I need with identifying the measurement methods and detailed...

Question Answered step-by-step I need with identifying the measurement methods and detailed… I need with identifying the measurement methods and detailed description of reliability and validity Introduction Healthcare-associated infections (HAIs) are a major patient safety problem. Disease-causing pathogens can be transmitted to patients through the hands of healthcare workers (HCWs); therefore, hand hygiene is one of the most important measures in preventing HAIs [1,2]. However, HCW compliance with hand hygiene is known to be insufficient. This has led the World Health Organization (WHO) to develop a multi-modal hand hygiene improvement strategy aimed at increasing compliance with hand hygiene [2e5]. The WHO guidelines recommend that hand hygiene should be performed using a liquid alcohol-based hand rub (ABHR); the ABHR should be poured on to the palm of the hand and a six-step handrubbing technique should be performed for 20e30 s [2]. ABHR is also available in other formats, including gels, foams, and wipes, and their antimicrobial efficacy has been studied extensively [6e12]. However, the antimicrobial efficacy of sprayed ABHR has not been assessed, despite the fact that spray dispensers have a number of advantages including direct dispensation of ABHR on to hand surfaces; avoidance of spillages; and delivery of precise, customized volumes [13]. If sprayed ABHR can be distributed evenly on to the hands, it is also unclear if handrubbing would be required for effective hand hygiene. The antimicrobial action of ABHR can be attributed to the protein denaturation effect of alcohol [2], and it remains unknown whether handrubbing is required solely to help spread the liquid ABHR on to all surfaces of the hands or if the efficacy of hand hygiene is affected if the handrubbing action is omitted. As the utilization of sprays to deliver liquid ABHR has become more common in healthcare facilities, it is important to clarify the role that these sprays can play in effective hand hygiene. This study aimed to determine whether the antimicrobial efficacy of sprayed ABHR, with or without handrubbing, is noninferior to handrubbing with poured ABHR, as currently recommended by the WHO guidelinesMethodsStudy setting, participants and eligibility criteria: A laboratory-based experimental study was conducted at the Microbiology Laboratory of the Infection Control Programme (IPC), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. The study was part of the IPC quality assurance programme approved by the local ethics committee, and all HCWs agreed to participate. Nineteen locally recruited HCWs who had extensive training and experience in hand hygiene according to the WHO guidelines were enrolled in the study. The number of recruited participants was based on the recommendation of European Norm 1500 of 18e22 subjects [11]. All of the participants had short fingernails. Exclusion criteria included the presence of artificial nails, jewelry and skin conditions affecting the handsStudy designAll of the experiments were based on European Norm 1500. Each participant performed three experiments using the same ABHR (isopropanol 60% v/v without any additional emollients or other ingredients). The experiments consisted of performing, in a randomized order: hand hygiene using 3 mL ABHR poured on to a palm of the hand with 30 s of handrubbing; hand hygiene using 3 mL sprayed ABHR with 30 s of handrubbing ; and (3) hand hygiene using 3 mL sprayed ABHR without handrubbing. Handrubbing consisted of the six-step technique promoted by WHO [2]. For Experiments 1 and 2, participants were instructed to repeat each step of the WHO ‘How to handrub’ technique five times to ensure uniformity of the handrubbing process. For Experiment 3, participants were instructed to maintain their hands in an upright position without moving for 30 s after applying ABHR. Spraying was applied using the GUD-1000 delivery system (Saraya Co. Ltd, Osaka, Japan). HCWs were instructed to move their fingertips under the nozzle, after which the spray instantaneously released 3 mL ABHR (Figure 1). Before the start of the experiment, each participant practiced this action once with a similar spray containing water. At the start of each experiment, participants were required to wash their hands using liquid soap and water. After contaminating their hands artificially with Escherichia coli ATCC 10536 suspension, microbiological sampling was performed both before and after the experiment in order to determine the bacterial count reduction.Artificial contamination and microbiological sampling Artificial contamination of the hands was performed by immersing both hands up to the mid-carpals in a bacterial suspension containing 108 colony-forming units (cfu)/mL of E. coli ATCC 10536 for 5 s, and then holding them up to air dry for 3 min. At baseline and immediately after each intervention, bacteria were recovered from both hands of each HCW using the fingertip method [11]. This procedure consisted of the HCW rubbing all five fingertips of each hand in a sterile Petri dish containing 10 mL tryptone soy broth for 1 min. Dilution and plating of microbiological samples Microbiological samples were serially diluted, and four different dilutions (101 to 104 ) were plated to accurately estimate bacterial counts. After achieving the required dilution, a 1-mL aliquot was spread over the surface of a tryptic soy agar plate before it was incubated at 361o C under aerobic conditions for 48 h. The resultant E. coli colonies were quantified by visual inspection, adjusted for the corresponding dilution factor and converted to log10.Study outcomes and statistical analysisThe antimicrobial efficacies of Experiments 2 and 3 were compared with Experiment 1, and determined by comparing the difference between the baseline and post-intervention bacterial counts that were recovered from the HCWs’ hands. Results were analysed using a generalized linear mixed model (GLMM) with random intercepts for each HCW, given the repeated measures design. The study evaluated whether the reduction in bacterial count was influenced by hand size by including this as a covariate in the model and testing the interaction between hand size and experiment. Hand surface areas were calculated and categorized as small (375 cm2 ), medium (376e424 cm2 ) and large (425 cm2 ) [13,14]. Statistical analyses were performed using R Version 3.0.2 (R Foundation for Statistical Computing, Vienna, Austria). It was hypothesized that handrubbing