The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare associated Infections

Pratt, Robert; Pellowe, Carol; Loveday, Heather; Robinson, Nicky; Gd, Smith; Barrett, Stephen; Davey, P; Harper, Peter; Loveday, Chey; McDougall, Claire; Mulhall, Anne; Privett, Sue; C, Smales; Taylor, Louise; Weller, Barbara; Wilcox, Mark H.

doi:10.1053/jhin.2000.0886

Cited by 277 publications

(144 citation statements)

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“…Not only has alcohol in preparations containing 60-90% alcohol been shown to provide the most effective decontamination for a wide variety of organisms, 6,7 but the use of rub-in gel or liquid preparations has increased compliance with hand-hygiene procedures across hospital staff. 8 The use of alcohol-based products for surgical hand disinfection is less wide-spread although current evidence Internationally, the Centers for Disease Control acknowledges the superior efficacy of alcohols in their Guidelines for Hand Hygiene in Health-Care Settings when compared to more traditional agents such as chlorhexidine gluconate or Povidone-iodine.…”

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confidence: 99%

Clean and Green: Saving Water in the Operating Theatre

Jehle

Jarrett

Matthews

2008

annals

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Ann R Coll Surg Engl 2008; 90: 22-24 22Tw enty years before Louis Pasteur developed the germ theory, Ignaz Semmelweis in Vienna established the practice of washing hands in a chloride solution to prevent puerperal fever. 1 Joseph Lister, who is widely credited for introducing asepsis into surgery, subsequently started sterilising bandages and surgical instruments with steam and used carbolic acid to clean wounds with great success. Today, surgical hand disinfection remains an important part of modern surgical practice.Traditionally, surgical hand disinfection (scrubbing) comprises washing with antimicrobial soap containing water, detergent and an antiseptic agent such as chlorhexidine, iodine, alcohol or a quaternary ammonium compound. The minimum recommended time to ensure disinfection varies between 2-6 min depending on the product used. Alternative alcohol-based hand rub disinfectants can provide superior disinfection 2 when compared to traditional techniques, thus saving a significant amount of water at a time when this resource is in high demand.The objectives of this study were to: (i) quantify water usage of operating theatre staff during surgical hand disinfection and thereby estimate potential water savings in using alternative means of hand disinfection; and (ii) investigate the cost involved in adopting a new hand disinfection technique in our hospital. Materials and MethodsThe number of operations and operating lists over a 1-year period, including the number of scrubbed staff members involved in every procedure, was determined from a prospectively collected theatre database. In order to determine the amount of water and disinfectants used during a scrubbing episode, we undertook a small observational study of 30 scrub episodes in our operating department, collecting data on the time period that taps were running and the number of squirts of soap or alcohol rub used by theatre staff. The volumes of the two traditional antimicrobial soaps used, chlorhexidine gluconate solution 20% (Hibiscrub™, Regent Medical Ltd, Irlam, UK) and Povidone-iodine 7.5% in aqueous solution (Videne ® , Adams Healthcare, Leeds, UK), was measured by then dispensing the soaps into a 50-ml syringe from their standard dispensers. The amount of alcohol rub (Sterillium ® , Bode Chemie, Hamburg, Germany) used to disinfect hands was measured from standard dispensers, again by using a 50-ml syringe. In addition, the There is a growing trend to use alcohol-based hand disinfectants in clinical practice. In addition to their antibacterial efficacy, these disinfectants offer an alternative to traditional surgical hand disinfection agents that can save water in the operating theatre.

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confidence: 99%

Clean and Green: Saving Water in the Operating Theatre

Jehle

Jarrett

Matthews

2008

annals

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“…1 Handwashing with soap and water has been the standard of care in most hospitals. Recently, many hospitals have introduced a waterless alcohol handrub for hand hygiene.…”

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Alcohol-Based Handrub: Evaluation of Technique and Microbiological Efficacy with International Infection Control Professionals

Widmer

Dangel

2004

Infect. Control Hosp. Epidemiol.

