Research Indicates Instant Hand Sanitizer Increases Handwashing Rates Among Healthcare Workers

Study in American Journal of Nursing Describes Long-Term Improvements

In Hand Hygiene



Apr 12, 2001, 01:00 ET from Kimberly-Clark Skin Wellness Institute

    ROSWELL, Ga., April 12 /PRNewswire/ -- A study published in the March
 issue of the American Journal of Nursing finds that healthcare workers were
 more likely to sanitize their hands when an alcohol-based hand sanitizing gel
 was available as an alternative to soap and water.  Handwashing or "hand
 antisepsis" rates increased by nearly 44 percent when the healthcare workers
 studied had access to the hand sanitizer.  Overall, the hand sanitizer was
 used in approximately 60 percent of the episodes of hand antisepsis.
     (Photo:   http://www.newscom.com/cgi-bin/prnh/20010403/KCLARKLOGO )
     Handwashing has been widely and repeatedly identified as the single most
 effective means of controlling and preventing nosocomial (hospital-acquired)
 infections.
     The three-phase observational study was conducted over a period of five
 months in two intensive care units at the University of California, San Diego,
 Medical Center.  To establish a baseline hand antisepsis compliance level,
 healthcare workers at the facility were observed washing their hands in
 39.6 percent of patient contact situations.  Each episode of patient contact
 studied had a maximum of two instances of compliance -- before and after
 patient contact -- in which healthcare workers should have degermed their
 hands using either soap and water or the instant hand sanitizer.
     Two to six weeks after introducing an alcohol-based hand sanitizing gel as
 an alternative to regular "soap-and-water" handwashing, compliance rates rose
 to 52.6 percent (a 32.8 percent improvement).  And 10 to 14 weeks after
 installing the hand sanitizer, hand antisepsis compliance rates continued to
 increase to 57 percent (an 8.4 percent increase over Phase II and a
 43.9 percent increase above the baseline level).
     Hand sanitizer dispensers mounted in the hallways outside of the patient
 rooms were nearly 30 times more likely to be used than the dispensers mounted
 anywhere inside the rooms.
     "Increasing compliance with handwashing protocols is an ongoing quest for
 infection control practitioners and other healthcare workers," explains Alvin
 Chapital, executive director, Kimberly-Clark Skin Wellness Institute, which
 provided funding and equipment for the study.  "This study supports the use of
 hand sanitizers as a viable method of producing a sustained, long-term
 increase in hand antisepsis compliance rates."
     Eddie Hedrick, manager, Infection Control and Staff Health, University of
 Missouri-Columbia Hospital and Clinics, and a faculty member of the Kimberly-
 Clark Skin Wellness Institute, agrees, stating: "If you can make hand
 antisepsis convenient, and can shorten the process with a product that doesn't
 cause the skin to dry, you can substantially increase compliance.  This study
 can be seen as a compelling call-to-action for healthcare workers who don't
 fully comply with APIC handwashing guidelines."
 
