Feasibility of hand disinfection in paediatric advanced life support (PALS): A simulation study

Hand disinfection is often omitted during emergencies because it may delay life-saving treatments. As healthcare-associated infections significantly worsen patient outcomes, the categorical omission of hand disinfection in emergencies should be re-evaluated. Real-world observations on this subject tentatively indicate compliance rates of <10%. In an adult simulation study, we have previously shown that proper hand disinfection without delaying patient care is feasible in >50% of scenarios. However, no comparable data have been published regarding emergencies in infants or children.

This observational study aimed to assess the feasibility of hand disinfection in simulated paediatric patients requiring advanced life support (PALS).

We observed 32 simulations of life-threatening conditions. Two observers counted all possible moments for administering hand hygiene, according to the World Health Organization protocol, and assessed them for time-neutral feasibility.

In the 32 scenarios, the feasibility of hand disinfection for all WHO moments ranged from 78.3 to 100%. Of all 573 hand disinfection moments, 552 (96.3%) were deemed feasible.Altogether 208 (36.3%) occurred before aseptic tasks. Of these, 187 (89.9%) were considered feasible. Hand disinfection for WHO-2 moments feasibility showed to be at least 50% in the cases. A total of 189 (90.9%) of all WHO-2 hand disinfections were applied by the role of the "iv-manager". Scenarios with shockable rhythms and peri-arrest showed higher feasibility ratios than those without.

The categorical omission of hand disinfection in PALS seems to be no longer acceptable or appropriate. The feasibility of hand hygiene should be re-evaluated in real-world scenarios.