A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers

Price, Lesley; Melone, Lynn; McLarnon, Nichola; Bunyan, D.; Kilpatrick, Claire; Flowers, Paul; Reilly, Jacqui

doi:10.1016/j.ajic.2018.01.020

Cited by 22 publications

(23 citation statements)

References 23 publications

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“…Although methodical hand rubbing with an antiseptic solution using the seven-step technique has been shown to reduce the formation of CFUs [36], there remains controversy, as some researchers claim that no single technique is clearly superior to any other, since the results obtained may be affected by other factors, such as the thoroughness of performance or the time employed in the procedure [37].…”

Section: Discussionmentioning

confidence: 99%

Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review

Martos-Cabrera

Mota-Romero

Martos-García

et al. 2019

IJERPH

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Background: Patient safety is a priority of any healthcare system, and one of the most effective measures is hand hygiene. For this, it is important that health staff have correct adherence and perform the technique properly. Otherwise, the incidence of nosocomial infections can increase, with consequent complications. The aim here was to analyze hand hygiene training and the effectiveness of different methods and educational strategies among nurses and whether they maintained correct adherence over time. Methods: A systematic review was conducted in the sources CINAHL (Cumulative Index to Nursing and Allied Health Literature), Dialnet, Lilacs (Latin American and Caribbean Health Sciences Literature), ProQuest (Proquest Health and Medical Complete), Medline, SciELO (Scientific Electronic Library Online), and Scopus. The search equation with Medical Subject Headings (MeSH) descriptors was “Nurs* AND (handwashing OR hand hygiene) AND clinical trial”. The review was performed following the recommendations of the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: n = 17 clinical trials were included, with a total of 5747 nurses and nursing students. Strategies such as reminder sounds, practical simulations, videos, and audiovisual media improved handwashing compliance. Adherence overtime increased by up to 60%. The greatest effectiveness was related to the use of povidone–iodine, which reduced colony formation compared Hand hygiene teaching strategies among nursing staff: a systematic review to soap. Conclusions: The strategies that go beyond teaching techniques such as lectures may be more effective at increasing hand hygiene compliance. Combined approaches to learning/instruction improve user satisfaction by enabling self-management, flexibility, and repetition.

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Section: Discussionmentioning

confidence: 99%

Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review

Martos-Cabrera

Mota-Romero

Martos-García

et al. 2019

IJERPH

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“…A presença de recomendação de técnica de higienização das mãos esteve presente em 87,5% das unidades. No entanto, almejava-se que obtivesse o valor máximo na pesquisa, por ser amplamente reconhecida como uma das principais estratégias para a prevenção das IRAS (Price et al, 2018;Anvisa, 2018).…”

Section: Discussionunclassified

Programas de Controle de Infecção Relacionada à Assistência à Saúde: avaliação de indicadores de estrutura e processo

Neves

Flório

Zanin

2022

RSD

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Este estudo possui o objetivo de avaliar os Programas de Controle de Infecção Relacionada à Assistência à Saúde em oito hospitais municipais de São Luís - MA. Trata-se de estudo descritivo e exploratório, quantitativo, realizado em 2020, por meio de aplicação de um instrumento constituído por quatro indicadores clínicos, sendo dois de estrutura (Estrutura Técnico-Operacional do Programa de Controle de Infecção Relacionada à Assistência à Saúde e Diretrizes Operacionais de Controle e Prevenção de Infecção Relacionada à Assistência à Saúde) e dois de processos (Sistema de Vigilância Epidemiológica de Infecção Relacionada à Assistência à Saúde e Atividades de Controle e Prevenção de Infecção Relacionada à Assistência à Saúde). O indicador que avalia as diretrizes operacionais apresentou a maior média de conformidade (70,5%), seguido do indicador que avalia a estrutura técnico-operacional (68,8%). Os indicadores de estrutura apresentaram menor conformidade (37,5%) nos componentes reuniões com lideranças e gestores, espaço físico exclusivo para suas atividades e padronização de soluções germicidas e antissépticos. Os indicadores de processo apresentaram menores índices nos componentes relacionados à realização de relatórios relativos às infecções hospitalares (37,5%) e realização de atividades de controle e prevenção no setor de nutrição e dietética (12,5%). Os serviços avaliados apresentam melhor desempenho nos indicadores de estrutura e denotam fragilidade quanto às atividades essenciais para prevenção de infecções hospitalares, como realização de vigilância epidemiológica e desenvolvimento de estratégias de prevenção e controle destas infecções em diversos setores do hospital.

