Hand hygiene techniques:Still a requirement for evidence for practice?

Introduction Two hand hygiene techniques are promoted internationally: the World Health Organisation’s 6 step and the Centre for Disease Control’s 3 step techniques; both of which may be considered to have suboptimum levels of empirical evidence for use with alcohol based hand rub (ABHR). Objectives The aim of the study was to compare the effectiveness of the two techniques in clinical practice. Methods A prospective parallel group randomised controlled trial (RCT) was conducted with 1:1 allocation of 6 step versus the 3 step ABHR hand hygiene technique in a clinical setting. The primary outcome was residual microbiological load. Secondary outcomes were hand surface coverage and duration. The participants were medical and nursing participants (n=120) in a large teaching hospital. Results The 6 step technique was statistically more effective at reducing the bacterial count 1900cfu/ml (95% CI 1300, 2400cfu/ml) to 380cfu/ml (95% CI 150, 860 cfu/ml) than the 3 step 1200cfu/ml (95% CI 940, 1850cfu/ml) to 750cfu/ml (95% CI 380, 1400cfu/ml) (p=0.016) but even with direct observation by two researchers and use of an instruction card demonstrating the technique, compliance with the 6 step technique was only 65%, compared to 100% compliance with 3 step technique. Further those participants with 100% compliance with 6 step technique had a significantly greater log reduction in bacterial load with no additional time or difference in coverage compared to those with 65% compliance with 6 step technique (p=0.01). Conclusion To our knowledge this is the first published RCT to demonstrate the 6 step technique is superior to the 3 step technique in reducing the residual bacterial load after hand hygiene using alcohol based hand rub in clinical practice. What remains unknown is whether the residual bacterial load after the 3 step technique is low enough to reduce risk of transmission from the hands and whether the 6 step technique can be adapted to enhance compliance in order to maximise reduction in residual bacterial load and reduce duration

Impact of surgical-site infection on health utility values: a meta-analysis

Background: SSI are recognised as negatively affecting patient quality of life. Currently, no meta-analysis of SSI utility values is available in the literature to inform estimates of this burden and investment decisions in prevention. Method: A systematic search of PubMed, Medline, CINAHL and the NHS Economic Evaluation Database was performed in April 2022 as per PROSPERO registration CRD 42021262633. Studies were included where quality of life data was gathered from adults undergoing surgery whereby quality of life data was presented as those with infection and those without at similar time points. Two researchers performed data extraction and quality appraisal independently, with a third as arbiter. Utility values were converted to EQ-5D. Meta-analyses were conducted using a random effects model across all relevant studies with subgroup analyses on SSI type and timing since surgery. Results: 15 studies met the inclusion criteria with 2817 patients; six studies across seven time points were used for meta-analysis. The pooled mean difference in EQ-5D utility in all studies combined was – 0.08 (95% CI -0.11 - -0.05, I2 = 40%, prediction interval -0.16 to -0.01.). The mean difference in EQ-5D utility associated with Deep SSI was -0.10 (95%CI -0.14 - -0.06, I2 = 0.00%) and the mean difference in EQ-5D persisted over time. Conclusion: The first synthesised estimate of SSI burden over the short and long term is provided. EQ-5D utility estimates for a range of SSI are essential for infection prevention planning and future economic modelling.I am uploading the PDF of the accepted manuscript and will update it with the PDF proof once availabl

Growth in nurse prescribing of antibiotics: the Scottish experience 2007-13

Objectives: The objective of this study was to retrospectively analyse patterns of primary care antibiotic prescribing by nurse prescribers in Scotland. Methods: Data on dispensed antibiotic prescriptions written by nurse prescribers in 2007–13 were obtained from the Prescribing Information System, a database of all NHS prescriptions dispensed in Scotland. Results: Since 2007, there has been a steady increase in the volume of antibiotic prescribing in primary care undertaken by nurse prescribers. There was considerable variability in the frequency of antibiotic prescribing among nurses and across NHS regions. Since 2007, an increasing proportion of antibiotics prescribed by nurses are those recommended for first-line empirical treatment of infection, with a reduction in the proportion of broader-spectrum agents. Other measures of prescribing quality (duration of treatment of adult females with urinary tract infection and use of recommended doses) have improved since 2007. Conclusions: This paper is the first, to our knowledge, to present an analysis of data on antibiotic prescribing in primary care by nurse prescribers. Inappropriate prescribing is a problem and, given the impact that antibiotic prescribing has on antimicrobial resistance, it is important that the prescribing behaviour of nurses is explored. This is especially significant as this is a growing body of prescribers who predominately work in the community, where the majority of antibiotics are prescribed. This analysis showed that practice varies across NHS regions an