Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU

Study objective: To evaluate the effectiveness of warning labels permanentl y attached to mechanical ventilators in improving the practice of hand wash ing and use of gloves by respiratory care practitioners (RCPs) in the ICU. Design: The study consisted of two 4-week periods. Daily observations of ha nd washing and use of gloves by RCPs were made over four 1-h observation pe riods. Prior to the first 4-week period, the importance of hand washing and use of gloves was presented to all staff. At the end of the first period, "Wash Hands Use Gloves" labels were permanently placed on all ventilators i n the ICU. The RCPs were not aware they were being observed for hand washin g and use of gloves in either period. Measurements and results: The total number of encounters between the RCPs a nd patients as well as the rates of hand washing and use of gloves were obt ained during the study. The rates of hand washing and use of gloves were si gnificantly higher during the second period when labels were attached to th e ventilators, as compared to the rates during the first period: hand washi ng, 92% vs 46% (p < 0.05); use of gloves, 92% vs 13% (p < 0.05), respective ly. During the first period, the rates of pre-encounter hand washing (78%, 48%, 27%, and 29% in weeks 1 through 4, respectively) and the use of gloves (56%, 37%, 32%, and 45% in weeks 1 through 4, respectively) were primarily declining. This was not observed during the second period of the study (94 %, 88%, 95%, and 92% in weeks 1 through 4, respectively) for the rates of p re-encounter hand washing and the use of gloves. Conclusions: Simple measures such as the placement of warning labels on mec hanical ventilators can significantly improve hand washing and use of glove s by RCPs in the ICU.