Efficacy of Alcoholbased handrub in comparison to hand

Efficacy of Alcohol-based hand-rub in comparison to hand washing in prevention of nosocomial infections Melinda Hawley BSN, RN-BC Results Purpose VS. Analyze the efficacy of alcohol based hand-rub (ABHR) in comparison to traditional hand washing in the prevention and reduction in non-spore • Minimal literature available with RCT utilizing different hand hygiene preparations-may be due to broad nature of the study of efficacy • In 2011 approx 722, 000 HAI & ~75, 000 deaths from HAI (majority outside of ICU’s) forming nosocomial infections. • 1: 25 hospitalized patients with HAI on any given day and costing healthcare industry billions of dollars every year in non-reimbursed medical costs. • Hand hygiene compliance among HCW low (estimated <40%) 45, 0% Healthcare Associated Infections as Reported to the National Healthcare Safety Network 2006 -2010 Methodology 40, 0% • A PICOT question was used to guide literature search • Multiple Barriers • ABHR most effective 55 -70% alcohol concentration 39, 2% • Alcohol denatures proteins = reduced risk of infection • Literature: only those articles dated after 1990 included • ABH against most Gram + and Gram - bacteria 35, 3% 35, 0% • 27 articles reviewed- only 15 relevant • Reduced risk of nosocomial infections caused by: • nursing and non-nursing research • Rapid critical appraisal used to evaluate relevancy 30, 0% • MRSA, VRE, Staphylococcus aureus and E-coli infections 30, 1% • Online Websites • Amount of ABHR used and dry time can affect efficacy 27, 4% • ABHR efficacy in comparison to: • CDC, WHO, Google Scholar 24, 9% 25, 0% • Online Databases 23, 1% 22, 7% CLABSI CAUTI VAP • CINAHL, Pub. Med SSI 20, 0% 18, 6% • Keyword Search Plain soap: 99. 9987% vs. 98. 1379% effective (Zarpellon et al. , 2008) • ABHR more effective than antimicrobial hand soap • 99. 99% vs. 99. 68% effective, (Paulson et al. , 1999) • Effectiveness reduced to 99. 98% after 3 rd use • Hand washing 15, 9% • ABHR not effective against Clostridium difficile bacteria 15, 0% • Hand hygiene, hand hygiene compliance (Paulson et al. , 1999) 13, 2% • Alcohol based hand-rub, hand sanitizer • Nosocomial infections (NI), hospital acquired infections (HAI) 9, 5% 10, 0% • Limitations • Limited research available to support efficacy of one preparation over Conclusion 5, 0% • Many people die each year due to preventable hospital acquired infections. another in preventing nosocomial infections. • Greater hand hygiene efforts are needed among HCW • Data presented by the CDC is 3 -4 years behind in reporting 0, 0% • Data tables published by the NHSN are available, the data is difficult to Jan 2006 -Oct 2007 (28, 502) Jan 2007 -Dec 2008 (47, 582) Jan 2009 -Dec 2010 (69, 475) • Use of ABHR in conjunction with 5 moments for hand hygiene will help decrease rate of NI • ABH considered Gold Standard accurately interpret due to various ways of reporting. • Considered 99. 99% effective against many non-sporeforming bacteria • Better microbial efficacy, less wash time, better skin tolerance compared to traditional hand washing. Significance to Nursing • Lack of Medicare reimbursement for nosocomial infection costs • $35. 7 -45 billion dollar annual cost (estimated) (Scott, 2009) • Need for education re: compliance rates, rates of infections, and efficacy of ABH • Encourage healthcare professionals to increase compliance with use of 5 moments • Suggestions for practice: • Include ABH at bedside for patient use • Encourage hand washing with soap and water after third use of ABH • Implement a hand hygiene initiative within patient care facilities • Can reduce and prevent incidence of NI caused by: MRSA, VRE, staphylococcus aureus and e-coli. • Hand washing recommended after 3 rd use of ABHR • 55 -70% alcohol concentration is best • Hand washing is required to remove spore-forming bacteria from surface of hands • Barriers to hand washing need to be overcome • Work loads • Time it takes to wash with soap and water • Inherent/ elective sense to need to wash hands • Lack of knowledge in hand hygiene • Suggestions for future research: • Hand hygiene by hospitalized patients WHO: 5 moments for Hand hygiene • Use of hand sanitizer by patients if available at bedside