Establishing a Learning Model for Correct Hand Hygiene Technique in a NICU

Abstract

The ability of healthcare workers to learn proper hand hygiene has been an understudied area of research. Generally, hand hygiene skills are regarded as a key contributor to reduce critical infections and healthcare-associated infections. In a clinical setup, at a Neonatal Intensive Care Unit (NICU), the outcome of a multi-modal training initiative was recorded, where objective feedback was provided to the staff. It was hypothesized that staff at the NICU are more sensitive towards applying increased patient safety measures. Outcomes were recorded as the ability to cover all hand surfaces with Alcohol-Based Handrub (ABHR), modelled as a time-series of measurements. The learning ability to rub in with 1.5 mL and with 3 mL was also assessed. As a secondary outcome, handrub consumption and infection numbers were recorded. It has been observed that some staff members were able to quickly learn the proper hand hygiene, even with the limited 1.5 mL, while others were not capable of acquiring the technique even with 3 mL. When analyzing the 1.5 mL group, it was deemed an insufficient ABHR amount, while with 3 mL, the critical necessity of skill training to achieve complete coverage was documented. Identifying these individuals helps the infection control staff to better focus their training efforts. The training led to a 157% increase in handrub consumption. The setting of the study did not allow to show a measurable reduction in the number of hospital infections. It has been concluded that the training method chosen by the staff greatly affects the quality of the outcomes.

Evidence-based hand hygiene: Liquid or gel handrub, does it matter?

“…By giving HCWs a volume calibrated to their hand can have three positive effects: coverage will increase for larger handed people, spillage and material waste will decrease, and compliance might increase as well since reports described that less rubbing time is preferred by HCWs. This is in line with the recent finding on the influencing factors of hand hygiene learning curves, measured in a clinical setup [33].…”

Development and Implementation of an Ultraviolet-Dye-Based Qualification Procedure for Hand Washing and Disinfection to Improve Quality Assurance of Pharmacy Preparations and Compounding, Especially in Cleanrooms: A Pilot Study

“…Another explanation suggests an important role of the volume of water applied. In hand washing, there is a continuous flow of moving water and soap foam, making the rubbing hand motions less crucial than when applying a ‘static’ volume of 3 mL of disinfection solution, as done during hand disinfection [ 51 ].…”

“…It was found in our study that, after the 4th step (see Figure 1 ) of the disinfection process, the majority of the operators required a second portion of 1–3 mL hand alcohol as the prescribed actions could not be completed within the drying time. This seems to depend on technique and probably experience, as some operators did achieve complete coverage within 20–30 s. Research by Nemeth et al also showed that increasing the volume of hand alcohol from 1.5 mL to 3 mL is effective only when the actions are performed correctly [ 51 ]. Increasing the volume of hand alcohol can provide operators with the extra time needed to complete the actions, even with a slower hand movement speed.…”

Preventing Healthcare-Associated Infections: Hand Disinfection Monitoring Using an Automated System in an Italian Neurological Hospital

“…The threshold for passing the test with an excellent technique was to achieve an overall disinfected hand area of 95% [20,35]. The scanner provided feedback on areas missed during disinfection.…”

“…Since the World Health Organization (WHO) recommendations on hand hygiene created in 2009, a five-dimensional model was proposed to support successful infection prevention and control (IPC): (1) Alcohol-Based Hand Rub (ABHR) at the point of care for the HCW, (2) ABHR assessment and performance feedback, (3) continuous training and education, (4) widespread reminders in the workplace, and (5) institutional safety and a supportive climate [32][33][34]. Recent studies have highlighted the value of automated systems for hand-disinfection technique assessment, albeit with limited geographic representativeness [22,35,36].…”