Parent Skin Cleansing Prior to Infant Contact in NICU Important to Reduce Staph Infections

MedicalResearch.com Interview with:
“Bart Infant” by Bart Everson is licensed under CC BY 2.0Gwen M. Westerling, BSN, RN, CIC
Infection Preventionist
Helen DeVos Children’s Hospital

MedicalResearch.com: What is the background for this study?

Response: The setting of this study is a Level III Neonatal Intensive Care Unit (NICU) with 106 beds.

In 2016, an increase in Hospital Acquired Infections (HAI) was noted in the Neonatal Intensive Care Unit (NICU) caused by Staphylococcus aureus (SA) through diligent Infection Prevention Surveillance. When we reviewed the literature we found the SA is a common skin colonizer and can be a problem for neonates with immature skin and immune systems.

Staphylococcus aureus is easily transmitted through direct contact with skin, the contaminated hands of health care workers, the environment and equipment. We also found one study that listed skin to skin care as a risk factor for acquisition of SA. Before we saw the increase in infections some process changes occurred in our NICU that included increased skin to skin care, meaningful touch between neonates and parents, and two person staff care. We hypothesized that the process changes were exposing neonates to increased amounts of Staphylococcus aureus and contributing to the increase in infections.

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6-Step More Effective than 3-Step Hand Hygiene Technique

MedicalResearch.com Interview with:

Professor Jacqui Reilly PhD Institute for Applied Health Research Glasgow Caledonian University Glasgow

Dr. Jacqui Reilly

Professor Jacqui Reilly PhD
Institute for Applied Health Research
Glasgow Caledonian University
Glasgow

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Reilly: Hand hygiene is the single most important intervention to reduce avoidable illness and prevent infections. Two techniques have been reported for hand hygiene use with alcohol-based hand rub (ABHR) in international guidance:  6 step by the WHO and 3 step by the Center for Disease Control. Neither of these techniques have an evidence base to support their effectiveness.

The study provides the first evidence in a RCT that the 6 step technique is superior in reducing residual bacterial load on the hands. The reduction was not related to coverage, type of organism or staff group. The 6 step technique was microbiologically more effective at reducing the median log10 bacterial count (3.28  to 2.58)than the 3 step (3.08  to 2.88), (p=0.02), but did not increase the total hand coverage area (98.8% versus 99.0%, p=0.15) and required 25% (95% CI: 6%-24%) more time (42.50 seconds  vs 35.0 seconds, p=0.002). Total hand coverage was not related to the reduction in bacterial count.

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Genomic Testing Confirms Contaminated Soap Did Not Impact Patients

MedicalResearch.com Interview with:
Dr Laurence Senn, médecin associée
Service de médecine préventive hospitalière
Mont Paisible
Lausanne

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Senn: Pseudomonas aeruginosa is a ubiquitous environmental bacterium that can cause infection in patients severely ill, and is thus a major cause of nosocomial infections in intensive care units. During an environmental investigation on potential reservoirs of P. aeruginosa, the liquid hand soap was found highly contaminated with this pathogen. The fact that unopened soap containers were found contaminated with P. aeruginosa proved that the contamination occurred during product manufacturing. Contaminated batches had been used in our hospital over the previous 5 months.

In order to evaluate the burden of this contamination on patients, our infection control team conducted an epidemiological investigation combining two molecular methods. First, we analyzed with a classical molecular typing method all P. aeruginosa isolated from patients during the period of exposition to the contaminated soap. Secondly, we targeted the analysis on some isolates sharing the same genotype that the one found in the soap with a modern, recently developed tool which consists in sequencing the whole genome of the bacteria. This method allowed us to have the “fingerprint” of each isolate. Our investigation ruled out any impact of the contaminated soap on patients.

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Most Nurses Skip Some Infection Control Measures

MedicalResearch.com Interview with:

Donna Powers, DNP, RN Kransoff Quality Management Institute North Shore Long Island Jewish Health System New York, NY

Dr. Donna Powers

Donna Powers, DNP, RN
Kransoff Quality Management Institute
North Shore Long Island Jewish Health System
New York, NY 

Medical Research: What is the background for this study? What are the main findings?

