Comparison of Waterless Hand Antisepsis Agents at Short Application Times: Raising the Flag of Concern

Abstract Objective: Although alcohol-based hand rinses and gels have recommended application times of 30 to 60 seconds, healthcare workers usually take much less time for hand hygiene. We compared the efficacies of four alcohol-based hand rubs produced in Europe (hand rinses A, B, and C and one gel formulation) with the efficacy of the European Norm 1500 (EN 1500) reference waterless hand antisepsis agent (60% 2-propanol) at short application times. Design: Comparative crossover study. Setting: Infection Control Program laboratory of a large tertiary-care teaching hospital. Participants: Twelve healthy volunteers. Intervention: Measurement of residual bacterial counts and log reduction factors following inoculation of fingertips with Staphylococcus aureus American Type Culture Collection (ATCC) 6538, Pseudomonas aeruginosa ATCC 15442, and a clinical isolate of Enterococcus faecalis. Results: All hand rinses satisfied EN 1500 standards following a single application for 15 and 30 seconds, but reduction factors for the gel formulation were significantly lower for all tested organisms (all P < .025). Conclusions: Under stringent conditions similar to clinical practice, all three hand rinses proved to be more efficacious than the marketed alcohol-based gel in reducing bacterial counts on hands. Further studies are necessary to determine the in vivo efficacy of alcohol-based gels and whether they are as efficacious as alcohol-based rinses in reducing the transmission of nosocomial infection

Determinants of Good Adherence to Hand Hygiene Among Healthcare Workers Who Have Extensive Exposure to Hand Hygiene Campaigns

Objective. To quantify the different behavioral components of healthcare workers' motivation to comply with hand hygiene in a healthcare institution with a 10-year history of hand hygiene campaigning. Design. Cross-sectional study, by use of an anonymous, self-administered questionnaire. Setting. A 2,200-bed university teaching hospital. Participants. A stratified random sample of 2,961 medical and nursing staff. Results. A total of 1,042 questionnaires (35.2%) were returned. Of the respondents, 271 (26.0%) were physicians, 629 (60.4%) were nurses, and 141 (13.5%) were nursing assistants. Overall, 1,008 respondents provided information about sex; 718 (71.2%) of these were women. Respondents provided demographic information and data about various behavioral, normative, and control beliefs that determined their intentions with respect to performing hand hygiene. Among behavioral beliefs, the perception that healthcare-associated infections are severe for patients was highly ranked as a determinant of behavior by 331 (32.1%) of the respondents, and the perception that hand hygiene is effective at preventing these infections was ranked highly by 891 respondents (86.0%). Among normative beliefs, perceived social pressure from patients to perform hand hygiene was ranked highly by 760 respondents (73.7%), pressure from superiors was ranked highly by 687 (66.8%), pressure from colleagues was ranked highly by 596 (57.9%), and pressure from the person perceived to be most influential was ranked highly by 687 (68.8%). Among control beliefs, the perception that hand hygiene is relatively easy to perform was rated highly by 670 respondents (65.1%). High self-reported rates of adherence to hand hygiene (defined as performance of proper hand hygiene during 80% or more of hand hygiene opportunities) was independently associated with female sex, receipt of training in hand hygiene, participation in a previous hand hygiene campaign, peer pressure from colleagues, perceived good adherence by colleagues, and the perception that hand hygiene is relatively easy to perform. Conclusions. In a setting with a long tradition of hand hygiene campaigns, behavioral beliefs are strongly in favor of hand hygiene, but adherence is driven by peer pressure and the perception of high self-efficacy, rather than by reasoning about the impact of hand hygiene on patient safety. Female sex, training, and campaign exposure increased the likelihood of compliance with hand hygiene. This additional insight can help to shape future promotional activit

Age Limit Does Not Replace Serologic Testing for Determination of Immune Status for Measles

Adults more than 40 years old are not necessarily immune to measles. A measles outbreak that involved healthcare workers occurred after contact with a 44-year-old patient. Results of a hospitalwide program of mass screening revealed that 117 (4.5%) of 2,600 individuals tested seronegative for measles; 31 (26.1%) of these 117 individuals were more than 40 years ol

Ventilator-Associated Pneumonia as a Quality Indicator for Patient Safety?

The economic and clinical burden of ventilator-associated pneumonia (VAP) is uncontested. In many hospitals, VAP surveillance is conducted to identify outbreaks and to monitor infection rates. Here, we discuss the concept of benchmarking in health care as modeled on industry, and we contribute personal arguments against considering the VAP rate as a potential candidate for benchmarking or for monitoring the quality of patient care. Accurate benchmarking of VAP rates currently seems to be unfeasible, because the patient case mix is often too diverse and complicated to be adjusted for, and diagnostic criteria and surveillance protocols vary. Thus, the risk of drawing inaccurate comparisons is high. In contrast, some risk factors for VAP are modifiable and can be monitored and used as quality indicators. Process-oriented surveillance permits bypass of case-mix and diagnostic constraints. A well-defined interhospital surveillance system is necessary to prove that interventions on procedures do really lead to a reduction of VAP rate

Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile

Objectives The aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (ABHRs) and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. Methods An interventional time-series analysis was performed to evaluate the impact of two promotion campaigns on the consumption of ABHRs and to assess their effect on the incidence of non-duplicate clinical isolates of MRSA and C. difficile from February 2000 through September 2006. This analysis was combined with a transfer function model of aggregated data on antibiotic use. Results Consumption of ABHRs correlated with MRSA, but not with C. difficile. The final model demonstrated the immediate effect of the second hand hygiene promotion campaign and an additional temporal effect of fluoroquinolone (time lag, 1 month; i.e. antibiotic effect delayed for 1 month), macrolide (lag 1 and 4 months), broad-spectrum cephalosporins (lag 3, 4 and 5 months) and piperacillin/tazobactam (lag 3 months) use. The final model explained 57% of the MRSA variance over time. In contrast, the model for C. difficile showed only an effect for broad-spectrum cephalosporins (lag 1 month). Conclusions We observed an aggregate-level relation between the monthly MRSA incidence and the use of different antibiotic classes and increased consumption of ABHR after a successful hand hygiene campaign, while no association with ABHR use was detected for C. difficil

Reduction of Urinary Tract Infection and Antibiotic Use after Surgery: A Controlled, Prospective, Before-After Intervention Study

Background. Urinary tract infection is the most frequent health care—associated complication. We hypothesized that the implementation of a multifaceted prevention strategy could decrease its incidence after surgery. Methods. In a controlled, prospective, before-after intervention trial with 1328 adult patients scheduled for orthopedic or abdominal surgery, nosocomial infection surveillance was conducted until hospital discharge. A multifaceted intervention including specifically tailored, locally developed guidelines for the prevention of urinary tract infection was implemented for orthopedic surgery patients, and abdominal surgery patients served as control subjects. Infectious and noninfectious complications, adherence to guidelines, and antibiotic use were monitored before and after the intervention and again 2 years later. Results. The incidence of urinary tract infection decreased from 10.4 to 3.9 episodes per 100 patients in the intervention group (incidence-density ratio, 0.41; 95% CI, 0.20-0.79; P = .004). Adherence to guidelines was 82.2%. Both the frequency and the duration of urinary catheterization decreased following the intervention. Recourse to antibiotic therapy after surgery dropped in the intervention group from 17.9 to 15.6 defined daily doses per 100 patient-days (P < .005) because of a reduced need for the treatment of urinary tract infection (P < .001). Follow-up after 2 years revealed a sustained impact of the strategy and a subsequent low use of antibiotics, consistent with stable adherence to guidelines (80.8%). Conclusions. A multifaceted prevention strategy can dramatically decrease postoperative urinary tract infection and contribute to the reduction of the overall use of antibiotics after surger

Data maturity analysis and business performance: a Colombian case study

Context: Colombia over the last decade has experienced a historic economic boom and Information Technology (IT) has been emerging as a tool to enable the competitiveness of companies. The last government (2014–2018) took different actions to explain how the use of data science and open data improve the business activity. The question to identify if there is a relationship between IT capacities, the organizational structure and the performance of the companies remains unresolved and is certainly an urgent issue for new government of Iván Duque. Purpose: Our study analyses the relationship between data structure and business performance measured through the efficiency of customer experience and provider operations processes. Methodology: our methodology is novel compared to previous researches which develop linear regression. It is based on the use of a fuzzy-set qualitative comparative analysis (fsQCA). Originality/value: our method allows to reveal multiple and complementary paths to achieve possible correlations between data and business performance. Findings: Our results show that data consistency, data usage and data protection are the three more frequent conditions to a better customer experience and provider operations efficiency. Surprisingly, data-driven profile is a necessary but not sufficient condition. Practical implications: our conclusions allow practitioners to uncover the strength of the data to orientate their digital strategy. Our recommendations could be used for the new governmental program of digital revival for Small and Medium EnterprisesPeer ReviewedPostprint (published version

Ventilator-associated pneumonia: caveats for benchmarking

Objective: To determine the influence of using different denominators on risk estimates of ventilator-associated pneumonia (VAP). Design and setting: Prospective cohort study in the medical ICU of a large teaching hospital. Patients: All consecutive patients admitted for more than 48h between October 1995 and November 1997. Measurements and results: We recorded all ICU-acquired infections using modified CDC criteria. VAP rates were reported per 1,000 patient-days, patient-days at risk, ventilator-days, and ventilator-days at risk. Of the 1,068 patients admitted, VAP developed in 106 (23.5%) of those mechanically ventilated. The incidence of the first episode of VAP was 22.8 per 1,000 patient-days (95% CI 18.7-27.6), 29.6 per 1,000 patient-days at risk (24.2-35.8), 35.7 per 1,000 ventilator-days (29.2-43.2), and 44.0 per 1,000 ventilator-days at risk (36.0-53.2). When considering all episodes of VAP (n=127), infection rates were 27.3 episodes per 1,000 ICU patient-days (95% CI 22.6-32.1) and 42.8 episodes per 1,000 ventilator-days (35.3-50.2). Conclusions: The method of reporting VAP rates has a significant impact on risk estimates. Accordingly, clinicians and hospital management in charge of patient-care policies should be aware of how to read and compare nosocomial infection rate