Healthcare Hygiene magazine December 2019

of product. The minimum time required by manufacturers is generally 15-20 seconds, with the volume required changing on the basis of the size of the hands to meet the time requirement. As Ellingson, et al. (2014) state, “Recent studies suggest that 15 seconds is insufficient for meeting standards for high-quality hand disinfection (EN 1500) and that physical coverage of hands with hand hygiene product in clinical settings is often substandard.” Hand hygiene expert Didier Pittet at the University of Geneva Hospitals and his co-investigators (Pires, et al. 2018) are among the researchers who put to the test the log10 reduction of bacteria on hands after washing and after using alcohol-based handrub (ABHR). Pittet emphasizes that “There is a greater reduction with ABHR,” and points to the European norms that manufacturers must follow that are based on microbiological efficacy. Pires, et al. (2018) state that, “Compliance with the WHO ‘how to handrub’ action is suboptimal. Simplifying the hand-hygiene action may improve practice. However, it is crucial to preserve antibacterial efficacy.” The researchers tested the non-inferiority of 15 versus 30 seconds handrubbing for Staphylococcus aureus and Escherichia coli contamination at different loads, using hand-size customized alcohol-based handrub (ABHR) volumes. In this EN1500-based study, 18 HCWs with extensive experience in hand hygiene rubbed hands with a hand-size customized volume of isopropanol 60% v/v. They repeated the following sequence: hand contamination (E. coli or S. aureus; broth containing 108 or 106 CFU/mL); baseline fingertips sampling; handrubbing (15 or 30 seconds); re-sampling. The main outcome was log10 CFU corrected reduction factor (cRF) on HCWs’ hands, applying a generalized linear mixed model with a random intercept for subject. According to Pires, et al. (2018), the median cRF was 2.1 log10. After fitting the model, cRF was significantly higher for S. aureus compared with E. coli but there was no significant effect for duration of handrubbing or contamination fluid con- centration. Fifteen seconds of handrubbing was non-inferior to 30. The researchers concluded that among experienced HCWs using a hand-size customized volume of ABHR, handrubbing for 15 seconds was non-inferior to 30 seconds in reducing bacterial load, irrespective of type of bacteria or contamination fluid concentration. This provides further support for a shorter, 15-seconds, hand-hygiene action. Studies have shown that training HCWs on proper technique can increase coverage and decrease bacterial counts on their hands. As Ellingson, et al. (2014) point out, “Some studies have indicated that rigid adherence to standardized step-by-step technique may not be as critical by demonstrating that sufficient pathogen reductions could be achieved by instructing HCWs simply to cover their hands with hand hygiene product (the ‘reasonable application’ approach) regardless of technique used. However, the studies finding reasonable application equivalent to a standardized technique had protocols using 3 mL of product, and it is unclear how often this volume is used in clinical practice (due to longer drying times associated with use of higher volumes). “ In the real world, breaking down barriers and boosting CLICK FOR compliance comes down to translating the science into practical The Best Practices for recommendations for your individual setting and its unique Proper Hand challenges. Hygiene “Healthcare personnel must understand how important hand hygiene is for protecting patients,” says Pittet. “Institutions play a big role in compliance and need to implement a multimodal strategy. Healthcare workers need to be trained, motivated, reminded, and there needs to be a safety culture within the institution. It is also important that handrub (or in certain cases running water) is available, that the handrub is a formulation that is well-tolerated by skin, etc.” “Getting your hand hygiene program to the next level just depends on what the barriers are,” confirms Paul Pottinger, MD, FACP, FIDSA, professor of medicine in the Division of Allergy & Infectious Diseases at the University of Washington Medical Center in Seattle. “It is so important to figure out who is having trouble, and where, when and why. The issue may be ignorance—or heaven forbid, indifference. 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Healthcare Hygiene magazine December 2019 | Page 21