Hand hygiene compliance in a universal gloving setting.

BACKGROUND: The use of gloves for every patient contact (ie, universal gloving) has been suggested as an infection prevention adjunct and alternative to contact precautions. However, gloves may carry organisms unless they are changed properly. In addition, hand hygiene is required before donning and after removing gloves, and there are scarce data regarding glove changing and hand hygiene in a universal gloving setting. METHODS: This nonrandomized observational before-after study evaluated the effect of education and feedback regarding hand hygiene. Compliance with hand hygiene and glove use was directly observed in a universal gloving setting at a 10-bed intensive care unit in a Japanese tertiary care university teaching hospital. RESULTS: A total of 6,050 hand hygiene opportunities were identified. Overall, hand hygiene compliance steadily increased from study period 1 (16.1%) to period 5 (56.8%), although there were indication-specific differences in the baseline compliance, the degree of improvement, and the reasons for noncompliance. There were decreases in the compliance with universal gloving and the incidence of methicillin-resistant Staphylococcus aureus. CONCLUSION: It is difficult to properly perform glove use and hand hygiene in a universal gloving setting, given its complexity. Direct observation with specific feedback and education may be effective in improving compliance.

Continuous ampicillin infusion as an alternative to intermittent infusion for adult inpatients: a case series.

Intravenous ampicillin has been extensively used for various kinds of infections for more than fifty years. This drug is administered intermittently, which can result in missed or delayed drug administration and sleep interruption that can have a negative impact on the quality of life during hospitalization. Continuous infusion may solve these concerns. We reviewed the cases of five patients who were treated with continuous ampicillin infusions in our hospital. The ampicillin serum concentrations were from 11.3 to 32.8 µg/mL, which was above the ampicillin MICs of the causative organisms, ≤0.06 to 4 µg/mL. Although the dosages given of ampicillin varied in each case, the serum concentrations showed a strong correlation with creatinine clearance (r(2) = 0.91). All the patients improved at the time of discharge, or transfer to another hospital, with no significant complications during the continuous infusion. Continuous ampicillin infusion could be a better alternative for frequent intermittent infusion for adult inpatients with infections due to ampicillin-susceptible organisms.