title: Prospective, controlled, cross-over trial of alcohol-based hand gel in critical care units .
abstract: BACKGROUND
  There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes.
  
  
  METHODS
  A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel.
  
  
  METHODS
  The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital.
  
  
  METHODS
  An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months.
  
  
  RESULTS
  During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P< .001). Improvement was observed among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P= .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel.
  
  
  CONCLUSIONS
  The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.
authors.affiliation: Department of Internal Medicine ,University of Nebraska Medical Center, Omaha, USA. merupp@unmc.edu
authors.forename: Mark E
authors.initials: ME
authors.lastname: Rupp
authors.forename: Teresa
authors.initials: T
authors.lastname: Fitzgerald
authors.forename: Susan
authors.initials: S
authors.lastname: Puumala
authors.forename: James R
authors.initials: JR
authors.lastname: Anderson
authors.forename: Rita
authors.initials: R
authors.lastname: Craig
authors.forename: Peter C
authors.initials: PC
authors.lastname: Iwen
authors.forename: Dawn
authors.initials: D
authors.lastname: Jourdan
authors.forename: Janet
authors.initials: J
authors.lastname: Keuchel
authors.forename: Nedra
authors.initials: N
authors.lastname: Marion
authors.forename: Delayne
authors.initials: D
authors.lastname: Peterson
authors.forename: Lee
authors.initials: L
authors.lastname: Sholtz
authors.forename: Valerie
authors.initials: V
authors.lastname: Smith
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local; D001419:Bacteria / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D001424:Bacterial Infections / Q000382:microbiology / Q000517:prevention & control; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D024901:Drug Resistance, Multiple, Bacterial; D000431:Ethanol; D005782:Gels; D019983:Guideline Adherence; D006225:Hand / Q000382:microbiology; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards; D006801:Humans; D007362:Intensive Care Units; D050296:Microbial Viability / Q000187:drug effects; D010564:Personnel, Hospital; D011446:Prospective Studies
chemical_list: D000891:Anti-Infective Agents, Local; D005782:Gels; D000431:Ethanol