Article

Healthcare workers' compliance with glove use and the effect of glove use on hand hygiene

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Despite considerable evidence that appropriate hand hygiene is the leading measure to prevent healthcare-associated infection, compliance with infection control recommendations remains low among healthcare workers. Literature regarding the role that concomitant glove use has on compliance with hand hygiene is limited and conflicting. The aims of this study were to examine healthcare workers' glove use by observation and to evaluate the effect that glove use has on compliance with hand hygiene. Non-participant observation was carried out on 12 randomly-selected wards in two district general hospitals. Although the overall compliance rate for glove use was high at 92%, gloves were also overused. The proportion of glove overuse was 42%. Overall hand hygiene compliance was 64%. However, hand hygiene compliance was significantly worse following glove overuse, demonstrating that inappropriate glove use may be a component of poor hand hygiene compliance. Recommendations arising from these results are that, in order to improve adherence to hand hygiene recommendations, multi-faceted interventions should be aimed at changing healthcare workers' glove use behaviour.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... (1,2). Eldivenlerin rutin kullanımı, ilk olarak AIDS (Acquired Immune Deficiency Syndrome) salgınına yanıt olarak önerilmiş ve Hastalık Kontrol Önleme Merkezi tarafından 1980'lerin sonlarında "evrensel önlemler" şeklinde adlandırılarak kullanıma girmiştir (2,3,4). Rutin eldiven kullanımı daha sonraları temasla ilişkili olarak artan kontaminasyon risklerini de bertaraf edebilmek üzere yaygınlaştırılmış ve vücut sıvılarına temas gerektiren ilgili tüm uygulamalarda standart önlemler arasında eldiven kullanımına da yer verilmiştir (2,4). ...
... Eldivenlerin rutin kullanımı, ilk olarak AIDS (Acquired Immune Deficiency Syndrome) salgınına yanıt olarak önerilmiş ve Hastalık Kontrol Önleme Merkezi tarafından 1980'lerin sonlarında "evrensel önlemler" şeklinde adlandırılarak kullanıma girmiştir (2,3,4). Rutin eldiven kullanımı daha sonraları temasla ilişkili olarak artan kontaminasyon risklerini de bertaraf edebilmek üzere yaygınlaştırılmış ve vücut sıvılarına temas gerektiren ilgili tüm uygulamalarda standart önlemler arasında eldiven kullanımına da yer verilmiştir (2,4). ...
... Tablo 4 Gereksiz eldiven kullanımının cinsiyet ve meslek gruplarına göre Tablo 5 incelendiğinde, cinsiyete ve meslek gruplarına göre istatistiksel olarak anlamlı olmadığı bulundu (p>0.05). (2,4,8,10). Sonuçlardaki bu farklılıklar, çalışmaların ayrı ülkelerde ve birbirinden farklı birimlerde yapılmasından, sağlık çalışanlarının eldiven giyme bilgi düzeylerinin birbirinden ayrı olmasından kaynaklanmış olabilir. ...
Article
Objective:Glove usage is recommended for healthcare professionals to protect themselves and reduce the risk of transmission of biological body fluids that get in contact with their hands from one patient to another. Unnecessary and incorrect usage of gloves increases the risk of cross contamination. This study aimed to evaluate the correct and necessary glove usage in the intensive care unit (ICU) where wearing gloves is not observed.Materials and Methods:This is a prospective, cross-sectional and observational study. The study was made in a third level general ICU of a university hospital. Glove usage practice of physicians, nurses and caregivers working in the ICU were determined by observation method. The “5 necessary moments” was observed in the appropriate glove usage. Wearing of gloves when unnecessary was evaluated as “unnecessary glove usage”. Observations were made by the ICU nurse and the infection control nurse.Results:A total of 395 observations were made on glove usage. The rate of appropriate glove usage is 67.8%, and misused gloves are 32.2%. The highest rate of correct glove usage was 86.1% (n=101), which was observed in the event of blood and/or body fluid contact. In the same patient, dirty procedures/changing gloves between different regions (n=68) were not performed. Unnecessary glove usage was observed at a rate of 85.1% (n=74). The distribution of glove usage by profession was statistically significant (chi-square: 44.15, p
... Relatively low HH compliance regarding the use of gloves found in our study had been previously seen (Burdsall et al., 2017;Flores & Pevalin, 2006). It was also found that HCWs who used gloves applied HH less, and vice versa (Cusini et al., 2015;Flores & Pevalin, 2006;Whitby et al., 2006). ...
... Relatively low HH compliance regarding the use of gloves found in our study had been previously seen (Burdsall et al., 2017;Flores & Pevalin, 2006). It was also found that HCWs who used gloves applied HH less, and vice versa (Cusini et al., 2015;Flores & Pevalin, 2006;Whitby et al., 2006). In some other studies, HCWs performed HH more frequently after the use of gloves (Basurrah & Madani, 2006;Gül, Üstündağ, & Zengin, 2012). ...
... It must be pointed out that the use of gloves cannot substitute HH under any circumstances. However, the glove use in clinical settings can be also inappropriate, which could result in glove contamination due to failure to remove gloves for different patients (Flores & Pevalin, 2006) and proper application of gloves and HH compliance requires more understanding of HCWs (Bora & Zarghami, 2018). The disuse of gloves observed in our study could originate in incorrect habits in clinical practice performance, the long-term lack of availability of gloves which burdened our hospitals in former regime, or negative standards in clinical settings. ...
Article
Full-text available
Aim To assess the quality of self‐assessment and the attitude of healthcare workers (HCWs) to hand hygiene (HH) as possible factors of unsatisfactory HH compliance in clinical practice. Background Non‐compliance of hand hygiene causes healthcare‐acquired infections (HAI) in patients. It is assumed that hand hygiene‐related infections make up approximately 80% of all infections in clinical practice. Our observations suggest that self‐assessment and attitude might be surprisingly important factors. Design and method The cross‐sectional approach using questionnaire and direct observation was applied. We followed STROBE guidelines. In total, questionnaires of 639 HCWs of surgical departments were included in the study, and 127 HCWs had been also directly observed. Results High self‐assessment regarding HH compliance and its knowledge was reported by 74% and 83% of HCWs, respectively. At the same time, only 51% of HCWs positively evaluated their colleagues with respect to hand hygiene. Similar to previous studies, we have found significant differences between physicians and nurses regarding the level of self‐assessment, attitude and perception of hand hygiene. Physicians were more critical in self‐assessment, and considered HH less important compared to nurses. The observations revealed drawbacks in hand hygiene practices. The high level of self‐overassessment might be a contributing factor to non‐compliance with hand hygiene. Conclusion It is necessary to establish systematic professional training and education of HCWs in relation to their hand hygiene, and to continuously monitor and evaluate the level of self‐assessment in clinical practice, mainly in surgery. Relevance to clinical practice A reasonable objective level of self‐assessment and attitude to HH are the most important conditions for preventing of HAI in patients. This article is protected by copyright. All rights reserved.
... 2,3 Use of nonsterile gloves has been associated with lower HH compliance rates at entry to patient rooms or before patient contact 4,5 and when gloves are used inappropriately during patient care (eg, worn when not necessary, worn without changing when necessary). 4,[6][7][8] The literature on the association between glove use and HH compliance after patient care or at room exit is mixed, with studies finding both better [9][10][11][12][13] and worse 4,5,7,14 HH compliance. ...
... 2,3 Use of nonsterile gloves has been associated with lower HH compliance rates at entry to patient rooms or before patient contact 4,5 and when gloves are used inappropriately during patient care (eg, worn when not necessary, worn without changing when necessary). 4,[6][7][8] The literature on the association between glove use and HH compliance after patient care or at room exit is mixed, with studies finding both better [9][10][11][12][13] and worse 4,5,7,14 HH compliance. ...
... Glove use is prominent among HCWs and can potentially undermine HH practices. 4,[6][7][8] This study examined practices and beliefs surrounding glove use and HH before gloving, chiefly at entry to the hospital rooms of patients. The findings indicate high rates of glove misuse (overuse when not necessary, underuse for contact precautions), low rates of HH before gloving and highlight gaps between selfreported and observed practices. ...
Article
Background: Understanding the perceptions and beliefs of health care workers (HCWs) regarding glove use and associated hand hygiene (HH) may be informative and ultimately improve practice. Research in this area is limited. This study examined the practices and beliefs of HCWs surrounding the use of nonsterile gloves and HH before gloving. Methods: The study was conducted at 3 large academic US hospitals using a parallel convergent mixed-method design. To estimate compliance rates, the gloving and HH practices of HCWs were observed at entry to patient rooms for 6 months. Interviews were conducted with 25 providers, nurses, and nursing assistants to investigate their beliefs and perceptions of these practices. Results: Observed HH compliance rates before gloving were 42%, yet in the interviews most HCWs reported 100% compliance. Observed compliance with gloving before entering contact precaution rooms was 78%, although all HCWs reported always gloving for standard and contact precautions. Most HCWs described using gloves more often than necessary. HCWs generally use gloves for their own safety and sanitize hands before gloving for patient safety. Numerous barriers to compliance with HH before gloving were discussed, including beliefs that gloves provide enough protection. Conclusions: HH and glove use are highly intertwined in clinical practice and should be considered jointly in infection prevention improvement efforts.
