A Barrier To Good Hand Hygiene

 

 

 

# 5939

 

 

It sounds counter-intuitive. 

 

That the use of latex (or vinyl) gloves could contribute to reduced hand hygiene compliance in health care settings. 

 

But that is exactly what a study - published in the December issue of Infection Control and Hospital Epidemiology – has uncovered.

 

The study, which was conducted at 15 hospitals in the UK, found that hand hygiene compliance – even in this age of heightened awareness of infection control - was `disappointingly low’.

 

Overall hand hygiene compliance was observed to be just 47.7%, while the use of gloves was associated with a further decrease to just 41%.

 

It would appear that the use of gloves can lead to a false sense of security, and the result is a reduction in hand hygiene.

 

The following press release comes from SHEA, the  Society for Healthcare Epidemiology of America. 

 

Latex gloves lead to lax hand hygiene in hospitals, study finds

CHICAGO -- Healthcare workers who wear gloves while treating patients are much less likely to clean their hands before and after patient contact, according to a study published in the December issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. This failure of basic hand hygiene could be contributing to the spread of infection in healthcare settings, the researchers say.

 

Glove use is appropriate for situations when contact with body fluids is anticipated or when patients are to be managed with contact precautions. However, use of gloves should not be considered a substitute for effective hand hygiene practices taking place before and after patient contact. Although gloves can reduce the number of germs transmitted to the hands, germs can sometimes still get through latex. Hands can also be contaminated by "back spray" when gloves are removed after contact with body fluids.

 

The researchers, led by Dr. Sheldon Stone of the Royal Free Hospital NHS Trust, observed more than 7,000 patient contacts in 56 intensive care and acute care of the elderly wards in 15 United Kingdom hospitals, making this one of the largest and most detailed studies on gloves and their impact on hand hygiene. Overall, the study found that hand hygiene compliance was "disappointingly low," at just 47.7 percent. Compliance was even lower in instances where gloves were worn, dipping to just over 41 percent.

 

"The chances of hands being cleaned before or after patient contact appear to be substantially lower if gloves were being worn," said Dr. Stone, the principal investigator. "We call this the phenomenon of the 'Dirty Hand in the Latex Glove.'"

(Continue . . . )

 

Cite: Christopher Fuller, Joanne Savage, Sarah Besser, Andrew Hayward, Barry Cookson, Ben Cooper, Sheldon Stone. The Dirty Hand in the Latex Glove: A Study of Hand-Hygiene Compliance When Gloves Are Worn. Infection Control and Hospital Epidemiology 32:12 (December 2011)

 

Given the huge burden of HAIs (Hospital Acquired Infections), the subject of hand hygiene comes up frequently in this blog. 

 

You’ll find a lot more on this subject in last month’s Giving Germs A Helping Hand, which looked at low handwashing compliance among doctors and other healthcare providers.

 

On May 5th of this year the World Health Organization promoted a CLEAN YOUR HANDS DAY  to encourage HCWs to improve and sustain hand hygiene practices around the world.

 

Clean Care is Safer Care

First Global Patient Safety Challenge
Clean Care is Safer Care

 

Additionally, the CDC’s hand hygiene website  has many resources, including a link to a new iPad/iPhone application called iScrub.

 

 

To round out this entry, some oldies but goodies from the AFD archives.

Doing The Hand Jive

Hand Hygiene Among Doctors Exposed

Gonna Wash Those Germs Right Off Of My Hands

»» Read More

MRSA: It’s Got Seasonality

 

 

 

# 5479

 

With our attentions diverted to the horrific tragedies in Japan, a number of important studies published over the past month have received less attention than they might otherwise.  

 

One such study that captured my attention appeared late last month in PloS One, that found a significant spike in MRSA infections reported by a Rhode Island Emergency room during warm weather months (3rd & 4th quarters of the year):

 

Seasonality of MRSA Infections

Mermel LA, Machan JT, Parenteau S (2011) Seasonality of MRSA Infections. PLoS ONE 6(3): e17925. doi:10.1371/journal.pone.0017925

Abstract

Using MRSA isolates submitted to our hospital microbiology laboratory January 2001–March 2010 and the number of our emergency department (ED) visits, quarterly community-associated (CA) and hospital-associated (HA) MRSA infections were modeled using Poisson regressions.

 

For pediatric patients, approximately 1.85x (95% CI 1.45x–2.36x, adj. p<0.0001) as many CA-MRSA infections per ED visit occurred in the second two quarters as occurred in the first two quarters.

 

For adult patients, 1.14x (95% CI 1.01x–1.29x, adj.p = 0.03) as many infections per ED visit occurred in the second two quarters as in the first two quarters.

 

Approximately 2.94x (95% CI 1.39x–6.21x, adj.p = 0.015) as many HA-MRSA infections per hospital admission occurred in the second two quarters as occurred in the first two quarters for pediatric patients.

