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Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study

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Abstract

Objective

We compared handwashing (HW) and alcohol-based handrub (ABH) for skin tolerance, acceptability, and hand hygiene compliance in health-care workers (HCWs) in a multicentric study.

Design and setting

Before/after study over two periods (P1 and P2) in seven ICUs. Monitoring of methicillin-resistant Staphylococcus aureus (MRSA) acquisition in two ICUs (U4 and U6).

Subjects and patients

All HCWs of the seven ICUs, and the patients of U4 and U6 without MRSA carriage on admission.

Interventions

Handwashing was available in P1 and P2. ABH was introduced after P1 and available throughout P2. HCWs completed questionnaires on skin tolerance in P1 and P2, and on acceptability in P2. Compliance with hand hygiene was assessed in P1 and P2 using a standardized method. ICU-acquired MRSA colonization/infection in U4 and U6 was recorded.

Measurements and main results

Hand erythema was reported during P1 and P2 by 21.7 and 11% of HCWs, respectively (P = 0.01), itching by 15.8 and 7.1% (P = 0.02), oozing by 0.8 and 1.1% (P = 0.82), and bleeding by 4.2 and 1.1% (P = 0.1). ABH was considered easier and quicker than HW (P < 0.01), but overall acceptability did not differ between the two. Compliance increased from 51% (334/647) in P1 to 60% (251/418) in P2, P < 0.01. No significant reduction in MRSA colonization/infection between P1 and P2 (P = 0.30) was observed, but the study was underpowered.

Conclusions

Self-report questionnaires show that when ABH is available in ICUs, fewer unpleasant skin sensations are reported. ABH is considered to be easier and quicker to use than HW and compliance is improved after glove removal.

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Acknowledgments

This work was supported by research grant PHRC from the Délégation à la Recherche Clinique, CHU de Clermont-Ferrand, Clermont-Ferrand. We are indebted to Mr Jeffrey Watts for assistance in the preparation of the manuscript.

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Authors and Affiliations

  1. CHU Clermont-Ferrand, unité de réanimation médicale, Pôle REUNNIRH, Hôp G Montpied, 63003, Clermont-Ferrand, France

    Bertrand Souweine & Alexandre Lautrette

  2. CHU Clermont-Ferrand, service d’hygiène hospitalière, Pôle REUNNIRH, Hôp G Montpied, 63003, Clermont-Ferrand, France

    Claire Aumeran & Ousmane Traoré

  3. CHR Moulins, service de réanimation médicale, 03000, Moulins, France

    Marcel Bénédit

  4. CHU Clermont-Ferrand, département d’anesthésie réanimation, Hôp G Montpied, 63003, Clermont-Ferrand, France

    Jean Michel Constantin, Michèle Bonnard & Dominique Guélon

  5. CHR Vichy, unité de réanimation polyvalente, 03200, Vichy, France

    Georges Amat

  6. CHU Clermont-Ferrand, service d’épidémiologie médicale et biostatistiques, Hôp G Montpied, 63003, Clermont-Ferrand, France

    Bruno Aublet

  7. CHU Clermont-Ferrand, laboratoire de bactériologie, Hôp G Montpied, 63003, Clermont-Ferrand, France

    Richard Bonnet

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  1. Bertrand Souweine
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  2. Alexandre Lautrette
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  11. Ousmane Traoré
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Correspondence to Ousmane Traoré.

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Souweine, B., Lautrette, A., Aumeran, C. et al. Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study. Intensive Care Med 35, 1216–1224 (2009). https://doi.org/10.1007/s00134-009-1485-5

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  • DOI: https://doi.org/10.1007/s00134-009-1485-5

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