Lapses in infection control the dirt on handwashing

Although guidelines have repeatedly stressed the importance of infection control practices such as hand hygiene, lapses in basic infection control continue to drive HAI rates. A review of 12 studies examining health-care workers' hand hygiene practices found rates of compliance with hand-washing recommendations ranging from 16 to 80 percent, with an average rate of 40 percent compliance (Boyce, 2001). A study of neonatal ICU personnel documented the presence of Gramnegative bacilli on the hands of 75 percent (Goldmann et al., 1978), and poor hand hygiene has been implicated directly as a cause of nosocomial infection. By comparing matched controls with 12 case-patients during an ICU VRE outbreak, Boyce and colleagues demonstrated that physical proximity to a case-patient and exposure to nurses who cared for a case-patient represented the primary risk factors for infection, implying that unwashed HCW hands moved VRE from patient to patient (Boyce et al., 1994).

Numerous possible barriers to compliance with infection control recommendations have been cited, ranging from lofty excuses, such as man's yearning for liberty, to more mundane reasons, such as time constraints (Farr, 2000). A large survey of hand hygiene practices at a university teaching hospital found poor compliance more likely in clinical settings with greater intensity of care, as defined by number of opportunities for hand hygiene per hour. These researchers found that compliance decreased in progressive 5 percent decrements as hand-cleansing opportunities increased by 10 opportunities per hour (Pittet et al., 2000). Although use of alcohol-based hand rubs greatly eases time constraints, adherence to recommendations is still embarrassingly low (Weinstein, 2001). It follows that increased workload related to staffing shortages could further reduce adherence to infection control guidelines. In an outbreak of catheter-related bloodstream infections in a surgical ICU, Fridkin and colleagues identified patient-to-nurse ratio as a major, independent risk factor for infection. Patients cared for by nurses with a 2 : 1 patient-to-nurse ratio had a relative risk for infection nearly 62 times that of patients cared for by nurses with a 1 : 1 ratio (Fridkin et al, 1996).

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