Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-03T00:30:41.972Z Has data issue: false hasContentIssue false

Handwashing and Glove Use in a Long-Term–Care Facility

Published online by Cambridge University Press:  02 January 2015

Betsy L. Thompson*
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Field Epidemiology, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemiology and Disease Control Program, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
Diane M. Dwyer
Affiliation:
Epidemiology and Disease Control Program, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
Xilla T. Ussery
Affiliation:
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia
Susan Denman
Affiliation:
Johns Hopkins University School of Medicine, Baltimore, Maryland
Pam Vacek
Affiliation:
Biometry Facility, University of Vermont College of Medicine, Burlington, Vermont
Benjamin Schwartz
Affiliation:
National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia
*
CDC/NCCDPHP/Division of Adult and Community Health, 4770 Buford Hwy, Mailstop K30, Atlanta, GA 30341-3724

Abstract

Objectives:

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).

Design:

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.

Setting:

255-bed, university-based LTCF in Baltimore, Maryland.

Participants:

A systematic sample of staff-resident interactions.

Results:

Gloves were worn in 139 (82%) of 170 interactions when indicated, but changed appropriately in only 21 (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.

Conclusions:

We documented marked deficiencies in glove use 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.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control. Recommendations for prevention of HIV transmission in health-care settings. MMWR 1987;36:3S18S.Google Scholar
2. Centers for Disease Control. Update: Universal Precautions for prevention of transmission of human immunodeficiency virus, Hepatitis B virus, and other bloodborne pathogens in healthcare settings. MMWR 1988;37:377-382,387388.Google Scholar
3. Lynch, P, Jackson, MM, Cummings, MJ, Stamm, WE. Rethinking the role of isolation practices in the prevention of nosocomial infections. Ann Intern Med 1987;107:243246.Google Scholar
4. Lynch, P, Cummings, MJ, Roberts, PL, Herriott, MJ, Yates, B, Stamm, WE. Implementing and evaluating a system of generic infection precautions: body substance isolation. Am J Infect Control 1990;18:112.CrossRefGoogle ScholarPubMed
5. Khabbaz, RF, Tenney, JH. Infection control in Maryland nursing homes. Infect Control Hosp Epidemiol 1988;9:159162.Google Scholar
6. Birnbaum, D, Schulzer, M, Mathias, RG, Kelly, M, Chow, AW. Adoption of guidelines for Universal Precautions and body substance isolation in Canadian acute-care hospitals. Infect Control Hosp Epidemiol 1990;11:465472.Google Scholar
7. Missouri Department of Health. Infection Control in Long Term Care Facilities With an Emphasis on Body Substance Precautions. Jefferson City, MO: Missouri Department of Health; 1992.Google Scholar
8. Goldrick, B, Larson, E. Assessment of infection control programs in Maryland skilled-nursing long-term care facilities. Am J Infect Control 1994;22:8389.Google Scholar
9. Casewell, M, Phillips, I. Hands as route of transmission for Klebsiella species. Br Med J 1977;2:13151317.Google Scholar
10. Saravolatz, LD, Pohlod, DJ, Arking, LM. Community-acquired methicillin-resistant Staphylococcus aureus infections: a new source for nosocomial outbreaks. Ann Intern Med 1987;97:325329.CrossRefGoogle Scholar
11. Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.Google Scholar
12. LeClair, JM, Freeman, J, Sullivan, BF, Crowley, CM, Goldmann, DA. Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation practices. N Engl J Med 1987;317:329334.CrossRefGoogle Scholar
13. Larson, E. A causal link between handwashing and risk of infection? Examination of the evidence. Infect Control Hosp Epidemiol 1988;9:2836.Google Scholar
