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PubMed1991

Faecal indicator bacteria on the hands and the effectiveness of hand-washing in Zimbabwe.

Two aspects of hand-washing were explored in this study. Mothers and children from 80 families in Zimbabwe were asked to wash their hands in the traditional manner in sterile water. Mothers were asked to answere a socio-economic questionnaire. By using the questionnaire and observations in conjunction with the microbiological data from hand-washing, factors were identified which contributed to high counts on the hands. These were: high relative humidity, living on a commercial farm, and having an infant in the family. Mothers and children 1-5 years of age had higher counts than children of 6-12 years. People recently involved in outdoor physical activities such as farming had higher counts than those involved in other activities. The traditional hand-washing method was also compared with two other hand-washing methods: hand-washing using soap and hand-washing using a container known as the mukombe. Hand-washing with soap was the most effective method closely followed by hand-washing using the mukombe. The least effective method was traditional hand-washing.

Adult↗

PubMed1998

Coordination of hand aperture with the spatial path of hand transport.

We have investigated the coordination of hand aperture with the spatial path of hand transport in prehensile movement by comparing straight prehensile movements with curved movements, in which subjects had to pass over a "via point" marked on the work surface before picking up an object in the target location. Spatial plots of hand aperture against hand transport showed that the preshaping of the hand to prepare an appropriate grasp was delayed in the curved movements relative to the straight movements, with most of the preshaping of the hand occurring after passing the via point, even when the via point occurred late in the course of the movement. The postponement of hand preshaping was apparently not due to subjects' segmenting the movement into two completely separate portions preceding and following the via point, since some degree of hand opening often occurred before the via point. We suggest that the delay in hand opening in curved movements involves a scheduling process, which uses information about hand transport to set an appropriate hand aperture.

Adult↗

PubMed2005

Experimental hand pain delays recognition of the contralateral hand--evidence that acute and chronic pain have opposite effects on information processing?

Recognising the laterality of a pictured hand involves making an initial decision and confirming that choice by mentally moving one's own hand to match the picture. This depends on an intact body schema. Because patients with complex regional pain syndrome type 1 (CRPS1) take longer to recognise a hand's laterality when it corresponds to their affected hand, it has been proposed that nociceptive input disrupts the body schema. However, chronic pain is associated with physiological and psychosocial complexities that may also explain the results. In three studies, we investigated whether the effect is simply due to nociceptive input. Study one evaluated the temporal and perceptual characteristics of acute hand pain elicited by intramuscular injection of hypertonic saline into the thenar eminence. In studies two and three, subjects performed a hand laterality recognition task before, during, and after acute experimental hand pain, and experimental elbow pain, respectively. During hand pain and during elbow pain, when the laterality of the pictured hand corresponded to the painful side, there was no effect on response time (RT). That suggests that nociceptive input alone is not sufficient to disrupt the working body schema. Conversely to patients with CRPS1, when the laterality of the pictured hand corresponded to the non-painful hand, RT increased approximately 380 ms (95% confidence interval 190 ms-590 ms). The results highlight the differences between acute and chronic pain and may reflect a bias in information processing in acute pain toward the affected part.

Arm↗

PubMed2006

Hand rub consumption and hand hygiene compliance are not indicators of pathogen transmission in intensive care units.

The objective of this study was to investigate whether nosocomial infection (NI) rates, hand hygiene compliance rates and the amount of alcohol-based hand rub used for hand disinfection are useful indicators of pathogen transmission in intensive care units (ICUs), and whether they could be helpful in identifying infection control problems. All isolates of 10 of the most frequent pathogens from patients who were hospitalized in an ICU for >48 h were genotyped to identify transmission episodes in five ICUs. The incidence of transmission was correlated with hand hygiene compliance, hand rub consumption and NI rates. The incidence of transmission episodes varied between 2.8 and 6.8 in the five ICUs. The NI rate was 8.6-22.5 per 1000 patient-days, hand hygiene compliance was 30-47% and hand rub consumption was 57-102 L per 1000 patient-days. There was no correlation between the incidence of transmission episodes and hand rub consumption or hand hygiene compliance. The correlation between transmission rates and NI rates was 0.4 (P = 0.5), and with the exclusion of one ICU, it was 1 (P < 0.01). The incidence of NI is a relatively good indicator for the identification of pathogen transmissions, but hand rub consumption and hand hygiene compliance, at least with the relatively low level of compliance found in this study, are not indicators of pathogen transmission.