with sprayed ABHR would not be inferior to handrubbing with poured ABHR. The definition of non-inferiority in European Norm 1500 was met when the difference in bacterial count reduction was less than log10 0.6 cgu/mL between the experiments.Results Of the 19 healthcare workers who participated in the study, seven (36.8%) were doctors, five (26.3%) were nurses and seven (36.8%) were other healthcare professionals. The majority were female (13/19, 68.4%). Six (31.6%) HCWs had small hands, nine (47.4%) had medium hands and four (21.1%) had large hands. The average baseline contamination of HCWs’ hands with E. coli ATCC 10536 was log10 6.91 cfu/mL [95% confidence interval (CI) 5.90e7.91] before hand hygiene. Hand hygiene using 3 mL ABHR poured on to a palm of the hand followed by handrubbing reduced bacterial load by a mean of log10 3.46 cfu/mL (95% CI 1.27e5.65). Hand hygiene using 3 mL sprayed ABHR with handrubbing reduced bacterial load by a mean of log10 3.66 cfu/mL (95% CI 1.68e5.64). Hand hygiene using 3 mL sprayed ABHR without handrubbing reduced bacterial load by a mean of log10 2.76 cfu/mL (95% CI 1.65e3.87) . The GLMM showed that, compared with poured ABHR with handrubbing, sprayed ABHR with handrubbing non-significantly increased the reduction in bacterial load by log10 0.20 cfu/mL (95% CI -0.23 to 0.62). For sprayed ABHR without handrubbing, the reduction in bacterial load was significantly decreased compared with poured ABHR with handrubbing by log10 -0.70 cfu/mL (95% CI -1.13 to -0.28) . Adjustment for hand size did not change the effect estimates, and no significant interaction with experiment was found, so hand size was not included in the final model. Using the -log10 0.6 cfu/mL non-inferiority margin specified by European Norm 1500, sprayed ABHR with handrubbing was found to be non-inferior to poured ABHR with handrubbing. Conversely, non-inferiority could not be confirmed for sprayed ABHR without handrubbingDiscussionTo the best of the authors’ knowledge, this is the first study based on European Norm 1500 to assess the antimicrobial efficacy of hand hygiene using aerosolized ABHR. This study has shown that the antimicrobial efficacy of handrubbing with sprayed ABHR is non-inferior to and not significantly different from the current WHO-recommended method of handrubbing with poured ABHR. Sprayed ABHR without handrubbing was significantly less effective than the WHO-recommended method, clearly indicating the importance of handrubbing for adequate hand hygiene. Despite increasing awareness that hand hygiene is a crucial part of infection control and prevention in the hospital setting, hand hygiene among HCWs is still far from intuitive, resulting in insufficient baseline compliance rates. Hand hygiene compliance rates, based on direct observation, reported in recently published literature range from 23% in a Thai tertiary care hospital [15], to 35% in a tertiary care hospital in the USA [16], to 50% in a set of Belgian acute care hospitals [17], and 61.4% in a Swiss teaching hospital [18]. The present study has shown that handrubbing with aerosolized ABHR could be used as an alternative to the WHO-recommended procedure of handrubbing with liquid ABHR. Using a spray method to dispense ABHR could improve the efficacy of hand hygiene as well as compliance. Spraying can deliver ABHR uniformly to a large hand surface area within a short period of time with minimal spillage, improving efficiency. Combined with the small droplets dispensed by the spray, the time required to dry the hands, and thus the hand hygiene action, could be reduced. As it has been shown that time pressure is a major barrier to compliance, this could have a positive influence on the frequency of hand hygiene [19e21]. Effective sprays that do not require handrubbing could further decrease the required time for hand hygiene, and therefore increase compliance [15,19,20]. Unfortunately, in this study, non-inferiority could not be confirmed when handrubbing after ABHR spraying was omitted in one of the experiment arms. Development of novel spray designs, or improvements in the ABHR formula used in sprays, could perhaps overcome this hurdle, and further development in this area is encouraged. However, health and safety issues should be considered, as aerosols may play a role in respiratory tract irritations which could reduce compliance with hand hygiene. This study has a few limitations. Firstly, it was conducted in a laboratory setting with HCWs who had extensive training and experience in hand hygiene. As such, the findings may not be directly generalizable to all HCWs or to the clinical setting. This study only looked at the antimicrobial efficacy of the experimental interventions against an E. coli control strain using isopropanol 60% v/v, and one type of spray. Further testing is required to see if the findings can be confirmed for commercially available ABHR formulations or other types of sprays with different spray patterns or droplet sizes. The impact of other types of bacteria which are commonly encountered in the healthcare setting should also be studied, although a previous study which compared 15 and 30 s of handrubbing with ABHR found that pathogen type did not influence the results [22]. Finally, the minimum bacterial count reduction of contaminated hands required to prevent transmission of infections in a real-world setting remains undefined; as such, it is difficult to extrapolate experimental findings to clinical practice. This study also had several strengths. It compared the efficacy of sprayed ABHR with and without handrubbing with the established WHO hand hygiene methodology according to European Norm 1500. The experiments were performed in a well-established infection and prevention laboratory with experience of hand hygiene experiments [12,13,21,22], and the order of the experiments was randomized. In the statistical methods, the authors corrected for repeated measurements among the 19 HCWs, and checked for the influence of hand size. In conclusion, this study has shown that handrubbing with sprayed ABHR is non-inferior compared with the current WHOrecommended method of handrubbing with the same ABHR poured on to the palm of the hand. ABHR delivered as a spray could be an alternative method to ensure appropriate hand disinfection and patient safety as long as the correct handrubbing steps are included. Future research should establish the efficacy of sprayed ABHR in other settings.Thank you Health Science Science Nursing NURS 5366 Share QuestionEmailCopy link Comments (0)