Hand Gel Use Did Not Decrease Infection Rates
By Debra Wood, RN, contributor
Even though researchers at the University of Nebraska Medical Center doubled the rate at which nurses and other care providers used alcohol-based hand gels, the number of hospital-acquired infections did not decrease. Still, the team believes hand hygiene is valuable.
“We want nurses to be washing their hands, and physicians and visitors,” said Teresa Fitzgerald, RN, a co-author of the study and an infection control specialist at the University of Nebraska Medical Center. “It is important, and you need to do it all of the time.”
With the popularity of alcohol-based preparations for hand hygiene growing, the Nebraska team sought to determine if introducing hand gels on two adult medical-surgical intensive care units would improve the nosocomial infection rate. The results were published in the journal Infection Control and Hospital Epidemiology.
Trained observers monitored compliance with hand hygiene for 300 hours during the two-year study period. Rates improved with education about hand hygiene and when hand gel was available on the unit. Hand-hygiene adherence rates rose from 38 percent to about 70 percent when hand gel was available.
“We were excited the hand-hygiene compliance went up,” Fitzgerald said.
Darlene Robinson, RN, BSN, OCN, infection control coordinator at Fox Chase Cancer Center in Philadelphia, called the research an important study, because it demonstrated that alcohol-based hand gel “provides a mechanism to increase compliance. It is easier and quicker, if you place it in the right location.”
Fox Chase has thee dispensers everywhere, including next to the elevators. She has no plans to change the hospital’s aggressive hand-hygiene campaign, saying that hand hygiene can reduce infection rates. She hopes someone else will conduct similar research to see if they replicate the results.
The Nebraska investigators cultured the hands of 69 nurses. Nail length, use of alcohol-based gel and wearing of at least one ring on the dominant hand were associated with more microbes recovered.
Throughout the study, the team monitored rates of central venous catheter-related bacteremia, urinary catheter-associated urinary tract infection and ventilator-associated pneumonia. Rates of these infections were low on both units, but they had a high rate of device use.
The researchers did not observe a relationship between the greater use of the hand gel and infection rates. They did not culture to check for asymptomatic colonization.
“This study looked only at nosocomial infections,” said Angela Hammer, manager of the department of infection prevention and control at Children’s Memorial Hospital in Chicago, commenting on the study, but not involved with the research. “It did not look at the transferring of organisms from hands to patients, which is what we are trying to achieve with hand hygiene.”
In the paper, the researchers speculate that 70 percent hand-hygiene compliance may not be enough to decrease pathogen transmission. They also said that reducing infection requires a multifaceted approach.
“[Hand hygiene] is only a small piece infection control,” Fitzgerald added. “Everybody has to be doing everything else right, putting lines in right, putting foley [catheters] in aseptically.”
Observing procedure techniques was not part of this study, but Fitzgerald did not rule it out for further investigation. The team also plans to study ways to improve hand-hygiene compliance. Fitzgerald hopes creating greater self-awareness about when to clean hands, with nurses observing each other, will encourage greater use of the gel.
“When we see hand-hygiene compliance at 100 percent, and we see everybody doing the procedures correctly, putting [lines and catheters] in aseptically and following guidelines, hopefully, we will see decreases,” Fitzgerald said.
Hammer said she found the study interesting but cautioned nurses not to stop using the gels and washing up based on the findings.
“Hand washing and alcohol hand gels have been proven to decrease microbial flora on hands, over and over again,” Hammer said. “What we are trying to achieve is that the hands do not become the method of carrying the organisms to a patient. Whether that patient is going to get infected with the organism is a different story and depends on what is going on in the unit, the devices the patient has and how immunocompromised the patient is.”
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