Indications for hand and glove disinfection in Advanced Cardiovascular Life Support: A manikin simulation study

Stefan Bushuven; Joachim Bansbach; Michael Bentele; Stefanie Bentele; Bianka Gerber; Nicolas Reinoso-Schiller; Simone Scheithauer

doi:10.3389/fmed.2022.1025449

Indications for hand and glove disinfection in Advanced Cardiovascular Life Support: A manikin simulation study

Front Med (Lausanne). 2023 Jan 6:9:1025449. doi: 10.3389/fmed.2022.1025449. eCollection 2022.

Authors

Stefan Bushuven^{1

2

3}, Joachim Bansbach³, Michael Bentele^{4

5}, Stefanie Bentele^{4

5

6}, Bianka Gerber⁴, Nicolas Reinoso-Schiller⁷, Simone Scheithauer⁷

Affiliations

¹ Institute for Infection Control and Infection Prevention, Hegau-Jugendwerk Gailingen, Health Care Association District of Constance, Gailingen, Germany.
² Institute for Medical Education, University Hospital, LMU Munich, Munich, Germany.
³ Department of Anesthesiology and Critical Care, Medical Center - University of Freiburg, Freiburg, Germany.
⁴ Institute for Anaesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital, Singen, Germany.
⁵ Training Center for Emergency Medicine (NOTIS e.V), Engen, Germany.
⁶ Department of Emergency Medicine, University-Hospital Augsburg, University of Augsburg, Augsburg, Germany.
⁷ Department of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, Göttingen, Germany.

Abstract

Background and aim: There are no investigations on hand hygiene during cardiopulmonary resuscitation (CPR), even though these patients are at high risk for healthcare-associated infections. We aimed to evaluate the number of indicated hand hygiene per CPR case in general and the fraction that could be accomplished without delay for other life-saving techniques through standardized observations.

Materials and methods: In 2022, we conducted Advanced Cardiovascular Life Support (ACLS) courses over 4 days, practicing 33 ACLS case vignettes with standard measurements of chest compression fractions and hand hygiene indications. A total of nine healthcare workers (six nurses and three physicians) participated.

Results: A total of 33 training scenarios resulted in 613 indications for hand disinfection. Of these, 150 (24%) occurred before patient contact and 310 (51%) before aseptic activities. In 282 out of 310 (91%) indications, which have the highest impact on patient safety, the medication administrator was responsible; in 28 out of 310 (9%) indications, the airway manager was responsible. Depending on the scenario and assuming 15 s to be sufficient for alcoholic disinfection, 56-100% (mean 84.1%, SD ± 13.1%) of all indications could have been accomplished without delaying patient resuscitation. Percentages were lower for 30-s of exposure time.

Conclusion: To the best of our knowledge, this is the first study investigating the feasibility of hand hygiene in a manikin CPR study. Even if the feasibility is overestimated due to the study setup, the fundamental conclusion is that a relevant part of the WHO indications for hand disinfection can be implemented without compromising quality in acute care, thus increasing the overall quality of patient care.

Keywords: ACLS (Advanced Cardiovascular Life Support); BLS (Basic Life Support); CPR - cardiopulmonary resuscitation; glove disinfection; hand disinfection; hospital acquire infection; infection prevention; life support.