The Protocol Contained 3 Sections:
1.
Written general hand hygiene rules
2.
Written hand hygiene rules specifically for anesthesia and surgery
3.
Visual representation of the OT, divided into 4 hand hygiene areas.
Hand Hygiene Adherence in the Operating Theater: Data From the Netherlands
Publication
Article
Infection Control TodayInfection Control Today, December 2022, (Vol. 26, No. 10)
Volume 26
Issue 10
The study's investigators noted that adequate hand hygiene in the OT by nonsterile health care workers and surgeons is vital to prevent post-operative wound infections.
A surgeon performing hand hygiene.
(Adobe stock)
Findings from a prospective observational study1 on health care workers’ adherence to a novel hand hygiene protocol in the operating theater (OT) were published recently in The Journal of Hospital Infection.
According to Manon D. van Dijk, Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, the Netherlands, and colleagues, this uniform way of observing hand hygiene adherence (HHA) in the OT enables evaluation of the effectiveness of interventions in the OT and facilitates friendly competition. In the Rotterdam-Rijnmond region, the HHA rate in the OT was below 50% and needed to be addressed in teaching hospitals and among physicians.
Because the Netherlands does not have protocols or observations tools in the OT, witnessing nonsterile health care workers (HCWs) perform HHA proved difficult, and a protocol needed to be created.
“Furthermore, regardless of the department or health care setting, hand hygiene observations are often performed by using the 5 moments of hand hygiene as stated by the World Health Organization (WHO),” the investigators wrote in the study. “These 5 moments are the golden standard and are in general easy to apply on clinical wards where there is a clear distinction between the patient zone and the health care zone. The patient zone includes everything that is attached to the patient or belongs to a specific patient, while everything that is not patient specific is referred to as health care zone. Health care workers should apply hand hygiene when changing from patient zone to health care zone, and vice versa.”
The study included 9 hospitals in the Rotterdam-Rijnmond region. Because these hospitals did not have specific hand hygiene protocols for nonsterile HCWs in the OT, the investigators created one with the hospitals’ input. Once the protocol was agreed upon, an observation tool was developed and tested. Using the tool, investigators calculated HHA rates by type of hospital and HCW.
Generally, hand hygiene should be performed when moving from one area to another. Across all hospitals, an average HHA rate of 48.0% (95% CI, 45.2%-61.2%) was observed in OTs. The academic teaching hospital received the lowest score at 23.1% (95% CI, 0.0%-45.8%), and the 2 specialized hospitals scored highest at 64.0% (95% CI, 30.6%-89.8%) and 76.7% (95% CI, 62.8%-84.5%). Interestingly, the average HHA scores from anesthesiologists were the lowest,31.6%, (95% CI, 19.2%-62.4%), whereas OT assistants scored the highest, at 57.4% (95% CI, 50.1%-78.2%).
“Nonetheless, adequate hand hygiene in the OT by nonsterile HCW and surgeons (performing nonsterile actions) is of utmost importance to prevent postoperative wound infections. Considering patients undergoing surgery are vulnerable to infection, exposure to infection risks in the OT should be kept as low as possible,” the authors wrote.
Some strengths of this study included the following: enabling uniform hand hygiene observations from one hospital to another, specifically designed for nonsterile HCW in the OT. This information will help infection preventionists to know which departments need extra assistance. The authors also mention that comparisons between hospitals could lead to friendly competition on which has the higher HHA rate. Competition also increases the rate of HHA in each hospital’s OT. Also, as many HCWs work in more than 1 facility, if the protocols were consistent among all the facilities, then the HCWs’ HHA could remain high because the infection prevention and control policies are the same, and they do not have to remember different policies.
Some limitations of this study included the implementation of COVID-19 infection prevention protocols. Also, because of COVID-19, 3 hospitals were not included in the final study, which did not allow for as many observations of HHA. Finally, because all the observations were only performed in 1 region of 1 country, more testing is needed to assess whether these protocols would function the same way in other countries and in other styles of OTs.
“However,” the investigators noted, “[because] almost all observations in the OT nowadays are still performed by using the 5 moments of hand hygiene of the WHO, we think that our protocol and observation tool could be a valuable addition to the existing literature.”
Reference:
1. Dijk MD van, Breejen MCMW den, Vermeeren JMJJ, Berg S van den, Beeck EF van, Vos MC. Compliance to a novel hand hygiene protocol tailored to non-sterile health care workers in the operating theatre. Journal of Hospital Infection. 2022;0(0). doi:10.1016/j.jhin.2022.10.009
Articles in this issue
ICT’s Product Locator: December 2022
Weekly Rounds: 50% Decrease in C difficile, Top Stories of 2022, and More
Hand Hygiene Adherence in the Operating Theater: Data From the Netherlands
Recounting the Top IPC Stories of 2022
LTC Facilities Face Unique Infection Control Issues During COVID-19 Pandemic
Artificial Intelligence Offers Advancements and Challenges in the IPC Sphere
Bug of the Month: Water Baby
IP in Dubai Speaks About APIC’s Cleaning, Disinfection, Sterilization Conference
Hot Topics in IPC: Mid-term Election Week
Is the Current Bivalent Booster the Correct One? Studies Suggest it Isn't
GSK RSV Vaccine Trial Demonstrates Promising Results
Monkeypox Outbreak: Answers for Patients
Is an HAdV an Underrecognized Cause of Hepatitis?
Environmental Hygiene Industry Leaders Converge to Discuss BPR Regulations
Containing Outbreak of Carbapenem-resistant Acinetobacter baumannii in a COVID-19 Ward
Recent Videos
Related Content
Comprehensive Strategies in Wound Care: Insights From Madhavi Ponnapalli, MD
November 22nd 2024Article
Madhavi Ponnapalli, MD, discusses effective wound care strategies, including debridement techniques, offloading modalities, appropriate dressing selection, compression therapy, and nutritional needs for optimal healing outcomes.
The Leapfrog Group and the Positive Effect on Hospital Hand Hygiene
November 21st 2024Article
The Leapfrog Group enhances hospital safety by publicizing hand hygiene performance, improving patient safety outcomes, and significantly reducing health care-associated infections through transparent standards and monitoring initiatives.
Managing Multimorbidity and Polypharmacy in HIV: Insights From Michelle S. Cespedes, MD, MS
November 20th 2024Article
Michelle S. Cespedes, MD, MS, discusses the challenges of managing multimorbidity and polypharmacy in HIV treatment, emphasizing patient education, evolving guidelines, and real-world insights from the REPRIEVE study.
Longhorn Vaccines and Diagnostics to Showcase Breakthrough Vaccine Data at IDWeek 2024
November 19th 2024Article
Longhorn Vaccines and Diagnostics revealed promising data on universal influenza vaccine LHNVD-110 and AMR sepsis vaccine LHNVD-303 at IDWeek 2024, addressing critical global health challenges.
