医务人员手污染的细菌学调查

目的 了解医务人员手的污染情况，加强手部卫生的管理，降低医源性感染。方法 我院感染科于2007年6月至2008年6月，用无菌棉签浸湿灭菌生理盐水涂抹医务人员的双手,随机采样做细菌培养102人次。结果 手的微生物污染情况相当严重。合格率68．6％，许多样本远远超过了临界值．细菌总数达100cfu／cm^2、90cfu／cm^2等。结论 医务人员手的污染是引起医院交叉感染的重要因素，必须重视医务人员的洗手卫生．对控制医院感染具有重要意义。     

PDCA循环管理在手术室医务人员手卫生管理中的应用

目的 探讨PDCA在手术室医务人员手卫生管理中得应用效果,提高手卫生的依从性.方法应用计划-实施-检查-处理的循环管理模式收集资料,提出问题,分析原因,制定整改措施,组织培训,检查考核,对手术室内医务人员手卫生进行持续质量改进,观察应用前后的效果.结果 实施PDCA管理后,手术室医务人员洗手率,合格率和对手卫生的依从性均有提高(P＜0.01).结论 实施PDCA循环管理可对手卫生进行持续质量改进,有效提高医务人员手卫生状况.     

医护人员手卫生现状分析与对策

手部卫生作为医院感染控制中的简单却十分重要的环节,正在全世界范围内引起广泛重视。引起医院感染的因素很多,而手是接触传播各种病原微生物的最重要媒介,医护人员的手是造成医院交叉感染的重要途径。医务人员手卫生情况在预防医院感染中起重要作用,加强手部卫生,提高医护人员洗手的依从性,保证病人安全和医务人员的职业安全,需要进一步提高对手部卫生的认识,完善手卫生措施,创造重视手卫生的氛围,有效改善手卫生状况,以减少医院感染的发生[1]。     

医务人员手卫生监测分析与改进措施

目的分析卫生洗手、卫生手消毒和外科手消毒的差异,探讨做好手卫生的改进措施和控制医院感染的有效措施。方法收集我院2009年1月~2012年6月手卫生监测数据,对相关数据进行统计学分析。结果卫生洗手合格率低,卫生手消毒和外科手消毒合格率高。从人员看,护士手卫生洗手比医生的做得更好,合格率高。手卫生监测检测到的细菌是医院感染的重要病菌。结论卫生手消毒、外科手消毒成效好,应予以推广。加强手卫生设施的改进、医务人员手卫生知识的培训,以增强意识,提高对手卫生的依从性,从而减少医院感染。     

重症监护室实习医生洗手依从性的行为教育干预

目的：探讨对重症监护室实习医生洗手行为的行为教育干预,强化实习医生手卫生意识,从准职业期提高其洗手的依从性。方法以本科室2012年10月~2013年4月来自不同院校的60名实习医生作为研究对象,对其洗手行为进行行为教育干预,干预前后根据观察量表进行观察并记录其洗手情况及实习医生手部细菌菌落数,并将结果资料统计分析。结果干预前后重症监护室实习医生的手卫生执行率、洗手方法正确情况及手细菌培养比较差异有统计学意义(P<0.01)。结论有效的行为教育干预能提高重症监护室实习医生的洗手依从性。     

广州市部分公共场所集中空调通风系统卫生现况调查

目的了解广州市部分公共场所集中空调通风系统的卫生现况，为规范公共场所集中空调通风系统的卫生管理提供依据。方法随机抽取广州市部分大型公共场所的集中空调通风系统，对新风量进行检测；对送风中可吸入颗粒物（PM10）、细菌总数、真菌总数、β-溶血性链球菌进行检测并对总挥发性有机化合物（TVOC）、军团菌进行检测。结果部分公共场所集中空调通风系统新风量合格率为99．01％，送风中PM10合格率为95．53％．细菌总数合格率为92．64％，真菌总数合格率为90．70％，β-溶血性链球菌合格率为100％；空气净化消毒装置的TVOC合格率为81．05％；冷却水冷凝水中军团菌合格率为89．58％。结论公共场所集中空调通风系统应加强卫生管理。     