 

No seasonal variation was observed among adult HA-MRSA infections per hospital admission. We demonstrated seasonality of MRSA infections and provide a summary table of similar observations in other studies.

(Continue . . . )

 

 

By examining hospital and emergency room records at a Rhode Island hospital over a 10 year span, the authors demonstrated that pediatric patients experienced approximately 1.85 times as many community-associated (CA) MRSA infections and 2.94 as many hospital-associated (HA) MRSA infections in the second two quarters of the year as opposed to the first two quarters.

 

While a similar pattern was observed for adults, it was less pronounced, with 1.14 times as many CA-MRSA infections in the 3rd & 4th quarters, but no detectable increase in adult HA-MRSA infections.

 

As far as what might explain these seasonal differences, the authors point out that higher temperatures alone cannot not account for the increases.

 

Temperatures in the 2nd quarter of the year in Rhode Island are generally higher than in the 4th quarter. 

 

While there are many unanswered questions, the authors suggest that factors such as excessive hydration of the skin (sweating), summer insect bites, and warm, humid environments conducive to bacterial survival and spread may account for the rise.

 

The spike during the 4th quarter may be due to a delay between colonization and apparent infection, or may even be partially attributed to increases in respiratory infections during the fall months which may lead to greater S. aureus transmission.

 

While more research on this phenomenon is needed, for now this study continues to highlight the importance of personal hygiene; hand washing, showering, caring for breaks in the skin (cuts, scrapes, insect bites), and respiratory etiquette  - along with the disinfection of surfaces that are apt to be contaminated with Staphylococcus aureus.

 

See CDC webpage on Prevention of MRSA Infections.

 

Steps that are important year-round, but may take on even greater importance during the 3rd & 4th quarters of the year.

»» Read More

Update On The Florida Dengue Cases

 

# 4732

 

 

Yesterday we were greeted by a flood of stories on Dengue Fever being detected in my home state of Florida.

 

These reports came on the heels of a CDC study suggesting as many as 1,000 Key West residents may have been recently infected with the disease.

 

Excerpts from the CDC’s press release follow:

 

Report Suggests Nearly 5 Percent Exposed to Dengue Virus in Key West

An estimated 5 percent of the Key West, Fla., population—over 1,000 people—showed evidence of recent exposure to dengue virus in 2009, according to a report from the Centers for Disease Control and Prevention (CDC) and the Florida Department of Health.

 

You can find coverage of the Key West story going back several months in this blog, including:

 

MMWR: Travel Associated Dengue Surveillance 2006-2008

MMWR: Dengue Fever In Key West

Dengue Resurfaces In Key West

The Threat Of Vector Borne Diseases

 

On Thursday, the story emerged that a man in Miami – who had not left the county in months – had Dengue, and yesterday, additional reports came in of Dengue in Ocala and in Orlando.

 

Late yesterday, we learned that the Miami case tested negative by PCR and serum antibody tests, and late yesterday it was announced that the Ocala and Orlando cases were travel associated – not locally acquired.

 

First this story (hat tip Dutchy on FluTrackers) from the Orlando Sentinel, then a little discussion.

 

 

 

Dengue fever in Orange, Marion

Neighboring Lake County is already under a mosquito-borne disease advisory after two horses tested positive for Eastern Equine Encephalitis, another disease spread by mosquitoes.

By Kevin P. Connolly, Christine Show and Walter Pacheco, Orlando Sentinel

3:56 p.m. EDT, July 16, 2010

State health officials Friday confirmed three cases of dengue fever in Orange County — shortly after reports of a suspected South Florida infection.

 

Test results Friday showed the suspected case in the Miami area came back negative.

 

The three people who tested positive for the mosquito-borne illness in Orange County did not acquire it locally. A case in Marion County also was contracted outside the U.S.

 

Orange County Health Department spokesman Dain Weister said two patients were infected in Puerto Rico —where the disease has reached epidemic proportions — and the other person acquired the infection in Haiti.

 

"It's important to remember that these cases are not endemic to this area," Weister said.

(Continue . . . )

 

The Health Department spokesperson might well have added the word `yet’ to his statement, since the way Dengue is carried into new areas is through infected travelers that are bitten by local mosquitoes.

 

It may, however, take a number of such visitors bringing the virus into an area before it can gain an effective toehold and begin to circulate locally.

 

Or, as we saw in 2007, it only took a single infected traveler to introduce Chikungunya to Ravenna, Italy which ultimately spread to at least 290 other people.

 

So the precautions and warnings issued by the CDC and local health departments on Dengue prevention are still important to heed.

 

In order to spread, Dengue requires the right mosquito vector.  And the two species best suited to transmit the virus are the Aedes aegypti and Aedes albopictus mosquitoes, which also can spread such diseases as West Nile, Malaria, Yellow Fever, and Chikungunya.

