Audit on the degree of application of universal precautions in a haemodialysis unit.
BACKGROUND: The purpose of the study was to investigate the degree of compliance with standard precautions (hand washing and wearing of gloves) by health workers in one haemodialysis unit. METHODS: During 4 months, two observers monitored the activities of the health care staff in the dialysis unit. Thirty five randomly distributed observation periods of 60 min duration covered one haemodialysis session. The observers evaluated (i) the total number of potential opportunities to implement standard precautions and (ii) the number of occasions when these were actually put into practice. RESULTS: A total of 364 opportunities to wear gloves and to wash hands thereafter and 273 opportunities to wash hands before a patient-oriented activity were observed. The proportion of occasions when gloves were actually used was 18.7%. Hand washing after a patient-oriented activity was performed only on 32.4% of occasions. Finally, only on 3% of such occasions was hand washing before the activity. CONCLUSIONS: The degree of compliance with standard precautions by health care personnel is unsatisfactory and this favours nosocomial transmission in haemodialysis units. (+info)
Handwashing: simple, but effective.
Using ward rounds in the department of surgery at a major teaching hospital, and with the help of the preregistration house officers (PRHO), we assessed whether the lesson taught to us by Semmelweis had been forgotten. We asked the PHROs to count the number of patients examined by their consultant or registrar on a ward round, together with the number of wounds examined, and the number of times they washed their hands between patients. Over a 2-week period, following seven consultants and four registrars, 26 ward rounds were followed. Of 239 patient events, which are defined as a clinician reviewing a patient in order to assess their treatment, a total of 88 involved an examination (37%) and, of these, 41 had postoperative wounds (47%). The number of times clinicians washed their hands between examinations was 36 (41%). Between the two groups of clinicians, the consultants washed their hands 30 times in 55 examinations (55%), while the registrars washed their hands six times in 23 examinations (26%). When Semmelweis died in 1865 his beliefs were still largely ignored by clinicians. It would seem from our results that in both senior and junior staff the simple exercise of handwashing is not practised de rigor. For the safety of the patient and the clinician we recommend a more fastidious adoption of the handwashing practice. (+info)
Viral meningitis in child care center staff and parents: an outbreak of echovirus 30 infections.
OBJECTIVE: A report of five cases of viral meningitis among adults with children enrolled in a child care center prompted an investigation of risk factors for viral transmission from children to adult household members. METHODS: To determine recent echovirus 30 (E30) infections, the authors conducted a serologic survey. To determine risk factors for infection among adult household members, they conducted a retrospective cohort study using written questionnaires. RESULTS: Recent E30 infections were found in 84% of children tested, 57% of adult household members tested, and 47% of staff members tested. Infected adults were more likely than infected children to have clinical meningitis. Among adult household members, changing diapers was a risk factor for recent infection. Women who changed > or = 90 diapers per month had a higher infection rate than women who changed fewer diapers; in contrast, men who changed > or = 90 diapers per month had a lower infection rate than men who changed fewer diapers. Handwashing was protective: there was a negative correlation between handwashing after diaper changes and E30 infection among adults with infected children in diapers. CONCLUSIONS: Because child care centers can be a source of enteroviral infections among adult household members, adults with viral meningitis should be questioned about their children's day care or preschool attendance. The importance of handwashing should be stressed to adults with children in day care. (+info)
Analysis of different communication channels for promoting hygiene behaviour.
A hygiene intervention study reduced diarrhoeal disease transmission in rural northeast Thailand by promoting hand-washing and dish-washing behaviour. Most of the target audience did not recognize a connection between these behaviours and diarrhoeal disease, and therefore a social marketing approach was used to develop a campaign promoting behaviours through a variety of communication channels keeping messages simple and in terms understood by the community. Overall, there was a strong correlation between the number of communication channels remembered by respondents and their knowledge score, with passive channels of printed media such as stickers, posters and leaflets associated with significantly higher scores than other channels. However, the same did not hold true for improvement in actual behaviour and only 'school children' were associated with significantly less fingertip contamination. In-depth interviews with conformers and non-conformers suggested that although most knew the intervention messages well enough, the importance they attached to them differed markedly. Thus dissemination of message knowledge was not consistent with the process of dissemination of actual practice. Where a strong sense of community spirit existed, friends, relatives and neighbours were more likely to discuss intervention activities with each other. (+info)
Skin hygiene and infection prevention: more of the same or different approaches?
