Table 15 'Hand-Hygiene - Staff's Compliance with Guidelines for use of Jewellery'

PSI 14: Hand Hygiene – Staff’s Compliance with Guidelines for us of Jewellery
Origin: PSI by SimPatIE
Dimension Description
Description of Specific
Aspects of Patient Safety
Improved adherence to hand hygiene has been shown to terminate
outbreaks in health care facilities, to reduce transmission of
antimicrobial resistant organisms and reduce overall infection rates
(40;41). Also it is the cheapest way of preventing nosocomial
infections.
Surgical wound infection may be caused by transfer of bacteria from
the hands of the surgical team during operative procedures. The
wearing of finger rings and nail polish is thought to reduce the efficacy
of the scrub as they are thought to harbour bacteria in microscopic
imperfections of nail polish and on the skin beneath finger rings.
The patient harm of bad hand hygiene makes surveillance of Staff’s
Compliance with Guidelines for us of Jewellery a suitable patient
safety measure.
Level of Determination of
Patient Safety
Safety is assessed at the aggregated patient level.
Aim of the PSI The PSI aims at monitoring presence of hand- and arm jewellery
among health care staff.
Source(s) Surveillance of hand hygiene is commonly known in Europe. This PSI
has been used in Aarhus University Hospital, Denmark together with
another five indicators related to hand hygiene.
Extent of Clinically
Testing
Though this indicator is in use in numerous hospitals in Scandinavia,
England and other parts of Europe, we have not found specific
scientific evidence describing clinical testing of the indicator.
A randomised controlled trail from 2001determined risk factors for
hand contamination and compared the efficacy of three randomly
allocated hand hygiene agents in a group of surgical intensive care unit
nurses. Cultured samples of one of the nurses’ hands before and
samples of the other hand after hand hygiene were made and
compared. Ring wearing was found to be associated with 10-fold
higher median skin organism counts; contamination with
Staphylococcus aureus, gram-negative bacilli, or Candida species; and
a stepwise increased risk of contamination with any transient organism
as the number of rings worn increased (44).
A Cochrane Review from 2000 was performed to assess the effect of
removal of finger rings and nail polish by the surgical scrub team, on
postoperative wound infection rates. The researchers concluded:
“Given the lack of evidence for either the safety or the harm associated
with nail polish and finger rings, health care organisations must
continue to develop institutional policies based on expert
opinions”(45).
SImPatIE WP4 – Catalogue of Patients Safety Indicators
39
Evidence of Clinically use
of Standards
The standard used in Aarhus University Hospital; Denmark for this
indicator was: 98% of health care staff do not use hand and arm
jewellery on duty.
PSI category Theme Related PSI: “Infection Control”.
Data definitions Presence of hand- and arm jewellery per 1000 health care staff.
Numerator Description Number of staff wearing hand- and/or arm jewellery.
Denominator Description Total number of health care staff present on the day of observation in
the unit/department.
Data Source An unannounced observational cross-sectional survey on the
prevalence of hand- and arm jewellery worn by health care staff.
Identifying the
institutional context
This PSI is relevant to quality improvement, accreditation and cost
containment, as prolonged hospital stays due to infections have
considerable economic impact.
Care Setting The PSI generally applies for high quality hygiene related to patient
contact by all health care workers.
Professionals Responsible
for Health Care
All health care providers in contact with patients in bed units.
Lowest Level of Health
Care Delivery Addressed
Individual clinical units or departments.
Allowance for Patient
Factors
No patient factors involved.
Stratification by
Vulnerable Populations
No stratification.
Standard of Comparison The timeframe is yearly monitoring.
Scoring No scoring advice given.