Improved hand hygiene in NICU with alcohol products

Cohen B, Saiman L, Cimiotti J, et al. Factors associated with hand hygiene practices in two neonatal intensive care units. Pedatr Infect Dis J 2003; 22(6):494-499.

Use of an alcohol-based product was associated with significantly improved hand hygiene in a study of neonatal intensive care units (NICU), a new study had found.

"We compared a traditional hand-washing time with an alcohol time," says Elaine Larson, RN, PhD, professor of pharmaceutical and therapeutic research at Columbia University School of Nursing in New York City. "When people used the alcohol, they were significantly more likely to touch babies with clean hands."

Larson and colleagues undertook the study to determine whether hand hygiene practices differ between levels of contact with neonates; to characterize the hand hygiene practices of different types of personnel; and to compare hand hygiene practices in NICUs using different products.

Research assistants observed staff hand hygiene practices during 38 sessions in two NICUs. Patient touches were categorized as touching within the neonates’ environment but only outside the isolette (Level 1); touching within the isolette but not the neonate directly (Level 2); or directly touching the neonate (Level 3). Hand hygiene practices for each touch were categorized into five groups: cleaned hands and new gloves; uncleaned hands and new gloves; used gloves; clean hands and no gloves; uncleaned hands and no gloves.

Overall, the research assistants observed 1,472 touches. On average, each neonate or his or her immediate environment was touched 78 times per shift. Nurses attending physicians and physicians in training were more likely to use appropriate practices during Level 3 touches. But only 22.8% of all touches were with cleaned and/or newly gloved hands. The mean number of direct touches by staff with cleaned hands was greater in the NICU using an alcohol-based hand rub than in the NICU using antimicrobial soap.