Influence of rings on the efficacy of hand sanitization and residual bacterial contamination.

BACKGROUND: Previous studies, conducted before widespread use of scrubless, alcohol-based hand sanitizers, demonstrated increased residual bacterial counts after hand hygiene on hands with jewelry. OBJECTIVE: To compare the impact of finger rings on the effectiveness of scrubless and water-aided alcohol-based hand sanitization methods with that of povidone-iodine scrub. DESIGN: Randomized, controlled study.Setting. University hospital.Participants. Sixty volunteer subjects from a pool of perioperative staff and medical students. INTERVENTION: After recruitment, participants wore a ring on one hand and no ring on the other hand. They were randomly assigned to perform hand hygiene with a povidone-iodine scrub, an alcohol wash, or a waterless alcohol-chlorhexidine lotion (n=20 subjects per method). After subjects completed hand hygiene, gloves were placed on their hands by means of sterile methods, and a "glove juice" technique was used to obtain samples for culture. The number of colony-forming units in each culture was counted, and the data were compared. RESULTS: There was no significant difference in the number of bacteria between hands with and hands without rings for the groups that used alcohol wash or alcohol-chlorhexidine lotion. However, for the povidone-iodine group, the number of bacteria on hands with rings was greater than the number on hands without rings (P<.05). The hands of participants who used waterless alcohol-chlorhexidine had the lowest bacterial count, regardless of the presence of rings (P<.01). CONCLUSIONS: The presence of rings does not negatively impact the effectiveness of alcohol-based hand sanitizers. Use of waterless alcohol-chlorhexidine lotion resulted in the lowest bacterial count.     

Comparison of the antibacterial efficacy and acceptability of an alcohol-based hand rinse with two alcohol-based hand gels during routine patient care

The aims of this study were to compare the antibacterial efficacy of handrubbing with an alcoholic rinse (AHRR) and two different alcoholic gels (AHRG) in reducing hand contamination under practical use conditions. We wanted to assess the acceptability of the three products and to determine the effect of each product on overall hand hygiene compliance. A prospective alternating time-series clinical trial was performed in a medical intensive care unit. The study was divided into three six-week periods (P1, P2, P3). Handrubbing was achieved with Sterillium rinse (AHRR) during P1, sterillium gel(AHRG-1) during P2 and Manugel Plus (AHRG-2) during P3. Pre- and post-rubbing hand contaminations were assessed immediately after a direct contact with a patient, using the glove juice technique. Health care workers (HCWs) evaluated the acceptability of the products through a self-administered anonymous questionnaire. Compliance of HCWs with hand hygiene was assessed during the three periods. We studied 242 handrubbing opportunities. The mean reduction factor (expressed as the Log(10) CFU/mL) of the AHRR, AHRG-1 and AHRG-2 were 1.28+/-0.95, 1.29+/-0.84 and 0.51+/-0.73, respectively (p<0.001). Assessment of the three products by HCWs indicated that AHRR and AHRG-1 were significantly better accepted than AHRG-2. The overall compliance of HCWs to hand hygiene was better when gel was available. Under practical use conditions, AHRG-1 and AHRR were more effective than AHRG-2, although all were claimed to pass the European standard EN1500. In vivo trials are essential to compare the antimicrobial efficacy of products for handrubbing.     

Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study

The aim of this study was to evaluate the comparative microbiological efficacy of hand rubbing and handwashing in healthcare workers from different wards, with particular emphasis on transient flora, and to assess predisposing factors for hand contamination after patient care in everyday practice. Over a six-month period, 50 healthcare workers were randomly assigned, using a crossover design, to perform handwashing with unmedicated soap and hand rubbing with an alcoholic solution following a healthcare procedure. Imprints of palms and fingertips were taken separately before and after each hand hygiene procedure. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Hand rubbing produced a significantly greater reduction in microbiological load than handwashing (P<0.0001 for palms and P=0.0003 for fingertips). In multivariate analysis, working in a medical ward rather than in an intensive care unit was significantly associated with increased hand contamination (P=0.03 for palms and P=0.02 for fingertips). Transient pathogens were found on 15% of healthcare workers' hands before hand hygiene. The only factor associated with hand contamination by transient pathogens was the absence of gloving during the healthcare procedure (odds ratio 4.8; 95% confidence interval 1.2-19; P=0.03). After hand rubbing, no transient pathogens were recovered, while these were found in two cases after handwashing. Hand rubbing is more efficacious than handwashing for the decontamination of healthcare workers' hands following contact with patients and patients' environments. Gloving may reduce microbiological hand contamination by transient pathogens.     

