Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units

Mark Edmund Rupp, Teresa Fitzgerald, Susan Puumala, James R. Anderson, Rita Craig, Peter Charles Iwen, Dawn Jourdan, Janet Keuchel, Nedra Marion, Delayne Peterson, Lee Sholtz, Valerie Smith

Research output: Contribution to journalArticle

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Abstract

BACKGROUND. There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes. DESIGN. A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel. setting. The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital. METHODS. An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months. RESULTS. During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P < .001). Improvement was observed .001 among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P = .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel. CONCLUSIONS. The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.

Original languageEnglish (US)
Pages (from-to)8-15
Number of pages8
JournalInfection Control and Hospital Epidemiology
Volume29
Issue number1
DOIs
StatePublished - Jan 1 2008

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Hand Hygiene
Critical Care
Cross-Over Studies
Hand
Gels
Alcohols
Cross Infection
Nails
Infection
Clostridium difficile
Nursing Staff
Incidence
Tertiary Healthcare
Workload
Teaching Hospitals
Nurses
Observation
Prospective Studies
Delivery of Health Care
Equipment and Supplies

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

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Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. / Rupp, Mark Edmund; Fitzgerald, Teresa; Puumala, Susan; Anderson, James R.; Craig, Rita; Iwen, Peter Charles; Jourdan, Dawn; Keuchel, Janet; Marion, Nedra; Peterson, Delayne; Sholtz, Lee; Smith, Valerie.

In: Infection Control and Hospital Epidemiology, Vol. 29, No. 1, 01.01.2008, p. 8-15.

Research output: Contribution to journalArticle

Rupp, ME, Fitzgerald, T, Puumala, S, Anderson, JR, Craig, R, Iwen, PC, Jourdan, D, Keuchel, J, Marion, N, Peterson, D, Sholtz, L & Smith, V 2008, 'Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units', Infection Control and Hospital Epidemiology, vol. 29, no. 1, pp. 8-15. https://doi.org/10.1086/524333
Rupp, Mark Edmund ; Fitzgerald, Teresa ; Puumala, Susan ; Anderson, James R. ; Craig, Rita ; Iwen, Peter Charles ; Jourdan, Dawn ; Keuchel, Janet ; Marion, Nedra ; Peterson, Delayne ; Sholtz, Lee ; Smith, Valerie. / Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units. In: Infection Control and Hospital Epidemiology. 2008 ; Vol. 29, No. 1. pp. 8-15.
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abstract = "BACKGROUND. There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes. DESIGN. A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel. setting. The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital. METHODS. An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months. RESULTS. During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37{\%} to 68{\%} in one unit and from 38{\%} to 69{\%} in the other unit (P < .001). Improvement was observed .001 among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P = .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel. CONCLUSIONS. The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.",
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AU - Rupp, Mark Edmund

AU - Fitzgerald, Teresa

AU - Puumala, Susan

AU - Anderson, James R.

AU - Craig, Rita

AU - Iwen, Peter Charles

AU - Jourdan, Dawn

AU - Keuchel, Janet

AU - Marion, Nedra

AU - Peterson, Delayne

AU - Sholtz, Lee

AU - Smith, Valerie

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N2 - BACKGROUND. There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes. DESIGN. A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel. setting. The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital. METHODS. An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months. RESULTS. During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P < .001). Improvement was observed .001 among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P = .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel. CONCLUSIONS. The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.

AB - BACKGROUND. There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes. DESIGN. A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel. setting. The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital. METHODS. An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months. RESULTS. During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P < .001). Improvement was observed .001 among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P = .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel. CONCLUSIONS. The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.

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