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Hand Hygiene Among Laboratory Workers •

Article  in  Infection Control and Hospital Epidemiology · October 2006

DOI: 10.1086/506404 · Source: PubMed

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Emine Alp Diana Haverkate

Erciyes Üniversitesi Radboud University Medical Centre (Radboudumc)
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Handhygiene in Laboratory Personnel
P 35
NUCI
Hand Hygiene in Laboratory
Personnel
A. Voss1,3, D. Haverkate1, E. Alp1,2
1. University Medical Centre St Radboud, Department of Medical
Microbiology, Nijmegen The Netherlands
2. Faculty of Medicine, Erciyes University, Department of Clinical
Microbiology and Infectious Disease, Kayseri, Turkey
3. University Medical Centre St Radboud, Nijmegen University
Centre of Infectious Diseases, Nijmegen The Netherlands
Introduction
NUCI
Laboratory workers are at risk of infection because of their daily exposure to
micro-organisms. Consequently, many cases of laboratory-associated
infections have been reported (1-5). OSHA, CDC and many other groups
provide standards and guidelines for laboratory safety. Hand hygiene is an
important element of all these standards (3,6). While health-care workers
(HCW) in patient care should disinfect their hands mainly to prevent
transmission of pathogens to patients, laboratory personnel should do so to
protect themselves.
Over the last decennia the promotion of hand hygiene among HCWs was a
major component of infection control programs and research – primarily
directed to patient care (7-13). However, there is no study on the compliance
of laboratory personnel with hand hygiene or its effect of preventing
infections among this group of HCWs.
The aim of our study was to measure the compliance of laboratory personnel
with different components of hand hygiene.
Study Components (2)
NUCI
3. Intervention included feed-back of the results, training with regard to
the guideline, and posters to support the no-jewellery policy.
Compliance with the no-jewellery policy were re-observed within a
week after the intervention and one month later.
To compare our data with clinical HCWs and other laboratory
personnel compliance with the no-jewellery policy was observed in
ICU-HCWs (86) and laboratory personnel from the endocrinology
laboratory (48).
Poster Diana Haverkate (VHIG congres)
April 2005
Abstract
NUCI
OBJECTIVE: To prospectively measure the compliance of laboratory personnel
with different components of hand hygiene.
METHODS: The study consisted of three components: 1. Observations (hand
hygiene methods and compliance with a no-jew ellery policy). 2. Microbiological
cultures from hands and wrists), and 3. Interventions and re-observation.
RESULTS: Compliance of l aboratory technici ans with hand hygiene was 100% at
the end of their duty. Of 49 laboratory workers, 36. 7% wore a ring, 46.9% a watch,
and 6. 1% a bracelet. The “attributable” colonization with comm ensal flora due to
watches and rings was 1.2 and 0.7 grades, respectively in 19 technicians wearing
jewellery. Potentially pathogeni c micro-organi sms were exclusively found on
hands of laboratory personnel that wore jew ellery (37% ). Colonization with
pathogenic micro-organism s was found in 1.0% (1/10) after disinfection, 2.2% (2/9)
after washing only, and 80% (4/5) after washing followed by disinfection.
CONCLUSION: Rings and watches reduce the effectiveness of hand-hygiene
leaving hands of laboratory techni cians with higher remains of commensal and
pathogenic flora. Future efforts to increase hand hygiene practi ces should not
only be directed at HCWs in patient care, but furthermore laboratory personnel.
Study Components (1)
NUCI
1. Observations with regard to the use of hand hygiene methods
(washing versus disinfection) and compliance with the basic rule of not
wearing jewellery (ring, wrist watch and bracelets).
2. Cultures from hands and wrists of laboratory personnel were taken
during their coffee break. If they wore jewellery, swabs were taken
from under the ring and/or watch, as well as from the same site(s) on
the other hand without jewellery. Samples were cultured on blood agar,
at 37C over night. Colony forming units of commensal flora were
classified on a growth density scale from 0 (no growth) to 5 (growth in
all segments of a semi-quantitative culture). Furthermore, the
presence of pathogens (Staphylococcus aureus, Pseudomonas
aeruginosa and enterobacteriaceae) was documented.
Compliance with hand hygiene
NUCI
n=11 n=17
washed
disinfect
W&D
n=9
Compliance with any method at the end of duty = 100%
1
Handhygiene in Laboratory Personnel April 2005

Non-compliance with the Colonization with commensal flora in

no-jewellery policy technicians with and without jewellery
NUCI NUCI

8
50,0% 7
45,0%
6
40,0%
5
35,0% no jewellery
4

n
30,0% jewellery
Lab 3
25,0%
20,0% ICU 2
15,0% 1
10,0% 0
5,0% 0 1 2 3 4 5
0,0% Growth density score of commensal flora
Ring Watch Bracelet
Grow th density scale: 0 = no growth, 1 = sporadic, 2 =first segment, 3 = second
segment, 4 = third segment, and 5 = last segment of a semiquantitative culture

Hand and wrist colonization with Compliance with the no-jewellery policy
pathogenic micro-organisms before and after intervention
NUCI NUCI

25 100
compliance (%)

80
20 ring
60
15
watch
Pathogens 40
bracelet
10
No-pathogens 20
0
5 1 2 3
0 observation
Jewellery No-jewellery

1 = pre-intervention, 2 = one-w eek after intervention, 3 = one-month after intervention

Conclusion Conclusion
NUCI NUCI

•Increasing compliance with hand hygiene is one of the most
important infection control activities, but so far no studies were
conducted in laboratory personnel.
• General compliance with hand hygiene among our laboratory personnel
was 100%, but … less than 50% use alcoholic hand-rubs.
• Colonization with pathogenic micro-organisms was lowest in those who
only used the disinfectant (1/10). The fact that 4 of 5 technicians (80%)
who washed and disinfected their hands still were colonized with
pathogenic micro-organisms, might have to do with the fact that they did
so after heavy contamination of their hands and/or that the alcoholic -rub
got diluted by water still remaining on inadequately dried hands.
• Wearing of jewelleries is a risk factor for increased
carriage of micro-organisms
 increases the amount of commensal flora
 only technicians wearing jewellery were colonized
with pathogenic micro-organisms.
• Interventional activities improved hand hygiene practices
• Infection control efforts directed at HCWs involved in
patient-care obviously were effective: compliance with the
no-jewellery policy was significantly higher in the ICUs
• Present Infection control efforts that are exclusively
directed to increase hand hygiene practices in patient care
HCWs, should be extended to at least laboratory personnel.

Poster Diana Haverkate (VHIG congres)

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