... Personalen bytte inte alltid handskar eller desinficerade händerna mellan olika patienter eller mellan olika sysslor (Flores & Pevalin, 2006b). Detta stöds av (Nobile et al., 2002) som kom fram till att nästan 10 % av hälso-och sjukvårdspersonalen inte bytte handskar mellan olika patienter. ...
... Att bli observerad kan ha en effekt på resultatet genom att personerna i undersökningen gör som de borde istället för som de brukar (Flores & Pevalin, 2006b;Kim et al., 2003;Stein et al., 2003). Även att uppge sin egen följsamhet genom att svara på en enkätundersökning, eller delta i intervjuer, kan ge felvärden. ...
... Nästan 10 % av hälso-och sjukvårdspersonalen bytte inte handskar mellan olika patienter (Nobile et al., 2002) och detta måste ses som oroande, då detta felaktiga handlande kan leda till smittspridning eftersom handskar är lika stora smittspridare som händer (SKL, 2005b). Det framgick också att handskar överanvändes (Flores & Pevalin, 2006b) vilket i vissa fall gör så att handskarnas syfte går förlorat. Handskar blir liksom händer orena och att använda vid moment som inte kräver det är dessutom slöseri med resurser. ...
... Healthcare workers' compliance with WHO guidelines may be poor, with gloves being worn when not required and vice versa. [5][6][7] Some investigators report lower rates of hand hygiene compliance if gloves are worn, 5,6,8 while others report unchanged or better rates of compliance. [9][10][11][12][13][14] It is hard to know how representative such studies are, as they vary in size, methodology, indications for glove use, and the numbers of wards or hospitals studied, with most taking place in only one hospital. ...
... Healthcare workers' compliance with WHO guidelines may be poor, with gloves being worn when not required and vice versa. [5][6][7] Some investigators report lower rates of hand hygiene compliance if gloves are worn, 5,6,8 while others report unchanged or better rates of compliance. [9][10][11][12][13][14] It is hard to know how representative such studies are, as they vary in size, methodology, indications for glove use, and the numbers of wards or hospitals studied, with most taking place in only one hospital. ...
... It is a much larger study (more wards and hospitals) than any other of which we are aware, and different investigators have used different definitions in the indications for glove use and the assessment of hand hygiene in association with glove wearing. Most studies have only assessed hand hygiene compliance after patient contact, 5,6,9,10,12,24 while others have used indications for glove use that differed from the WHO guidelines. 12,14 Our study excluded patients under contact precautions housed in side rooms, although not those housed in ward bays, whereas other studies included many such patients. ...
Article
Full-text available
Wearing of gloves reduces transmission of organisms by healthcare workers' hands but is not a substitute for hand hygiene. Results of previous studies have varied as to whether hand hygiene is worse when gloves are worn. Most studies have been small and used nonstandardized assessments of glove use and hand hygiene. We sought to observe whether gloves were worn when appropriate and whether hand hygiene compliance differed when gloves were worn. Observational study. Healthcare workers in 56 medical or care of the elderly wards and intensive care units in 15 hospitals across England and Wales. We observed hand hygiene and glove usage (7,578 moments for hand hygiene) during 249 one-hour sessions. Observers also recorded whether gloves were or were not worn for individual contacts. Gloves were used in 1,983 (26.2%) of the 7,578 moments for hand hygiene and in 551 (16.7%) of 3,292 low-risk contacts; gloves were not used in 141 (21.1%) of 669 high-risk contacts. The rate of hand hygiene compliance with glove use was 41.4% (415 of 1,002 moments), and the rate without glove use was 50.0% (1,344 of 2,686 moments). After adjusting for ward, healthcare worker type, contact risk level, and whether the hand hygiene opportunity occurred before or after a patient contact, glove use was strongly associated with lower levels of hand hygiene (adjusted odds ratio, 0.65 [95% confidence interval, 0.54-0.79]; P < .0001). The rate of glove usage is lower than previously reported. Gloves are often worn when not indicated and vice versa. The rate of compliance with hand hygiene was significantly lower when gloves were worn. Hand hygiene campaigns should consider placing greater emphasis on the World Health Organization indications for gloving and associated hand hygiene. National Research Register N0256159318.
... Most studies assessed compliance with IPC by means of self-reporting, using self-developed questionnaires and few studies measured compliance using direct observation by a trained observer (Table 2). Several factors that may affect HCWs' compliance and noncompliance with the IPC measures were reported in many research studies [3,8,17,19,21,26,30,34,47,49,53,55,56]. Three of the major factors prompting HCWs to comply with the IPC measures were knowledge, education and training, and experience [8, 17-19, 26, 30, 34, 47, 49]. ...
... Predictors of HCWs noncompliance included high workload [31,34] and time constraints [34], more beds and/or higher patient-to-nurse ratio [3,19], and professional category-specific [47]. Glove overuse seemed to reduce hand hygiene compliance [56]. Noncompliance of HCWs to occupational vaccinations recommendations was due to lack of fear of contracting the infection (e.g. ...
Article
Full-text available
Background Knowledge of infection prevention and control (IPC) procedures among healthcare workers (HCWs) is crucial for effective IPC. Compliance with IPC measures has critical implications for HCWs safety, patient protection and the care environment. Aims To discuss the body of available literature regarding HCWs' knowledge of IPC and highlight potential factors that may influence compliance to IPC precautions. Design A systematic review. A protocol was developed based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis [PRISMA] statement. Data sources Electronic databases (PubMed, CINAHL, Embase, Proquest, Wiley online library, Medline, and Nature) were searched from 1 January 2006 to 31 January 2021 in the English language using the following keywords alone or in combination: knowledge, awareness, healthcare workers, infection, compliance, comply, control, prevention, factors . 3417 papers were identified and 30 papers were included in the review. Results Overall, the level of HCW knowledge of IPC appears to be adequate, good, and/or high concerning standard precautions, hand hygiene, and care pertaining to urinary catheters. Acceptable levels of knowledge were also detected in regards to IPC measures for specific diseases including TB, MRSA, MERS-CoV, COVID-19 and Ebola. However, gaps were identified in several HCWs' knowledge concerning occupational vaccinations, the modes of transmission of infectious diseases, and the risk of infection from needle stick and sharps injuries. Several factors for noncompliance surrounding IPC guidelines are discussed, as are recommendations for improving adherence to those guidelines. Conclusion Embracing a multifaceted approach towards improving IPC-intervention strategies is highly suggested. The goal being to improve compliance among HCWs with IPC measures is necessary.
... There has been an observation of persistent problem with the perception of HH in associated with the use of gloves. Relatively low HH compliance in regard to the use of gloves is confirmed by Girou[37], Ji G,[38] Flores[39] study. In the study of McBryde et al.,[40] gloves were used in more than 75.0% of all health workers in accordance with the guidelines of HH and in the case of doctors, it was only 27.0%. ...
... In the study of McBryde et al.,[40] gloves were used in more than 75.0% of all health workers in accordance with the guidelines of HH and in the case of doctors, it was only 27.0%. Results of studies have found conflicting results with the respect to adherence of HH with regard to the use of gloves,Thompson,[41] Whitsby,[42] Girou,[37] Flores[39] found that HW who used gloves implemented HH less and vice versa, other studies Meengs, [43] Lankford, [44] Basurrah, [45] Gül et. al. ...
... Results from the study of 89 third-year student nurses in their third semester revealed inconsistencies in their clinical decision making and lack of an evidence base about the appropriate use of gloves during care delivery. Studies by Girou et al (2004) and Flores and Pevalin (2006) have discussed inappropriate glove use and the overuse of gloves in healthcare, resulting in gloves being worn for tasks that carry no risk to health professionals. We also found that students often wear gloves inappropriately -for example, 76% of study participants said they would wear gloves for washing a patient's hands and face and 42% said they would wear gloves for changing patients' clothes. ...
... In addition, 20% stated they would wear gloves when performing physiological observations. This correlates with Flores and Pevalin's (2006) finding that nurses wore gloves when undertaking cardiovascular observations. An emerging theme from the focus groups was that participants conformed to the practice observed by their mentors. ...
Article
Full-text available
Gloves can prevent infection but their use among student nurses is inconsistent. To explore pre-registration student nurses' views of non-sterile glove use in clinical practice. An online survey was conducted and focus groups carried out among third-year student nurses. The online survey showed that gloves were often worn inappropriately, while the focus groups revealed students conformed to their mentors' use of gloves. Student nurses' decisions on wearing gloves seem to be based on the culture of the clinical care environment rather than trust policy. Glove overuse deprives patients of therapeutic touch and may lead to contact dermatitis in nurses. All student nurses must be able to identify clinical situations when gloves are not indicated, using appropriate risk assessment.
