Introduction of a Waterless Alcohol-Based Hand Rub in a Long-Term–Care Facility

Abstract

Objective:To examine the impact of introduction of an alcohol-based hand rub on hand hygiene knowledge and compliance and hand colonization of healthcare workers (HCWs) in a long-term-care facility (LTCF).Methods:Two floors of an LTCF participated. Ward A used the hand rub as an adjunct to soap and water; ward B was the control. HCWs' hands were cultured using the bag-broth technique forStaphylococcus aureus,gram-negative bacilli (GNB),Candida,and vancomycin-resistant enterococci (VRE). HCWs completed a questionnaire at baseline and after an educational intervention and introduction of rub.Results:Hand hygiene practices, knowledge, and opinions did not change after the educational or rub intervention. Ward A HCWs thought that the rub was faster (P= .002) and less drying (P= .04) than soap. Hand hygiene frequency did not differ at baseline between the two floors, but increased on ward A by the end of the study (P= .04). HCWs were colonized frequently with GNB (66%),Candida(41%), S.aureus(20%), and VRE (9%). Although colonization did not change from baseline on either ward, the rub was more effective in clearing GNB (P= .03) and S.aureus(P= .003). Nosocomial infection rates did not change.Conclusion:The alcohol-based hand rub was a faster, more convenient, less drying method of hand hygiene for HCWs in an LTCF, and it improved compliance. Although microbial colonization did not change, the rub was more efficacious in removing pathogens already present on the hands of HCWs.

Preventing healthcare-associated infection through education: Have surgeons been overlooked?

“…Infection rates decreased from 4.9 to 2.1 cases per 1,000 catheter days. The effectiveness of a self-study module combined with posters, fact sheets and lectures has since been further demonstrated in the ICU setting, with several studies showing significant decreases in catheter-related bloodstream infection (CRBSI) [17,[26][27][28], VAP [18,29] and hand hygiene adherence [30].…”

Hand Hygiene in the New Millennium: Drawing the Distinction Between Efficacy and Effectiveness

“…1 Two articles appearing in this issue of Infection Control and Hospital Epidemiology raise important issues pertaining to the position of alcohol hand rubs in the new guideline. 2,3 The first of these, by Dharan et al, describes a comparison of the antimicrobial efficacies of several waterless hand hygiene products when used at short application times (15 seconds). 2 These investigators compared one gel containing 60% ethanol with four alcohol-based rinses including a reference rinse containing 60% isopropyl alcohol in a crossover study of 12 volunteers in whom they tested the five hand rubs according to a modification of the European standard for establishing the efficacy of alcohol hand rubs (EN 1500).…”

“…2 In the second of these, Mody et al attempt to measure the impact of an alcohol-based hand rub (62% ethanol gel) on compliance with hand hygiene in a long-term-care facility. 3 This was a four-phase interventional trial (ie, baseline, education, introduction of the alcohol rub, and longterm follow-up of the rub) conducted on two 36-bed wards of a long-term-care facility. On ward A, the rub was made available along with usual soap and water hand washing.…”

“…2 In contrast, the study by Mody et al did attempt to measure the effectiveness of hand rub over plain soap and water in preventing infections. 3 However, because infections were compared between only two 36-bed units during 11 months, the study had low statistical power to demonstrate anything but a major reduction in rates. This fact led to the authors' recommendation that a larger, multicenter study be undertaken.…”

“…3 Although this would have been a reasonable surrogate marker for effectiveness, again no difference could be documented between intervention (alcohol rub) and control (plain soap and water) wards. Similar to the multitude of studies reviewed in the new guideline, 1 Mody et al were able to demonstrate the superior efficacy of alcohol rub over plain soap and water based on results of their cultures.…”