Education of hand rubbing technique to prospective medical staff, employing UV-based digital imaging technology

Abstract

The aim of this study was to objectively assess the hand hygiene performance of medical students. Hand rubbing technique was evaluated by employing innovative UV-light-based imaging technology, identifying patterns and trends in missed areas after applying WHO's six-step protocol. This specially designed hand hygiene education and assessment program targeted 1,344 medical students at two distant sites in Central Europe. Students were introduced to a short video, presenting the basics of hand hygiene, and then received further demonstration from professional trainers, focusing on the correct execution of WHO's six-step technique. To verify the acquired skill, participants rubbed their hands with UV-marked alcohol-based solution. Digital images of the hands were recorded under UV light, followed by computer evaluation and assessment. Immediate objective visual feedback was given to the participants showing missed areas on their hands. The statistical analysis of missed spots was based on retrospective expert-driven manual evaluation. Significant difference in rubbing quality was found between female and male participants [35.3% (CI 95%: 33-38%) versus 29.0% (CI 95%: 27-31%), p < 0.001], dominant and non-dominant hands [43.4% (CI 95%: 39-48%) versus 34.9% (CI 95%: 32-38%), p = 0.002], and various zones of the hands' dorsal side. Based on the participants' feedback and the evaluation of the infection control specialists, it can be stated that the identification of typically missed patterns and the instant visual feedback have a vital role in improving the hand hygiene technique of prospective medical staff. Keywords: hand hygiene assessment, fluorescein trial, medical students training Introduction "Have we forgotten the lesson of Semmelweis?" -stands the question in Lancet [1], referring to the generally weak hand hygiene (HH) performance of physicians in hospitals. Fortunately, the 4% compliance rate reported at a gynecology ward represents an extremely low value [2], but the usually reported rates of 20-50% are still far below expectations [3][4][5]. The main reported reasons for this poor performance include the tight time schedules, forgetfulness, unsatisfactory knowledge on HH guidelines, denying the importance of hands as a source of infection, negative influence of older, more experienced specialists, and skin irritations caused by hand rub solutions [6,7]. Education and training play a vital role in promoting HH [8,9].It is a widely shared concept that the nursing staff shows a better compliance on average than the physicians [3,10]. The unsatisfactory quality of knowledge is clearly supported by the observation that according to physicians' opinion, less HH moments are enough than the amount believed necessary by other healthcare workers [11]. As an interesting analogy, the question of antibiotic resistance is generally believed of high importance by medical students; however, it will be treated superficially during their later work as physicians, similarly to the question of HH [12]. Nurses consider the d...

Using an ultraviolet cabinet improves compliance with the World Health Organization’s hand hygiene recommendations by undergraduate medical students: a randomized controlled trial

“…This was similar to the baseline rate observed in the first-year intervention group (30.7%), with ongoing training yielding a positive impact on outcomes. Lehotsky et al observed that third-year students in the basic surgical techniques class used a UV based system for assessment and auto feedback immediately after receiving HH education [16]. This study reported a completeness rate of handrubbing of 61.8%, which is also very similar to the rate observed during the second-year intervention group (60%).…”

“…Some studies previously reported using supervised personal feedback with UV light inspection systems in the medical students' training programs [11,12,16]. In all these studies, the absence of a control group did not allow individualizing the proper effect of feedback with Table 4 Respect of the WHO's hand hygiene opportunities on second year ("the five moments for HH in health care") The moments refer to the WHO's indications for hand hygiene ("the five moments for HH in health care") Compliance at the entry is 100% in both groups because assessment of application of the AHR under UV light was done at this step Each student was evaluated during the scenario-based learning for an arterial puncture (first attempt).…”

“…Some studies previously reported using supervised personal feedback with UV light inspection systems in the medical students’ training programs [ 11 , 12 , 16 ]. In all these studies, the absence of a control group did not allow individualizing the proper effect of feedback with UV within the rest of the training program.…”

Health Technology Assessment of Ultraviolate light based imaging technology to reduce burden of hospital acquired infections: A Study Protocol

“…Over last few years, there has been a wide use of ultraviolate (UV) based uorescent markers for assessing quality of hand hygiene [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. This technological intervention involves performance of recommended WHO six steps using Alcohol-based hand rub with a uorescent marker by health care workers followed by viewing under UV based lamp to identify the quality of hand hygiene.…”

Health Technology Assessment of Ultraviolate light based imaging technology to reduce burden of hospital acquired infections: A Study Protocol

“…Over last few years, there has been a wide use of ultraviolate (UV) based fluorescent markers for assessing quality of hand hygiene [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. This technological intervention involves performance of recommended WHO six steps using Alcohol-based hand rub with a fluorescent marker by health care workers followed by viewing under UV based lamp to identify the quality of hand hygiene.…”