... Although nurses generally accept the notion that wearing gloves is not a substitute for good HH practices, using gloves as an alternative for HH remained high despite interventions to improve HH [31]. In fact, some authors depicted wearing gloves as a contributing factor to poor CwHH and recommended interventions that alter the healthcare worker's gloves use behavior as part of any initiative to improve CwHH [32,33]. ...
Article
Full-text available
Background Hand hygiene (HH) among healthcare workers, especially nurses, is the main preventive measure to control healthcare associated infections but compliance with hand hygiene (CwHH) remains low in various settings including Kuwait. This study aimed to assess the knowledge of, attitudes towards, and CwHH among nursing staff in secondary care hospitals in Kuwait. Methods A cross-sectional study was conducted on nursing staff in all six secondary care hospitals in Kuwait. Data on knowledge of, attitudes towards, and self-reported CwHH were collected through a self-administered questionnaire that was developed based on WHO’s questionnaire, while the data on actual compliance were objectively collected through direct observation of nurses during routine care by two independent observers using WHO’s observation form. Results Of 829 nurses approached, 765 (92.2%) responded and participated. Of all participants, 524 (68.5%) were able to list “My Five Moments for Hand Hygiene” fully and appropriately. However, several misconceptions (e.g. air circulation in hospital is the main route of infection) about HH were found among the nurses. CwHH was (25.0%) by direct observation while self-reported compliance was (69.5%) each varied significantly (p < 0.001) between different hospitals. Female nurses compared to male nurses and non-Arab compared to Arab nationalities were more likely to report CwHH in multivariable analysis. Several items on knowledge of and attitudes towards HH were also associated with self-reported CwHH. Conclusion Observed CwHH among nursing staff in secondary care hospitals in Kuwait was low, which highlights the need to make more efforts to improve HH practices. Interventions that have been used elsewhere and found to be effective may be tested in Kuwait. Despite the good overall knowledge on HH among nurses, there are several misconceptions that need to be corrected.
... Though increased consumption by hospital visitors or HCWs taking ABHR home for personal use could explain an increase in consumption without effect on compliance, it is unlikely that this would explain for such a large increase. With respect to the increase in glove use, it is unlikely to positively influence an increase in ABHR use because there is strong evidence in the literature for a negative association between glove use and hand hygiene compliance [20][21][22]. Internal communication at HUG confirmed an increase in the incidence of adverse skin reactions among HCWs during the pandemic. Though the relationship between ABHR consumption and hand hygiene compliance is complex, tolerability and acceptability warranted further research. ...
Article
Full-text available
Introduction Healthcare workers often experience skin dryness and irritation from performing hand hygiene frequently. Low acceptability and tolerability of a formulation are barriers to hand hygiene compliance, though little research has been conducted on what specific types of formulation have higher acceptability than others. Objective To compare the acceptability and tolerability of an ethanol-based handrub gel with superfatting agents to the isopropanol-based formulations (a rub and a gel formulation) currently used by healthcare workers at the University of Geneva Hospitals, Geneva, Switzerland. Methods Forty-two participants were randomized to two sequences, testing the isopropanol-based formulation that they are using currently (Hopirub® or Hopigel®), and the ethanol-based formulation containing superfatting agents (Saniswiss Sanitizer Hands H1). Participants tested each of the formulations over 7–10 day work shifts, after which skin condition was assessed and feedback was collected. Results H1 scored significantly better than the control formulations for skin dryness ( P = 0.0209), and participants felt less discomfort in their hands when using that formulation ( P = 0.0448). H1 caused less skin dryness than Hopirub®/Hopigel® ( P = 0.0210). Though overall preference was quite polarized, 21 participants preferred H1 intervention formulation and 17 preferred the Hopirub®/Hopigel® formulation that they normally used in their care activities. Conclusion We observed a difference in acceptability and strongly polarized preferences among the participants' reactions to the formulations tested. These results indicate that giving healthcare workers a choice between different high-quality products is important to ensure maximum acceptability.
... Controversial data exist on the impact of gloves on HH compliance, but a decreased HH adherence when wearing gloves has been reported in several studies in human healthcare settings. [41][42][43] Universal gloving has even been associated with a significant increase of device-related infections in humans. 43 Since the CleanHands application version available at the time of this study did not allow to record the use of gloves by healthcare workers, the impact of wearing gloves on HH compliance in the veterinary personnel could not be assessed in this study. ...
Article
Full-text available
Background: Hand hygiene (HH) is one of the most important measures to prevent healthcare-associated infections. Data on HH compliance in companion animal veterinary institutions in Europe are sparse. Methods: This observational study assessed HH according to WHO standards in three large and two medium-sized clinics and two primary care practices in Switzerland. Associations with HH indication, professional group, clinical area and institution were determined using a generalized linear mixed effects model. Results: Based on 2056 observations, overall HH compliance [95% confidence interval] was 32% [30%-34%]. HH compliance was highest in the consultation area (41% [38%-45%]) and after contact to body fluids (45% [40%-50%]), and lowest in the pre-OR area (20% [15%-24%]) and before clean/aseptic procedures (12% [9%-15%]). Veterinarians showed a higher HH compliance (37% [34%-40%]) than veterinary nurses (25% [22%-28%]). HH compliance was lower before clean/aseptic procedures compared to all other indications (all p < 0.015 except 'before touching a patient' in medium-sized clinics/practices, p = 0.095) and higher in the consultation area compared to all other areas in large clinics (all p < 0.04). Conclusion: Effective HH training should urgently be promoted for all veterinary personnel with special emphasis on the importance of HH before clean/aseptic procedures.
... Some investigators [29][30][31] found that HCWs were less likely to perform hand hygiene if they wore gloves for a task while others found the reverse. [32][33][34] Our result corroborates the results of the latter studies. ...
Article
Full-text available
Objective To determine whether the order in which healthcare workers perform patient care tasks affects hand hygiene compliance. Design For this retrospective analysis of data collected during the Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) study, we linked consecutive tasks healthcare workers performed into care sequences and identified task transitions: 2 consecutive task sequences and the intervening hand hygiene opportunity. We compared hand hygiene compliance rates and used multiple logistic regression to determine the adjusted odds for healthcare workers (HCWs) transitioning in a direction that increased or decreased the risk to patients if healthcare workers did not perform hand hygiene before the task and for HCWs contaminating their hands. Setting The study was conducted in 17 adult surgical, medical, and medical-surgical intensive care units. Participants HCWs in the STAR*ICU study units. Results HCWs moved from cleaner to dirtier tasks during 5,303 transitions (34.7%) and from dirtier to cleaner tasks during 10,000 transitions (65.4%). Physicians (odds ratio [OR]: 1.50; P < .0001) and other HCWs (OR, 2.15; P < .0001) were more likely than nurses to move from dirtier to cleaner tasks. Glove use was associated with moving from dirtier to cleaner tasks (OR, 1.22; P < .0001). Hand hygiene compliance was lower when HCWs transitioned from dirtier to cleaner tasks than when they transitioned in the opposite direction (adjusted OR, 0.93; P < .0001). Conclusions HCWs did not organize patient care tasks in a manner that decreased risk to patients, and they were less likely to perform hand hygiene when transitioning from dirtier to cleaner tasks than the reverse. These practices could increase the risk of transmission or infection.
... Although glove use reduced transfer, there is concern that in practice the benefits of gloves might be offset by a reduction in compliance with hand hygiene in personnel wearing gloves. 26,27 Use of same PPE for examination of the contaminated and clean mannequins could have enhanced the benefit of either gloves plus gowns or gloves alone as in clinical practice no barriers might be appropriate during examination of the clean mannequin. Finally, the assessment of contamination was nonquantitative. ...
Article
Full-text available
Background There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission. Design Simulated patient care interactions. Objective To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission. Methods In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment. Results For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not. Conclusions Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.
... The primary role of disposable surgical gloves, disposable plastic aprons and other PPE is to diminish the risk of pathogen transmission between patients, healthcare workers and the environment. [22] Compared with previous studies where compliance rates ranged between 12% and 94%, [23,24] in this study disposable surgical gloves were used in 90.6% of opportunities in which they were indicated. It is important to note that the need for hand cleansing is not eliminated when disposable surgical gloves are used, and it should still be performed prior to donning as well as after removal of gloves. ...
