Who Hand Hygiene
Health care-associated infection rates at USC University Hospital are higher than the national average. Poor hand hygiene is considered the leading cause of health care-associated infections, contributes to the spread of multi-resistant organisms, and is recognized as a significant contributor to infection outbreaks. Completion of this brief on-line CME activity will be recorded in your USC University Hospital medical staff records, and you will receive 1 unit of AMA category 1 CME credit. Objectives: At the completion of this activity, participants should be able to: •List indications for hand hygiene in the clinical setting. Read moreList risk factors for poor hand hygiene. Describe hand hygiene rates and effect on hospital infections. Improve hand hygiene performance in clinical settings. There is no industry support for this CME activity.
- 1.
Which one of the following is a risk factor for poor handwashing?
- A.
Female gender
- B.
Not wearing gowns/gloves
- C.
Being a nurse (rather than a physician)
- D.
Being a physician (rather than a nurse)
- E.
Working on a medicine ward (rather than intensive care)
Correct Answer
D. Being a pHysician (rather than a nurse)Explanation
Correct answer - 4. Being a physician, as compared to being a nurse, has been shown to indicate increased risk for poor hand hygiene practices.Rate this question:
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- 2.
Risk factors for poor handwashing and hand hygiene practices include the following:1
- Doctor status (rather than a nurse)
- Nursing assistant status (rather than a nurse)
- Physiotherapist
- Technician
- Male gender
- Working in intensive care
- Working in surgical care unit
- Working in emergency care
- Working in anesthesiology
- Working during the week (vs. week-end)
- Wearing gowns/gloves
- Before contact with patient environment
- After contact with patient environment e.g. equipment
- Caring for patients aged less than 65 years old
- Caring for pts recovering from clean/clean-contaminated surgery in post-anaesthesia care unit
- Patient care in non-isolation room
- Duration of contact with patient (< or equal to 2 minutes)
- Interruption in patient-care activities
- Automated sink
- Activities with high risk of cross-transmission
- Understaffing/overcrowding
- High number of opportunities for hand hygiene per hour of patient care
- 3.
Improved hand hygiene in recent hospital studies was associated with which of the following?
- A.
A reduction of catheter-related infections from 7.7 per 1000 catheter-days to 1.3 per 1000 catheter-days in 103 ICUs.2
- B.
A significant hospital-wide reduction (57%) in MRSA bacteraemia.3
- C.
A significant reduction (100%) of superficial surgical site infections (SSI) in neurosurgery; significantly lower SSI incidence in intervention ward compared with control ward.4
- D.
A significant reduction in health care-associated infections (HCAI) in adult ICUs (from 47.5/1000 patient-days to 27.9/1000 patient-days). 5
- E.
All are correct.
Correct Answer
E. All are correct.Explanation
Hand hygiene is the primary measure proven to be effective in preventing health care-associated infections and the spread of antimicrobial resistance in hospitals and ICUs.1
2. Pronovost PJ, et al. Sustaining reductions in catheter related blood stream infections in Michigan intensive care units: Observational study. BMJ 2010, 0340:c309.
3. Johnson PD et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Medical Journal of Australia, 2005, 183:509-514.
4. Le TA et al. Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam. Infection Control and Hospital Epidemiology, 2007, 8:583-588.
5. Rosenthal VD, Guzman S, Safdar N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. American Journal of Infection Control, 2005, 33:392-397.Rate this question:
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- 4.
Which of the following is a recommendation of the World Health Organization (WHO)? Perform hand hygiene:
- A.
Before and after having direct contact with patients
- B.
With alcohol-based hand rub if hands are not visibly soiled
- C.
After removing gloves
- D.
Before handling an invasive device (regardless of whether or not gloves are used)
- E.
All are WHO recommendations
Correct Answer
E. All are WHO recommendationsExplanation
Correct answer 4. All of these are recommendations regarding hand hygiene from the WHO.1Rate this question:
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- 5.
WHO indications for hand hygiene:1 A. Wash hands with soap and water when visibly dirty or visibly soiled with blood or other body fluids (IB) or after using the toilet. B. If exposure to potential spore-forming pathogens is strongly suspected or proven, including outbreaks of C. difficile, hand washing with soap and water is the preferred means. C. Use an alcohol-based handrub as the preferred means for routine hand antisepsis in all other clinical situations described in items D(a) to D(f) listed below if hands are not visibly soiled. If alcohol-based handrub is not obtainable, wash hands with soap and water. D. Perform hand hygiene: a) before and after touching the patient. b) before handling an invasive device for patient care, regardless of whether or not gloves are used. c) after contact with body fluids or excretions, mucous membranes, non-intact skin, or wound dressings. d) if moving from a contaminated body site to another body site during care of the same patient. e) after contact with inanimate surfaces and objects (including medical equipment) in the immediate vicinity of the patient. f) after removing sterile or non-sterile gloves. E. Before handling medication or preparing food perform hand hygiene using an alcohol-based handrub or wash hands with either plain or antimicrobial soap and water. F. Soap and alcohol-based handrub should not be used concomitantly. 1. WHO Guidelines on Hand Hygiene in health care: a summary. 2006
- 6.
Which one of the following is CORRECT?
- A.
Hand hygiene with alcohol-based cleanser should take 10-20 seconds
- B.
Hand hygiene with alcohol-based cleanser should take 20-30 seconds
- C.
Washing hands with soap and water should take 10-20 seconds
- D.
Washing hands with soap and water should take 20-30 seconds
Correct Answer
C. Washing hands with soap and water should take 10-20 secondsExplanation
The entire procedure for hand washing with soap and water should take 40-60 seconds, and alcohol-based hygiene should take 20-30 seconds.1
1. WHO Guidelines on Hand Hygiene in health care: a summary. 2006Rate this question:
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- 7.
Which one of the following is FALSE?
- A.
In a large Swiss university hospital, doctors cleansed their hands 57% of the times that they should have.1
- B.
In an Australian hospital hand washing campaign, mean compliance improved significantly from 21% at baseline to 48%.129
- C.
In the USC University hospital in 2009, doctors’ compliance with hand hygiene guidelines was 67%.
Correct Answer
C. In the USC University hospital in 2009, doctors’ compliance with hand hygiene guidelines was 67%.Explanation
Option 3. is FALSE. In 2009 at USC University Hospitals, mean compliance with hand hygiene was only 55% (mean of monthly physician observation reports).8
Please help reduce health care-associated infections in our hospital by improving your hand hygiene. We want all of our physicians to become good role models for the rest of the hospital staff. Thank you.
7. Pittet A, Simon S, et. Al. Hand Hygiene among Physicians: Performance, Beliefs, and Perceptions. Annals of Internal Medicine 2004 (volume 141, pages 1-8).
8. Grayson ML et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Medical Journal of Australia, 2008, 188:633-640.
9. Mean data from USCUH 2009.Rate this question:
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