     Key Findings
     The study is the only trial to evaluate usage of alcohol-based hand
 sanitizers continuously over a period of months, before and after installation
 of the hand sanitizer dispensers, in a medical setting.  After baseline
 handwashing compliance rates were measured (Phase I), seventy-three dispensers
 containing an instant hand sanitizing gel were installed both inside and
 outside the patient rooms in a 20-bed surgical intensive care unit (SICU) and
 a 13-bed medical intensive care unit (MICU).  Phase II of the study evaluated
 the impact of the hand sanitizing gel on hand antisepsis compliance two to six
 weeks post-installation.  Phase III measured compliance 10 to 14 weeks post-
 installation of the hand sanitizers.
     In Phases I and II, physicians cleansed their hands less often than
 nursing personnel, who in turn cleansed their hands less often than ancillary
 personnel (such as radiation technicians and physical therapists).  In Phase
 II, hand antisepsis rates among ancillary personnel improved the most (42
 percent) over baseline, followed by physicians (39.2 percent) and nursing
 personnel (31.6 percent).
     Overall during Phase II, healthcare workers chose the hand sanitizing gel
 over a traditional "soap-and-water" handwash in 60.1 percent of the episodes
 of hand antisepsis.  The nursing staff was the most likely to incorporate the
 hand sanitizer into hand antisepsis, using it in 62.8 percent of observed
 episodes.  Physicians used the hand sanitizer during 61.6 percent of their
 hand antisepsis episodes, and ancillary personnel used it in lieu of soap 52.4
 percent of the time.
     In Phase III, ancillary personnel continued to have the highest rate of
 handwashing compliance, with 83.5 percent of their patient contacts involving
 at least one instance of hand antisepsis, a 14.9 percent increase from Phase
 II and a 63.1 percent increase over the baseline rate.  Nursing personnel
 cleansed their hands in 56.9 percent of patient contacts, a 5 percent increase
 from Phase II and a 38.1 percent increase over baseline.  Physicians were
 observed cleansing their hands in 43.7 percent of patient care episodes, an
 increase of 7.1 percent from Phase II and a 49.2 percent improvement over the
 baseline rate.
     According to its authors, "[the] study attempted to address each of the
 often-cited explanations given for noncompliance with published guidelines and
 individual hospital policy: inconvenience, lack of time, and the drying
 effects of repeated use of soap and water on skin.  Gel dispensers were
 installed at convenient locations throughout the two units under study, and
 using the gel required less time than did soap and water. Yet, at the
 conclusion of the study, we had not achieved 60 percent overall compliance."
     "[Since] full compliance with hand antisepsis guidelines may not be a
 realistic goal, we believe that our study's findings may best be used to re-
 evaluate the current indications for hand antisepsis," the authors concluded.
 "It would be useful to employ a system of risk stratification by procedure,
 one which clearly delineates which patient care activities carry higher and
 lower risks of hand transmission of microorganisms.  Compliance would seem a
 more likely result if the need for hand antisepsis were emphasized for those
 procedures that are more likely to transmit pathogenic microorganisms and not
 for those less likely to do so."
 
     About the American Journal of Nursing
     The American Journal of Nursing is the largest and oldest circulating
 nursing journal in the world, and is the official journal of the American
 Nurses Association.  The American Journal of Nursing is owned and published by
 Lippincott Williams & Wilkins, a unit of Wolters Kluwer International Health &
 Science (WKIHS).  WKIHS is a group of leading publishing companies offering
 specialized publications and software in nursing, medicine, pharmacy, science,
 and related areas.  WKIHS also includes Ovid Technologies, New York; Facts and
 Comparisons, St. Louis; Adis International, Auckland, New Zealand; and Kluwer
 Academic Publishing, The Netherlands.
 
     About the University of California San Diego Medical Center
     The University of California San Diego Medical Center is one of five
 academic health centers in the prestigious University of California system.
 UCSD Medical Center provides a broad spectrum of medical services, including a
 major cancer center, one of the most comprehensive organ transplant programs
 in the country, the county's only Level 1 Trauma Center, and one of the
 leading regional burn centers in the nation.
     UCSD Medical Center has been responsible for important breakthroughs in
 the care and treatment of serious diseases.  This leadership in medical
 research frequently enables the Medical Center to offer new clinical
 treatments and drugs before they are generally available.  Equipped with
 state-of-the-art technology, UCSD Medical Center's advanced diagnostic ability
 and treatment capabilities are recognized internationally.
 
     About the Kimberly-Clark Skin Wellness Institute
     The Kimberly-Clark Skin Wellness Institute was established in 1998 to
 advance the cause of better skin health in "away-from-home" settings - at the
 office or the factory, at school or in the hospital, when traveling or eating
 out, and even at play.  The Kimberly-Clark Skin Wellness Institute, based in
 Roswell, Georgia, focuses on skin health through research, education and
 communication of skin wellness practices.  It was founded and is supported by
 Kimberly-Clark Corporation, a leading global manufacturer of health care,
 personal care, consumer tissue and away from home products, including skin
 cleansers and dispensing systems.  Visit the Kimberly-Clark Skin Wellness
 Institute web site at www.kcskinhealth.com.
 