Article
Full-text available
Background: Intensive care unit (ICU)-related healthcare-associated infections (HCAIs) are two to three times higher in lower-income countries than in higher-income ones. Hand cleansing and other hygiene measures have been documented as one of the most effective measures in combating the transmission of HCAIs. There is a paucity of data pertaining to hygiene practices in the ICU in developing countries. Objectives: To determine compliance with hygiene practices among healthcare workers in a tertiary hospital ICU. Methods: Hygiene practices of healthcare workers in a tertiary academic hospital ICU in Johannesburg, South Africa, were discreetly observed over an 8-week period. Compliance with hand cleansing and other hygiene practices was documented and analysed. Retrospective consent was obtained, and subject confidentiality was maintained. Results: A total of 745 hygiene opportunities were observed. Of the 156 opportunities where handwashing with soap and water was indicated (20.9%), compliance was noted in 89 cases (57.1%), while an alcohol-based hand rub was inappropriately used in 34 cases (21.8%) and no hand hygiene was performed in the remaining 33 cases (21.1%). Of the 589 opportunities where an alcohol-based hand-rub was indicated, it was used in 312 cases (53.0%). Compliance with the donning of disposable surgical gloves, disposable plastic aprons and being 'bare below the elbows' was noted in 114 (90.6%), 108 (71.1%) and 355 (47.7%) opportunities, respectively, where these were indicated. Conclusions: Overall compliance with hygiene measures among healthcare workers in the ICU was suboptimal in this study, but in keeping with general international trends. Regular retraining of staff, frequent reminders, peer oversight and regular audits may improve compliance.
... Majority of the respondents (96.0%) wear gloves in any procedure. This is similar to a study conducted in 24 where majority of the respondents (92.0%) use gloves. The majority of those who never use gloves said it was not necessary (60.0%) followed by the lack of enforcement (20.0%). ...
Article
Full-text available
This study determines the prevalence of occupational diseases and safety practices among health workers of General Hospital, Minna. The study was Cross Sectional Descriptive. Stratified Sampling Technique was adopted. Semi structured questionnaire was used to collect data. Data was analyzed in frequency tables. The most common occupational disease among the respondents include: Stress & Exhaustion 61.2%, Needle Stick Injury 52.8% and Neck and Low Back Pain 56.4%. Forty-two point eight percent (42.8%) of the respondents have received at least one dose of Hepatitis B Vaccine. Majority 57.2% never receive the Vaccine. There was no association between socio-demographic characteristics and receipt of vaccine. About 18.4% of the respondents have being exposed to fluids of HIV/AIDS patients through needle stick injury. Majority of them 60.9% have gone for Post Exposure Prophylaxis against HIV. More than half of the respondents 58.8% have been using Personal Protective Equipments (PPE). The study concludes that there is poor knowledge, high attitude and high level of practice of control of occupational hazards among health workers among the respondents. There should be strengthening of Health Education and Training of Health Workers on Occupational Hazards and its Control.
... These results were not unexpected and are consistent with findings elsewhere. 23,[30][31][32] Another self-protection practice that has always been globally high has been hand hygiene compliance with after patient contact (Moment 3 after exposure to body fluids and Moment 4 after patient contact). [33][34][35] The influence of previous contact precautions guidelines and the related poster had omitted hand hygiene. ...
Article
Full-text available
Background: Patients colonized or infected with methicillin-resistant Staphylococcus aureus and or vancomycin-resistant Enterococcus are placed under contact precautions. Contact precautions require patients to be placed in single rooms and their health care workers (HCWs) to wear gowns, aprons and gloves on entry and doffing on exit. Glove use is widely accepted to be associated with poor hand hygiene compliance. We trailed the removal of gloves for contact precautions for contacts not expected to involve body fluids to improve hand hygiene between multiple contacts of the patient and patient zone. Methods: We have conducted a 5 phase study of the removal of gloves for contacts without body fluids in 250 HCWs using pretrial focus groups (N = 12), hand microbiology (N = 40) (reported elsewhere), development of a modified contact precautions poster, trial of modified poster (n = 100), posttrial focus group discussion (n = 22), and a survey of HCWs postrollout in additional locations (n = 76). Results: Pretrial focus groups identified 4 themes, and the leading theme identified as the facilitator for glove use as self-protection. HCWs viewed current contact precaution guidelines as preventing them from making their own judgement regarding the need for gloving for patient contacts, leading continuous glove use without changing gloves between multiple contacts. Participants believed that the trial empowered them to make their own clinical judgment for gloves and to consciously use hand hygiene between dry (no body fluid) contacts. Four themes were discussed during the posttrial focus groups and although self-protection remained the central theme, hand hygiene replaced glove use. Participants spoke of an appreciation of and increased trust in hand hygiene during nonglove use for dry contacts. The survey responses from additional sites were mostly positive for the safety of nonglove use for dry contacts, it improved hand hygiene and that the adoption of the modified guidelines was empowering. Conclusions: The trial of nonglove use for expected dry contact, while caring for patients under contact precautions for methicillin-resistant S aureus and or vancomycin-resistant Enterococcus, was successful in refocusing HCWs reliance on hand hygiene for self-protection. Mandatory glove use for contact precautions was believed to contribute to their failure to change gloves between procedures on the same patient and patient zone, with HCWs now recognizing multiple contacts with the same gloves as a risk for contamination.
... Bizim çalışmamız dahil, farklı zamanlarda yapılan bu çalışmalara göre ülkemizde hemşirelerde el hijyeni bilincinde gelişme olduğu görülmektedir. İngiltere'de 2006 yılında yapılan bir çalışmada hastanede eldiven kullanım sıkılığının doktorlarda %71, hemşirelerde %91 olduğu gösterilmiştir (21). Bu durum İngiltere'de hastanelerde iş sağlığı uygulamalarında hemşirelerin daha özenli davranmalarından, daha eğitimli olmalarından ya da daha iyi denetim mekanizmalarına tabi tutulmalarından kaynaklanıyor olabilir. ...
Article
Full-text available
Amaç: Sağlık çalışanları iş yerlerinde birçok tehlike, kaza ve hastalık riski ile karşı karşıyadır. Bu çalışmanın amacı bir üniversite hastanesi sağlık çalışanlarının iş sağlığı-güvenliği durumunu saptayarak, risk faktörlerini belirlemektir. Gereç ve Yöntem: Kesitsel nitelikteki çalışma 2017'de Hatay Mustafa Kemal Üniversitesi Tıp Fakültesi Hastanesi'nde yapılmıştır. Araştırma evreni 855 sağlık çalışanı olup, üç günlük veri toplama sürecinde %30,4 (260)'üne ulaşılmıştır. Araştırmaya katılmayı kabul eden 209 (%80,0) kişiye anket ve "Hastanelerde Çalışan Sağlık Personeli İş Güvenliği Ölçeği" uygulanmıştır. Ölçek likert tipinde olup, 7 faktörden oluşmaktadır. Ölçekten maksimum 6 puan alınmakta, puan 6'ya yaklaştıkça iş güvenliğinin sağlandığı yönünde yorumlanmaktadır. Analizlerde Student-T, tek yönlü varyans ve Pearson Korelasyon testleri kullanılmıştır. Bulgular: Sağlık personelinin yaş ortalaması 30,8±6,1, %61,2'si kadın, %37,8'si hemşire ve %24,4'ü hekimdir. %72,7'si el dezenfektanını, %82,8'i eldiveni kullanmakta; %93,7'si sabuna, %90,3'ü el dezenfektanına, %87,9'u eldivene ulaşabilmektedir. İş güvenliği ölçeğinden aldıkları genel puan ortalaması 2,9±0,9 (1,00-5,69) olup, normal dağılım göstermektedir (p>0,05). Kadınların puan ortalaması 2,7±0,8 iken, erkeklerinki 3,2±1,0'dır (p=0,002). Çocuğu olanların puan ortalaması daha yüksektir (p=0,003). Dahili branştakilerin puan ortalaması 2,69±0,9 iken cerrahi branştakilerin 3,17±0,9, temel branştakilerin ise 2,72±0,9'dir (p=0,004). En düşük puanlar sırasıyla Faktör 1 (Mesleki Hastalıklar ve Şikayetleri) ve Faktör 4'den (Yönetsel Destek ve Yaklaşımlar) alınmıştır. Sonuç: Hastane sağlık çalışanlarının iş güvenliği ölçeği puan ortalaması tam puanın yarısına yakındır. Kadınların, dahili branş çalışanlarının ve çocuğu olmayanların iş sağlığı-güvenliği algısı daha düşüktür. Anahtar Sözcükler: Hastane, iş sağlığı, sağlık hizmetleri, sağlık çalışanları ABSTRACT Aim:Health care workers are susceptible to numerous risks of danger, illness and accidents. The aim is to determine the condition of occupational health-safety and risk factors in a university hospital healthcare workers. Materials and Methods: Across-sectional study was conducted at Hatay Mustafa Kemal University Hospital in 2017. We reached 30.4% (260 healthcare worker) of there search population (855) in three days of data collection, 209 (80,0%) persons were participated. The survey and ''Healthcare Worker's Work Safety Scale'' we reapplied. The scale is likert type, consist of 7 factors and maximum 6 points. Student-T, One Way ANOVA and Pearson Correlation tests were used. Results:The mean age of healthworkers is 30,8±6,1, 61,2% is woman, 37,8% is nurse and 24,4% is physcian. 72,7% of them are using hand sanitizer, 82,8% of them are using hand glove; 93,7% , 90,3% and 87,9% of them find soap, hand sanitizer and glov eavailable respectively. The mean score of the healthcareworkers on scale is 2,9±0,9 (1,00-5,69) and shows normal distribution (p>0,05). While woman's mean score is 2,7±0,8, man's is 3,2±1,0 (p=0,002). The mean score of them in medical disciplines is 2,69±0,9, surgical disciplines is 3,17±0,9 and basic sciences disciplines is 2,72±0,9 (p=0,004). They having child have high mean score (p=0,003). The lowest mean scores of the scale are on Factor-1 (occupational diseases and complaints) and Factor-4 (administrative support and approaches). Conclusion: Hospital healthworkers' job security score average is close to half of full score. Perception on occupational health and safety of woman, in medical disciplines and without having a child are lower.