2007年度广州市星级宾馆客房卫生质量监测结果及分析

目的了解广州市星级宾馆客房的卫生状况，提高客房内空气及公共用品用具的卫生质量。方法对广州市区内的35家星级宾馆的客房空气质量、噪声、照度及公共用品的消毒效果进行卫生监测，并对结果进行统计分析．同时将细菌学部分的检验结果与2002年度作比较。结果2007年度空气质量指标中合格率最低的是CO2，仅78．99％．空气细菌数的合格率为80．36％，公共用品用具中洁具类的合格率最高为98．13％，2007年度的空气细菌数及公共用品用具的合格率均明显高于2002年度。结论目前广州市星级宾馆客房的卫生状况较SARS发生前已有明显的改善，但仍应加强卫生管理工作。     

品管圈活动提高ICU护士洗手依从性研究

目的：通过品管圈活动提高护理人员的手卫生知识和洗手依从性。方法2013年9月我科室组建QCC小组,引入质量管理概念,选定主题。由QCC小组进行现况调查,找出护士洗手依从性差的原因,制定干预改进措施。结果护理人员手部卫生知识评分及洗手依从性较干预前有显著提高,差异有统计学意义(<0.05)。结论采用QCC对重症监护病房护理人员洗手行为进行管理,能有效提高ICU护士手卫生知识和洗手依从性,从而降低患者院内感染机率。     

2016年贵州省黄果树地区手卫生调查分析

目的 掌握医务人员手卫生依从性和正确率。方法 选取2016年1月~12月贵州省安顺市人民医院不同临床科室中不同类型的医务人员作为研究对象,采用直接观察法,由院感专职人员用自制调查表,调查医务人员手卫生依从性和正确率,最后录入Excel表中进行分类统计。结果 共观察到手卫生指征总数10803次,执行4381次,依从性率为40.55%,执行正确3667次,正确率为83.70%;其中不同类型的医务人员中,手卫生依从性率最高和最低分别为护士（43.14%）和实习医生（38.24%）;正确率最高为护士（84.60%）,最低为实习护士（82.84%）;在5个手卫生指征中,依从性率最高和最低分别为接触患者血液/体液后（47.17%）和接触患者周围环境后（31.39%）;正确率最高和最低分别为接触患者血液/体液后（85.22%）和接触患者后（82.90%）。结论 护士手卫生依从性率和正确率高于其他医务人员,洗手指征中接触血液/体液后的依从性率和正确率均高于其他洗手指征。应注重各个手卫生指征重要性的认识,加强带教老师手卫生行为和习惯的宣传,发挥护士在手卫生方面的带头作用。     

医院手卫生质量管理持续改进策略的成效分析

目的：主要探讨医院手卫生质量管理持续改进策略的成效分析。方法根据临床的需求对医院洗手设备以及配备的手消毒剂，再安装相对应的洗手设施，观察在洗手液与消毒液相结合的情况下，再结合监督考核反馈机制，医院手卫生质量管理的效果是否有效提升。结果于2010年~2013年，临床吸收设备在不断的更新与完善，医院干手设备也慢慢的合理化；在洗手液与消毒液的使用上，每床每日20ml左右的科室，从2012年第一季度的5个增加到2013年第四季度的20个，同一个时期消耗消毒液和洗手液的量为每床每日15ml左右的科室，由以前的15个增加到现今的45个；我院手卫合格率在2011年~2012年，上升了5%；医院的感染力下降了1%。结论医院实施手卫生质量管理持续改进策略，这样不仅能够增加医务人员洗手的依从性，还能够有效的较低医院的感染率。     

Hand hygiene in reducing transient flora on the hands of healthcare workers: An educational intervention

Aim: Hand hygiene has now been recognised as one of the most effective intervention to control the transmission of infections in a hospital and education is an important tool to ensure its implementation. In order to convince the users and as a part of education, it is important to generate evidence on the role of hand hygiene in reducing the bacterial flora on their hands. The present study was undertaken in a tertiary care hospital to demonstrate the presence of bacterial flora on the hands of healthcare workers (HCW) in different categories, to teach them proper hand hygiene technique using alcohol-based hand rub and determine the outcome for reduction of bacteria. Materials and Methods: A total sample size of 60 subjects including resident doctors, medical students, nurses and hospital attendants were included in the study after obtaining informed consent. Each person was educated on the technique of hand hygiene with alcohol-based hand rub and hand impressions were cultured before and after hand hygiene. All the subjects were also given a questionnaire to assess their perception on hand hygiene. The WHO posters on proper hand hygiene were displayed in the appropriate areas of the hospital in addition, as an educational tool. Results: Majority (42 out of 60) of the HCWs had bacterial count up to 100 colonies or more on both hands before the application of hand rub while working in the hospital. After use of alcohol hand rub with a proper hand hygiene technique, it was found that the percentage reduction was 95-99% among doctors and nurses, 70% among hospital attendants and 50% among sanitary attendants. Staphylococcus aureus was present on the hands of eight persons of which three were methicillin-resistant Staphylococcus aureus. Conclusions: The study demonstrates that transient bacteria are present on the hands of HCWs but majority could be removed by proper hand hygiene, which needs continuous education to be effective. It also shows that active education by demonstrating the proper hand hygiene technique and direct observation of the practices, though demanding, are ideal to understand the attitudes and practices of HCWs and helps in planning implementation strategies.     