 

 

 

Map showing the distribution of dengue fever (red) and the distribution of the Aedes aegypti mosquito (cyan)  in the world, as of 2006. Agricultural Research Service of the US Department of Agriculture.

 

Map showing the native habitat (blue) and recent spread (green) of the Aedes albopictus mosquito.

 

According to a recent report, as many as 28 states in the US have at least one of the these mosquito vectors.

 

Mosquitoes here in Florida (and elsewhere) may carry other diseases, such as  SLE (St. Louis Encephalitis), EEE (Eastern Equine Encephalitis), and West Nile Virus.

 

 

 As the Miami-Dade County Health Department reminds us, to protect yourself from mosquitoes, you should practice the “5 D's”:

• Dusk and Dawn – avoid being outdoors when mosquitoes are very active 
  
• Dress – wear clothing that covers most of your skin 
  
• DEET – repellents containing up to 30 percent DEET (N, N-diethyl-meta-toluamide) are recommended. Other effective mosquito repellents include picaridin, oil of lemon eucalyptus, and IR 3535. Always read label directions for approved usage before your apply a repellent. Some repellents are not suitable for children. 
  
• Drainage – check around your home to remove standing water, where mosquitoes may lay eggs.

Getting rid of mosquito breeding sites is one of the keys to prevention. 

• Clean out eaves, troughs and gutters 
  
• Remove old tires or drill holes to drain those used in playgrounds 
  
• Turn over or remove empty plastic pots 
  
• Pick up all beverage containers and cups 
  
• Check tarps on boats or other equipment that may collect water 
  
• Pump out bilges on boats 
  
• Replace water in birdbaths and pet or other animal feeding dishes at least once a week 
  
• Change water in plant trays, including hanging plants, at least once a week 
  
• Remove vegetation or obstructions in drainage ditches that prevent the flow of water

»» Read More

Sydney ERs Report `Nasty Virus’

 

 

 

# 4431

 

Dr. Gordian Fulde is the head of the Emergency Department at St. Vincent’s Hospital in Sydney, Australia and writes a column for the Daily Telegraph.

 

This morning, his column mentions an influx of patients into local Emergency Rooms with a nasty respiratory virus, some of whom are developing pneumonia.   This appears to be an `off season’ virus, as the flu season `down under’ is still several months away.

 

The identity of this virus isn’t stated, other than the belief that it isn’t the novel H1N1 swine flu. As we’ve discussed in the past (see ILI’s Aren’t Always The Flu) there are a lot of different viruses out there capable of causing `flu-like’ symptoms.

 

First the report, then a few comments.

 

 

Nasty virus taking Sydney people down

• Dr Gordian Fulde
• From: The Daily Telegraph
• March 15, 2010 12:00AM

SYDNEYSIDERS are being hit by a virus that is not only taking down people but also hospital staff.

 

It is an unseasonal virus, not the swine flu, that is really nasty and the emergency department has been flooded by people coming in sick with it.

 

It has caused some people, even young ones, to get pneumonia.

 

This is not the right time of the year but it is amazing how it is spreading. It seems to be attacking the head so people feel like they are getting the flu.

 

They will have a nasty cough and we are seeing a lot of sore throats and infections that are so severe we have to admit people.

 

Some patients have had throats so swollen they can't swallow or breath properly and even their neck is swollen.

 

Last fall we saw similar reports coming out of Emergency Rooms here in the United States, and it was eventually determined that a particularly nasty Rhinovirus was to blame.  

 

I blogged about it several times, including When The `Flu’ Isn’t The Flu,  and Maggie Fox, Health and Science Editor of Reuters wrote about it here:

 

 

Not just swine flu - new cold virus may lurk, too

Tue Nov 17, 2009 3:24pm EST

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - Runny nose, fever, cough, even pneumonia -- the symptoms sound like swine flu but children hospitalized at one U.S. hospital in fact had a rhinovirus, better known as a common cold virus, doctors said on Tuesday.

 

Hundreds of children treated at Children's Hospital of Philadelphia had a rhinovirus, and federal health investigators are trying to find out if it was a new strain, and if this is going on elsewhere in the country.

 

“What began to happen in early September is we started seeing more children coming to our emergency room with significant respiratory illness," said Dr. Susan Coffin, medical director of infection control and prevention at the hospital.

(Continue. . .)

 

None of which is to suggest that what the residents of Sydney are seeing is the same Rhinovirus (although it might be).  There are, quite frankly, a lot of plausible candidates. 

 

Including some we’ve probably not identified.

 

The take home message here is, whatever the cause, good respiratory etiquette remains important, even if the pandemic virus is waning in your community.  

Covering your coughs, washing your hands, and staying home when you are sick are good ideas all of the time.  

 

Not just during a pandemic.  And not just during flu season, either.

»» Read More