... Subsequently, the World Health Organization (WHO) guidelines on hand hygiene recognised the potential for NSCG to be over-used and provided guidance on when gloves are indicated and when they are not required (WHO, 2009). However, recent studies suggest that the use of NSCG has extended to a wide range of care activities that do not involve direct contact with BBF and their use has been associated with a risk of cross-contamination because they are put on too early, removed too late and acquire pathogens during use that can then be transferred to susceptible sites, or other surfaces and patients (Flores and Pevalin, 2006;Fuller et al., 2011;Girou et al., 2004;Loveday et al., 2014aLoveday et al., , 2014bSnyder et al., 2008). ...
Article
Introduction: There is evidence that non-sterile clinical gloves (NSCG) are over-used by healthcare workers (HCWs) and are associated with cross-contamination. This study aimed to determine attitudes of student nurses and members of the public to the use of NSCG. Methods: Third-year student nurses completed a questionnaire indicating tasks for which they would wear NSCG and influences on their decision. Correlations between tasks were identified using exploratory factor analysis. An online survey of the public was conducted using snowball sampling method. Results: Sixty-seven students completed the questionnaire; they indicated use of NSCG for low-risk tasks and reported their own judgement as the main influence on their decision to wear them. Correlated tasks included 'perceived to be risky' or 'definitive indication for gloves/no gloves' and 'related to personal hygiene'. A total of 142 respondents completed the public survey. They reported being uncomfortable with HCW wearing gloves for some personal tasks, e.g. assisting to toilet and dressing, but 94% preferred their use for washing 'private parts'; 29% had observed inappropriate glove use by HCWs during recent contact with healthcare. Conclusion: Student nurses reported using NSCG routinely for tasks for which they are neither required nor recommended. The public observe inappropriate glove use and are uncomfortable with their use for some personal tasks.
... Përdorimi i dorëzave mjekësore nga PSH rekomandohet për dy arsye kryesore: 1) për të zvogëluar rrezikun e kontaminimit të duarve të PSH me gjak dhe lëngje të tjera trupore; 2) Për të zvogëluar rrezikun e përhapjes së mikrobeve në mjedis dhe transmetimit nga PSH tek pacienti dhe anasjelltas si dhe nga njëri pacient tek tjetri. 701,884,907,908 Dorëzat ekzaminuese për një përdorim (dispozabile), qoftë sterile apo josterile, janë zakonisht të prodhuara nga materiali lateks gome apo materiale të tjera sintetike si vinili, nitrili dhe neopreni (polimere dhe kopolimere të kloroprenit). Për shkak të prevalencës së rritur të mbindjeshmërisë së PSH dhe pacientëve ndaj lateksit, FDA ka aprovuar një varietet dorëzash me pudër dhe pa pudër me përmbajtje të reduktuar proteinike, si dhe dorëza sintetike që janë në dispozicion nga institucionet shëndetësore për përdorimin nga PSH dhe pacientët, të cilët kanë mbindjeshmëri ndaj lateksit. ...
... According to our study, the rate of using gloves for cleaning was 97.8%, of using bonnets was 39.9%, of using medical masks was 56.5%, and of wearing work clothes was 100%. According to a study done in an English hospital, the rate of using gloves was 91% among nurses, and 100% in allied health personnel [25]. With regard to the protective equipment, the use of gloves and work clothes was common. ...
Article
Full-text available
Objective: The aim of this study was to analyze the attitudes and conduct of hospital's cleaning staff regarding cleaning and hand hygiene. Methods: In May and June 2014 the cleaning staff of Elazig Training and Research hospital's participated in this descriptive research. Data was collected by a survey prepared by the researchers. The SPSS program was used to analyze the data. Results: Of the participants, 70.3% of them were male, and their mean age was 38.69 ± 6.61. The percentage of the hand washing before starting work was 29.8% for the primary school graduates or lower education. For those with higher levels of education, the percentage was 68.2% (p < 0.001). The percentage of participants who wash their hands after work was 54.3% for the primary school graduates and those with lower levels of education. For those with a higher level of education, the percentage was 84.1% (p < 0.001). The participants' use of personal protective equipment during work was that 97.8% of them used gloves, 39.9% bonnets, 56.5% medical masks. Conclusions: The attitudes and conduct of the cleaning staff are not sufficiently hygienic. These employees need training before and throughout their employment.
... In their observational study using a speciallydesigned audit tool, they demonstrated over-use and misuse of non-sterile gloves when no body fluids were present, suggesting this "had the potential for cross transmission on gloved hands (p. 30)." Flores and Pevalin (2006) suggest this has to do with multiple pressures, workload, and poor information, as well as a lack of role models at ward level. ...
Article
Full-text available
Climate change and limited natural resources will impact on the sustainable supply and disposal of materials used in health care. Healthcare students need opportunities to reflect on the ecological footprint of health services to mitigate against negative effects on service delivery. In order to raise awareness of these issues, there is a need for evidence-based teaching tools which are relevant and meaningful to nursing practice. An evidence-based sustainability skills teaching session was delivered to 293 nursing students from child and adult health disciplines. Following the sessions, evaluation sheets were distributed to the participants, of which 290 responded. The majority of nurses valued both the delivery and the content of the training and some were motivated to complete further study. The evaluation provided valuable information on how to deliver sustainability education and important insights into where more information and support was needed in order to change practice. Embedding sustainability teaching in skill sessions appears to be a realistic way of informing and motivating learners to consider current and best practice. Following training, further evaluation of practice-based behaviour is needed.
... Tidigare forskning pekar på att handskanvändning påverkar följsamheten till handhygien i en negativ riktning (Flores & Pevalin, 2006;Girou et al., 2004). Socialstyrelsen och Tenorio et al. (2006;2001) poängterar vikten av att desinfektera händerna efter användandet av handskar, då handskar lätt går sönder och händerna förorenas när handskarna tas av. ...
... These have identified NSG being worn for procedures that do not involve exposure to BBF and that have not been removed in a timely way (Thompson et al, 1997;Prieto and Macleod Clark, 2005;Chau et al, 2011). Other studies have suggested that the use of NSG may have an adverse effect on compliance with the 5MHH (Fuller et al, 2011;Flores and Pevalin, 2006). ...
Article
Background: The use of non-sterile gloves (NSG) has become routine in the delivery of health care, often for procedures for which they are not required; their use may increase the risk of cross contamination and is generally not integrated into hand hygiene audit. This paper describes a small-scale application and validation of an observational audit tool devised to identify inappropriate use of NSG and potential for cross contamination. Methods: Two observers simultaneously observed the use of NSG during episodes of care in an acute hospital setting. The inter-rater reliability (IRR) of the audit tool was measured corrected for chance agreement using Kappa. Results: A total of 22 episodes of care using NSG were observed. In 68.6% (24/35) of procedures there was no contact with blood/body fluid; in 54.3% (19/35) NSG-use was inappropriate. The IRR was 100% for eight of 12 components of the tool. For hand hygiene before and after NSG removal it was 82% (Kappa = 0.72) and 95% (Kappa = 0.87). Conclusions: In this small-scale application of a glove-use audit tool we demonstrated over-use and misuse of NSG and potential for cross transmission on gloved hands. The audit tool provides an effective mechanism for integrating glove use into the audit of hand hygiene behaviour.<br/
... Hand rubbing with an alcohol based waterless hand antiseptic seems to be the best method of increasing compliance with hand hygiene. (4)(5)(6) Alcohol-based hand rubs are recommended for use by HCWs for routine decontamination. Most of these preparations in the form of liquid and gel contain between 60% and 70% ethanol. ...
Article
Full-text available
Background: Antiseptic agents or plain soap and water are mainly used for hand hygiene in Egypt. The impact of hand hygiene depends not only on the regularity and thoroughness of the procedures used but also on the type of hand-washing agent selected. Objectives: To compare the efficacy of alcohol-based hand rubs versus traditional hand washing with soap and water in reducing hand contamination during routine patient care. Material and methods: The study included 20 volunteered nurses in 3 intensive care units and the renal dialysis unit, in the Alexandria University Students' Hospital. A total of 200 samples were collected by direct finger-print of the dominant hand taken from all nurses before and after applying hand hygiene procedures. Three hand-rubs available in the Egyptian market (Brands A, B; alcohol-based liquid, and C; alcohol-based gel) were used and compared to a locally prepared hand-rubbing solution (D) and to hand washing with non-antiseptic soap and water (SW). Results: Hand washing with non-antiseptic soap and water and all of the four used alcohol-based hand-rubs showed significant reduction of bacterial counts on the examined hands. The median percentage reductions were 99%, 94%, 77%, and 87% with brands A, B, C and D respectively and only 30% reduction with soap and water (x2: 23.023, p <0.001). Conclusions and recommendations: Alcohol-based hand rub is far more efficient than traditional hand washing, and more convenient and time saving. Locally prepared hand rub is comparable to readymade ones. It is recommended as a hand hygiene practice in critical areas, particularly when sink and running water are inaccessible.
