Actualidades en la higiene de manos quirúrgica. Revisión de la literatura / Current trends in hand hygiene for surgery. A literature review / Atualidades na higiene de mãos cirúrgica. Revisão da literatura

Resumen Introducción: La higiene de manos quirúrgica, procedimiento esencial en cirugía; es una técnica que ha evolucionado y se ha ido actualizando tras el surgimiento de evidencia científica. El manual de la Organización Mundial de la Salud (OMS) publicado hace diez años es uno de los documentos que plasman cambios de esta técnica, como dejar de usar el cepillo. Sin embargo, es necesario analizar la evidencia actual con la finalidad de reconocer las nuevas tendencias de acuerdo con los resultados de las investigaciones publicadas. Objetivo: Realizar una revisión actualizada de la literatura sobre la higiene de manos quirúrgica. Desarrollo: El lavado de manos quirúrgico con cepillo es un procedimiento que se realiza en la mayoría de las instituciones hospitalarias de México; pocas han incursionado en la técnica en la que se omite el uso de cepillo. Existen diversos estudios que sustentan que el uso de cepillos debe ser erradicado debido al daño tisular que estos ocasionan. La abrasión dérmica provocada por el uso de cepillos origina que el personal se cepille las superficies de las manos y brazos por menos tiempo que el recomendado y esto a su vez impide un efecto idóneo por parte de los antisépticos. Las sustancias más recomendadas son la clorhexidina y las soluciones a base de alcohol. Conclusiones: La higiene de manos quirúrgica sin cepillo debe ser considerada debido a que disminuye costos hospitalarios, garantiza la efectividad de la descontaminación de manos, ocasiona menos lesiones dérmicas y contribuye a la reducción de las infecciones relacionadas al sitio quirúrgico.

Abstract Introduction: Hand hygiene for surgery is an essential clinical procedure whose technique has been evolving as the result of new scientific evidence. The related WHO manuals reflect the changes in this procedure; for example, the now non-binding need of using a brush. Nevertheless, it is necessary to continue analyzing the current evidence in order to recognize the new guidelines which are being established as the result of new published research. Objective: To carry out an updated literature review on hand hygiene for surgery. Development: Hand washing for surgery using a brush has long been a regular practice in Mexican hospitals, however, there are diverse studies which support the omission of brushes due to the tissue damage which these utensils can cause - including dermal abrasions which can make the staff tend to brush their hands and arms for less time in comparison to the recommended standards, resulting in incomplete antiseptic effects. Conclusions: Having in mind that some of the most recommended antiseptic substances are chlorhexidine and alcohol-based gels, hand hygiene for surgery without using a brush should be considered because it can reduce costs, guarantee hands decontamination, generate less dermal lesions, and contribute to the reduction of related surgical site infections.

Resumo Introdução: A higiene de mãos cirúrgica é um procedimento essencial em cirurgia; é uma técnica que evoluiu e se tem ido atualizando trás o surgimento de evidência científica. O manual da OMS publicado faz dez anos é um dos documentos que traduzem as mudanças desta técnica, como é deixar de usar a escova. No entanto, é necessário analisar a evidência atual com a finalidade de reconhecer as novas tendências conforme os resultados das pesquisas publicadas. Objetivo: Realizar uma revisão atualizada da literatura sobre a higiene de mãos cirúrgica. Desenvolvimento: O lavado de mãos cirúrgico com escova é um procedimento que se realiza na maioria das instituições hospitalares do México; poucas incursionaram na técnica na qual se omite o uso de escova. Existem diversos estudos que sustentam que o uso de escovas deve ser erradicado devido ao dano tissular que estes ocasionam. A abrasão dérmica provocada pelo uso de escovas origina que o pessoal se escove as superfícies das mãos e braços por menos tempo que o recomendado e isto por sua vez impede um efeito idóneo por parte dos antissépticos. As sustâncias mais recomendadas são a clorexidina e as soluções a base de álcool. Conclusões: A higiene de mãos cirúrgica sem escova deve ser considerada devido a que diminui custos hospitalares, garante a efetividade da descontaminação de mãos, ocasiona menos lesões dérmicas e contribui à redução das infecções relacionadas ao sítio cirúrgico.

Knowledge, Attitude, and Practice of Hand Hygiene among Clinical Year Medical Students at Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia

Background: Healthcare-associated infection (HCAI) is defined as any infection that the patient gets during hospitalization or after discharge, which was not present at the time of admission. Several factors contribute to HCAIs such as inappropriate hand hygiene, which is considered the most important and simplest precautionary measure to reduce the prevalence and control infection. This study aimed to assess the knowledge, attitude, and practices of hand hygiene among clinical year medical students of Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia. Methods: A cross-sectional survey of 240 clinical year medical students (4th and 5th year) at IMSIU was conducted using a validated self-administered questionnaire. It was cross-sectionally distributed to our participants. Results: Total 196 male students (n=196/240) participated in the questionnaire with a response rate of 81.7%. All participants were male students with the mean age of 23 years old. Overall, the level of knowledge, attitude and practices of hand hygiene among clinical year medical students at IMSIU, Riyadh, Saudi Arabia was found to be moderate (50%-75%). Conclusion: The present study warrants for systematic educational programs for students’ awareness regarding the knowledge, attitude and practice towards hand hygiene use and implementation of strict guidelines to regulate nosocomial infection.