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“…Furthermore, studies focusing on handwashing with soap and water or investigating the effect of wearing long, varnished or artificial nails or hand jewellery, the use of gloves or with outcomes related to compliance with hand hygiene opportunity or technique or skin tolerance were not deemed eligible because these factors are not directly associated with the process of ABHR application. Finally, studies evaluating the effectiveness of ABHR products or hand rubbing technique were not considered for inclusion because systematic reviews on the effectiveness of these factors have already been conducted [ 8 , 10 ].…”

Section: Methodsmentioning

confidence: 99%

“…Systematic reviews exist on the interventions for improving compliance with hand hygiene [ 7 ], and on the effectiveness of hand hygiene technique [ 8 ], but none to the authors’ knowledge of other factors influencing hand hygiene effectiveness. There is a need to better understand the impact of these recognised factors on hand hygiene effectiveness, to identify the optimal duration of hand rubbing, and to determine the volume of ABHR that should be used to prevent infection transmission in healthcare.…”

Section: Introductionmentioning

confidence: 99%

Systematic review on factors influencing the effectiveness of alcohol-based hand rubbing in healthcare

Price

Gozdzielewska

Alejandre

et al. 2022

Antimicrob Resist Infect Control

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Background The effectiveness of hand rubbing with alcohol-based handrub (ABHR) is impacted by several factors. To investigate these, World Health Organization (WHO) commissioned a systematic review. Aim To evaluate the impact of ABHR volume, application time, rubbing friction and hand size on microbiological load reduction, hand surface coverage or drying time. Methods Medline, CINAHL, Web of Science and ScienceDirect databases were searched for healthcare or laboratory-based primary studies, published in English, (1980- February 2021), investigating the impact of ABHR volume, application time, rubbing friction or hand size on bacterial load reduction, hand coverage or drying time. Two reviewers independently performed data extraction and quality assessment. The results are presented narratively. Findings Twenty studies were included in the review. Categories included: ABHR volume, application time and rubbing friction. Sub-categories: bacterial load reduction, hand size, drying time or hand surface coverage. All used experimental or quasi-experimental designs. Findings showed as ABHR volume increased, bacterial load reduced, and drying times increased. Furthermore, one study showed that the application of sprayed ABHR without hand rubbing resulted in significantly lower bacterial load reduction than poured or sprayed ABHR with hand rubbing (− 0.70; 95%CI: − 1.13 to − 0.28). Evidence was heterogeneous in application time, volume, technique, and product. All studies were assessed as high risk of bias. Conclusions There is insufficient evidence to change WHO recommendation of a palmful of ABHR in a cupped hand applied for 20–30 s or manufacturer-recommended volume applied for about 20 s (Centers for Disease Control and Prevention). Future hand hygiene research should standardise volume, application time, and consider hand size.

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A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers

Abstract: This review provides evidence of the effectiveness of the WHO technique but does not identify the most effective hand hygiene technique. Questions to be addressed by further research are identified. Meanwhile, current practices should continue.

Cited by 22 publications

References 23 publications

Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review

Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review

Programas de Controle de Infecção Relacionada à Assistência à Saúde: avaliação de indicadores de estrutura e processo

Systematic review on factors influencing the effectiveness of alcohol-based hand rubbing in healthcare

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