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PICOT Handwashing

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by

Aliza Feinberg

on 16 October 2013

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Transcript of PICOT Handwashing

What is the effectiveness of using alcohol-based solution in hand hygiene based on CDC guidelines in reducing nosocomial infection on an oncology unit compared to routine soap and water hand washing
There is sound basis for making a practice change to using alcohol-based hand rubbing solution. This change is supported by guidelines from credible sources such as the CDC and WHO. Research demonstrated that alcohol-based hand rubbing solution removes microorganisms effectively, requiring less time and irritation to the hands less often than does hand washing with soap or other antiseptic agents and water. (Wilawan Picheansathian, 2004) Additionally, it is important to make alcohol-based solutions easily accessible at the bedside increases compliance with hand hygiene among healthcare workers. There is strong evidence to support a recommendation for a change in practice by implementing the PICOT project.
Recommendations:
Evidence 1: Experimental Randomized Control Trial (RCT)
Evidence 3: Opinion of nationally recognized experts based on research evidence (Clinical Practice Guidelines)
Evidence 4: Opinion of nationally recognized experts based on research evidence (Clinical Practice Guidelines)
Nurses and other healthcare providers often fail to follow standard protocols regarding hand hygiene. These protocols are evidence based and are designed to provide patient and provider safety. Identifying ways to improve hand hygiene will provide safety for providers and improve patient outcomes.
The Problem
PICOT Question

Population - Oncology patients
Intervention - Alcohol-based solution in hand hygiene
Comparison - Routine soap and water hand washing
Outcome - Reducing nosocomial infection
Time - During hospitalization
The Question
The most current guidelines from the World Health Organization (2009) indicate that use of alcohol-based hand rubs is the preferred method of preventing hospital-acquired infections. It is suggested that alcohol solutions should contain between 60%-80% alcohol to effectively denature proteins in the bacteria. Research suggests that hand washing with plain soap and water can actually increase bacteria. The only appropriate time to use soap and water is if hands are visibly soiled or the patient is suspected or proven to have Clostridium difficile.
WHO guidelines on hand hygiene in health care
Overall Quality:
High
–WHO is a global resource and expert on health care. This guideline is a compilation of research from organizations and hospitals in member countries, including the United States.
The most current recommendation from the CDC Guideline for Hand Hygiene in Health care settings report shows the preference for alcohol based hand rubs over the use of plain or antimicrobial hand soap (CDC 2002, p. 8). Although alcohols are not appropriate for use when hand are visibly dirty, studies have shown that ethanol and isopropanol hand rubs may reduce viable bacterial counts on hands more than plain soap or antimicrobial soap. The CDC advocates that alcohol-based products are more effective for standard hand washing or hand antisepsis than soap or antimicrobial soaps.
Center for Disease Control Guideline for Hand Hygiene in Heath care settings
Overall Quality:
High
–The CDC is a federal resource and expert for health information, data, and guidelines. Its recommendations are based on current data and a strong evidence base. Therefore this guideline is credible.
Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomized clinical trial
Emmanuelle Girou, Sabrina Loyeau, Patrick Legrand, Françoise Oppein, Christian Brun-Buisson (2002) did a randomized control study to compare the efficacy of handrubbing with an alcohol based solution versus conventional handwashing with antiseptic soap in reducing hand contamination during routine patient care. In the study, 23 healthcare workers were assigned into two groups, where 12 of the participants were assigned to the group that did handrubbing with alcohol based solution and 11 did handwashing with antiseptic soap when hand hygiene was indicated before and after patient care. Imprints were taken of fingertips and palm of the dominant hand before and after hand hygiene procedures. Bacterial counts quantified blindly. There was a higher median percentage in reduction of bacterial contamination with handrubbing with alcohol-based solution as compared to handwahing. The percentage was 83% versus 58%. The results showed that During routine patient care handrubbing with an alcohol-based solution is significantly more efficient in reducing hand contamination than handwashing with antiseptic soap.
Overall Quality:
Good
- The RCT included healthcare workers from three different Intensive Care Units. The sample size was small, but the findings were consistent and reliable.
Evidence 2: Systematic Review of Experimental Studies
A Systematic review on the effectiveness of alcohol-based solutions for hand hygiene
Wilawan Picheansathian(2004) did a systematic review to evaluate the clinical evidence supporting the use of alcohol-based solutions in hospitals as an option for hand hygiene. The review looked at 41 studies related to the effectiveness of alcohol-based solutions done and published from January 1992 to April 2002 in English and Thai. The reviewer used different databases to search for the studies. Among the databases searched included Medline, DARE, CINAHL and Dissertation Abstracts International. All studies were assessed as having adequate methodological quality. Results of this systematic review supported that alcohol-based hand rubbing removes microorganisms effectively, requires less time and irritates hands less often than does handwashing with soap or other antiseptic agents and water. Additionally,it was suggested that making alcohol-based solutions easily accessible at bedside increases compliance with hand hygiene among healthcare workers.
Overall Quality:
Good
- The systemic review utilized many studies and compared their findings. Some of the sources were more than ten years ago, but when the study was performed the sources were current.
EBP Hand Hygiene
By
Andrew Amon
Sarah Bach
Aliza Feinberg
Agnes Kemboi
Thornell Lewis

References
Center for Disease Control (2002). CDC guideline for hand hygiene in the health care setting. Retrieved from http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf

Girou, E., Loyeau, S., Legrand, P., Oppein, F., & Brun-Buisson, C. (2002). Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. BMJ: British Medical Journal (International Edition), 325(7360), 362-365. doi:10.1136/bmj.325.7360.362 Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC117885/

Picheansathian, W. (2004). A systematic review on the effectiveness of alcohol-based solutions for hand hygiene. International Journal of Nursing Practice, 10(1), 3-9. doi:10.1111/j.1440-172X.2003.00457.x Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1440-172X.2003.00457.x/abstract

World Health Organization. (2009). WHO guidelines on hand hygiene in health care. Retrieved from http://apps.who.int/iris/bitstream/10665/44102/1/9789241597906_eng.pdf
Andrew: Randomized control trial
Agnes: Systemic review
Sarah: Clinical practice guideline (CDC)
Aliza: Clinical practice guideline (WHO), presentation
Thornell: Current practice, recommendations
Member Contributions
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