Infection Control & Hospital Epidemiology (2018), 39, 1000–1002 doi:10.1017/ice.2018.119
Concise Communication
Design and validation of an anatomically based assessment scale for handwashing with alcohol-based hand rub
Daniel Aiham Ghazali MD, PhD1,2, Julie Thomas MD3, Elsa Deilhes MD4, Catherine Laland MD5, Sarah Thévenot MD5, Jean Pierre Richer MD, PhD6 and Denis Oriot MD PhD6,7
1Simulation Center, University of Paris-Diderot, Paris, France, 2Emergency Department and EMS, University Hospital of Bichat, Paris, France, 3Pediatric Department, University Hospital of Poitiers, France, 4Pediatric Department, Hospital of Niort, France, 5Hygiene Department, University Hospital of Poitiers, France, 6Anatomy and Simulation Laboratory, University of Poitiers, France and 7Pediatric Emergency Department, University Hospital of Poitiers, France
Abstract
An anatomically based assessment scale of handwashing quality with alcohol-based hand rub was designed. Contents of the scale divided each hand into 40 zones. Psychometric measurements were studied in 30 participants (120 hand sides). The scale was both valid (Cronbach α: 0.83 dorsal side and 0.73 palmar side) and reproducible (linear regression R2, 0.91; intraclass correlation coefficient, 0.99).
(Received 6 February 2018; accepted 28 April 2018; electronically published June 13, 2018)
Nosocomial infections are an undesirable result of treatment in a hospital or healthcare service unit unrelated to the patient’s ori- ginal condition.1 Hand hygiene is a key element in reducing nosocomial infections. Handwashing with alcohol-based hand rub (ABHR) has emerged as the most effective method in terms of the quality and efficiency of hand hygiene.2 This efficacy is dependent on correct performance of washing in terms of dura- tion and number of steps.3 Currently, the most widely used assessment and training method for hand hygiene technique is based on ultraviolet (UV)-dyed ABHR. This method monitors the marker’s distribution under UV light.4 A fluorescent com- ponent (Aniosgel 85 NPC with Tinopal CBS-CL, Anios Labora- tories, Lille-Hellemmes, France) emits blue fluorescence under UV-A radiation in an educational box.5 Blue fluorescence on the hands attests to the efficient application of ABHR and disinfec- tion of the corresponding zone.6 Handwashing is closely asso- ciated with hand anatomy and function. Therefore, different zones should not be considered identical. The hand is not a flat surface, and handwashing implies the biomechanical functioning of the hands. In this study, we aimed to design and validate an anatomically
based assessment scale of the quality of handwashing with ABHR. The goal of this validation was to ensure a reliable and repro- ducible scale with accuracy between scores and performance, independent of professional status.
Author for correspondence: Dr Daniel Aiham Ghazali, MD, PhD, Emergency
Department and EMS, University Hospital of Bichat, 46, rue Henri Huchard, 75018 Paris, France. E-mail:
aiham@hotmail.com
Cite this article: Ghazali DA, et al. (2018). Design and Validation of an
Anatomically Based Assessment Scale for Handwashing With Alcohol-Based Hand Rub. Infection Control & Hospital Epidemiology 2018, 39, 1000–1002. doi: 10.1017/ice.2018.119
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. Statistics
Our analysis was conducted using Statview version 4.5 software (SAS Institute, Cary, NC). Our descriptive analysis used mean and standard deviation (SD) of every variable. The internal
Methods Study
This prospective study took place in the Pediatric Department of the University Hospital of Poitiers, France. The local ethics committee and the hygiene committee approved this study (no. 2016-5). All participants signed an informed consent form. All results remained anonymous.
Creation of the instrument
We implemented the 5-step Downing framework to create an instrument for psychometric testing.7 An anatomist, 2 hygiene specialists, and 2 simulation experts divided the hands into 18 anatomical zones for the palmar side and 22 zones for the dorsal side (Figure 1a). Handwashing was performed using the 7-step method8 for 20–30 seconds, based on ultraviolet (UV)-dyed ABHR (see the Supplemental Material). Both sides of both hands were photographed. At total 80 possible points were possible, 2 independent observers (observers 1 and 2) assigned a score for each area: 0 for dark (unclean) or 1 for white (clean). The observers were provided training on the use of the scale.
Psychometric testing
Analysis of the internal structure of the scale was performed in 30 participants including physicians, residents, nurses, and students (120 hand sides).
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