Research Methodology Group Members: April Tulloch Kerekia Walker Sashield Walker Daneik Wallace Juliann Wallace Nicole Wallace Lecturer: Dr. J. Lindo

PICO In neonatal care is hand washing as effective as using a hand sanitizer in reducing nosocomial infections by reducing microbial count and infection rates ?

P- POPULATION

 In a study done by Larson et al (2005) 2 neonatal intensive care units were used including 2932 neonatal hospital admissions and 119 nurse participants.

I- INTERVENTION

I – INTERVENTION  A hand hygiene product was tested: a traditional antiseptic hand wash (Larson et al 2005).

C – COMPARISON

C- COMPARISON  An alcohol hand sanitizer.

O- OUTCOME

O-Outcome  Infection rates and microbial counts on nurses' hands were equivalent during hand washing and alcohol phases.

RESULTS  After adjusting for study site, birth weight, surgery, and follow-up time, there were no significant differences in neonatal infections between the 2 products; odds ratios for alcohol compared with hand washing were 0.98 (95% confidence interval [CI], ) for any infection (Larson et al 2005).

RESULTS  0.99 (95% CI, ) for bloodstream infections, 1.61 (95% CI, ) for pneumonia, 1.78 (95% CI, ) for skin and soft tissue infections, and 1.26 (95% CI, ) for central nervous system infections. The skin condition of participating nurses was significantly improved (Larson et al 2005).

RESULTS  during the alcohol phase (P =.02 and P =.049 for observer and self-assessments, respectively), but there were no significant differences in mean microbial counts on nurses’ hands (3.21 and 3.11 log10 colony-forming units for hand washing and alcohol, respectively; P =.38) Larson et al (2005).

Second Study

P-POPULATION 23 healthcare workers: permanent and temporary nurses and nursing assistants of each unit in Three intensive care units (Girou et al 2002).

I- INTERVENTION  Hand rubbing with alcohol based solution

C- COMPARISON  Hand washing with antiseptic soap

O- OUTCOME  The reduction of total bacterial hand contamination

RESULTS  With hand rubbing the median percentage reduction in bacterial contamination was significantly higher than with hand washing (83% v 58%, P=0.012), with a median difference in the percentage reduction of 26% (95% confidence interval 8% to 44%). The median duration of hand hygiene was 30 seconds in each group (Girou et al. 2002).

CONCLUSION

 In conclusion, both studies admit that hand washing and hand sanitizing are efficient hand hygiene procedures in reducing infection rates, microbial counts and hand contamination. However, only one study highlighted that nurses' skin condition was improved using alcohol based hand sanitizer.

Appraisal of Sources Larson et al (2005) and Girou et al (2002)  Cites and utilizes appropriate and contemporary data; no older than ten years.  Content of studies were explained in detail as it to pertains to the method, population, sample size and adequate background on topic.  Authors and their team were experienced medical doctors with wide knowledge of the topic being studied.  Viewing of was not hampered by fee request or software requirement.

References  Girou, E. et al. (2002). Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: Randomised clinical trial. BMJ, 326 (362).  Larson, L. E. et al. (2005). Effect of antiseptic handwashing vs alcohol sanitizer on health care–associated infections in neonatal intensive care unit. JAMA Pediatrics, 159 (4).

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