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18 Hand Hygiene & Preventing HAIs H and dryers spread much more bacteria than paper towels in a pub- lic bathroom setting, according to research from the University of Leeds. To conduct the experiment, researchers contaminated hands with harmless bacteria not usually found in public restrooms, Lactobacillus. Then, when that bacterium was found in the air, it could be tied to the hands. They con- ducted air samples around hand dryers and paper towel dispensers. For jet dryers, air bacteria counts were 4.5 times higher than around warm air dryers and 27 times higher compared to air when paper towels were used. Additionally, bacteria stayed in the air beyond the 15 second dry time around the dryers, with 48 percent of the bacteria collected more than five minutes after drying ended. "These findings are important for understanding the ways in which bacte- ria spread, with the potential to transmit illness and disease," said Professor Mark Wilcox, with the University of Leeds' School of Medicine. n W hen asked how they would improve hand hygiene compliance, a group of senior managers at a hospital in Aus- tralia came up with seven main strategies, accord- ing to a study published in BMC Infectious Diseases. Researchers conducted face-to-face interviews with 13 senior managers at a teaching hospital, asking them to suggest new strategies to improve hand hy- giene compliance or for any ideas to strengthen ex- isting strategies. The study authors then performed thematic analysis of the interviews. Through that analysis, they found the following seven themes: • Start the culture change with leaders • Refresh the message • Connect the World Health Organization's five moments for hand hygiene to the whole patient journey • Provide actionable audit results • Empower patients to remind healthcare workers to wash their hands • Possibly reframe non-compliance with hand hygiene protocol as a healthcare error • Introduce penalties for non-compliance n A quality improvement project at a Missouri academic medical center was able to improve hand hygiene compliance and decrease central line-associated blood stream infections by focusing on four key ar- eas, according to a study in the American Journal of Infection Control. The quality improvement team implemented several changes in each area, detailed below: Staff education • Put new screensavers in to remind staff about hand hygiene between glove use • Create new training modules for annual educational purposes • Reeducate all nurses on use of hand hygiene between glove use • Reeducate the dietary staff about hair netting and hand hygiene Staff accountability • Compliance monitoring of hand hygiene • Individual disciplinary action for failure to practice proper hand hy- giene Hand sanitizer product selection and accessibility • Replace all sanitizers with an 85 percent ethyl alcohol product • Place stickers on all sanitizer dispensers with a phone number to call to refill or replace Organizational culture • Include hand hygiene education for medical students and residents • Engage patients and families in hand hygiene efforts with tip sheets on proper hand hygiene and encourage them to remind healthcare work- ers of proper hand hygiene protocol After implementing the four-pronged program over a six-year span, hand hygiene adherence increased from 58 percent in April 2006 to 98 percent in September 2012. Additionally, rates of CLABSIs decreased from 4.08 per 1,000 device days to 0.42. n Hand Dryers vs. Paper Towels: Study Ends Debate By Heather Punke 7 Ways to Improve Hand Hygiene, From Hospital Managers By Heather Punke 4 Areas to Focus on for Improved Hand Hygiene By Heather Punke