医务人员手机染菌量监测分析

医院是救死扶伤的场所，也是病原微生物聚集的场所，医院的特殊环境可使医务人员有因工作而发生医院感染的职业危害。手机是医务人员重要的通讯工具，其在临床检查治疗中由于工作限制和条件限制，常未洗手就接听电话。为了解医务人员手机细菌污染情况，我们对此进行了监测，现将监测结果报告如下。     

Analysis of bacterial infections in a neonatal intensive care unit

An analysis was made of all cases of infection among 181 neonates admitted to the neonatal intensive care unit (NICU) during one year. Twenty-four per cent had an infection on admission; their infections correlated with prolonged ruptured membranes and the degree and site of colonization. The predominant organisms found in perinatal infections were Staphylococcus aureus, Group B streptococci and Escherichia coli. Thirty per cent acquired a hospital infection. This correlated with the length of the period of instrumentation. The majority of the hospital-acquired infections was caused by Gram-positive cocci (micrococci, Staph. saprophyticus, Staph. aureus, forming 65 per cent of the total), E. coli and Pseudomonas aeruginosa. Most hospital infections were nosocomial and not auto-infection. The outcome of the neonates with hospital infection was good, except for those with pseudomonas infection. Acquisition of hospital infection prolonged the period of hospitalization up to twice that required for neonates without infection.     

Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit.

BACKGROUND: Hand hygiene (HH) is critical to infection control, but compliance is low. Alcohol-based antiseptics may improve HH. HH practices in Russia are not well described, and facilities are often inadequate. SETTING: Four 6-bed units in a neonatal intensive care unit in St. Petersburg, Russia. METHODS: Prospective surveillance of HH compliance, nosocomial colonization, and antibiotic administration was performed from January until June 2000. In February 2000, alcohol-based hand rub was provided for routine HH use. Eight weeks later, a quality improvement intervention was implemented, consisting of review of interim data, identification of opinion leaders, posting of colonization incidence rates, and regular feedback. Means of compliance, colonization, and antibiotic use were compared for periods before and after each intervention. RESULTS: A total of 1,027 events requiring HH were observed. Compliance was 44.2% before the first intervention, 42.3% between interventions, and 48% after the second intervention. Use of alcohol rose from 15.2% of HH indications to 25.2% between interventions and 41.5% after the second intervention. The incidence of nosocomial colonization (per 1,000 patient-days) with Klebsiella pneumoniae was initially 21.5, decreased to 4.7, and then was 3.2 in the final period. Rates of antibiotic and device use also decreased. CONCLUSIONS: HH may have increased slightly, but the largest effect was a switch from soap and water to alcohol which may have been associated with decreased cross-transmission of Klebsiella, although this may have been confounded by lower device use. Alcohol-based antiseptic may be an improvement over current practices, but further research is required.     

新生儿重症监护病房医务人员手卫生依从性多中心干预研究

目的通过采取一系列干预措施提高我国新生儿重症监护病房(NICU)医务人员手卫生依从性。方法以多中心研究的方式,选取全国9个省及直辖市17所三级甲等医院,采用世界卫生组织(WHO)手卫生调查方法,每月对医务人员进行手卫生依从性调查。2013年10月1日—2014年3月31日为干预前;2014年4月1日—9月30日采取及时反馈与强化培训等干预措施,即为干预后。结果医务人员手卫生依从率干预前为80.29%,干预后为80.85%,干预前后比较,差异无统计学意义(P0.05)。不同规模NICU医务人员手卫生依从率干预前后比较,差异均有统计学意义(均P0.05),其中20张、20~30张床位的NICU医务人员手卫生依从率干预后均高于干预前(均P0.05),30张床位的NICU医务人员手卫生依从率干预后低于干预前(P0.001)。保洁人员手卫生依从率由干预前的58.82%提高至干预后的68.09%,差异有统计学意义(P0.05);不同手卫生指征中除清洁或无菌操作前,其他手卫生指征医务人员手卫生依从率干预前后比较,差异均有统计学意义(均P0.05)。结论我国NICU医务人员的手卫生依从性处于较高水平,采取强化培训、及时反馈等干预措施对不同规模NICU、不同岗位医务人员、不同手卫生指征的手卫生依从性有一定影响。     

