Evaluation of hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system.

BACKGROUND: Hand hygiene is a major means for preventing healthcare-associated infections. One critical point in understanding poor compliance is the lack of relevant markers used to monitor practices systematically. METHODS: This study analysed hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system in an infectious disease ward with 17 single bedrooms. Healthcare workers (HCWs) were tracked while performing routine care over 171 days. A multi-level multi-variate logistics model was used for data analysis. The main outcome measures were hand disinfection before entering the bedroom (outside use) and before entering the patient care zone, defined as the zone surrounding the patient's bed (inside/bedside use). Variables analysed included HCWs' characteristics and behaviour, patients, room layouts, path chains and duration of HCWs' paths. FINDINGS: In total, 4629 paths with initial hand hygiene opportunities when entering the patient care zone were selected, of which 763 (16.5%), 285 (6.1%) and 3581 (77.4%) were associated with outside use, inside/bedside use and no use, respectively. Hand hygiene is caregiver-dependent. The shorter the duration of the HCW's path, the worse the bedside hand hygiene. Bedside hand hygiene is improved when one or two extra HCWs are present in the room. INTERPRETATION: Hand hygiene compliance at the bedside, as analysed using the continuous monitoring system, depended upon the HCW's occupation and personal behaviour, number of HCWs, time spent in the room and (potentially) dispenser location. Meal tray distribution was a possible factor in the case of failure to disinfect hands.

MediHandTrace ®: a tool for measuring and understanding hand hygiene adherence.

The proper implementation of hand hygiene at key moments during patient care is the most important means of preventing healthcare-associated infection. Although there are many programmes aimed at enhancing hand hygiene, the compliance of healthcare workers (HCWs) remains incredibly low. One limiting factor is the lack of standardized measures and reports of hand hygiene opportunities. Direct observational audits have reported the weaknesses in this field. We report here a radiofrequency identification-based real-time automated continuous recording system (MediHandTrace(®)) that permits the tracking of hand hygiene opportunities and the disinfection compliance of HCWs that we evaluated against video recordings as being accurate (99.02%), sensitive (95.65%) and specific (100%). The system can also provide information that is useful to understand HCW non-compliance and will allow the evaluation of future intervention studies.

[Detection of visual acuity disorders and amblyopia in preschool children]. / Detección de trastornos de agudeza visual y ambliopía en preescolares.

OBJECTIVE: To call attention to the visual sharpness disorders which pre-school children on a determined paediatric list present. DESIGN: A descriptive study. SETTING: Riaño Health Centre, Langreo, Asturias. PARTICIPANTS: Pre-school children aged 4 and 5 at the study date (1994). MEASUREMENTS AND MAIN RESULTS: A total of 155 children captured for the study through the nursing child programme were evaluated. Data were collected from their corresponding clinical histories. Evaluation was performed by Paediatrics and Ophthalmology specialists and second-year interns in Family and Community Medicine at the Valle del Nalón hospital. To check ocular alignment, the Hirschberg test was used; and to explore visual sharpness, the Pigassou optotype was applied. Disturbance of ocular alignment was suspected in 40.6% of cases and pathology was confirmed in 58.3%; whereas in 44% of cases referral to the ophthalmologist was due to errors in the visualisation of the optotype, with 50% presenting pathology. Amblyopia was found in 5.4% of the total population studied. In the breakdown of ophthalmic pathology it was observed that compound astigmatism was the most common finding (25%). CONCLUSIONS: 1. The high prevalence of Amblyopia found underlines the importance of considering it as a priority objective in prevention programmes. 2. The Hirschberg test and early use of optotypes should be considered elementary routine exploration tests in the scheduled check-ups. 3. It would be useful to strengthen training within the population as a whole as well as improve the linking of Primary and Specialist Care.

[Mucolipidosis II or "I-cell disease" in the newborn infant. 2 new cases]. / Mucolipidosis II o "I-cell disease" en el recién nacido. Dos nuevos casos.

Clinical and biochemical findings of two patients with neonatal mucolipidosis II are presented. Characteristic coarse facial features, shortness of stature, psychomotor retardation and vacuolated lymphocytes were observed in both cases. However, in one case symptoms presentation was earlier and course of the disease was markedly more severe, with death occurring at the age of 3 months. Biochemically similar increase of serum multiple lysosomal enzymes and decrease of fibroblast activities was demonstrated in both patients. Authors have found elevations of some acid hydrolases in sera from parents (obligate heterozygotes) of both patients and in individuals from two more families also obligated carries.