Hygiene Behaviour and Associated Factors among In-School Adolescents in Nine African Countries

Background

This report examines hygiene behaviour and associated factors among 13-15 year old in-school adolescents in nine African countries.

Purpose

The total sample included 25,760 school children aged 13-15 years from nationally representative samples from nine African countries.

Method

We examined the prevalence of and relationship between tooth brushing, hand washing before eating, hand washing after toileting, hand washing with soap and a range of psychosocial factors such as socio-demographic characteristics, health behaviour, mental health or well-being and protective factors.

Results

Overall, sub-optimal hygiene behaviour was reported, the proportions of school children reporting optimal (>once a day) tooth brushing (77.3%) was higher than the proportions reported for washing their hands regularly before meals (62.2%), after toileting (58.4%) and washing their hands with soap (35.0%). In multivariate analysis higher education, health-enhancing behaviours such as daily fruits or vegetable consumption, and protective factors such as caregiver supervision were associated with tooth brushing, hand washing before meals, hand washing after toileting and washing of hands with soap.

Conclusion

The cross-national data on hygiene behaviour from nine African countries found sub-optimal hygiene behaviour. Various determinants of optimal hygiene behaviour were identified that can guide programmes to improve hygiene behaviour of this adolescent population.

     

Study of hand hygiene and enteroparasite infestation among food handlers working in a medical college of North India

The present study was conducted to assess: 1) Prevalence of enteroparasite infestation among food handlers working in food service establishments located in the campus of a medical college, 2) Presence of enteric organisms on their hands and nails and their hand washing practices. A total of 151 food handlers were interviewed regarding their socio-demographic and professional characteristics. Their hand washing practices were also observed. Stool examination for enteroparasites and stool culture for Salmonella & Shigella and culture of nail clippings / nail bed swabs for detecting presence of enteric organisms were also carried out. Prevalence of enteroparasite infestation was observed to be 41.1%. None of the stool samples was observed to be positive for Salmonella or Shigella. Enteric organisms were isolated from nail clippings/nail bed swab samples of 76 (73.1%) study subjects. Hand washing practices were observed to be poor with low use of soap. Findings highlight importance of periodic stool examination and deworming of food handlers and need to educate them about importance of maintaining hand hygiene with a focus on improving their hand washing practices.     

Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs

The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.     

Single treatment with ethanol hand rub is ineffective against human rhinovirus--hand washing with soap and water removes the virus efficiently

Ethanol-containing hand rubs are used frequently as a substitute for hand washing with water and soap. However, not all viruses are inactivated by a short term rubbing with alcohol. The capacity of a single round of instructed and controlled hand cleaning with water and soap or ethanol-containing hand rub, respectively, was tested for removal of human rhinovirus administered onto the skin of healthy volunteers on the back of the hands. Hand washing with soap and water appeared to be much more efficient for removing rhinoviruses from skin than rubbing hands with an ethanol-containing disinfectant. After washing with soap and water the virus was detected in 3/9 (33.3%) test persons from the left hand and 1/9 (11.1%) cases from the right hand, whereas the virus was detected invariably by real-time RT-PCR from both hands after cleaning with alcohol hand rub (P-value <0.01). Both substances evaluated clinically were also tested in vitro for virucidal efficacy against Human rhinovirus2 (HRV2) using a standardized assay. Both tested substances were poor within the contact time used in the hand-cleaning test. In conclusion, thorough and conventional hand washing with water and soap can clean efficiently hands contaminated with the virus responsible for an extensive share of common cold episodes.     

