Factors interfering with the microflora on hands: a regression analysis of samples from 465 healthcare workers

Abstract

fagernes m. & lingaas e. (2011) Factors interfering with the microflora on hands: a regression analysis of samples from 465 healthcare workers. Journal of Advanced Nursing 67(2), 297–307. Abstract Aims. This paper is a report of a study of the impact of finger rings, wrist watches, nail polish, length of fingernails, hand lotion, gender and occupation on hand microbiology of healthcare workers. Background. The impact of the above mentioned variables on hand microbiology of healthcare workers is not well defined. Large scale studies suitable for multivariate analysis are needed to elucidate their role. Methods. Both hands of 465 Norwegian healthcare workers were sampled by the glove juice method during two study periods (2004 and 2007), and examined for total number of bacteria and presence of Staphylococcus aureus, Enterobacteriacea and non‐fermentative Gram‐negative rods. Multiple regression analysis was performed. Results. The use of a wrist watch was associated with an enhanced total bacterial count on hands compared to hands without a watch [(B) 3·25 (95% CI: 1·73–6·07), P < 0·001], while the use of one plain finger ring increased the carriage rate of Enterobacteriaceae [odds ratio 2·71 (95% CI: 1·42–5·20), P = 0·003]. The carriage rate of Staphylococcus aureus was enhanced with fingernails longer than 2 mm [odds ratio 2·17 (95% CI: 1·29–3·66), P = 0·004] and after recent use of hand lotion [odds ratio 22·52 (95% CI: 4·05–125·30), P < 0·001]. No effect of nail polish was observed. We found an association between occupation and carriage rate of S. aureus and Enterobacteriaceae. Conclusions. Health care workers should remove finger rings and watches at work. Fingernails should be shorter than 2 mm, nail polish may be used.

Video observation of hand hygiene practices during routine companion animal appointments and the effect of a poster intervention on hand hygiene compliance

“…watches, rings, bracelets) increases the number of microbes harbored on the hands [43]. The majority of veterinary personnel seen performing hand hygiene in this study wore at least one such item, and removal of hand jewelry prior to hand hygiene was rarely observed.…”

“…There are very few studies examining the effect of wearing watches or bracelets on hand hygiene, with varying results [42,47]. While these items may or may not interfere with washing or sanitizing the hands and fingers, they have potential to interfere with these processes at the level of the wrist, and since they have been shown to increase bacterial load on the hands [43], some infection control guidelines recommend that these items be removed prior to patient contact or hand hygiene [7,8,32]. At a minimum, rings, watches and bracelets should be avoided if they are elaborate in design, or made from materials that absorb liquid and cannot be adequately cleaned if contaminated.…”

A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps”

“…Identifying certain risk groups and typical mistakes regarding the application patterns allows for the design of specific education programs and also helps to left the use of a hand rubbing protocol. Another advantage of the methodology is the ability to easily involve several thousand health care staff in the investigation, a major increase compared to the 465 subjects of the largest similar study [8]. Instead of applying restricted observation of nurses and physicians only, as most similar studies do, our investigations involved all staff of a single hospital because all health workers have the potential to contribute to cross-infection [31].…”

“…Several studies have investigated staff compliance to hand hygiene guidelines, however, most involved relatively small number of subjects, typically 50–500 [4-8]. Studies of hand hygiene in hospitals have focused on hand washing standards [9-11], improving hand rubbing technique [12,13], or the composition of the hand rub and scrub [14-18], the attitude of staff regarding compliance to hand hygiene moments [19,20], the impact of finger rings, wrist watches and other accessories upon hand hygiene quality [8,21], and strategies of monitoring the compliance to the 5 moments [22].…”

“…Studies of hand hygiene in hospitals have focused on hand washing standards [9-11], improving hand rubbing technique [12,13], or the composition of the hand rub and scrub [14-18], the attitude of staff regarding compliance to hand hygiene moments [19,20], the impact of finger rings, wrist watches and other accessories upon hand hygiene quality [8,21], and strategies of monitoring the compliance to the 5 moments [22]. Consensus guidelines and recommendations regarding hand hygiene have been produced through the WHO and descriptions on how they can be introduced have been published in [23,24].…”