Effect of an automated sink on handwashing practices and attitudes in high-risk units.

OBJECTIVE: To assess the effects of an automated sink on handwashing practices and attitudes of staff. DESIGN: Quasi-experimental crossover design. SETTING: Two high-risk patient care areas, one postanesthesia recovery room (Site 1), and one neonatal intensive care unit (Site 2) in two tertiary care hospitals. PARTICIPANTS: All patient care staff on study units; approximately 55 individuals. INTERVENTIONS: An automated sink was installed to replace one handwashing sink for about five weeks; the sink was then crossed-over for an equivalent time period to the other location. Handwashing practices of all unit staff were observed in three two-hour observation periods/week. Questionnaires were distributed to staff two weeks after sink installation and at the study's end. RESULTS: One thousand, six hundred ten handwashes were observed. Handwashing practices differed significantly by site. For both sites, hands were washed significantly better but significantly less often with the automated sink (all p less than .001). Staff expressed negative attitudes, however, about certain features of the sink, and these negative attitudes increased over the study period. CONCLUSIONS: Automated devices must be flexible enough to allow adjustments based on staff acceptance. Application of new technology to improve hand hygiene requires a multifaceted approach to behavior change.

Risk factors of nosocomial bacteremia associated with pulmonary artery catheters in a critical care unit.

An epidemiologic investigation at a community teaching hospital identified 17 cases of endemic primary nosocomial bacteremias associated with the use of pulmonary artery catheters (PACs). A matched-case control study was undertaken to identify risk factors associated with these bacteremias. Factors significantly associated with bacteremia were length of hospitalization; length of stay in the critical care unit; length of time the PAC introducer was left in place and used as an intravenous (IV) access device after PAC withdrawal; respiratory compromise; PAC site infection; prior infections at other sites; concomitant hyperalimentation; and number of IV piggyback administrations per day prior to onset of bacteremia. Pathogens isolated included coagulase-negative Staphylococcus species (55.6%), Staphylococcus aureus (22.2%), Candida albicans (14.8%), and enterococci (7.4%). These pathogens were generally resistant to antibiotics given before the development of bacteremia. Bacteremia was associated with significant mortality, a prolonged hospital stay, and increased hospital charges. This study identifies important risk factors to consider in formulating guidelines to prevent and control PAC-associated nosocomial infections.

Duration of handwashing in intensive care units: a descriptive study.

The duration of handwashing was studied in two community hospitals (teaching and nonteaching). The duration in seconds of 180 handwashes by health care personnel and 52 handwashes by non-health care personnel were recorded. The mean duration for health care personnel was 8.62 +/- 0.29 SEM; the degree of patient contact did not influence the duration of handwashing. The duration of handwashing was two times longer in health care personnel vs. non-health care personnel (8.62 +/- 0.29 vs. 4.14 +/- 0.42; t = 7.7; p less than 0.001). Comparisons revealed no statistically significant difference in duration between personnel at teaching and nonteaching hospitals or among those in different occupations. The data indicate that the duration of handwashing among health care personnel is below the standard recommended by authorities in hospital infection control. This may be an important factor in the transmission and persistence of nosocomial infection in critical care units. The antimicrobial efficacy of handwashing agents should be reevaluated considering the actual duration of handwashing by health care personnel within the hospital environment or efforts should be made to increase the duration of handwashing.

Movement of personnel and wound contamination.

We studied the association between the movement of operating room personnel and bacterial contamination of the operative field during 12 clean operations. Settle plates placed on the patient's chest and instrument table were exposed during the operation. As a control, settle plates were exposed in the same locations when no personnel and patients were in the room. Bacterial contamination of the aseptic field was categorized as disseminating (Group A: greater than 42 combined movements) and nondisseminating (Group B: less than 42 combined movements). There were 24 persons in each group. There was a highly significant difference between the two groups in the colony counts on settling plates. More vigorous movement was associated with increased bacterial contamination of the operative field. Low bacterial colony counts were found in the control plates, ruling out environmental sources of contamination. Bacterial fallout correlated with the movement of personnel. Measures to reduce excessive movement in the OR are recommended.