Meta-analysis of Hand Sanitation Practices

Consistent and effective hygiene standards remain of the utmost importance in healthcare settings. In the following analysis, I will summarize and evaluate the critical success of implementing alcohol hand-rub solutions as a general rule. After a broad consideration of this logistic policy, I will follow up with case studies examining the matter at healthcare facilities in St. Petersburg, Russia and São Paolo, Brazil. For nurses in critical and intensive care units, the availability of alcohol-based hand sanitizers for increases hand hygiene compliance remains in question. The review of the following reports will lend guidance to the sanitation situation thereby laying the groundwork a clearer understanding of effective healthcare policy.

The implementation of proper hygiene techniques depends on many factors. Ensuring that physicians, nurses, and other health personnel passing through hospitals understand the importance of nosocomial infections (such as C. Difficile) remains essential; people need to be educated about the value of proper hygiene with alcohol-based gels—this significantly affects the adherence rate (Rupp, Sholtz, Fitzgerald, Smith, Peterson, Marion, et al., 2008, p. 10). Upon widespread availability and with a solid briefing, rates of sanitation increased dramatically in all groups (Rupp et al., 2008, p. 11). However, the study also noted that the nosocomial infection rate remained unchanged despite improved hand hygiene (Rupp et al., 2008, p. 13). Findings thus far suggest that hand hygiene augmented with alcohol-based hand sanitizers may increase clean hands but with minimal impact on infection rates within the hospital setting.

There appears to be strong evidence that alcohol-based hygiene is currently acceptable among health care workers as an effective sanitation technique. Studies by Maury, Alzieu, Baudel, Haram, Barbut, Guidet, et al. (2000) suggest that healthcare workers view it as both easy and minimally irritating to the skin (p. 326). In their report, Maury et al. (2000) observed the greatest compliance when practitioners had access to their own bottle of hand sanitizer—the issue appears to remains a matter of practicality for many (p. 326). Even so, alcohol-based sanitizing will not remove dirt and other substances by themselves and will not replace conventional hand-washing methods as film deposits accumulate after multiple hand sanitizer uses (Maury et al., 2000, p. 326). As such, there appears to be strong evidence for hand-sanitizing playing a complementary role in the sanitation process rather than an exclusive role.

In St. Petersburg, Russia, it seems that hand sanitization participation remains low. Brown, Lubimova, Khrustalyeva, Shulaeva, Tekhova, Zueva, et al. (2003) led a study where active participation in hand sanitizing increased from 48% to 66% as gel-based solutions were offered (p. 173). In a country with significantly higher nosocomial infection rates than the United States, proper sanitation remains a major challenge in health practitioner settings (Brown et al., 2003, p. 173). Hygiene appears to play a lesser role in Russia as many practitioners prefer to don gloves rather than sanitize their hands (Brown et al., 2003, p. 176). As such, it appears Russian facilities invokes a different cleanliness standard than United States healthcare settings.

The study in São Paolo, Brazil, differentiated in its observation method and resulted in some of the lowest handwashing rates recorded in the studies. Staff was not informed that it was being observed and hand-washing rates peaked at pre-intervention settings among physiotherapists only around 40% (Santana, Furtado, Coutinho & Medeiros, 2007, p. 366). It also appears that the more signage is used to remind people to sanitize their hands, the less they actually do it (Santana et al., 2007, p. 366). In Brazil, sanitation levels appear to be minimal.

Results from a meta-analysis of these four studies indicate that alcohol-based sanitation techniques provide a limited advantage to traditional hand washing techniques based on convenience. Their merits deserve careful promotion, especially outside the United States.

References

Brown, S. M., Lubimova, A. V., Khrustalyeva, N. M., Shulaeva, S. V., Tekhova, I., Zueva, L. P., et al. (2003). Use of an alcohol‐based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infection Control and Hospital Epidemiology, 24(3), 172-179.

Maury, E., Alzieu, M., Baudel, J. L., Haram, N., Barbut, F., Guidet, B., et al. (2000). Availability of an alcohol solution can improve hand disinfection compliance in an intensive care unit. American Journal of Respiratory and Critical Care Medicine, 162(1), 324-327.

Rupp, M. E., Sholtz, L., Fitzgerald, T., Smith, V., Peterson, D., Marion, N., et al. (2008). Prospective, controlled, cross‐over trial of alcohol‐based hand gel in critical care units. Infection Control and Hospital Epidemiology, 29(1), 8-15.

Santana, S. L., Furtado, G. H., Coutinho, A. P., & Medeiros, E. A. (2007). Assessment of healthcare professionals’ adherence to hand hygiene after alcohol‐based hand rub introduction at an intensive care unit in Sao Paulo, Brazil. Infection Control and Hospital Epidemiology, 28(3), 365-367.