Factors associated with Army obstetricians-gynecologists' practice of HIV prevention education during routine gynecologic care.

The authors evaluate obstetricians-gynecologists' (OB-GYNs') anxiety about clinical uncertainty and patient, physician, and organizational factors associated with their selection of HIV-related educational activities for high-risk and low-risk written case simulations. A total of 117 U.S. Army OB-GYNs completed a mailed, anonymous questionnaire. Overall, informants were much less likely to educate in response to the low-risk simulation; however, more informants who were anxious about uncertainty were more likely to do so in a model that included supportive institutional policies, willingness to educate despite patient barriers, and comfort with the topic. OB-GYNs were more likely to educate in response to the high-risk simulation given greater willingness to discuss HIV despite organizational barriers, supportive policies, and comfort. Findings suggest a need to better understand the role that anxiety about uncertainty plays in HIV prevention and the need to promote organizational policies that support and remove barriers to clinically based education.     

The importance of soap selection for routine hand hygiene in hospital.

Five different types of liquid soap were studied in hospital wards, each during two months'' use. Altogether 1306 finger print samples were taken from the hands of the staff by sampling twice a week and the acceptability of the soaps was measured by a questionnaire. During the use of different soaps only slight differences were found in the numbers of total bacteria or in the occurrence of Staph. aureus and gram-negative bacilli on the hands. During the use of the emulsion-type product studied, several persons who had dermatological problems had lower mean bacterial counts of the fingers than during the use of the other soaps. This soap was also favourably accepted by the staff. After over one year''s use of pine oil soap and alcohol, the staff of the hospital was satisfied with the method. However, several persons with skin problems admitted to not using soap or alcohol. The considerable differences found in the acceptability of soaps imply that for use in hospital the choice of a soap acceptable to the nursing staff is important in promoting proper hand hygiene.     

Intrinsic Klebsiella pneumoniae contamination of liquid germicidal hand soap containing chlorhexidine.

We describe intrinsic contamination with Klebsiella pneumoniae occurring during the manufacture of germicidal hand soap, labeled as containing 2% chlorhexidine, used throughout a 350-bed community medical center. A 3-year retrospective study failed to find evidence of increased incidence of clinical isolates of this strain.     

A pilot study of three methods for the reduction of bacterial contamination of dental unit water systems in routine use

Three different methods for minimizing the bacterial contamination of the water system in a SIRONA C2 type dental unit were investigated sequentially. Without any decontamination method, water from the hand piece, air-water-jet and mouthwash were continuously contaminated by 10(3) to 10(5) colony forming units (cfu) of aerobic mesophilic bacteria per milliliter. A reduction to below 100 cfu/ml was achieved by continuous adding of a chemical microbicide based on hydrogen peroxide and silver ions. However, this was only possible after rinsing the system thoroughly for at least two minutes after interruptions of the treatment. Long-lasting low counts of below 100/ml were obtained by means of an in-line bacteria filter, in connection with the provision of a thermo-chemical or thermal decontamination of the water pipes and hand pieces after the filter. The electrolyte release of chlorine from the dental unit tap water by anodic oxidation without addition of any chemical disinfectant also resulted in continuously low colony numbers of the water. In this case, regular decontamination of the end parts of the pipes and hand pieces was not necessary.     