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BACKGROUND AND OBJECTIVE:The Centers for Disease Control and Prevention has published a new guideline on hand hygiene promoting the use of the alcohol-based handrub, but the technique was not addressed. The goal of this study was to evaluate the influence of technique on the efficacy of the alcohol-based handrub.PARTICIPANTS: Healthcare workers (HCWs) attending a course in hospital epidemiology.METHODS: A fluorescent dye was added to a hand antiseptic, and hands were checked under ultraviolet light after antiseptic cleansing. Data regarding the numbers of predefined fluorescent areas on the skin were collected in addition to demographic data such as age, gender, job description, and job experience. Results of the visualization test were compared with the data from microbiological samples before and after the procedure by the hand plate technique.RESULTS: Sixty HCWs were tested, 63% of whom had worked in infection control for more than 10 years. Sixty-six percent of all participants still had detectable bacteria after antisepsis. The mean log 10 CFU reduction was 2.0 (range, 0-3.85). Twenty-five percent of all HCWs achieved less than 1.1 log 10 CFU. Staphylococcus aureus was isolated from 13% (one of them being methicillin resistant) and gram-negative bacilli from 6.7%. After using the alcohol handrub, one subject still remained positive for S. aureus. Years of experience was the single most important factor predicting antimicrobial efficacy.CONCLUSIONS: Technique is of crucial importance in hand antisepsis. Major deficiencies were detected among even highly trained HCWs. Training should be provided before switching from handwashing to the alcohol handrub (Infect Control

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“…This figure creates a substantial socioeconomic burden for the health service, with the extra costs incurred in the United States considered to be in excess of $5 billion (8). Although a large number of these cases, approximately 30%, are thought to be preventable (30), the requirement to produce clean instruments is an "essential prerequisite" for ensuring effective disinfectant or sterilant activity (28).…”

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confidence: 99%

Comparative Study of Surgical Instruments from Sterile-Service Departments for Presence of Residual Gram-Negative Endotoxin and Proteinaceous Deposits

2006

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The ineffective cleaning of surgical instruments may be a vector for the transmission of hospital-acquired infections. The aim of this research was to investigate whether further decontamination procedures need to be instigated in sterile-service departments (SSDs) to reduce the risk of nosocomial illnesses, such as endotoxemia, sepsis, or iatrogenic Creutzfeldt-Jakob disease (to date, 1,147 cases of confirmed Creutzfeldt-Jakob disease deaths in the United Kingdom since 1990 have been reported). Instrument sets were obtained from nine anonymous United Kingdom National Health Service (NHS) primary care trust SSDs. The investigation implemented an advanced light microscopy technique, episcopic differential interference contrast microscopy with the sensitive fluorescent reagents SYPRO Ruby and 4,6-diamidino-2-phenylindole dihydrochloride (DAPI), to detect proteinaceous and microbial contamination levels. Gram-negative lipopolysaccharide (LPS) endotoxin was monitored using a dansylated polymyxin B fluorochrome agent. None of the 260 instruments examined displayed signs of microbial colonization or LPS endotoxin contamination. However, over 60 percent of the instruments showed a high degree of protein soiling (0.4 to 4.2 g protein/mm2 ). Some instruments appeared soiled with crystalline deposits that may consist of a potentially hazardous material contributing to inflammation and/or surgical shock. It is clear that the overall standard for cleaning must be raised in order to fulfill the imminent introduction of new European standards and to reduce the risk of cross-patient contamination and iatrogenic transmission.

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The epic Project: Developing National Evidence-based Guidelines for Preventing Healthcare associated Infections

Cited by 277 publications

References 0 publications

Clean and Green: Saving Water in the Operating Theatre

Clean and Green: Saving Water in the Operating Theatre

Alcohol-Based Handrub: Evaluation of Technique and Microbiological Efficacy with International Infection Control Professionals

Comparative Study of Surgical Instruments from Sterile-Service Departments for Presence of Residual Gram-Negative Endotoxin and Proteinaceous Deposits

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