3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。noteもあります https://note.com/twin1980

Simplifying the World Health Organization Protocol: 3 Steps Versus 6 Steps for Performance of Hand Hygiene in a Cluster-randomized Trial

CIDに報告された、スイス単施設によるWHO手指衛生プロトコルに関するクラスター無作為化試験

3 steps vs 6 steps

 

primary endpoints

  • ompliance with the assigned technique
  • reduction of bacterial counts on the hands of health-care workers.

 

academic.oup.com

 まとめ 感想

 

3Stepsの方が、6Stepsと比べて、コンプライアンスよくて、手の細菌数は差がなかった。ということは3Stepsがいいですね。

6stepsは、実際困難ですよね。

 

本研究は、単施設の検討ですが、様々なフォロー研究がこれから発表されると思いますので、良い結果が出ることを祈ってます。

このようなプロセス減らせる研究は素晴らしいですね。

 

ただし、本研究は患者さんへの院内感染数は示していないので

本質的なインパクトはまだまだブラックBOXです。

 

Compliance with technique and indications  (P < .001)

  • 3-step : 51.7% (595/1151) and 75.9% (1151/1516)
  • 6-step : 12.7% (116/915) and 65.0% (915/1407)  

 

 

The reduction factor (RF) of bacterial colony counts (P = .629)

  • (median RF 0.97 log10 colony-forming units [CFU] [interquartile range 0.39–1.59] for the 3-step technique vs median RF 1.04 log10 CFU [interquartile range 0.49–1.52] for the 6-step technique).

 

Abstract


Background

In an experimental setting, a simplified, 3-step hand hygiene technique for applying alcohol-based hand rub was non inferior in terms of reduction of bacterial counts, as compared to the conventional World Health Organization 6-step technique. We therefore compared compliance and microbiological efficacy between both hand hygiene techniques in routine clinical practice.

Methods

We performed a cluster-randomized trial from October–November 2015 at the University Hospital Basel, Switzerland: a tertiary, academic care center (ISRCTN45923734). We randomly assigned 12 wards to either the 3-step technique or the conventional 6-step technique of hand rubbing. The primary endpoints were compliance with the assigned technique and reduction of bacterial counts on the hands of health-care workers.

Results

Overall, 2923 hand hygiene indications were observed, and compliance was 70.7% (2066/2923). Compliance with technique and indications was 51.7% (595/1151) and 75.9% (1151/1516) on wards assigned to the 3-step technique, respectively, as compared to 12.7% (116/915) and 65.0% (915/1407) on wards assigned to the 6-step technique (P < .001). The reduction factor (RF) of bacterial colony counts did not differ between techniques (median RF 0.97 log10 colony-forming units [CFU] [interquartile range 0.39–1.59] for the 3-step technique vs median RF 1.04 log10 CFU [interquartile range 0.49–1.52] for the 6-step technique; P = .629).

Conclusions

In a clinical setting, the simpler hand hygiene technique, consisting of 3 steps, resulted in higher compliance with both hand hygiene indications and technique, as compared to the 6 steps. As the results of the microbiological analyses exclude inferiority, the conventional 6 steps could be safely replaced by a simpler hand hygiene technique.

Clinical Trials Registration

ISRCTN45923734.

 

 

J-IDEO (ジェイ・イデオ) Vol.1 No.2

J-IDEO (ジェイ・イデオ) Vol.1 No.2