Hand hygiene knowledge among undergraduate medical students in Junagadh, Gujarat, India

Background: Hand hygiene is now regarded as one of the most important element of infection control activities. Medical students in their clinical training phase throng the healthcare facilities and can potentially transmit infections besides being the healthcare providers of future when their pattern of training will reflect on their infection control practices. Therefore, this study was carried out to assess the knowledge of undergraduate medical students regarding hand hygiene practices.Methods: A cross-sectional study was carried out and data was collected by using “WHO hand hygiene knowledge questionnaire for health care workers” among 2nd M.B.B.S medical students at Junagadh. Knowledge was graded as good, moderate or poor based on the total number of correct answers.Results: Total 123 students participated in the study. There were 65 (53%) females and 58 (47%) were males. The mean hand hygiene knowledge score (out of 25) was 15.05 (SD: ±2.37, 95% CI: 14.63-15.48). Majority of the participants (76%) had moderate knowledge of hand hygiene practices.Conclusions: In the present study majority of the students had not received formal training regarding hand hygiene practices. Majority of the students had moderate knowledge of hand hygiene. Incorporation of teaching and training of hand hygiene practice in the undergraduate teaching during the initial study years is the need of the hour to prevent further emergence of antimicrobial resistance and health care associated infections.

Evaluation Of Hand Hygiene Training And Its Effect On Mdr Bacteria Detection In Various Intensive Care Units Of Era’S Lucknow Medical College

Hand hygiene is nowadays considered as one of the most important measures to prevent transmission and acquisition of HCAIs (health care associated infections). Monitoring hand hygiene compliance and providing healthcare workers with feedback regarding their performance are considered integral parts of a successful hand hygiene promotion programme. A total of 50 ICU staffs(resident doctors, faculty & nurses e.t.c.) were included in this interventional study. Baseline data of hand hygiene practices of all staffs and pre-intervention hand culture were obtained. Post intervention hand culture were taken after 30 days of training and interactive sessions as well as continous availability of ABHR in the ICU. Results of post-intervention hand culture showed a marked decrease in isolation of bacteria specially those of MRSAand ESBL. MRSAwas low by 35% and in non of the cases ESBL was reported. In all the ICUs frequency of hand hygiene was poor(average 31%) but improved significantly after intervention (70%).Introduction of ABHR was found to be an effective tool for improving hand hygiene. As a result of periodic training, monitoring, surveillance hand cultures and awareness generating campaign, transmission of resistant bacteria can be reduced, thus reducing the burden of nosocomial infection in a hospital set-up.

Implementación de la estrategia "Atención Limpia es Atención Segura" en un hospital de tercer nivel en Medellín, Colombia / Implementation of the strategy "Clean Care is Safer Care" in a third level hospital in Medellín, Colombia

Introduction: Hand hygiene is the most cost-effective and simple measure of preventing healthcare associated infections (HAI). The approach to improve low compliance must be through multimodal interventions such as the "Clean Care is Safer Care" strategy (WHO). Aim: To estimate the efficacy of a multimodal strategy in improving hand hygiene in five wards of a tertiary care hospital in Medellín, Colombia (2008-2010). Methods: Quasi-experimental before-after study. Results: Hand hygiene compliance significantly increased after the intervention (82 to 89%, p = 0.007). The knowledge score increased from a median of 26 (IQR=22-28) to 30 (IQR=26-32, p = 0.001). Alcohol-based hand rub consumption increased significantly from 10.5 liters to 58.1 liters per 1000 patient-days [incidence ratio (IR) = 2.39, 95% CI = 1.99; 2.88]. Monthly HAI rates showed no significant variations during the same period [IR = 0.90, 95% CI = 0.71; 1.13]. Discussion: This and other recent studies demonstrate that implementing a multimodal strategy for hand hygiene significantly increases compliance with this measure, irrespective of type of health worker or hospital department. Conclusions: Implementing a multimodal strategy we achieved significant increases in hand hygiene compliance but mild or no significant variations in monthly HAI rates.

Introducción: La higiene de manos es una medida costo-efectiva para prevenir las infecciones asociadas a la atención de salud (IAAS). Para mejorar el cumplimiento se recomienda implementar estrategias multimodales como "atención limpia es atención segura" de la OMS. Objetivo: Estimar el efecto de la estrategia multimodal en cinco unidades de un hospital de tercer nivel en Medellín, Colombia (2008-2010). Métodos: Estudio cuasi-experimental antes y después. Resultados: El cumplimiento general con la higiene de manos aumentó de forma significativa en el período posterior a la implementación (82 a 89%, p = 0,007). El puntaje de conocimientos aumentó entre los dos períodos de tiempo (Mediana = 26, RIC = 22-28 vs Mediana = 30, RIC = 26-32; p = 0,001). El consumo de alcohol aumentó de 10,5 litros a 58,1 litros por 1.000 pacientes/día [razón de incidencias (RI) = 2,39; 95% CI = 1,99; 2,88]. Las tasas mensuales de IAAS no mostraron variaciones [RI = 0,90; 95% CI = 0,71; 1,13]. Discusión: Este estudio demuestra que la implementación de una estrategia multimodal para la higiene de manos aumenta significativamente el cumplimiento con esta medida, independientemente del tipo de trabajador y el servicio hospitalario. Conclusión: Con la estrategia multimodal se aumentó significativamente el cumplimiento con la higiene de manos.