 

SOURCE Kimberly-Clark Skin Wellness Institute
    ROSWELL, Ga., April 12 /PRNewswire/ -- A study published in the March
 issue of the American Journal of Nursing finds that healthcare workers were
 more likely to sanitize their hands when an alcohol-based hand sanitizing gel
 was available as an alternative to soap and water.  Handwashing or "hand
 antisepsis" rates increased by nearly 44 percent when the healthcare workers
 studied had access to the hand sanitizer.  Overall, the hand sanitizer was
 used in approximately 60 percent of the episodes of hand antisepsis.
     (Photo:   http://www.newscom.com/cgi-bin/prnh/20010403/KCLARKLOGO )
     Handwashing has been widely and repeatedly identified as the single most
 effective means of controlling and preventing nosocomial (hospital-acquired)
 infections.
     The three-phase observational study was conducted over a period of five
 months in two intensive care units at the University of California, San Diego,
 Medical Center.  To establish a baseline hand antisepsis compliance level,
 healthcare workers at the facility were observed washing their hands in
 39.6 percent of patient contact situations.  Each episode of patient contact
 studied had a maximum of two instances of compliance -- before and after
 patient contact -- in which healthcare workers should have degermed their
 hands using either soap and water or the instant hand sanitizer.
     Two to six weeks after introducing an alcohol-based hand sanitizing gel as
 an alternative to regular "soap-and-water" handwashing, compliance rates rose
 to 52.6 percent (a 32.8 percent improvement).  And 10 to 14 weeks after
 installing the hand sanitizer, hand antisepsis compliance rates continued to
 increase to 57 percent (an 8.4 percent increase over Phase II and a
 43.9 percent increase above the baseline level).
     Hand sanitizer dispensers mounted in the hallways outside of the patient
 rooms were nearly 30 times more likely to be used than the dispensers mounted
 anywhere inside the rooms.
     "Increasing compliance with handwashing protocols is an ongoing quest for
 infection control practitioners and other healthcare workers," explains Alvin
 Chapital, executive director, Kimberly-Clark Skin Wellness Institute, which
 provided funding and equipment for the study.  "This study supports the use of
 hand sanitizers as a viable method of producing a sustained, long-term
 increase in hand antisepsis compliance rates."
     Eddie Hedrick, manager, Infection Control and Staff Health, University of
 Missouri-Columbia Hospital and Clinics, and a faculty member of the Kimberly-
 Clark Skin Wellness Institute, agrees, stating: "If you can make hand
 antisepsis convenient, and can shorten the process with a product that doesn't
 cause the skin to dry, you can substantially increase compliance.  This study
 can be seen as a compelling call-to-action for healthcare workers who don't
 fully comply with APIC handwashing guidelines."
 
