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No Time for Handwashing!? Handwashing Versus Alcoholic Rub Can We Afford 100% Compliance?

Published online by Cambridge University Press:  02 January 2015

Andreas Voss  and
Andreas F. Widmer
Andreas Voss
Affiliation:
Department of Medical Microbiology, Division of Hospital Epidemiology and Infection Control, University Hospital Nijmegen, The Netherlands
Andreas F. Widmer
Affiliation:
Department of Clinical Epidemiology, University Hospital, Basel, Switzerland
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Abstract

Handwashing is the most important and least expensive measure to prevent transmission of nosocomial infections. However, compliance rarely exceeds 40% under study conditions. Alcoholic hand disinfection (AHD) generally is used in Europe. In contrast, handwashing with medicated soap is practiced most frequently in the United States. Healthcare workers often explain the failure to comply with handwashing or AHD as due to the limited time available for this practice. We calculated a time consumption for handwashing and AHD in a representative model intensive-care unit with 12 healthcare workers, based on different compliance levels (40%, 60%, and 100%), duration of handwashing (40-80 seconds), and AHD (20 seconds). Comparing the extremes of our model, given 100% compliance, handwashing consumes 16 hours of nursing time per day shift, whereas AHD from a bedside dispenser requires only 3 hours (P=.01). We conclude that 100% compliance with handwashing may interfere with patient care and partly explains the low compliance. In contrast, AHD, with its rapid activity, superior efficacy, and minimal time commitment, allows 100% healthcare-worker compliance without interfering with the quality of patient care.

Type
Readers' Forum
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 3 , March 1997 , pp. 205 - 208
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. 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;11:589–594.CrossRefGoogle ScholarPubMed
2. Quraishi, ZA, McGuckin, M, Blais, FX. Duration of handwashing in intensive care units: a descriptive study. Am J Infect Control 1984;11:83–87.CrossRefGoogle Scholar
3. Graham, M. Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:77–81.CrossRefGoogle Scholar
4. Albert, RK, Condie, F. Hand-washing patterns in medical intensive-care units. N Engl J Med 1981;304:1465–1466.CrossRefGoogle ScholarPubMed
5. Doebbeling, BN, Stanley, GL, Sheetz, CT, et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:88–93.CrossRefGoogle ScholarPubMed
6. Dubbert, PA, Dolce, J, Richter, W, Miller, M, Chapman, SW. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191–193.CrossRefGoogle ScholarPubMed
7. Larson, EL, Eke, PI, Wilder, MP, Laughon, BE. Quantity of soap as a variable in handwashing. Infect Control 1987;9:371–375.CrossRefGoogle Scholar
8. Widmer, AF. Infection control and prevention strategies in the ICU. Intensive Care Med 1994;20(suppl 4):7S–11S.Google Scholar
9. Garner, JS, Favero, MS. CDC guidelines for handwashing and hospital environmental control. Infect Control 1986;7:231–235.Google Scholar
10. Ehrenkranz, NJ. Bland soap handwash or hand antisepsis? The pressing need for clarity. Infect Control Hosp Epidemiol 1992;13:299–301.CrossRefGoogle ScholarPubMed
11. Perceval, A. Wash hands, disinfect hands, or don't touch? Which, when, and why? Infect Control Hosp Epidemiol 1993;14:273–275.CrossRefGoogle ScholarPubMed
12. Lilliy, HA, Lowbury, EJ, Wilkins, MD. Limits to progressive reduction of resident skin bacteria by disinfection. J Clin Pathol 1979;32:382–285.Google Scholar
13. Davies, GE, Francis, J, Martin, RR. 1:6-di-4′-chlorophenyldiguanidohexane (‘Hibitane’): laboratory investigation of a new antibacterial agent of high potency. Br J Pharmacol 1954;9:192–193.Google Scholar
14. Harrington, C, Walker, H. The germicidal action of alcohol. Boston Medical and Surgical Journal 1903;148:548–551.CrossRefGoogle Scholar
15. Widmer, AF, Perschmann, M, Gasser, TC, Frei, R. Alcohol versus chlorhexidine gluconate for preoperative hand scrub: a randomized cross-over clinical trial. In: Abstracts of the 34th Interscience Conference on Antimicrobial Agents and Chemotherapy; 1994; Orlando, FL. Abstract J180.Google Scholar