Article
Full-text available
Background Nosocomial infections are particularly common among hospitalized patients who undergo resuscitation compared with other types of care. Hand hygiene remains the simplest and most effective measure to prevent and control the risk of infection. Objective The main objectives are to evaluate hand hygiene compliance among nursing staff in the different intensive care units and to identify the factors influencing the adherence of nursing staff to the practice. Methods It was a quantitative descriptive study using a questionnaire and an observation grid with all the nursing staff working in all the intensive care units of our university hospital. Results The study showed a hand contamination rate of (80%), a hand hygiene compliance rate of (21.3%), it also showed the different factors explaining non-adherence, these are not necessarily related to training, nor to the availability of material resources but related to hidden reasons, non-apparent factors, which are often more important. (Workload and work environment) Conclusion This study examined hand hygiene in the ICU setting, obtained data on overall compliance, which remains poor, and the various factors influencing nurses' adherence to the practice.
Article
Background : Nonsterile gloves (NSG) are often overused, while the emphasis should lie in hand hygiene (HH). Furthermore, improper HH leads to contamination of NSG in glove boxes. The aim of this study was to compare microbial loads on hands from health-care workers (HCW) after HH to NSG and to study the influence of position and filling level of glove boxes on contamination rates. Methods : Fingerprints on agar plates were made from randomly chosen HCWs directly after HH. Plates were incubated and colony-forming units (CFU) counted. NSG taken from glove boxes were also sampled. Filling level and position (horizontal vs vertical) of the glove boxes were recorded. Results : Median CFU count was similar for hands after HH (N=107, median 1, IQR 5) and NSG (N=185, median 1, IQR 2, p-value 0.33). Only few samples in both groups showed growth of pathogenic bacteria. Neither the filling level (p-value 0.76), nor the position of the glove box (p-value 0.68) had an influence on NSG contamination. Conclusion : Microbial loads of hands after HH are comparable to NSG. Filling level or position of the glove box did not influence glove contamination. Whether similar microbial counts translate into comparable nosocomial infection rates warrants further research.
Article
The main objective of the study was to evaluate two fit testing methods for protective gloves using anthropometric measurements. The gloves differed in terms of textile materials (woven fabric without elastomeric fibres and knitted fabric with elastomeric fibres), with and without size allowances, respectively. The evaluation method proposed may supplement the standard glove fitting procedure given in Standard EN 420:2003+A1:2009. The standard specifies only a method for measuring hand circumference and length, while the Authors used an original approach to measure the length and width for the purposes of glove fitting. The objective of the case study was to determine the optimum size difference between the protective glove and the user’s hand. The methodology developed shows how to evaluate gloves made of woven or knitted fabrics with or without elastomeric fibres in the context of glove fitting, which has direct implications for user comfort and the safety of manual work.
Article
Guidelines recommend that health care personnel (HCP) wear gloves for all interactions with patients on contact precautions. We aimed to assess hand hygiene (HH) compliance during contact precautions before and after eliminating mandatory glove use. We assessed HH compliance of HCP in the care of patients on contact precautions in 50 series before (2009) and 6 months after (2012) eliminating mandatory glove use and compared these results with the hospital-wide HH compliance. We assessed 426 HH indications before and 492 indications after the policy change. Compared with 2009, we observed a significantly higher HH compliance in patients on contact precautions in 2012 (52%; 95% confidence interval [95% CI], 47-57) vs 85%; 95% CI, 82-88; P < .001). During the same period, hospital-wide HH compliance also increased from 63% (95% CI, 61-65) to 81% (95% CI 80-83) (P < .001). However, the relative improvement (RI) of HH compliance during contact precautions was significantly higher than the hospital-wide relative improvement (RI, 1.6; 95% CI, 1.49-1.81 vs 1.29; 95% CI, 1.25-1.34), with a relative improvement ratio of 1.27 (95% CI, 1.15-1.41). Eliminating mandatory glove use in the care of patients on contact precautions increased HH compliance in our institution, particularly before invasive procedures and before patient contacts. Further studies on the effect on pathogen transmission are needed before revisiting the current official guidelines on the topic. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
Article
Background The incorrect use of clinical gloves and the failure to change them between procedures increases the risk of cross-transmission. Much attention has been focused on compliance with hand hygiene. Aim To investigate the use of gloves, their potential for cross-contamination, and factors that influence the decision of healthcare workers (HCWs) to wear them. Methods The use of gloves was observed in six wards in a single UK hospital trust. Risk of cross-contamination was defined as a violation of a ‘moment of hand hygiene’ during the glove-use episode. Twenty-five HCWs from the wards included in the observational audit were interviewed to identify the drivers for glove use. Findings A total of 163 glove-use episodes were observed over a period of 13 h. Glove use was inappropriate in 69 out of 163 (42%) episodes, with gloves commonly used inappropriately for low-risk procedures (34/37; 92%). In 60 out of 163 (37%) episodes of glove use there was a risk of cross-contamination, most (48%) being associated with failure to remove gloves or with perform hand hygiene after use. HCW interviews indicated that the decision to wear gloves was influenced by both socialization and emotion. Key emotions were disgust and fear. Assumptions that patients preferred gloves to be used, confusion about when to wear them, and social norms and peer pressure were also important influences. Conclusion Glove use is associated with risk of cross-contamination and should be more explicitly integrated into hand hygiene policy. An understanding of the drivers of glove-use behaviour is required to design interventions to reduce misuse and overuse.
Article
The purpose of this study was to evaluate nurses’ knowledge of infection prevention procedures, the degree to which they were applied correctly, and whether length of service affected either knowledge or application. Nurses with over five years of experience had significantly increased understanding of infection prevention (p=0.009) and significantly increased application of knowledge to practice (p=0.001), compared to nurses with five years or less experience. In particular, understanding of hand hygiene and use of personal protective equipment (PPE) was poor although application was compliant, while knowledge of care of patients with meticillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile was poor, which was reflected by substandard application of knowledge to practice. The results of this study suggest that focusing infection prevention education around patients with specific infections, such as MRSA and C. difficile, rather than on individual standard precautions may more effectively increase knowledge and therefore application of infection prevention practices.
Article
Full-text available
Cd 1–x Zn x S thin films prepared by a chemical bath deposition (CBD) method. Cadmium acetate, zinc acetate and thiourea used as a cadmium, zinc and sulfur ions in solution, respectively. Five types of samples were synthesized onto glass substrates with different Cd 2+ and Zn 2+ sources molarities in alkaline solution (pH=11) and at a temperature 80 o C. The films' thickness was in the range (102-120) nm and most film's thickness decreased while Zn concentration in solution increased. The transmittance of films increased as Zn concentration increased. All films, however, have high transmittance of 65-85% in the wavelength region (500-900) nm, which is high enough for solar cell applications. The energy band gaps of Cd 1–x Zn x S films calculated and their values were (2.24-3.7) eV. The values of the width of the tails of localized states in the forbidden gap of the films obtained from Urbach plots and varied in the range (0.025-0.11) eV. The optical constants such as, extinction coefficient, refractive index, real and imaginary parts of the dielectric constant are found. The dispersion energy E d and a single-oscillator energy E o measured from the single oscillator model below the absorption edge are used to calculate the moments of the optical spectra M -1 and M -3 .
Article
Tin oxide (SnO2) thin films were deposited by radio frequency (RF) magnetron sputtering on clean corning glass substrates. These films were then annealed for 15 min at various temperatures in the range of 100–5008C. The films were investigated by studying their structural and electrical properties. X-ray diffraction (XRD) results suggested that the deposited SnO2 films were formed by nanoparticles with average particle size in the range of 23–28 nm. XRD patterns of annealed films showed the formation of small amount of SnO phase in the matrix of SnO2. The initial surface RMS roughness measured with atomic force microscopy (AFM) was 25.76 nm which reduces to 17.72 nm with annealing. Electrical resistivity was measured as a function of annealing temperature and found to lie between 1.25 and 1.38 mVcm. RMS roughness and resistivity show almost opposite trend with annealing.