Anti-Infective Agents, Local↗

PubMed2004

Lifting over an obstacle: effects of one-handed lifting and hand support on trunk kinematics and low back loading.

Mechanical loading of the low back during lifting is a common cause of low back pain. In this study two-handed lifting is compared to one-handed lifting (with and without supporting the upper body with the free hand) while lifting over an obstacle. A 3-D linked segment model was combined with an EMG-assisted trunk muscle model to quantify kinematics and joint loads at the L5S1 joint. Peak total net moments (i.e., the net moment effect of all muscles and soft tissue spanning the joint) were found to be 10+/-3% lower in unsupported one-handed lifting compared to two-handed lifting, and 30+/-8% lower in supported compared to unsupported one-handed lifting. L5S1 joint forces also showed reductions, but not of the same magnitude (18+/-8% and 15+/-10%, respectively, for compression forces, and 15+/-17% and 11+/-14% respectively, for shear forces). Those reductions of low back load were mainly caused by a reduction of trunk and load moment arms relative to the L5S1 joint during peak loading, and, in the case of hand support, by a support force of about 250 N. Stretching one leg backward did not further reduce low back load estimates. Furthermore, one-handed lifting caused an 6+/-8 degrees increase in lateral flexion, a 9+/-5 degrees increase in twist and a 6+/-6 degrees decrease in flexion. Support with the free hand caused a small further increase in lumbar twisting. It is concluded that one-handed lifting, especially with hand support, reduces L5S1 loading but increases asymmetry in movements and moments about the lumbar spine.

Abdomen↗

PubMed2006

Introducing alcohol-based hand rub for hand hygiene: the critical need for training.

BACKGROUND: Use of an alcohol-based hand rub for hand hygiene has recently been recommended by the Centers for Disease Control and Prevention. However, the proper technique for using hand rub has not been well described and is not routinely taught in hospitals. OBJECTIVE: To evaluate the impact of training on proper technique as outlined by the European Standard for testing alcohol-based hand rubs (European Norm 1500) in a clinical study. DESIGN, SETTING, AND PATIENTS: Prospective study including 180 healthcare workers (HCWs) in a 450-bed, university-affiliated geriatric hospital where alcohol-based hand rub was introduced in the late 1970s. INTERVENTION: Structured training program in hand hygiene with alcohol-based hand rub. Technique for using hand rub was tested by the addition of a fluorescent dye to the disinfectant and the number of areas missed was quantified by a validated visual assessment method. In addition, the number of bacteria eradicated was estimated by calculating the difference between the log(10) number of colony-forming units (cfu) of bacteria on the fingertips before and after the procedure, and reported as reduction factor (RF). MAIN OUTCOME MEASURE: Log(10) cfu bacterial counts on fingertips before and after training in the appropriate technique for using hand rub. RESULTS: At baseline, only 31% of HCWs used proper technique, yielding a low RF of 1.4 log(10) cfu bacterial count. Training improved HCW compliance to 74% and increased the RF to 2.2 log(10) cfu bacterial count, an increase of almost 50% (P<.001). Several factors, such as applying the proper amount of hand rub, were significantly associated with the increased RF. CONCLUSION: These results demonstrate that education on the proper technique for using hand rub, as outlined in EN 1500, can significantly increase the degree of bacterial killing.

Alcohols↗

PubMed1988

Effect of hand splints on stereotypic hand behavior of three girls with Rett syndrome.

The purpose of this multiple baseline study was to examine the effect of bilateral hand splints on the persistent stereotypic hand movements of three adolescent girls with Rett syndrome. Among the most characteristic features of Rett syndrome are stereotypic hand-writing and hand-biting behavior and loss of previously acquired functional hand skills. The hand splints used in this study consisted of cuffs encircling the palm that positioned the subjects' thumbs in abduction. Duration percentages of subjects' stereotypic hand behavior and functional hand use were calculated from five-minute videotaped segments recorded during a finger-feeding condition and a free-time condition. All three subjects demonstrated a decrease in the amount of time spent in stereotypic hand behavior after application of hand splints, and one subject showed an increase in finger-feeding skills while wearing hand splints. Limitations of the study are discussed, and suggestions for clinical application and future research are offered.

Adolescent↗

PubMed2005

A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home.