某院新生儿重症监护室定植菌筛查及临床意义

目的了解某院新生儿重症监护室（NICU）收治的新生儿体内细菌定植情况和临床特点。方法对2011年4月-2012年3月入住该院NICU的277例新生儿咽拭子、诱导痰、脐分泌物、血标本进行定植菌筛查或感染菌培养,其中无感染者仅作咽拭子培养。结果277例新生儿中,29例送检标本检测到细菌,细菌检出率为10.47%;菌种包括19株表皮葡萄球菌,5株大肠埃希菌,3株肺炎克雷伯菌,1株金黄色葡萄球菌,1株阴沟肠杆菌。日龄≤2 d的新生儿细菌分离率为2.20%,3～7 d者为21.54%,8～28 d者为36.67%;日龄≤2 d与3～7 d及8～28 d新生儿的细菌分离率差异均有显著性（χ2分别为26.52、46.54,均P＜0.01）,日龄3～7 d与8～28 d新生儿的细菌分离率差异无显著性（χ2=2.42,P＞0.05）。结论该院NICU新生儿体内细菌定植以表皮葡萄球菌为主。出生48 h内新生儿细菌定植率低,开展定植菌筛查临床意义不大,建议对出生48 h内的新生儿不再常规进行定植菌筛查,可对出生3 d以上的新生儿进行定植菌筛查。     

Centralized infant formula preparation room in the neonatal intensive care unit reduces incidence of microbial contamination

Increasing concern regarding potential pathogens in infant formulas led to this evaluation of the influence of procedural and environmental factors on infant formula contamination. In two phases of study, a total of 526 formula samples were analyzed for contamination. In Phase 1, conducted from October 2001 through May 2002, nursing staff prepared formulas in the neonatal intensive care unit at bedside; in Phase 2, conducted from February 2006 through June 2006, dietetic technicians prepared formulas in a centralized feeding preparation room. Two types of formula, ready-to-feed and powder, were sampled. Each sample was divided into two portions; the first was cultured immediately, and the second after 8 hours at room temperature. Multivariate binary logistic regression models were tested to identify the major factors contributing to contamination. Results showed formulas prepared at bedside were 24 times more likely to show contamination than those prepared in a central location (P<0.001) and that powdered formulas were 14 times more likely to be contaminated than ready-to-feed formulas (P<0.001). In addition, samples that had been warmed (P<0.050) and those that were either milk-based or casein hydrolysate (P<0.001) were more likely to be contaminated. This study suggests that centralized feeding preparation results in a significant decrease in prevalence of microbial growth. Because contamination risk increases significantly with the use of powdered formulas, sterile liquid formulas should be considered when possible to minimize risk of microbial exposure in the neonatal intensive care unit population.     

Epidemiology of nosocomial bacterial infections in a neonatal and pediatric Tunisian intensive care unit

OBJECTIVE: The authors had for aim to describe the epidemiology of nosocomial bacterial infections in the neonatal and pediatric intensive care unit of the Tunis children's hospital. DESIGN: A prospective surveillance study was made from January 2004 to December 2004. All patients remaining in the intensive care unit for more than 48 h were included. CDC criteria were applied for the diagnosis of nosocomial infections. RESULTS: 340 patients including 249 (73%) neonates were included. 22 patients presented with 22 nosocomial bacterial infections. The incidence and the density incidence rates of nosocomial bacterial infections were 6.5% and 7.8 per 1,000 patient-days, respectively. Two types of infection were found: bloodstream infections (68.2%) and pneumonias (22.7%). Bloodstream infections had an incidence and a density incidence rate of 4.4% and 15.3 per 1,000 catheter-days, respectively. Pneumonia had an incidence and a density incidence rate of 2% and 4.4 per 1,000 mechanical ventilation-days, respectively. The most frequently isolated pathogens were Gram-negative bacteria (68%) with Klebsiella pneumoniae isolates accounting for 22.7%. The most common isolate in bloodstream infections was K. Pneumoniae (26.7%), which was multiple drug-resistant in 85% of the cases, followed by Staphylococcus aureus (20%). Pseudomonas aeruginosa was the most common isolate in pneumonia (28.6%). Associated factors of nosocomial infection were invasive devices and colonization with multiple drug-resistant Gram-negative bacteria. CONCLUSIONS: The major type of nosocomial bacterial infections in our unit was bloodstream infection and the majority of infections resulted from Gram-negative bacteria. Factors associated with nosocomial bacterial infections were identified in our unit.