Evidence-based Hand Hygiene - Can You Trust the Fluorescent-based Assessment Methods?

Bánsághi, Száva; Viola, Sári,; Szerémy, Péter; Lehotsky, Ákos; Takács, Barnabás; Tóth, Brigitta Krisztina; Haidegger, Tamás

doi:10.12700/aph.18.11.2021.11.16

Cited by 3 publications

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“…The scanner took digital images of both sides of the hands under UV-A light, and produced instant visual feedback regarding the coverage of the disinfectant. The users could see the evaluated images on the screen, and thus had the opportunity to learn how to avoid mistakes [ 28 ]. Every participant was allowed to use the device only once a day.…”

Section: Methodsmentioning

confidence: 99%

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

Németh

Nádor

Szilágyi

et al. 2022

JCM

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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.

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Section: Methodsmentioning

confidence: 99%

“…The other practical problem was the over-dosage of the disinfectant. Some workers balanced their technical deficiency with multiple ABHR dosage, which led to very high amounts of used disinfectant, and caused a raise on the financial side of some departments, particularly at the NICU [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

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

Németh

Nádor

Szilágyi

et al. 2022

JCM

Self Cite

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“…However, despite the established link between the UV dye covered surface and the reduction of contamination, a quantitative determination of the reduction factor according to the Szilágyi criteria is yet to be established [ 49 ]. Additionally, interpretation by different observers and further investigation of the effect of hand hygiene of personnel on the safety and stability of produced medicines may provide insightful revelations [ 55 ]. Nevertheless, when the average hand surface area of women (392 cm 2 ) and men (448 cm 2 ) is considered, even with the two small errors allowed according to the Szilágyi criteria [ 49 ], 99.70% and 99.74% of the hand surface area were covered by the applied product [ 56 ], respectively.…”

Section: Discussionmentioning

confidence: 99%

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

Knol,

Stob,

Woerdenbag

2024

Pharmacy

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Even though, nowadays, most medicines are manufactured industrially, patients may have medical needs that can only be met by a tailor-made approach. This requires the availability of pharmacy preparations made under Good Manufacturing Practice (GMP) conditions. An efficient hand hygiene practice is essential herewith, especially if sterile products that are prepared in a cleanroom are concerned. The effectiveness of hand washing and hand disinfection procedures greatly relies on adequate training. We carried out an observational cross-sectional pilot study aimed at optimizing hand hygiene training with objective and measurable quality assessments using an ultraviolet (UV) dye. Practical acceptance criteria for qualifying personnel through this method were set and evaluated. In total, 25 GMP-qualified cleanroom operators washed and disinfected their hands with UV dye hand wash lotion and UV dye hand alcohol, respectively. To obtain a proof-of-concept, the results were judged based on adherence to the WHO six-step protocol and associated acceptance criteria. Commonly missed areas were brought to light, and the influence of procedure duration was investigated. UV-dye-based assessments appeared to be more valuable in hand disinfection than in hand washing. In both procedures, the back of the hands and the thumbs were frequently missed. This underpins the need for enhanced and repeated education on hand washing and disinfection. Additionally, a dry skin gave rise to extra cleaning challenges. From this pharmacy practice pilot study with a focus on pharmaceutical product care, it may be concluded that the application of UV-dye-based assessments offers valuable insights for pharmacists to optimize hand hygiene, thereby increasing the safety of tailor-made medicines and on-site preparations.

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“…Distribution, and consequently hand coverage differences between liquid and gel formulated ABHRs were measured employing an innovative electronic and completely automated digital health technology system (Semmelweis Hand Hygiene System, HandInScan Zrt., Debrecen, Hungary), which has been shown to be superior to any human expert-based evaluation method [ 29 ]. Furthermore, application times, volume awareness and disinfectant spillage were also assessed for every single hand hygiene event.…”

Section: Methodsmentioning

confidence: 99%

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

Voniatis

Bánsághi

Veres

et al. 2023

Antimicrob Resist Infect Control

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Background Recent studies put under scrutiny the prevailing hand hygiene guidelines, which incorporate quantitative parameters regarding handrub volume and hand size. Understanding the criticality of complete (i.e., efficient) hand hygiene in healthcare, objectivization of hand hygiene related parameters are paramount, including the formulation of the ABHR. Complete coverage can be achieved with optimal Alcohol-Based Hand Rub (ABHR) provided. The literature is limited regarding ABHR formulation variances to antimicrobial efficiency and healthcare workers’ preference, while public data on clinically relevant typical application differences is not available. This study was designed and performed to compare gel and liquid format ABHRs (the two most popular types in Europe) by measuring several parameters, including application time, spillage and coverage. Methodology Senior medical students were invited, and randomly assigned to receive pre-determined ABHR volumes (1.5 or 3 ml). All the 340 participants were given equal amounts of gel and liquid on two separate hand hygiene occasions, which occurred two weeks apart. During the hand hygiene events, by employing a digital, fully automated system paired with fluorescent-traced ABHRs, disinfectant hand coverage was objectively investigated. Furthermore, hand coverage in relation to the participants’ hand sizes was also calculated. Additional data collection was performed regarding volume differences and their effect on application time, participants’ volume awareness (consciousness) and disinfectant spillage during the hand hygiene events. Results The 1.5 ml ABHR volume (commonly applied in healthcare settings) is insufficient in either formulation, as the non-covered areas exceeded significant (5%+) of the total hand surface area. 3 ml, on the contrary, resulted in almost complete coverage (uncovered areas remained below 1.5%). Participants typically underestimated the volume which they needed to apply. While the liquid ABHR spreads better in the lower, 1.5 ml volume compared to the gel, the latter was easier handled at larger volume. Drying times were 30/32 s (gel and liquid formats, respectively) when 1.5 ml handrub was applied, and 40/42 s when 3 ml was used. As the evaporation rates of the ABHR used in the study are similar to those available on the market, one can presume that the results presented in the study apply for most WHO conform ABHRs. Conclusion The results show that applying 1.5 ml volume was insufficient, as large part of the hand surface remained uncovered (7.0 ± 0.7% and 5.8 ± 1.0% of the hand surface in the case of gel and liquid, respectively) When 3 ml handrub was applied drying times were 40 and 42 s (gel and liquid, respectively), which is a very long time in daily clinical practice. It looks like we cannot find a volume that fits for everyone. Personalized, hand size based ABHR volumes may be the solution to find an optimal balance between maximize coverage and minimise spillage and drying time. 3 ml can be a good volume for those who have medium size hands. Large handed people should use more handrub to reach appropriate coverage, while small-handed ones may apply less to avoid massive spillage and not to take unrealistically long to dry.

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Evidence-based Hand Hygiene - Can You Trust the Fluorescent-based Assessment Methods?

Cited by 3 publications

References 0 publications

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

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

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

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

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