Occurrence of potentially pathogenic bacteria on the hands of hospital patients before and after the introduction of patient hand disinfection

The leading cause of nosocomial infections and spread of multiresistant bacteria is considered to be the failure of healthcare workers to perform appropriate hand hygiene. The role of the hands of hospital patients in the spread of infection has received little attention. The aim of the present study was to investigate the occurrence of potentially pathogenic bacteria on the patients' hands. Quantitative cultures were repeatedly taken from the fingertips of patients at a rehabilitation clinic before and after an intervention in which patient hand disinfection was introduced and promoted. Before the intervention, the occurrence on the hands of Escherichia coli, Klebsiella spp., enterococci, Staphylococcus aureus and yeast was a common finding. The colony counts of S. aureus were often higher than the counts of other organisms. After the intervention, the level of hand contamination was lower. The difference was statistically significant (p < 0.05) concerning Enterobacteriaceae, both when the patients were resting and at lunch time, for enterococci and total bacterial counts at lunch time, and for yeast when they were resting. Concerning S. aureus, the difference was not statistically significant, neither while resting nor at lunch time. The role of the patients in the spread of pathogenic bacteria merits more discussion.     

Hand hygiene practices among community Health Officers in Rivers State,Nigeria

Background

Health care associated infections are most commonly transmitted by the hands of Health care workers and other hospital personnel.

Objective

To investigate compliance with hand hygiene guidelines and methods of hand hygiene practice among community health officers in Rivers State Nigeria.

Methods

Self administered questionnaires were distributed to 68 community health officers. The questionnaires consisted of 19 items which contained information on bio-demographic characteristics and hand hygiene practices. Data were analysed using SPSS-16 statistical software. Proportions were compared using Chi- square test and ‘p’ value less than 0.05 was considered statistically significant.

Results

The response rate was 97.1%. There were 11 (16.7%) males and 55 (83.3%) females with a male to female ratio of 1: 5. The age of the participants ranged from 28–56 years with a mean age of 39.7±6.7. Washing of hands before and after contact with patient was 60.1% and 97% respectively. The difference was significant (p<0.01). Allergy to gloves was 15.2%. About three-quarter (77.3%) of the workers used soap and water to wash the hands when soiled or visibly contaminated. None of the workers used alcohol hand rub.

Conclusion

Though there was improved compliance to hand hygiene guidelines, this still fall short of acceptable standards. The provision and promotion of the proper use of alcohol-based hand rub may further improve compliance with hand hygiene by reducing the time required to perform it and the convenience of the method.     

Epidemiologic study of acute infantile gastroenteritis in New Caledonia

In a test area (suburbs of Nouméa), a survey on acute infantile gastro-enteritis showed an annual incidence of 2.2% and a hospitalization rate of 27.5%. The 0 to 23 months age group was the most exposed. The factors of severity were: a low age, a high frequency of liquid stool, vomits, fever and associated acute respiratory infection. The etiologic diagnosis was possible in 76% of cases: 49.5% enteropathogens (22% bacteria, 27.5% viruses), 26.5% non-intestinal infections. The asymptomatic carriers were 11.5% for bacteria and 27.4% for viruses. In regard to epidemiology, the housing hygiene, the potable water supply and the presence of suitable water closet were over 90%. On the contrary, the individual hygiene was neglected, especially the hand washing. The pathogens are transmitted by the dirty hands of asymptomatic carriers. Mass media campaigns and health education of parents and children are the recommended prophylactic measures.     

A 1-minute hand wash does not impair the efficacy of a propanol-based hand rub in two consecutive surgical hand disinfection procedures

We studied the effect of a 1-min hand wash on the bacterial hand flora in two consecutive surgical hand disinfection procedures. A propanol-based hand rub (PBHR; Sterillium®) and n-propanol (60%, v/v) were tested in a Latin-square design according to EN 12791 in four variations. The reference alcohol was always applied for 3 min after a 1-min hand wash (variation 1). The PBHR was applied for 1.5 min (first application) or 0.5 min (second application). Variation 2 included a 1-min hand wash before both applications, variation 3 included the hand wash before application 1, in variation 4 hands were not washed at all before application. Pre- and post-values were obtained according to EN 12791. The reference disinfection reduced bacteria by 2.99 log₁₀ (immediate efficacy) and 2.22 log₁₀ after 3 h. The second reference disinfection reduced bacteria by 0.95 log₁₀ (immediate efficacy) and 0.68 log₁₀ after 3 h. The PBHR always yielded an equivalent reduction with and without a preceding hand wash (p?>?0.05; Friedman test). A 1-min hand wash before application of the PBHR did not significantly change its efficacy for surgical hand disinfection in two consecutive surgical procedures of 3 h.