Hand Hygiene Compliance among Visitors at a Long-term Care Hospital in Korea: A Covert Observation Study

PURPOSE: This study aimed to assess hand hygiene (HH) compliance among visitors at a long-term care hospital in South Korea. METHODS: The study was conducted at a 502-bed long-term care hospital located in Gyeonggi-do Province. From July 1 to August 15, 2017, including more than 6 weekends and one holiday, a trained observer covertly assessed visitors' HH at all five units (360 beds in total) of the study hospital building until the completion of 1,000 HH opportunities (i.e., 200 opportunities per unit). The modified World Health Organization (WHO) HH observation form was used. Instead of professional categories and the “before clean/aseptic procedure” moment, the estimated age range for each visitor were recorded in four categories: children (<14 years old), adolescents (14~18), adults (19~64), and the elderly (≥65). The collected data were analyzed using SPSS 22.0. RESULTS: A total of 1,000 HH opportunities were observed from 766 visitors (an average of 1.31 per visitor) and the overall HH compliance rate was 20.3%. Overall, 53.7% of the HH cases were performed with soap and water. Among the 4 HH moments, the “after body fluid exposure risk” moment showed the highest compliance rate (83.5%); 93.9% used soap and water. The most commonly exposed potential body fluid among visitors was saliva (48.1%). CONCLUSION: For hospital visitors in long-term care hospitals, HH education programs including HH moments need to be developed and implemented. Further studies are necessary to evaluate visitors' HH compliance in various hospital settings and find the related variables influencing visitors' HH.

Simulation Results for Contamination Comparisons by Various Use Protocols of Personal Protective Equipment / 대한내과학회지

BACKGROUND/AIMS: Due to a lack of scientific evidence and unstandardized protocols, the correct use of personal protective equipment (PPE) is not always easy for healthcare personnel (HCP). This study aimed to generate experimental evidence to reduce contaminations during PPE doffing. METHODS: With institutional review board approval, 4 standardized HCP were recruited to examine selected PPE protocols based on consultations with 10 invited Korean infection control leaders. Using fluorescent powder and ultraviolet light, each PPE protocol was evaluated for contaminations by comparing methods or steps. Pictures of contaminated areas and videos of HCP practice were evaluated for case analysis by linking all collected data using assigned study experiment codes. RESULTS: A total of 38 simulation experiments were conducted during December 14–20, 2016. No significant difference was found among minor variations in PPE protocols. Rather, after an intensive, 1-minute patient care simulation (e.g., physical assessment), severe powder contaminations on the front and under the sleeves of coveralls were found. Even after the outer-glove surface was wiped clean, partial contaminations still remained, especially between fingers and on fingertips. Moreover, after cleaning glove surface contaminations using wipes, each doffing step caused different contaminations. Among different types of N95 respirators, the foldable N95 type was the most stable during doffing processes, with less possibility of contamination. CONCLUSIONS: Based on this study's findings with visual evidence of contaminations during PPE doffing processes, some meaningful recommendations were feasible, such as the use of disposable long-sleeve aprons over coveralls. Further study is necessary to evaluate these recommendations.

Simulation Results for Contamination Comparisons by Various Use Protocols of Personal Protective Equipment / 대한내과학회지

BACKGROUND/AIMS@#Due to a lack of scientific evidence and unstandardized protocols, the correct use of personal protective equipment (PPE) is not always easy for healthcare personnel (HCP). This study aimed to generate experimental evidence to reduce contaminations during PPE doffing.@*METHODS@#With institutional review board approval, 4 standardized HCP were recruited to examine selected PPE protocols based on consultations with 10 invited Korean infection control leaders. Using fluorescent powder and ultraviolet light, each PPE protocol was evaluated for contaminations by comparing methods or steps. Pictures of contaminated areas and videos of HCP practice were evaluated for case analysis by linking all collected data using assigned study experiment codes.@*RESULTS@#A total of 38 simulation experiments were conducted during December 14–20, 2016. No significant difference was found among minor variations in PPE protocols. Rather, after an intensive, 1-minute patient care simulation (e.g., physical assessment), severe powder contaminations on the front and under the sleeves of coveralls were found. Even after the outer-glove surface was wiped clean, partial contaminations still remained, especially between fingers and on fingertips. Moreover, after cleaning glove surface contaminations using wipes, each doffing step caused different contaminations. Among different types of N95 respirators, the foldable N95 type was the most stable during doffing processes, with less possibility of contamination.@*CONCLUSIONS@#Based on this study's findings with visual evidence of contaminations during PPE doffing processes, some meaningful recommendations were feasible, such as the use of disposable long-sleeve aprons over coveralls. Further study is necessary to evaluate these recommendations.

Fecal Bacteriotherapy for Recurrent Clostridium difficile Infection: A Systematic Literature Review / 병원감염관리

BACKGROUND: Over the past several years, Clostridium difficile has become a major healthcare-associated pathogen. Fecal bacteriotherapy has been reported as an effective intervention for treating recurrent C. difficile infection by restoring the normal intestinal microbiota. METHODS: Articles on fecal bacteriotherapy were collected through PubMed, CINAHL, Cochrane Library, and Web of Science databases using the keywords "Clostridium difficile," "feces," "fecal transplantation," "fecal microbiota transplantation," and "fecal bacteriotherapy." Using a systematic literature review, variables of interest from articles that met the inclusion criteria were extracted and summarized. RESULTS: Among 141 articles that were published in English from January 1, 2000 to August 31, 2012, 8 studies were selected for analysis after assessing the titles, abstracts, and full contents. Fecal bacteriotherapy procedures varied with respect to donor selection, screening, infusion route, and preparation of the suspension. Donors were mostly family members or relatives, and donor screening included tests for blood borne and stool pathogens. Selected infusion routes were colonoscopy (62.5%), nasogastric tube (25%), and enema (12.5%). The success rate was reported to be 73-100%. There was a lack of a standard procedure for fecal bacteriotherapy in all of the selected studies. CONCLUSION: Fecal bacteriotherapy is an effective intervention for combating C. difficile infection that has a high success rate and no adverse effects. This therapy would be helpful for infection control in hospital settings by facilitating early eradication of C. difficile infection.