The association between shift patterns and the quality of hand antisepsis in a neonatal intensive care unit: An observational study

Rittenschober-Böhm, Judith; Bibl, Katharina; Schneider, Michael; Klasinc, Romana; Szerémy, Péter; Haidegger, Tamás; Ferenci, Tamás; Mayr, Michaela; Berger, Angelika; Assadian, Ojan

doi:10.1016/j.ijnurstu.2020.103686

Cited by 7 publications

(3 citation statements)

References 44 publications

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“…Workplace overload and stress have become a critical issue with NICU staff on a global scale, leading to gaps in patient safety, in some cases [ 40 ]. The lack of time spent is often cited as one of the leading causes of non-compliance, with hand hygiene requirements.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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

Németh

Nádor

Szilágyi

et al. 2022

JCM

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“…Typically missed areas (thumbs and dorsum) were not different when using the two formulations, suggesting that the same hand hygiene technique was followed in both cases. Several previous studies also found that thumbs and fingertips are the most frequently missed areas , [31,32], which suggests that the personal hand hygiene technique may be inappropriate in many cases.…”

Section: Discussionmentioning

confidence: 98%

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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“…Research in this special issue has adopted innovative longitudinal designs with objective data to further our understanding of the negative impact of long shifts on nurses’ wellbeing and performance, in particular on nurses’ sickness absence ( Rodriguez Santana et al., 2020 ). Shifts of 12 hours or more for nurses were also associated with reduced quality of hand antisepsis, measured with a scanner which can identify the coverage achieved during hand antisepsis ( Ritterschober-Böhm et al., 2020 ). This result is of high importance especially in the light of the current COVID-19 pandemic, during which long shifts have been widely adopted as a strategy to enhance staffing levels to cope with increasing demands on health services ( Huh, 2020 ).…”

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confidence: 99%