14. Conly, JM, Hill, S, Ross, J, Lertzmann, J, Louis, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330339.CrossRefGoogle Scholar
15. Doebbeling, BN, Stanley, GL, Sheetz, CT, et al. Comparative efficacy of alternative handwashing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:8893.Google Scholar
16. Scheckler, WE, Peterson, PJ. Infections and infection control among residents of eight rural Wisconsin nursing homes. Arch Intern Med 1986;146:19811984.CrossRefGoogle ScholarPubMed
17. Alvarez, S, Shell, CG, Woolley, TW, Berk, SL, Smith, K. Nosocomial infections in long-term facilities. J Gerontol 1988;43:M9M17.CrossRefGoogle ScholarPubMed
18. Hoffman, N, Jenkins, R, Putney, K. Nosocomial infection rates during a one-year period in a nursing home care unit of a Veterans' Administration hospital. Am J Infect Control 1990;18:5563.Google Scholar
19. Jacobson, C, Strausbaugh, LJ. Incidence and impact of infection in a nursing home care unit. Am J Infect Control 1990;18:151159.Google Scholar
20. Smith, PW, Daly, PB, Roccaforte, JS. Current status of nosocomial infection control in extended care facilities. Am J Med 1991;91:281S285S.Google Scholar
21. Jackson, MM, Fierer, J, Barrett-Connor, E, et al. Intensive surveillance for infections in a three-year study of nursing home patients. Am J Epidemiol 1992;135:685696.Google Scholar
22. Kristensen, MS, Wernberg, NM, Anker-Moller, E. Healthcare workers' risk of contact with body fluids in a hospital: the effect of complying with the Universal Precautions policy. Infect Control Hosp Epidemiol 1992;13:719724.CrossRefGoogle Scholar
23. Stock, SR, Gafni, A, Bloch, RF. Universal Precautions to prevent HIV transmission to health care workers: an economic analysis. Can Med Assoc J 1990;142:937946.Google ScholarPubMed
24. Bloodborne pathogens. Federal Register 1991;56:6403964044.Google Scholar
25. Larson, E, Bobo, L, Bennett, R, et al. Lack of caregiver hand contamination with endemic bacterial pathogens in a nursing home. Am J Infect Control 1992;20:1115.Google Scholar
26. Degroot-Kosolcharoen, J, Jones, JM. Permeability of latex and vinyl gloves to water and blood. Am J Infect Control 1989;17:196201.Google Scholar
27. Korniewicz, DM, Laughon, BE, Butz, A, Larson, E. Integrity of vinyl and latex procedure gloves. Nurs Res 1989;38:144146.CrossRefGoogle ScholarPubMed
28. Korniewicz, DM, Laughon, BE, Cyr, WH, Lytle, CD, Larson, E. Leakage of virus through used vinyl and latex examination gloves. J Clin Microbiol 1990;28:787788.Google Scholar
29. Olsen, RJ, Lynch, P, Coyle, MB, Cummings, J, Bokete, T, Stamm, WE. Examination gloves as barriers to hand contamination in clinical practice. JAMA 1993;270:350353.CrossRefGoogle ScholarPubMed
30. Kelen, GD, Green, GB, Hexter, DA, et al. Substantial improvement in compliance with Universal Precautions in an emergency department following institution of policy. Arch Intern Med 1991;151:20512056.Google Scholar
31. Albert, RK, Condie, F. handwashing patterns in medical intensive-care units. N Engl J Med 1981;304:14651466.Google Scholar
32. Preston, GA, Larson, EL, Stamm, WE. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641645.CrossRefGoogle Scholar
33. Mayer, JA, Dubbert, PM, Miller, M, Burkett, PA, Chapman, SW. Increasing handwashing in an intensive care unit. Infect Control 1986;7:259262.CrossRefGoogle Scholar
34. Donowitz, LG. Handwashing technique in a pediatric intensive care unit. Am J Dis Child 1987;141:683685.Google Scholar
35. Dubbert, PM, Dolce, J, Richter, W, Miller, M, Chapman, SW. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191193.Google Scholar
36. Graham, M. Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:7780.Google Scholar
37. Simmons, B, Bryant, J, Nieman, K, Spencer, L, Arheart, K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589594.Google Scholar
38. Kaplan, LM, McGuckin, M. Increasing handwashing compliance with more accessible sinks. Infect Control 1986;7:408410.Google Scholar