The purpose of this article is to review research indicating a link between hand hygiene and nosocomial infections and the effects of hand care practices on skin integrity and to make recommendations for potential changes in clinical practice and for further research regarding hand hygiene practices. Despite some methodological flaws and data gaps, evidence for a causal relationship between hand hygiene and reduced transmission of infections is convincing, but frequent handwashing causes skin damage, with resultant changes in microbial flora, increased skin shedding, and risk of transmission of microorganisms, suggesting that some traditional hand hygiene practices warrant reexamination. Some recommended changes in practice include use of waterless alcohol-based products rather than detergent-based antiseptics, modifications in lengthy surgical scrub protocols, and incorporation of moisturizers into skin care regimens of health care professionals. (+info)
Domestic hygiene and diarrhoea - pinpointing the problem.
Improving domestic hygiene practices is potentially one of the most effective means of reducing the global burden of diarrhoeal diseases in children. However, encouraging behaviour change is a complex and uncertain business. If hygiene promotion is to succeed, it needs to identify and target only those few hygiene practices which are the major source of risk in any setting. Using biological reasoning, we hypothesize that any behaviours which prevent stools from getting into the domestic arena, the child's main habitat, are likely to have a greater impact on health than those practices which prevent pathogens in the environment from being ingested. Hence safe stool disposal, a primary barrier to transmission, may be more important than hand-washing before eating, which constitutes a secondary barrier, for example. We review the epidemiological evidence for the effect of primary and secondary barrier behaviours and suggest that it supports this conclusion. In the absence of local evidence to the contrary, hygiene promotion programmes should give priority to the safe disposal of faecal material and the adequate washing of hands after contact with adult and child stools. (+info)
Hospital acquired infection has a direct effect on the quality of patient care and is therefore, a major issue in the context of clinical governance. The role of hand washing by health care workers in hospital acquired infection is discussed and recommendations made. (+info)
Contamination of foods by food handlers: experiments on hepatitis A virus transfer to food and its interruption.
Hepatitis A virus (HAV) is an important pathogen which has been responsible for many food-borne outbreaks. HAV-excreting food handlers, especially those with poor hygienic practices, can contaminate the foods which they handle. Consumption of such foods without further processing has been known to result in cases of infectious hepatitis. Since quantitative data on virus transfer during contact of hands with foods is not available, we investigated the transfer of HAV from artificially contaminated fingerpads of adult volunteers to pieces of fresh lettuce. Touching the lettuce with artificially contaminated fingerpads for 10 s at a pressure of 0.2 to 0.4 kg/cm(2) resulted in transfer of 9.2% +/- 0.9% of the infectious virus. The pretreatments tested to interrupt virus transfer from contaminated fingerpads included (i) hard-water rinsing and towel drying, (ii) application of a domestic or commercial topical agent followed by water rinsing and towel drying, and (iii) exposure to a hand gel containing 62% ethanol or 75% liquid ethanol without water rinsing or towel drying. When the fingerpads were treated with the topical agents or alcohol before the lettuce was touched, the amount of infectious virus transferred to lettuce was reduced from 9.2% to between 0.3 and 0.6% (depending on the topical agent used), which was a reduction in virus transfer of up to 30-fold. Surprisingly, no virus transfer to lettuce was detected when the fingerpads were rinsed with water alone before the lettuce was touched. However, additional experiments with water rinsing in which smaller volumes of water were used (1 ml instead of 15 ml) showed that the rate of virus transfer to lettuce was 0.3% +/- 0.1%. The variability in virus transfer rates following water rinsing may indicate that the volume of water at least in part influences virus removal from the fingerpads differently, a possibility which should be investigated further. This study provided novel information concerning the rate of virus transfer to foods and a model for investigating the transfer of viral and other food-borne pathogens from contaminated hands to foods, as well as techniques for interrupting such transfer to improve food safety. (+info)