Dr. Powers: Despite widely published, accessible guidelines on infection control and negative health consequences of noncompliance with the guidelines, significant issues remain around the use of Standard Precautions to protect nurses  from bloodborne infectious diseases.

Only 17.4% of ambulatory nurses reported compliance with all nine standards. The nurses represented medicine, cardiology, dialysis, oncology, pre – surgical testing, radiation and urology practices. Compliance rates varied considerably and were highest for wearing gloves (92%) when exposure of hands to bodily fluids was anticipated, however only 63% reported washing hands after glove removal.  68% provided nursing care considering all patients as potentially contagious. Overall, the ambulatory care nurses chose to implement some behaviors and not others, and this behavior puts them at risk for acquiring a bloodborne infection.”

The study also found knowledge of HCV was variable. Although HCV is not efficiently transmitted by sexual activity, more than one in four nurses (26 %) believed that sexual transmission is a common way that HCV is spread.  14 percent believed incorrectly that most people with HCV will die prematurely because of the infection, 12 percent did not know that HCV antibodies can be present without an infection, and 11 percent did not know there are multiple HCV genotypes.

A statistically significant relationship was found between compliance and perception of susceptibility to HCV illness (P = .05) and between compliance and perception of barriers to use of Standard precautions (P=.005).

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Plain Soap Does The Job Just As Well As Antibacterial Soap for Hand Washing

hand washingMedicalResearch.com Interview with:
Min Suk Rhee, Ph.D.
Professor Department of Biotechnology
Department of Food Bioscience & Technology
College of Life Sciences & Biotechnology
Korea University Seoul Korea 

Medical Research: What is the background for this study? What are the main findings?

Dr. Min Suk Rhee: In December 2013, the US FDA (United States Food and Drug Administration) proposed an amendment that manufacturers of antibacterial hand soaps intended for use with water must demonstrate that they are safer and more effective than plain soap. As triclosan is the most common active antiseptic ingredient used in soap and its potential risk remains controversial, we investigated the effectiveness of antibacterial soap containing triclosan 0.3% from in vitro and in vivo experiment.

The main finding of this study is that presence of antiseptic ingredients (in this case, triclosan) in soap does not always guarantee higher antimicrobial efficacy during hand washing.

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Antibacterial Gloves May Reduce Cross Contamination In ICU Setting

Ojan Assadian, M.D., DTMH Professor for Skin Integrity and Infection Prevention Institute for Skin Integrity and Infection Prevention School of Human & Health Sciences University of Huddersfield Queensgate, Huddersfield UKMedicalResearch.com Interview with:
Ojan Assadian, M.D., DTMH
Professor for Skin Integrity and Infection Prevention
Institute for Skin Integrity and Infection Prevention
School of Human & Health Sciences
University of Huddersfield
Queensgate, Huddersfield UK

MedicalResearch: What is the background for this study? What are the main findings?

Prof. Assadian: Although medical gloves serve as an important mechanical barrier to prevent healthcare workers’ hands from getting contaminated with potentially pathogenic microorganisms, their inappropriate and incorrect use may support microbial transmission, eventually resulting in indirect horizontal cross-contamination of other patients.

We conducted a clinical study designed to determine the efficacy of a newly developed synthetic antibacterial nitrile medical glove coated with an antiseptic, polyhexamethylen-biguanid hydrochloride (PHMB), on its external surface, and compared this antibacterial glove to an identical non-antibacterial glove in reducing surface contamination after common patient care measures in an intensive care unit.

We found significantly lower numbers of bacteria on surfaces after performing typical clinical activities such as intravenous fluid handling, oral toilet, or physiotherapy, if touched with antibacterial gloves.