     Key Findings
     The study is the only trial to evaluate usage of alcohol-based hand
 sanitizers continuously over a period of months, before and after installation
 of the hand sanitizer dispensers, in a medical setting.  After baseline
 handwashing compliance rates were measured (Phase I), seventy-three dispensers
 containing an instant hand sanitizing gel were installed both inside and
 outside the patient rooms in a 20-bed surgical intensive care unit (SICU) and
 a 13-bed medical intensive care unit (MICU).  Phase II of the study evaluated
 the impact of the hand sanitizing gel on hand antisepsis compliance two to six
 weeks post-installation.  Phase III measured compliance 10 to 14 weeks post-
 installation of the hand sanitizers.
     In Phases I and II, physicians cleansed their hands less often than
 nursing personnel, who in turn cleansed their hands less often than ancillary
 personnel (such as radiation technicians and physical therapists).  In Phase
 II, hand antisepsis rates among ancillary personnel improved the most (42
 percent) over baseline, followed by physicians (39.2 percent) and nursing
 personnel (31.6 percent).
     Overall during Phase II, healthcare workers chose the hand sanitizing gel
 over a traditional "soap-and-water" handwash in 60.1 percent of the episodes
 of hand antisepsis.  The nursing staff was the most likely to incorporate the
 hand sanitizer into hand antisepsis, using it in 62.8 percent of observed
 episodes.  Physicians used the hand sanitizer during 61.6 percent of their
 hand antisepsis episodes, and ancillary personnel used it in lieu of soap 52.4
 percent of the time.
     In Phase III, ancillary personnel continued to have the highest rate of
 handwashing compliance, with 83.5 percent of their patient contacts involving
 at least one instance of hand antisepsis, a 14.9 percent increase from Phase
 II and a 63.1 percent increase over the baseline rate.  Nursing personnel
 cleansed their hands in 56.9 percent of patient contacts, a 5 percent increase
 from Phase II and a 38.1 percent increase over baseline.  Physicians were
 observed cleansing their hands in 43.7 percent of patient care episodes, an
 increase of 7.1 percent from Phase II and a 49.2 percent improvement over the
 baseline rate.
     According to its authors, "[the] study attempted to address each of the
 often-cited explanations given for noncompliance with published guidelines and
 individual hospital policy: inconvenience, lack of time, and the drying
 effects of repeated use of soap and water on skin.  Gel dispensers were
 installed at convenient locations throughout the two units under study, and
 using the gel required less time than did soap and water. Yet, at the
 conclusion of the study, we had not achieved 60 percent overall compliance."
     "[Since] full compliance with hand antisepsis guidelines may not be a
 realistic goal, we believe that our study's findings may best be used to re-
 evaluate the current indications for hand antisepsis," the authors concluded.
 "It would be useful to employ a system of risk stratification by procedure,
 one which clearly delineates which patient care activities carry higher and
 lower risks of hand transmission of microorganisms.  Compliance would seem a
 more likely result if the need for hand antisepsis were emphasized for those
 procedures that are more likely to transmit pathogenic microorganisms and not
 for those less likely to do so."
 
     About the American Journal of Nursing
     The American Journal of Nursing is the largest and oldest circulating
 nursing journal in the world, and is the official journal of the American
 Nurses Association.  The American Journal of Nursing is owned and published by
 Lippincott Williams & Wilkins, a unit of Wolters Kluwer International Health &
 Science (WKIHS).  WKIHS is a group of leading publishing companies offering
 specialized publications and software in nursing, medicine, pharmacy, science,
 and related areas.  WKIHS also includes Ovid Technologies, New York; Facts and
 Comparisons, St. Louis; Adis International, Auckland, New Zealand; and Kluwer
 Academic Publishing, The Netherlands.
 
     About the University of California San Diego Medical Center
     The University of California San Diego Medical Center is one of five
 academic health centers in the prestigious University of California system.
 UCSD Medical Center provides a broad spectrum of medical services, including a
 major cancer center, one of the most comprehensive organ transplant programs
 in the country, the county's only Level 1 Trauma Center, and one of the
 leading regional burn centers in the nation.
     UCSD Medical Center has been responsible for important breakthroughs in
 the care and treatment of serious diseases.  This leadership in medical
 research frequently enables the Medical Center to offer new clinical
 treatments and drugs before they are generally available.  Equipped with
 state-of-the-art technology, UCSD Medical Center's advanced diagnostic ability
 and treatment capabilities are recognized internationally.
 
     About the Kimberly-Clark Skin Wellness Institute
     The Kimberly-Clark Skin Wellness Institute was established in 1998 to
 advance the cause of better skin health in "away-from-home" settings - at the
 office or the factory, at school or in the hospital, when traveling or eating
 out, and even at play.  The Kimberly-Clark Skin Wellness Institute, based in
 Roswell, Georgia, focuses on skin health through research, education and
 communication of skin wellness practices.  It was founded and is supported by
 Kimberly-Clark Corporation, a leading global manufacturer of health care,
 personal care, consumer tissue and away from home products, including skin
 cleansers and dispensing systems.  Visit the Kimberly-Clark Skin Wellness
 Institute web site at www.kcskinhealth.com.
 
 SOURCE  Kimberly-Clark Skin Wellness Institute