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Assessing the thoroughness of hand hygiene: “Seeing is believing”

https://doi.org/10.1016/j.ajic.2014.03.003Get rights and content

The thoroughness of hand hygiene (HH) was evaluated using a simulation method in which health care workers (HCWs) rubbed their hands with a fluorescent substance, washed with water, and placed their hands under an ultraviolet detector to identify areas missed. Most residue points were located in the tips of the nails (38.6%), followed by fingertips (17.4%). This stress-free “seeing is believing” program can encourage HCWs' active participation in sustaining the HH culture of health care institutions.

Section snippets

Methods

This study was approved by the Ethics Committee of National Taiwan University Hospital. Under the anonymity basis, oral informed consent was obtained from each participant.

The HH technique campaign for HCWs was conducted between May 1 and May 30, 2012. The HCWs volunteered to participate in this event. We educated the HCWs on proper HH technique using a 7-step procedure with a Chinese Kong-Fu–based slogan: interior, exterior, interlacing, bow, thumbs, fingertips, and wrists (Fig 1). During the

Results

A total of 388 HCWs from 30 of the hospital's 85 wards volunteered to participate in this study, including 64 doctors, 253 nurses, and 60 other HCWs. The average age of participants was 32.1 ± 8.1 years (range, 18-60 years). The majority of participants were female (80.2%; 311 of 388).

For all participants, the duration of HH exceeded the recommended 10-15 seconds, ranging from 11 to 260 seconds (mean, 57.4 ± 38.9 seconds). Most participants could wash off the fluorescent agent, with 135 of 386

Discussion

In this study, we have demonstrated that a stress-free, “seeing is believing” simulation program can be successfully adapted for HH education. We provided feedback to HCWs identifying the nails and fingertips as the most frequently missed spots. The integration of knowledge, practice, and visual feedback can strengthen the learning process and improve the compliance with and thoroughness of HH.

Simulation techniques have been adopted in the health care system to protect patient safety. A benefit

Acknowledgments

We thank David Devore for his critical review of the manuscript. We are grateful to members of the NTUH Center for Infection Control for their sustained support of the hand hygiene program, as well as the hospital staff for their commitment to improving patient safety and reducing health care–associated infections.

Author contributions: Y.-C.C., K.-L.T., and S.-C.P. conceived and designed the experiments; K.-L.T. and I.-C.H. performed the experiments; K.-L.T. and E.C. analyzed the data; E.C.,

References (13)

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    Park HY et al. [4] report better compliance in nurses (90.5%) but without differences in hand surface coverage between nurses (8.3%) and doctors (8.8%) and lower compliance rates for other healthcare professionals. Other studies have described the evaluation of HH quality using a fluorescent substance and adenosine triphosphate technology [5–7]. Pan SC [5] identifies the tips of the nail and the fingertips as the most common residue points after application of a fluorescent substance, and Szilagi L et al. [6] identified a failure to clean the dorsal and palmar areas in 24 and 18% of the instances.

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The Center for Excellence for Hand Hygiene is supported by the Center for Disease Control, Department of Health, Taiwan (EU098040). Y. C. Chen also received a grant from the Department of Health, Taiwan (DOH100-TD-B-111-001). These funding organizations were not involved in study design or conduct; data collection, management, analysis, or interpretation; or manuscript preparation and approval.

Conflict of interest: None to report.

S.-C.P. and E.C. contributed equally to this work.

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