Gel-based Handrub Improves Hospital Hygiene

NewsBot · May 5, 2007

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Press Release:
Gel-based Handrub Improves Hospital Hygiene

Giving health care workers easy access to alcohol-based handrubs can improve hygiene in hospitals, a study published today in the Online Open Access journal Critical Care suggests.

Good hand hygiene among health care workers can help minimise the spread of infections within hospitals. Alcohol-based handrubs are the standard method of hand hygiene worldwide, yet compliance amongst hospital staff remains low.

One of the best ways to boost compliance is to give workers bottles of handrub to keep in their pockets, report Prof Didier Pittet and colleagues from the University of Geneva Hospitals, Switzerland, who monitored the hand hygiene of 102 health care workers based in the same intensive care unit. Using a gel, rather than liquid-based product also made hand hygiene more acceptable and was reported to improve the skin condition of workers' hands.

The workers were first given access to a liquid-based handrub, which was then switched a few months later to a gel-based formulation of the same product. An independent observer recorded opportunities for hand hygiene and actual hand cleansing.

Overall compliance was low, with nurses most likely to follow hand hygiene recommendations compared to doctors. When the gel was introduced, compliance increased from 32% to 41%. But making the handrub immediately available generated the biggest increase in compliance -- a jump of 15%.

Some hand hygiene measures have previously been found to cause skin irritation and more than half the health care workers in the study reported they preferred the gel to the liquid-based product, indicating that it improved the condition of their skin. No cases of significant skin damage occurred with either formulation of the handrub. Alongside availability, improved skin tolerance is an important factor in trying to persuade health care workers to take the necessary steps to improve hand hygiene.
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NewsBot · May 5, 2007

Liquid versus gel handrub formulation: a prospective intervention study
Ousmane Traore , Stephane Hugonnet , Jann Lubbe , William Griffiths and Didier Pittet
Critical Care 2007, 11:R52 doi:10.1186/cc5906

Introduction
Hand hygiene is one of the cornerstones of the prevention of health care-associated infection, but health care worker (HCW) compliance with good practices remains low. Alcohol-based handrub is the new standard for hand hygiene action worldwide and usually requires a system change for its successful introduction in routine care. Product acceptability by HCWs is a crucial step in this process.

Methods
We conducted a prospective intervention study to compare the impact on HCW compliance of a liquid (study phase I) versus a gel (phase II) handrub formulation of the same product during daily patient care. All staff (102 HCWs) of the medical intensive care unit participated. Compliance with hand hygiene was monitored by a single observer. Skin tolerance and product acceptability were assessed using subjective and objective scoring systems, self-report questionnaires, and biometric measurements. Logistic regression was used to estimate the association between predictors and compliance with the handrub formulation as the main explanatory variable and to adjust for potential risk factors.

Results
Overall compliance (phases I and II) with hand hygiene practices among nurses, physicians, nursing assistants, and other HCWs was 39.1%, 27.1%, 31.1%, and 13.9%, respectively (p = 0.027). Easy access to handrub improved compliance (35.3% versus 50.6%, p = 0.035). Nurse status, working on morning shifts, use of the gel formulation, and availability of the alcohol-based handrub in the HCWs pocket were independently associated with higher compliance. Immediate accessibility was the strongest predictor. Based on self-assessment, observer assessment, and the measurement of epidermal water content, the gel performed significantly better than the liquid formulation.

Conclusion
Facilitated access to an alcohol-based gel formulation leads to improved compliance with hand hygiene and better skin condition in HCWs.
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