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Communications to the Editor |

Hand Hygiene in the ICU FREE TO VIEW

Stijn Blot, RN, MA; Koenraad Vandewoude, MD; Francis Colardyn, MD
Author and Funding Information

Affiliations: University Hospital Gent Gent, Belgium,  American University of Beirut Beirut, Lebanon

Correspondence to: Stijn Blot, RN, MA, Burn Unit, University Hospital Gent, De Pintelaan 185, B-9000 Gent, Belgium; e-mail: icu@rug.ac.be



Chest. 2000;117(3):919-920. doi:10.1378/chest.117.3.919
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Published online

To the Editor:

In his prospective observational study concerning hand hygiene, Khatib et al1 focused on hand washing and the use of gloves while manipulating patients receiving mechanical ventilation. We agree that hand hygiene is a cornerstone in the prevention of nosocomial infection; nevertheless, we want to add some information to the article by Khatib et al.1

In our ICU, the use of gloves is recommended whenever contamination of hands is possible. Gloves have to be removed between separated tasks on one patient and certainly between different patients. Indeed, using plasmid profile typing, Patterson et al2 described transmission of Acinetobacter calcoaceticus by an incorrect use of gloves.

Concerning the hand washing technique, Khatib et al1 did not mention how long the washing procedure must take. This is an important aspect because, even when using disinfecting soap, the washing procedure must take at least 2 min to be effective. Because of the high degree of urgency in critical care settings, achievement of this optimal standard of hygiene is not always possible. Therefore, in our ICU, hand hygiene is achieved by use of cutanous antiseptic (isopropyl-alcohol 70° + glycerin). Also, when gloves are worn, this disinfectant must be applied between separated tasks on one patient and between tasks on different patients. Because hand washing is too time consuming, it is indicated only when hands are visibly dirty. Furthermore, we recommend the use of surgical masks when manipulating patients receiving mechanical ventilation to avoid hand-nose contact.

This, together with a reduction in antibiotic load, has led to an impressive reduction in antibiotic resistance in our ICU.3

References

Khatib, M, Jamaleddin, G, Abdallah, A, et al (1999) Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU.Chest116,172-175. [PubMed] [CrossRef]
 
Patterson, JE, Vechio, J, Pantelinck, EL, et al Association of contaminated gloves with transmission ofAcinetobacter calcoaceticusvar.anitratusin an intensive care unit.Am J Med1991;91,479-483. [PubMed]
 
Colardyn, F, Hoste, E, Claeys, G, et al Control of antibiotic (AB) resistance in an ICU: a 4-year surveillance [abstract]. Clin Infect Dis. 1998;;27 ,.:963
 
To the Editor:

Stijn Blot and colleagues present some comments about our recent publication (July 1999)1 on the practice of hand washing and the use of gloves while managing patients receiving mechanical ventilation in the ICU. Their major concern is the duration of hand washing. They believe that an effective hand washing with disinfecting soap should take at least 2 min. They add that this might not be achieved regularly because of the high degree of urgency in the ICU. They highlight their experience with the use of cutaneous antiseptic, and they recommend the use of surgical masks.

Our study was aimed at evaluating the effectiveness of warning labels permanently attached to mechanical ventilators in improving the practice of hand washing and the use of gloves by respiratory care practitioners (RCPs) in the ICU. We evaluated the occurrence or frequency of hand washing rather than the practice of hand washing itself. Consequently, we felt no need to elaborate about the practice of hand washing in our ICU. However, we feel that this letter forum could be a chance to elaborate on the issue. As intended in our study, we focused our observations on RCPs. Their scope of services includes blood gas measurements, bronchodilator therapy, endotracheal tube management (eg, suctioning and tube fixation), mechanical ventilator management (eg, applying settings as ordered, checking settings, and alarm levels, assessing lung mechanics), as well as manipulation of breathing circuits (eg, changing breathing circuits and heat and moisture exchangers). Although RCPs do intubate patients in our ICU, these encounters were not considered part of the study, which was focusing only on patients who are already intubated and receiving mechanical ventilation. As such, there was not a real sense of urgency in the above-mentioned services that prohibited our RCPs from adequately performing hand washing (at least 1 to 2 min with antiseptic solution) and using gloves. As for Blot and colleagues’ recommendation to use surgical masks, we feel that this could be a good practice; however, it was not an objective of our study.

References
Khatib, M, Jamaleddine, G, Abdallah, A, et al Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU.Chest1999;116,172-175. [PubMed] [CrossRef]
 

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References

Khatib, M, Jamaleddin, G, Abdallah, A, et al (1999) Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU.Chest116,172-175. [PubMed] [CrossRef]
 
Patterson, JE, Vechio, J, Pantelinck, EL, et al Association of contaminated gloves with transmission ofAcinetobacter calcoaceticusvar.anitratusin an intensive care unit.Am J Med1991;91,479-483. [PubMed]
 
Colardyn, F, Hoste, E, Claeys, G, et al Control of antibiotic (AB) resistance in an ICU: a 4-year surveillance [abstract]. Clin Infect Dis. 1998;;27 ,.:963
 
Khatib, M, Jamaleddine, G, Abdallah, A, et al Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU.Chest1999;116,172-175. [PubMed] [CrossRef]
 
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