplinary Perspectives on Infectious Diseases, 2012. Retrieved from: http://www.hindawi.com/journals/ipid/2012/579681/abs/ Rosenthal, V. D., Guzman, S., & Safdar, N. (2005). Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. American journal of infection control, 33(7), 392-397. Retrieved from: http://www.nursingconsult.com/nursing/journals/0196-6553/full-text/PDF/s019665530500430x.pdf?issn=0196-6553&full_text=pdf&pdfName=s019665530500430x.pdf&spid=15731325&article_id=492627 World Health Organization. (2002). Prevention of hospital-acquired infections: A Practical Guide 2nd edition. Retrieved from: http://www.who.int/emc