39. Larson, E, McGeer, A, Quraishi, ZA, et al. Effects of an automated sink on handwashing practices and attitudes in high-risk units. Infect Control Hosp Epidemiol 1991;12:422428.Google Scholar
40. Larson, E. Guideline for use of topical antimicrobial agents. Am J Infect Control 1988;16:253266.Google Scholar
41. Smith, PW, Rusnak, PG. APIC guideline for infection prevention and control in the long-term care facility. Am J Infect Control 1991;19:198215.CrossRefGoogle ScholarPubMed
42. Infection Control Guidelines for Long Term Care Facilities. Epidemiology and Disease Control Program. Maryland Department of Health and Mental Hygiene; 1989.Google Scholar
43. Bloodborne pathogens. Federal Register 1991;56:6417564182.Google Scholar
44. Greenland, S, Robins, JM. Estimation of a common effect parameter from sparse follow-up data. Biometrics 1985;41:5568.Google Scholar
45. Patterson, JE, Vecchio, J, Pantelick, EL, et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var. anitratus in an intensive care unit. Am J Med 1991;91:479483.Google Scholar
46. Garner, JS, Simmons, BP. Guideline for isolation precautions in hospitals. Infect Control 1983;4:245325.Google Scholar
47. Weinstein, RA, Kabins, SA. Isolation practices in hospitals. Ann Intern Med 1987;5:781782. Letter.CrossRefGoogle Scholar
48. Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove, implications for glove reuse and handwashing. Ann Intern Med 1988;109:394398.Google Scholar
49. Lynch, P, Cummings, MJ, Stamm, WE, Jackson, MM. Handwashing versus gloving. Infect Control Hosp Epidemiol 1991;12:139. Letter.Google Scholar
50. Birnbaum, D, Schulzer, M, Mathias, RG, Kelly, M, Chow, AW. Handwashing versus gloving. Infect Control Hosp Epidemiol 1991;12:140. Letter reply.Google Scholar
51. Larson, E, Killien, M. Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:9399.Google Scholar
52. Willy, ME, Dhillon, GL, Loewen, NL, Wesley, RA, Henderson, DA. Adverse exposures and Universal Precautions practices among a group of highly exposed health professionals. Infect Control Hosp Epidemiol 1990;11:351356.Google Scholar
53. Marcil, WM. Handwashing practices among occupational therapy personnel. Am J Occup Ther 1993;47:523528.Google Scholar
54. Garibaldi, RA, Brodine, S, Matsumiya, S. Infections among patients in nursing homes, policies, prevalence, and problems. N Engl J Med 1981;305:731735.Google Scholar
55. Bentley, DW. Current challenges and future opportunities. Infect Control Hosp Epidemiol 1989;10:481483.Google Scholar
56. Perceval, A. Wash hands, disinfect hands or don't touch? Which, when, and why? Infect Control Hosp Epidemiol 1993;14:273275.Google Scholar
57. Lidwell, OM, Towers, AG, Ballard, J, Gladstone, B. Transfer of micro-organisms between nurses and patients in a clean air environment. J Appl Bacteriol 1974;37:649656.Google Scholar
58. Lester, MR. Looking inside 101 nursing homes. Am J Nurs 1964;64:111116.Google Scholar
59. Price, LE, Sarubbi, FA, Rutala, WA. Infection control programs in twelve North Carolina extended care facilities. Infect Control 1985;6:437441.Google Scholar
60. Franson, TR, Duthie, EH, Cooper, JE, Van Oudenhoven, G, Hoffmann, RG. Prevalence survey of infections and their predisposing factors at a hospital-based nursing home care unit. J Am Geriatr Soc 1986;34:95100.Google Scholar
61. Bradley, SF, Terpenning, MS, Ramsey, MA, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417422.Google Scholar
62. Hsu, CCS. Serial survey of methicillin-resistant Staphylococcus aureus nasal carriage among residents in a nursing home. Infect Control Hosp Epidemiol 1991;12:416421.Google Scholar
63. Strausbaugh, LJ, Jacobson, C, Sewell, DL, Potter, S, Ward, TT. Methicillin-resistant Staphylococcus aureus in extended-care facilities: experience in a Veterans' Affairs nursing home and review of the literature. Infect Control Hosp Epidemiol 1991;12:3645.Google Scholar