Article
Healthcare associated infections (HCAI) are huge problem all over the world, and 5-10% of all hospitalized patients will develop infection during hospitalization. From the times of I. P. Semelweiss we know that clean hands are the most important single factor that can decrease the number of HCAI. World Health Organization (WHO) has recognised this problem and developed Guidelines for hand hygiene in healthcare institutions. This also was the reason of developing Croatian national Guidelines. The main goal of the Guidelines was to decrease number of HCAI associated with the hands of healthcare workers. These Guidelines are meant for all healthcare workers and other hospital staff who come to the direct contact with patients. An interdisciplinary team of experts developed these Guidelines using WHO Guidelines, other existing guidelines and literature reviews for hand hygiene. Grades of evidence for specific recommendations were determined using CDC/HICPAC grading system. Categorization is based on existing data, theoretical basis, applicability and economic impact. After a broad discussion in different professional societies, Guidelines were accepted. Guidelines include recommendations for hand hygiene indications, hand hygiene technique, surgical hand preparation, choosing hand hygiene preparations, skin care, nails, glove use, patients and visitors hand hygiene, role of education, as well as role of healthcare institution and role of government. Furthermore, in the Guidelines the concept of "Five moments for hand hygiene" is explained in detail, and main literature data are presented.
Article
Full-text available
Registered nurses’ hand hygiene (HH) compliance is generally higher than that of physicians. This may partially be explained by differences in undergraduate HH education. A HH Questionnaire (HHQ) containing a HH knowledge quiz, Practices Inventory, Beliefs Scale, Importance Scale, and a social desirability scale, was used to examine healthcare students’ HH knowledge, beliefs, practices, and education in Australia, Sweden, Greece and Italy.The HHQ was completed by 899 nursing and 505 medical students from 18 universities. The scales demonstrated adequate reliability (α = 0.71-0.81). The mean score on the HH quiz was 64.4%. On 5-point Likert scales, students reported positive HH beliefs (3.94/5), and practices (4.58/5), and perceived that HH was considered important in the clinical setting (3.99/5). A third of students did not know the indications for alcohol-based hand gels. Interactive teaching strategies were considered more effective by students than those that were not.Nursing students’ HH knowledge scores, and scores on the Beliefs and Importance scales were significantly higher (p < .001) than those of medical students. Nursing students were significantly more likely to perceive that HH was considered important in the curriculum, were assessed on HH knowledge and skills more frequently during their degree (x¯ = 7.64 vs 3.69 times), and were more likely to report positive HH practices (p < .001). There were small (r = 0.12–0.15) statistically significant correlations between social desirability scores and scores on the scales. The very high social desirability scores of some students indicated a limited capacity for accurate self-assessment, indicating that students need training in self-assessment.There was a significant relationship between HH knowledge, the number of teaching strategies used and the number of times HH was assessed during the degree (p = .015). The number of teaching strategies, HH beliefs, frequency of HH assessment, perceptions of the importance of HH in the curriculum and as an infection control measure had a significant influence on students’ HH practices (p < .001). Perceptions of the importance given to HH in the curriculum, by supervisors and facilities, and as an infection control measure influenced students’ scores on the Beliefs scale.The higher knowledge scores of nursing students, underpinned by the greater emphasis on HH education and assessment in nursing curricula suggests that HH knowledge could be improved through repeated HH education and assessment in undergraduate curricula. Teaching in tutorials and clinical settings may be more effective than methods that don’t involve interaction between students and teachers. The influence of students’ perceptions of the importance placed on HH in their curriculum, and the clinical setting, indicates the importance of good role models in the socialisation of students.While the HHQ examined students’ HH knowledge, beliefs and practices, it did not determine the quality of the education that students received. As students’ knowledge acquisition can also be influenced by aptitude and education quality, further research is needed to examine these factors.
Article
Hand hygiene remains the single most effective measure to prevent hospital acquired infection and yet poor compliance is reported repeatedly. Nurses represent the largest labour group and perform the greatest amount of direct patient care in the contemporary National Health Service. They receive their initial hand hygiene training in the pre-registration curriculum within a competence framework based on knowledge, skills and attitudes. The pre-eminent training method is one that delivers behavioural competence, making the tacit assumption that compliance will follow. In this study a mixed methods approach demonstrated that students overestimated their knowledge and skills, found it difficult to give an objective account of their performance, and reported an improbable level of compliance. The reasons why people can be self serving in their judgements may be due to information processing errors, exacerbated by the model of education and training. Flawed self assessments may present major barriers to improved performance if students view their compliance as better than it actually is. Conceptualising hand hygiene as a taxonomy of learning and introducing the cognitive strategies of reflection and self assessment would better enable students to problem solve, seek out new information, draw on past experience and gain greater and deeper understanding of the complex topic of hand hygiene behaviour.
Article
Full-text available
Cross-transmission of microorganisms by the hands of health care workers is considered the main route of spread of nosocomial infections. To study the process of bacterial contamination of health care workers' hands during routine patient care in a large teaching hospital. Structured observations of 417 episodes of care were conducted by trained external observers (S.T. and V.S.). Each observation period started after a hand-cleansing procedure and ended when the health care worker proceeded to clean his or her hands or at the end of a coherent episode of care. At the end of each period of observation, an imprint of the 5 fingertips of the dominant hand was taken and bacterial colony counts were quantified. Regression methods were used to model the intensity of bacterial contamination as a function of method of hand cleansing, use of gloves during patient care, duration and type of care, and hospital ward. Bacterial contamination increased linearly with time on ungloved hands during patient care (average, 16 colony-forming units [CFUs] per minute; 95% confidence interval, 11-21 CFUs per minute). Patient care activities independently (P<.05 for all) associated with higher contamination levels were direct patient contact, respiratory care, handling of body fluid secretions, and rupture in the sequence of patient care. Contamination levels varied with hospital location; the medical rehabilitation ward had higher levels (49 CFUs; P=.03) than did other wards. Finally, simple hand washing before patient care, without hand antisepsis, was also associated with higher colony counts (52 CFUs; P=.03). The duration and type of patient care affect hand contamination. Furthermore, because hand antisepsis was superior to hand washing, intervention trials should explore the role of systematic hand antisepsis as a cornerstone of infection control to reduce cross-transmission in hospitals.
Article
Full-text available
Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol- based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates. This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene.
Article
Full-text available
We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) were observed in the old hospital and 417 (58%) in the new hospital. Hand-hygiene compliance was significantly better in the old hospital (161/304; 53%) compared to the new hospital (97/417; 23.3%) (p<0.001). Health-care workers in a room with a senior (e.g., higher ranking) medical staff person or peer who did not wash hands were significantly less likely to wash their own hands (odds ratio 0.2; confidence interval 0.1 to 0.5); p<0.001). Our results suggest that health-care worker hand-hygiene compliance is influenced significantly by the behavior of other health-care workers. An increased number of hand-washing sinks, as a sole measure, did not increase hand-hygiene compliance.
Article
Full-text available
In spite of its importance, handwashing frequency in healthcare workers is generally low. The rebuilding and relocation of an 800-bed tertiary referral hospital on the same campus allowed assessment of the impact of easy accessibility to sinks on handwashing compliance. The new hospital design ensured that no clinical activity could occur more than 5 m (usually much less) from a sink. In the old hospital, clinical staff were often up to 30 m from a sink. Covert observation of nursing staff was undertaken in intensive care, infectious diseases, internal medicine and urology wards, over a total of 24 h during three consecutive days, two months before and one and 10 months after relocation to the new hospital. In all areas, handwashing compliance was greater before than after-patient contact. Initial increases (9-24%) in after-patient contact handwashing frequency following patient contact were demonstrated in units of both high and low clinical care activity one month after relocation. However, no sustained clinically significant improvement could be demonstrated nine months later. Glove use was shown to diminish compliance with handwashing protocols by as much as 25%. Improved accessibility to sinks does not lead to an improvement in healthcare workers' handwashing compliance.
Article
In 1998, the Department of Health (England) commissioned the first phase of national evidence-based guidelines for preventing healthcare associated infections. These focused on developing a set of standard principles for preventing infections in hospitals together with guidelines for preventing hospital-acquired infections (HAI) associated with the use of short-term indwelling urethral catheters in acute care and with central venous catheters in acute care. These guidelines are systematically developed broad statements (principles) of good practice that all practitioners can use and which can be incorporated into local protocols. A nurse-led, multi-professional team composed of infection prevention practitioners, clinical microbiologists/retrovirologist, epidemiologists, and researchers developed the guidelines. A rigorous guideline development process was used to inform the systematic reviews, the clinical and critical appraisal of relevant evidence, and linking that evidence to evolving guidelines. Both general and specialist clinical practitioners were involved in all stages of developing these guidelines, as were representatives from relevant Royal Colleges, learned societies, other professional organisations and key stakeholders. The introduction to these guidelines describes a robust and validated guideline development model that can be used by others to develop future guidelines. This model is described in more detail in the associated technical reports that can be found on the project web site <http://www. epic.tvu.ac.uk>. Locating and appropriately using good quality evidence to inform guideline development in this field is challenging. Evidence from rigorously conducted experimental studies was frequently limited and consequently a range of other types of evidence were systematically retrieved and carefully appraised. The concluding discussion on implementation highlights potential issues for clinical governance and areas for future research and suggests issues that need to be addressed to allow practitioners to successfully incorporate these guidelines into routine clinical practice.