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Norovirus and Enteroviruses May Be Resistant to Alcohol Based Hand Disinfectants

dr-erwin-duizer.pngMedicalResearch.com Interview with:
Erwin Duizer, PhD
Head of section Enteric Viruses
Centre for Infectious Diseases Control
National Institute for Public Health and the Environment
The Netherlands

Medical Research: What is the background for this study?

Dr. Duizer: Hand hygiene is important for interrupting the transmission chain of viruses through hands. Alcohol-based hand disinfectants are widely used in hospitals and healthcare facilities, due to convenience, rapidity, and broad acceptance by healthcare personnel. The effectiveness of alcohol-based hand disinfectant has been shown for bacteria and enveloped viruses but their effectiveness in reducing transmission of non-enveloped viruses, such as norovirus, is less certain. Therefore we tested, in a joint project of the RIVM and Wageningen University, the virucidal activity of a propanol based product and an ethanol based product in quantitative carrier tests. Additionally, the virus reducing effect of hand washing (according to health care guidelines) and the use the propanol based product was tested in a quantitative finger pad test. Continue reading

Hand Dermatitis Increases In Health Care Workers Due To Hand Washing Measures

MedicalResearch.com Interview with:
Dr Jill Stocks PhD, Research Fellow
Centre for Occupational and Environmental Health,
Centre for Epidemiology; NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care
Institute of Population Health, University of Manchester, UK.

Medical Research: What is the background for this study? What are the main findings?

Dr. Stocks: Reducing healthcare-associated infections has been a priority in the UK over recent decades; and this has been reflected in interventions and guidelines focussing on improving hygiene procedures. During 2004 to 2008 the Cleanyourhands campaign promoted hand hygiene in all NHS trusts. There was anecdotal evidence from dermatologists and occupational physicians that irritant contact dermatitis was on the increase in healthcare workers, and that it was caused by hand hygiene. We investigated whether or not there was an increase in the incidence of irritant contact dermatitis in healthcare workers due to hand hygiene or other types of hygiene coinciding with the interventions and guidelines promoting hygiene. We used reports made by dermatologists to the Occupational and Health reporting network, a voluntary surveillance scheme collecting reports of work-related ill-health. Trends in incidence of irritant contact dermatitis due to hygiene in healthcare workers were compared with trends in control groups (irritant contact dermatitis in workers with other jobs) using a quasi-experimental (interrupted time series) design. We found a 4.5 fold increase in irritant contact dermatitis due to hand hygiene and hygiene in general in healthcare workers between 1996 and 2012. The results also suggested a steepening of the increase in incidence during the rollout period of the Cleanyourhands campaign but the limitations of the data made this less clear cut.
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Hand Washing: Is It Necessary Before Putting on Non-Sterile Gloves?

Clare Rock, MD Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore, MD, 21201MedicalResearch.com Interview with:

Clare Rock, MD
Department of Epidemiology and Public Health
University of Maryland School of Medicine
Baltimore, MD, 21201

Summary paragraph:

Dr. Rock: Hand hygiene is an essential step in infection prevention and a focus on improving and sustaining hand hygiene compliance is needed.  However, it remains unclear whether or not hand hygiene is required prior to non-sterile glove use.  Our study would support that it is not a necessary step and a potential waste of healthcare worker time.
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Hand Hygiene Improvement Program – Electronic Monitoring and Compliance

Sarah Edmonds, Scientist at GOJO.MedicalResearch.com eInterview with: Sarah Edmonds, Scientist at GOJO.

MedicalResearch.com: What are the main findings of the study?

Answer: Implementation of electronic hand hygiene compliance monitoring with a clinical hand hygiene program significantly increased hand hygiene compliance rates, with rates during the study period being 92% higher than at baseline.

MedicalResearch.com: Were any of the findings unexpected?

Answer: While not necessarily unexpected we did find that electronic compliance monitoring alone may not be sufficient to raise compliance rates for a sustained period of time. After the clinical program concluded there was a significant drop in compliance rates so it is important to continue to monitor hand hygiene rates and continue to promote the program to sustain increased hand hygiene compliance.
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