OBJECTIVE: Good hand hygiene may reduce the spread of infections in families with children who are in out-of-home child care. Alcohol-based hand sanitizers rapidly kill viruses that are commonly associated with respiratory and gastrointestinal (GI) infections. The objective of this study was to determine whether a multifactorial campaign centered on increasing alcohol-based hand sanitizer use and hand-hygiene education reduces illness transmission in the home. METHODS: A cluster randomized, controlled trial was conducted of homes of 292 families with children who were enrolled in out-of-home child care in 26 child care centers. Eligible families had > or =1 child who was 6 months to 5 years of age and in child care for > or =10 hours/week. Intervention families received a supply of hand sanitizer and biweekly hand-hygiene educational materials for 5 months; control families received only materials promoting good nutrition. Primary caregivers were phoned biweekly and reported respiratory and GI illnesses in family members. Respiratory and GI-illness-transmission rates (measured as secondary illnesses per susceptible person-month) were compared between groups, adjusting for demographic variables, hand-hygiene practices, and previous experience using hand sanitizers. RESULTS: Baseline demographics were similar in the 2 groups. A total of 1802 respiratory illnesses occurred during the study; 443 (25%) were secondary illnesses. A total of 252 GI illnesses occurred during the study; 28 (11%) were secondary illnesses. The secondary GI-illness rate was significantly lower in intervention families compared with control families (incidence rate ratio [IRR]: 0.41; 95% confidence interval [CI]: 0.19-0.90). The overall rate of secondary respiratory illness was not significantly different between groups (IRR: 0.97; 95% CI: 0.72-1.30). However, families with higher sanitizer usage had a marginally lower secondary respiratory illness rate than those with less usage (IRR: 0.81; 95% CI: 0.65-1.09). CONCLUSIONS: A multifactorial intervention emphasizing alcohol-based hand sanitizer use in the home reduced transmission of GI illnesses within families with children in child care. Hand sanitizers and multifaceted educational messages may have a role in improving hand-hygiene practices within the home setting.

Anti-Infective Agents, Local↗

PubMed2006

Cost analysis of hand hygiene using antimicrobial soap and water versus an alcohol-based hand rub.

Proper hand hygiene is acknowledged as the most critical element of an adequate infection control program in the oral healthcare setting. However, adherence to proper hand hygiene protocols is often lacking. Poor compliance with hand hygiene protocols has been attributed to such factors as lack of time, hand irritation, hand dryness, forgetfulness, skepticism over importance, understaffing, perceived low risk of cross-infection, inconvenience, and the belief gloves alone offer protection. In the medical environment the use of alcohol-based hand rubs now represent the preferred method of performing hand hygiene when delivering non-surgical care. In this study we compared the costs associated with traditional hand washing against an alcohol-based hand rub protocol in the dental setting. The results indicate an alcohol-based hand rub protocol is less costly and less time consuming when compared to traditional handwashing in the dental setting, creating a new paradigm for hand hygiene in the dental office.

Alcohols↗

PubMed2006

One-handed versus two-handed chest compressions in paediatric cardio-pulmonary resuscitation.

OBJECTIVES: To determine emergency department (ED) staff preference for one- or two-handed paediatric chest compressions and to determine if there was a difference in compression rates delivered and fatigability between the techniques. METHODS: This was a randomised, cross-over observational study of paediatric CPR performed on a standard paediatric manikin by ED staff. Consenting, eligible staff [ED doctors and nurses] performed CPR in pairs with chest compressions delivered using a one- and two-handed technique. The outcomes of interest were compression rates for one- and two-handed CPR, decrease in compression rate over time for each technique and staff preference for technique. Data was analysed using descriptive statistics, Chi Square test and Mann-Whitney U-test as appropriate. RESULTS: Sixty-two ED staff participated in the study. Compression rates with both techniques were similar and higher than guidelines recommend (133.6 min(-1) for one-handed and 135.7 min(-1) for two-handed respectively). The compression rate slowed by 6.9 compressions/min over 1 min in one-handed compressions compared with 2.6 compressions/min in two-handed compressions (p = 0.0264). 65.6% of participants reported that they preferred the two-handed compression technique. CONCLUSION: This study showed that CPR compression rate is similar with one- and two-handed compression techniques, but compression rate decreased more quickly with the one-handed technique. The majority of staff preferred the two-handed compression technique for reasons of ease, control and uniformity with other CPR techniques.

Cardiopulmonary Resuscitation↗

PubMed1985

Ethidium binding to left-handed (Z) DNAs results in regions of right-handed DNA at the intercalation site.

