Effect of gloved hand disinfection on hand hygiene before infection-prone procedures on a stem cell ward.

BACKGROUND: Hand hygiene compliance even before infection-prone procedures (indication 2, 'before aseptic tasks', according to the World Health Organization (WHO)) remains disappointing. AIM: To improve hand hygiene compliance by implementing gloved hand disinfection as a resource-neutral process optimization strategy. METHODS: We performed a three-phase intervention study on a stem cell transplant ward. After baseline evaluation of hand hygiene compliance (phase 1) gloved hand disinfection was allowed (phase 2) and restricted (phase 3) to evaluate and differentiate intervention derived from learning and time effects. The incidence of severe infections as well as of hospital-acquired multidrug-resistant bacteria was recorded by active surveillance. FINDINGS: Hand hygiene compliance improved significantly from 50% to 76% (P < 0.001) when gloved hand disinfection was allowed. The biggest increase was for infection-prone procedures (WHO 2) from 31% to 65%; P < 0.001. Severe infections decreased by trend (from 6.0 to 2.5 per 1000 patient-days) whereas transmission of multidrug-resistant organisms was not affected. CONCLUSION: Gloved hand disinfection significantly improved compliance with the hand hygiene, especially in activities relevant to infections and infection prevention. Thus, this process optimization may be an additional, easy implementable, resource-neutral tool for a highly vulnerable patient cohort.

Rapid restoration of red blood cell mass in severely anemic surgical patients who refuse transfusion.

Optimal parenteral nutritional support, concomitant with replacement doses of intravenous iron dextran injection, can be safe, effective, and lifesaving for severely anemic patients who are unable to receive blood transfusions. Six patients who had sustained massive acute blood loss and two who had severe chronic anemia received as much as 140 mL of iron dextran injection intravenously. The average initial hemoglobin level in the acute group was 5.0 g/dL (range, 2.6 to 8.4 g/dL) and increased to an average of 10.6 g/dL (range, 7.5 to 12.8 g/dL) in 23 days (range, 17 to 30 days); the hemoglobin level in the chronic group was 3.8 g/dL and increased to 10.6 g/dL over an average period of 121 days. Two total abdominal colectomies, a right transverse colectomy and fistulectomy, a pyloroplasty and vagotomy, and a highly selective vagotomy were accomplished without complications in five of the patients. There were no adverse reactions to the hematopoietic therapy.