Hand Hygiene A Handbook for Medical Professionals

• Developed and presented by the world leaders in this fundamental topic 
• Fully integrates World Health Organization (WHO) guidelines and policies
• Offers a global perspective in tackling hand hygiene issues in developed and developing countries
• Coverage of basic and highly complex clinical applications of hand hygiene practices
• Includes novel and unusual aspects and issues in hand hygiene such as religious and cultural aspects and patient participation
• Offers guidance at the individual, institutional, and organizational levels for national and worldwide hygiene promotion campaigns

Didier Pittet MD, MS, CBE, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

John M. Boyce MD, Hospital Epidemiology and Infection Control, Yale-New Haven Hospital, and Yale University School of Medicine, New Haven, CT, USA

Benedetta Allegranzi MD, Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, and Faculty of Medicine, University of Geneva, Geneva, Switzerland

Contributors xi

Preface xv

Foreword xvii

1. The Burden of Healthcare-Associated Infection 1
Benedetta Allegranzi, Sepideh Bagheri Nejad, and Didier Pittet

2. Historical Perspectives 8
Andrew J. Stewardson and Didier Pittet

3. Flora and Physiology of Normal Skin 12
Gürkan Kaya and Didier Pittet

4. Dynamics of Hand Transmission 18
Andrew J. Stewardson, Benedetta Allegranzi, and Didier Pittet

5. Mathematical Models of Handborne Transmission of Nosocomial Pathogens 28
Ben S. Cooper and Nantasit Luangasanatip

6. Methodological Issues in Hand Hygiene Science 36
Matthew Samore and Stephan Harbarth

7. Statistical Issues: How to Overcome the Complexity of Data Analysis in Hand Hygiene Research? 42
Angèle Gayet-Ageron and Eli Perencevich

8. Hand Hygiene Agents 51
Pascal Bonnabry and Andreas Voss

9. Methods to Evaluate the Antimicrobial Efficacy of HandHygiene Agents 58
Manfred L. Rotter, Syed A. Sattar, and Miranda Suchomel

10. Hand Hygiene Technique 70
Marie-Noëlle Chraïti and Andreas F. Widmer

11. Compliance with Hand Hygiene Best Practices 76
Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet

12. Barriers to Compliance 85
John M. Boyce, Benedetta Allegranzi, and Didier Pittet

13. Physicians and Hand Hygiene 89
Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet

14. Surgical Hand Preparation 94
Andreas F. Widmer and Joseph Solomkin

15. Skin Reaction to Hand Hygiene 101
Elaine Larson

16. Alcohol-Based Handrub Safety 105
John M. Boyce and M. Lindsay Grayson

17. Rinse, Gel, Foam, Soap … Selecting an Agent 109
Andreas Voss

18. Behavior and Hand Hygiene 115
Mary-Louise McLaws and Hugo Sax

19. Hand Hygiene Promotion Strategies 123
Benedetta Allegranzi and Didier Pittet

20. My Five Moments for Hand Hygiene 134
Hugo Sax, Benedetta Allegranzi, and Didier Pittet

21. System Change 144
Benedetta Allegranzi, Andreas Voss, and Didier Pittet

22. Education of Healthcare Professionals 152
Elaine Larson, Marie-Noëlle Chraïti, and Wing-Hong Seto

23. Glove Use and Hand Hygiene 156
Marie-Noëlle Chraïti, Benedetta Allegranzi, and Elaine Larson

24. Monitoring Hand Hygiene Performance 162
Hugo Sax and John M. Boyce

25. Performance Feedback 172
Andrew J. Stewardson and Hugo Sax

26. Marketing Hand Hygiene 180
Julie Storr and Hugo Sax

27. Human Factors Design 185
Lauren Clack and Hugo Sax

28. Institutional Safety Climate 193
Enrique Castro-Sánchez, Alison Holmes, and Didier Pittet

29. Personal Accountability for Hand Hygiene 201
Robert M. Wachter and Peter Pronovost

30. Patient Participation and Empowerment 206
Yves Longtin, Susan E. Sheridan, and Maryanne McGuckin

31. Religion and Hand Hygiene 216
Jaffar A. Al-Tawfiq and Ziad A. Memish

32. Hand Hygiene Promotion from the US Perspective: PuttingWHO and CDC Guidelines into Practice 221
Katherine Ellingson

33. WHO Multimodal Promotion Strategy 230
Benedetta Allegranzi and Didier Pittet

34. Monitoring Your Institution (Hand Hygiene Self-Assessment Framework) 244
Benedetta Allegranzi, Andrew J. Stewardson, and Didier Pittet

35. National Hand Hygiene Campaigns 249
Claire Kilpatrick and Julie Storr

36. Hand Hygiene Campaigning: From One Hospital to the Entire Country 256
Philip L. Russo and M. Lindsay Grayson

37. Improving Hand Hygiene through Joint Commission Accreditation and the Joint Commission Center for Transforming Healthcare 263
Mark R. Chassin, Barbara I. Braun, and Anne Marie Benedicto

38. A Worldwide WHO Hand Hygiene in Healthcare Campaign 275
Claire Kilpatrick, Julie Storr, and Benedetta Allegranzi

39. The Economic Impact of Improved Hand Hygiene 285
Nicholas Graves

40. Hand Hygiene: Key Principles for the Manager 294
Eleanor Murray, Alison Holmes, and Didier Pittet

41. Effect of Hand Hygiene on Infection Rates 299
Benedetta Allegranzi, Stephan Harbarth, and Didier Pittet

42A.Hand Hygiene in Specific Patient Populations and Situations: Critically Ill Patients 317
Caroline Landelle, Jean-Christophe Lucet, and Didier Pittet

42B. Hand Hygiene in Specific Patient Populations and Situations: Neonates and Pediatrics 324
Walter Zingg and Hanan H. Balkhy

42C. Hand Hygiene in Long-Term Care Facilities and Home Care 329
Maria Luisa Moro, Marie-Noëlle Chraïti, and Benedetta Allegranzi

42D.Hand Hygiene in Ambulatory Care 337
Marie-Noëlle Chraïti, Sepideh Bagheri Nejad, and Benedetta Allegranzi

42E. Hand Hygiene in Hemodialysis 344
Marie-Noëlle Chraïti, Sepideh Bagheri Nejad, and Benedetta Allegranzi

42F. Hand Hygiene in Specific Patient Populations and Situations: Anesthesiology 350
François Stéphan

43. Hand Hygiene in Resource-Poor Settings 357
Nizam Damani, Shaheen Mehtar, and Benedetta Allegranzi

44A. Role of Hand Hygiene in MRSA Control 367
Stephan Harbarth

44B. Role of Hand Hygiene in Clostridium difficile Control 373
John M. Boyce and Walter Zingg

44C. Role of Hand Hygiene in Respiratory Diseases Including Influenza 378
Wing Hong Seto and Benjamin J. Cowling

44D. Handborne Spread of Noroviruses and its Interruption 385
Syed A. Sattar and Yves Longtin

45. Conducting a Literature Review on Hand Hygiene 391
Daniela Pires, Fernando Bellissimo-Rodrigues, and Didier Pittet

Appendix 400

Index 409

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