Article
Reviews the methodological and empirical literature on systematic field observation in several fields. Three historical waves of interest in and refinement of systematic field observation techniques are identified, and sociological contributions to each are noted. These techniques have been applied in studies that cover a variety of research purposes and topical subject matters. There are three distinct conceptual and methodological paradigms advocated by researchers who do systematic field observation: the behavior variables approach, the behavior element approach, and the constructivist approach. -Author
Article
Modern medicine still has to contend with the major problem of infections resulting from patient care. Despite considerable evidence that appropriate hand hygiene is the leading measure to reduce cross-infection, compliance with recommendations remains notoriously low among healthcare workers. In high-demand situations, such as in most critical-care units, or at times of overcrowding or understaffing, promoting hand cleansing with an alcohol-based handrub solution seems to be the most practical means of improving compliance. It requires less time, acts faster, irritates hands less often, and is superior to traditional handwashing or medicated hand antiseptic agents. Furthermore, it was used in the only programme that reported a sustained improvement in hand-hygiene compliance associated with decreased infection rates. Although easy access to fast-acting hand-hygiene agents is the main tool of any campaign to obtain sustained improvement with hand-hygiene practices, a multidisciplinary approach is necessary to produce behavioural change.
Article
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
Article
To describe methicillin-resistant Staphylococcus aureus (MRSA) control in a hospital, including a surgical intensive care unit (SICU) outbreak. Prospective surveillance of newly identified patients with MRSA. Barrier isolation (disposable gloves for direct contact with patient or immediate environment) was used for the routine care of hospitalized MRSA patients as of October 1991. Beginning in 1992, MRSA isolates were typed by restriction endonuclease enzyme analysis of plasmid DNA (REAP) and/or pulsed-field gel electrophoresis of genomic DNA (PFGE). Surveillance information and MRSA typing were used concurrently to identify nosocomial case clustering, confirm cross-infection, and support a need for additional outbreak control interventions. University-affiliated public hospital. Patients with newly identified MRSA colonization or infection from 1991 through 1993 and epidemiologically associated staff providing care to eight SICU patients in an outbreak. Barrier isolation for affected and unaffected patients in and admitted to the SICU institution when the outbreak was identified and cross-infection confirmed. Anterior nares cultures of staff in contact with outbreak cases for detection of MRSA colonization. Fifty-six hospitalized patients with community-acquired MRSA and 80 patients with nosocomial MRSA colonization or infection were identified during the 3 years. After the introduction of barrier isolation, the annual frequency of new nosocomial MRSA cases decreased and only one outbreak (eight cases in the SICU) caused by type-related isolates occurred. The other 35 nosocomial cases of MRSA during 1992 and 1993 were not epidemiologically related or were caused by isolates with different types. The SICU outbreak ended after instituting barrier isolation for all patients (with and without MRSA) in and admitted to the unit. Six colonized SICU staff were identified. All outbreak cases had identical or related MRSA types by PFGE and REAP. Staff isolates were different from case isolates by typing, and staff were not restricted and not given treatment for colonization. After more than 6 months of follow up, no further outbreaks of MRSA in the SICU or elsewhere in the hospital occurred despite returning to barrier isolation for affected patients only. MRSA in hospitals and outbreaks of MRSA in ICUs can be controlled by surveillance and minimal barrier interventions. REAP or PFGE typing of MRSA can be used to support or refute the presence of cross-transmission. Typing also may be helpful when planning and assessing the effectiveness of interventions directed at endemic, as well as outbreak, MRSA control.
Article
To determine glove use and handwashing practices, the factors associated with infection control practices, and the frequency of potential microbial transmission in a long-term-care facility (LTCF). Observational study of 230 staff-resident interactions in an LTCF. We recorded resident characteristics, type of activity, staff credentials, and movements of the staff member's hands, then used the LTCF's guidelines to judge appropriateness of glove use and handwashing. 255-bed, university-based LTCF in Baltimore, Maryland. A systematic sample of staff-resident interactions. Gloves were worn in 139 (82%) of 170 interactions when indicated, but changed appropriately in only 1 (16%) of 132. Hands were washed when needed before an interaction in 27%, during an interaction in 0%, and after an interaction in 63%. Gloves were less likely to be used when caring for residents with gastrostomy tubes compared with other residents (relative risk, 0.85; 95% confidence interval, 0.73-0.98). Guidelines were followed more frequently during wound care than during other activities. Microbial transmission potentially could have occurred in 158 (82%) of 193 evaluable interactions. We documented marked deficiencies in glove and handwashing, demonstrated the possible impact of these deficiencies, and identified factors associated with inadequate handwashing and glove use. This information can be used in future educational and research efforts to improve infection control practices.
Article
Concern frequently is voiced about individuals not complying with guidelines intended to prevent spread of antibiotic-resistant pathogens from patient to patient, but institutional decisions to ignore Centers for Disease Control and Prevention guidelines recommending detection and isolation of colonized patients also have contributed greatly to the increasing rate of infections due to these pathogens. This is so because colonized patients are the main reservoir for spread, and barrier precautions prevent spread much more effectively than Standard Precautions. Providing effective leadership and changing this culture of noncompliance must begin with the infection control team believing that spread is both important and preventable.
Article
Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel. We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant. We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001). The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
Article
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
Article
Handwashing is the most effective and economic intervention shown to reduce nosocomial infection rates. However, studies have consistently documented low hand disinfection compliance. Literature regarding the roles that concomitant glove use and isolation precautions play in health care worker compliance with hand disinfection is limited. It is unclear whether workers change gloves and disinfect hands adequately between exposures to different body sites/secretions while caring for a patient. This was an observational study in which hand disinfection compliance and glove use among workers was evaluated in 2 intensive care units at a tertiary care hospital. Five hundred eighty-nine opportunities for hand disinfection were recorded in 40 hours of observation. Overall compliance was 22.1%. We found a statistically significant, positive association between glove use and subsequent hand disinfection (relative risk [RR], 3.9 [95% CI, 2.5-6.0]; P <.0001). Isolation precautions did not significantly increase disinfection compliance. Only 4.8% (3/63) of workers appropriately complied with disinfection when hands were exposed to multiple body sites/secretions while caring for a patient. Glove use increases compliance with hand disinfection. Isolation precautions do not increase compliance. Workers do not appropriately comply with disinfection guidelines when attending to multiple body sites/secretions on the same patient. Compliance with hand disinfection remains low.
Article
Improvement in hand hygiene compliance is important for reducing cross-infection by micro-organisms. The objective of this prospective observational study was to measure how the improper use of gloves limits compliance to hand hygiene and exposes patient's to infection. The study was conducted in five wards (three intensive care units and two medical wards) in a French university hospital. Staff-patient and staff-environment contacts were observed in 120 healthcare workers caring for patients colonized or infected with pathogenic bacteria. Hand hygiene was not undertaken due to improper gloving in 64.4% (95%CI, 64.1% to 65.1%) of instances. Possible microbial transmission might have occurred in 18.3% (95%CI, 17.8% to 18.8%) of all contacts because used gloves were not removed before performing care activities that necessitated strict aseptic precautions. Failure to change or remove contaminated gloves was a major component in the poor compliance with hand hygiene and carried a high-risk of microbial transmission. Improving hand hygiene compliance will require changing healthcare workers behaviour towards glove use.
Protective clothing: principles and guidance Bathgate: Fitwise r13 Rates of hand disinfection associated with glove use, patient isolation, and changes between exposure to various body sites The measurement of observer agreement for categorical data
  • Bathgate Pw Kim
  • M Roghmann
  • En Perencevich
  • Ad Harris
  • Koch
Bathgate: Fitwise Infection Control Nurses Association (2002b) Protective clothing: principles and guidance Bathgate: Fitwise r13 Kim PW, Roghmann M, Perencevich EN, Harris AD (2003) Rates of hand disinfection associated with glove use, patient isolation, and changes between exposure to various body sites. Am J Infect Control 31:97-103. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159-74. Lankford MG, Zembower TR, Tricks WE, Hacek DM, Noskin GA, Peterson LR. (2003) Influence of role models and hospital design on hand hygiene of health care workers
Structured field observation
  • M J Mccall
McCall MJ. (1984) Structured field observation. Ann Rev Socio 10: 263-82.
Hand decontamination guidelines. Fitwise: Bathgate. ICNA. (2002b) Protective clothing: principles and guidance
  • Icna
ICNA. (2002a) Hand decontamination guidelines. Fitwise: Bathgate. ICNA. (2002b) Protective clothing: principles and guidance. Fitwise: Bathgate.
Single-use medical devices: implications and consequences of reuse. DB(04)
Medical Devices Agency. (2000) Single-use medical devices: implications and consequences of reuse. DB(04). Medical Devices Agency; London.
Hand-washing: a modest measure -with big effects
Handwashing Liaison Group. (1999) Hand-washing: a modest measure -with big effects. BMJ 318: 686. See: http://bmj.com/cgi/ content/full/318/7185/686 (accessed 8 November 2006).
  • Pittet D.
  • Hartstein AI
  • Thompson BL
  • Garner JS