Hot topics in the news

Over the past week, there were 2 studies related to infection prevention that attracted a fair amount of attention by the mainstream media.

A paper in Psychological Science (full text here), looked at whether various messages on signs placed near sinks in hospitals could have an impact on handwashing compliance. Of note, the two authors of the study have no medical training--they're professors in business schools. They randomly assigned one of three signs to be posted near 66 soap dispensers, with the following messages:

• Hand hygiene prevents you from catching diseases
• Hand hygiene prevents patients from catching diseases
• Gel in, wash out (control message)

They hypothesized that healthcare workers are overconfident and overestimate their own invulnerability, thus a message that focused on protecting the patient rather than themselves would be more effective. Two experiments were performed: in the first, the effect of the messages was measured by the volume of soap used in the dispensers; in the second experiment, conducted 9 months later, covert observers who worked on the study units recorded hand hygiene compliance by direct observations. The results were a 33% increase in volume of product usage, and a 10% increase in hand hygiene compliance at sinks which had the sign that focused on protecting patients. Although these results were statistically significant, this study has many flaws. The methods section of the paper tells us little about the setting--the type of hospital, the size of the hospital, on how many patient care units the signs were posted, or the type of care units involved. The experiments were brief, each lasting only 2 weeks. We are not told how many healthcare workers were involved; this is particularly important since the number of hand hygiene observations was very small (a total of 322 opportunities before the intervention and 245 opportunities after the intervention). When the results were categorized by practitioner type (nurse, physicians, ancillary staff), the numbers of observations were  extremely small. All in all, it's hard to put much stock in this short, small study in a single hospital.

The other study in AJIC, cultured the clothing (white coats, nurse uniforms, and OR scrubs) of a convenience sample of 135 healthcare workers  in a hospital in Jerusalem. Cultures were set up to detect S. aureus, Enterobacteriaceae, Pseudomonas spp and Acinetobacter spp. Overall, 50% of the cultures were positive for one of the above pathogens. Acinetobacter was most common, found on 32% of white coats, 38% of nurses uniforms, and 43% of OR scrubs. So we have another study that documents what we already know: healthcare worker clothing is commonly contaminated. But the key question remains as to whether the organisms can be transferred to patients. More on that here.