Marena Carlo, Lodola Lorenzo, Zecca Marco, Bulgheroni Anna, Carretto Edoardo, Maserati Renato, Zambianchi Luigina
Department of Pediatrics, IRCCS Policlinico "San Matteo," Pavia, Italy.
Am J Infect Control. 2002 Oct;30(6):334-40. doi: 10.1067/mic.2002.125809.
Handwashing (HW) by clinical staff is the single most important measure for preventing transmission of nosocomial infection (NI). The primary objectives of this study were to improve the motivation and awareness of the importance of HW practices among health care workers (HCWs) and to assess the effectiveness of a new chemical system in checking HW compliance. In addition, we evaluated the efficacy and tolerability of 2 soap solutions used during regular working hours by HCWs at our institution.
A preliminary short training course was performed to promote HW compliance and awareness. We chose 2 surgical wards at our 1200-bed teaching hospital. Sampling of hands was conducted weekly during routine activities of HCWs without advance warning. We used the staff list as a sampling frame to select subjects. Data were collected anonymously. On the basis of a crossover study design, a plain soap and one containing 4% chlorhexidine gluconate (CHG) were used alternatively in each ward for 4 consecutive months. Hand samples were evaluated with microbiologic cultures and with a commercially available kit that measures adenosine triphosphate (ATP) bioluminescence. As additional process indicators, we examined the amount of hand soap and CHG solution distributed and rate of NIs.
A total of 74 HCWs were evaluated for hand contamination. During the 4-month study, we found a significant reduction in colony-forming unit counts (P <.008) and ATP levels (P <.002) compared with baseline values. The results showed a positive correlation (r = 0.68, P <.0001) between the microbial counts detected by standard culture and ATP levels measured with the commercial kit. Plain soap (P <.003) was more effective than CHG in reducing colony-forming unit counts among HCWs in the vascular surgery ward. We documented a reduction in the NI rate and an increase in the consumption of soap and paper towels.
HW compliance improved during the study period among HCWs. The method to measure ATP bioluminescence is simple and easy to perform and provides reliable results within a few minutes of sampling hands. It can be used extensively to test HW compliance among HCWs.
临床工作人员洗手是预防医院感染（NI）传播的最重要措施。本研究的主要目的是提高医护人员（HCWs）洗手的积极性和对洗手重要性的认识，并评估一种新的化学系统在检查洗手依从性方面的有效性。此外，我们评估了我院医护人员在正常工作时间使用的两种肥皂溶液的疗效和耐受性。
开展了一个初步的短期培训课程，以促进洗手依从性和提高认识。我们在拥有1200张床位的教学医院选择了2个外科病房。在医护人员日常活动期间每周对手部进行采样，且不事先通知。我们以工作人员名单作为抽样框架来选择受试者。数据以匿名方式收集。基于交叉研究设计，在每个病房交替使用普通肥皂和含4%葡萄糖酸氯己定（CHG）的肥皂，为期连续4个月。通过微生物培养和一种测量三磷酸腺苷（ATP）生物发光的商用试剂盒对手部样本进行评估。作为额外的过程指标，我们检查了分发的洗手液和CHG溶液的量以及医院感染率。
共对74名医护人员的手部污染情况进行了评估。在为期4个月的研究中，我们发现与基线值相比，菌落形成单位计数（P <.008）和ATP水平（P <.002）显著降低。结果显示，标准培养检测到的微生物计数与商用试剂盒测量的ATP水平之间呈正相关（r = 0.68，P <.0001）。在血管外科病房的医护人员中，普通肥皂在减少菌落形成单位计数方面比CHG更有效（P <.003）。我们记录到医院感染率降低，肥皂和纸巾的消耗量增加。
在研究期间，医护人员的洗手依从性有所提高。测量ATP生物发光的方法简单易行，且在采样手部后几分钟内就能提供可靠结果。它可广泛用于检测医护人员的洗手依从性。
