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Handwashing machines, handwashing compliance, and potential for cross-contamination
1Division of Hospital Epidemiology, Cook County Hospital, University of Illinois School of Public Health.
Abstract:
Although handwashing is considered an important factor in the prevention of nosocomial infections, the optimal technique has not been determined and compliance is often difficult to obtain. Handwashing compliance is particularly important in intensive care areas of the hospital. In an effort to improve HW compliance, the surgical intensive care unit in our hospital purchased three handwashing machines. Four months after installation of the handwashing machines, an outbreak of methicillin-resistant Staphylococcus aureus occurred in the intensive care unit. As part of evaluating the outbreak, we cultured the handwashing machines, including the portholes and the paper towel dispenser. Cultures were positive for methicillin-resistant Staphylococcus epidermidis, Achromobacter species, and Streptococcus viridans. The design of the handwashing machines made contamination of sleeves and already-washed hands possible. An observational study revealed that handwashing compliance was poor but improved from 22% to 38% when the handwashing machines were in use. Nurses preferred handwashing at the sink and physicians preferred the handwashing machine. Handwashing machines may increase handwashing compliance because of their novelty, but they may also result in novel problems.
Insights
Handwashing machines in intensive care units may increase compliance but can also harbor bacteria, potentially leading to hospital-acquired infections. Further research is needed to assess their safety and efficacy.
Area of Science:
- Healthcare-associated infection prevention
- Microbiology
- Hospital infection control
Background:
- Hand hygiene is crucial for preventing nosocomial infections, especially in intensive care units (ICUs).
- Optimal handwashing techniques and compliance remain challenges in healthcare settings.
- Handwashing machines were introduced in a surgical ICU to improve compliance.
Purpose of the Study:
- To evaluate the impact of handwashing machines on hand hygiene compliance in an ICU.
- To investigate potential microbial contamination associated with handwashing machines.
- To assess the role of handwashing machines in a methicillin-resistant Staphylococcus aureus outbreak.
Main Methods:
- Observational study of handwashing compliance before and after machine installation.
- Microbial culturing of handwashing machines, including portholes and dispensers.
- Analysis of handwashing machine design for potential contamination pathways.
Main Results:
- Handwashing compliance increased from 22% to 38% with machine use.
- Handwashing machines were contaminated with methicillin-resistant Staphylococcus epidermidis, Achromobacter species, and Streptococcus viridans.
- Machine design allowed for potential contamination of sleeves and hands.
- Nurses preferred sinks, while physicians preferred machines.
Conclusions:
- Handwashing machines may temporarily improve compliance due to novelty.
- The machines pose a risk of microbial contamination and potential spread of infections.
- Novel problems, including contamination risks, may arise from using handwashing machines in ICUs.