The equilibrium binding of ethidium to the right-handed (B) and left-handed (Z) forms of poly(dG-dC).poly(dG-dC) and poly(dG-m5dC).poly(dG-m5dC) was investigated by optical and phase partition techniques. Ethidium binds to the polynucleotides in a noncooperative manner under B-form conditions, in sharp contrast to highly cooperative binding under Z-form conditions. Correlation of binding isotherms with circular dichroism (CD) data indicates that the cooperative binding of ethidium under Z-form conditions is associated with a sequential conversion of the polymer from a left-handed to a right-handed conformation. Determination of bound drug concentrations by various titration techniques and the measurement of circular dichroism spectra have enabled us to calculate the number of base pairs of left-handed DNA that adopt a right-handed conformation for each bound drug; 3-4 base pairs of left-handed poly(dG-dC).poly(dG-dC) in 4.4 M NaCl switch to the right-handed form for each bound ethidium, while approximately 25 and 7 base pairs switch conformations for each bound ethidium in complexes with poly(dG-dC).poly(dG-dC) in 40 microM [Co(NH3)6]Cl3 and poly(dG-m5dC).poly(dG-m5dC) in 2 mM MgCl2, respectively. The induced ellipticity at 320 nm for the ethidium-poly(dG-dC).poly(dG-dC) complex in 4.4 M NaCl indicates that the right-handed regions are nearly saturated with ethidium even though the overall level of saturation is very low. The circular dichroism data indicate that ethidium intercalates to form a right-handed-bound drug region, even at low r values where the CD spectra show that the majority of the polymer is in a left-handed conformation.

Chemical Phenomena↗

PubMed2003

Left- versus right-hand tracking performance by right-handed boys and girls: examination of performance asymmetry.

This study compared left- versus right-hand performance within healthy, right-handed, 8- or 9-yr.-old boys and girls on a finger-movement tracking task. 38 boys and 38 girls were randomly assigned to use either the left hand first and right hand second or vice versa in tracking a sine wave target with extension and flexion movements of the index finger. The data were analyzed with a three-way analysis of variance with repeated measures followed by pair-wise comparisons with a Bonferroni correction. Analysis yielded a significant hand x test interaction and a significant improvement for subjects tracking with the right hand on Test 1 and left hand on Test 2. No significant change occurred for subjects tracking with the left hand on Test 1 and right hand on Test 2. No interaction was observed with sex as a factor. This study suggests that asymmetry of performance favoring the left hand occurs in right-handed boys and girls during finger-movement tracking.

Child↗

PubMedDate not supplied

The effect of hand splints on stereotypic hand behavior in Rett's syndrome.

The purpose of this study was to examine the effect of hand splints and one elbow restraint on persistent stereotypic hand movements of four girls with Rett's syndrome. Among the most characteristic features of Rett's syndrome are stereotypic hand wringing and loss of previously acquired functional hand skills. Hand splints and one elbow restraint were used in this study. The subject's stereotypic hand behavior and functional hand use were calculated from five-minute segmental video tape recordings. The study consisted of three phases: baseline, intervention, and withdrawal. All subjects demonstrated a decrease in stereotypic hand behavior after the application of hand splints. Although splints showed a positive effect on hand movements in Rett's syndrome, they could also lead to other, undesirable, movements. Whether splints have a positive effect on the functional use of the hand should be investigated in more subjects.

Child↗

PubMed2000

A microbiological evaluation of warm air hand driers with respect to hand hygiene and the washroom environment.

A finger rinse technique for counting micro-organisms on hands showed no significant difference in the level of recovered micro-organisms following hand drying using either warm air or paper towels. Contact plate results appeared to reflect the degree of dampness of hands after drying rather than the actual numbers of micro-organisms on the hands. In laboratory tests, a reduction in airborne count of Pseudomonas aeruginosa and Staphylococcus aureus of between 40 and 75% was achieved from 600 readings comparing inlets and outlets of warm air hand driers. In washroom trials, the number of airborne micro-organisms was reduced by between 30 and 75%. Air emitted from the outlet of the driers contained significantly fewer micro-organisms than air entering the driers. Drying of hands with hand driers was no more likely to generate airborne micro-organisms than drying with paper towels. Levels of micro-organisms on external surfaces of hand driers were not significantly different to those on other washroom surfaces. This work shows that warm air hand driers, of the type used in this study, are a hygienic method of drying hands and therefore appropriate for use in both the healthcare and food industry.

Air Microbiology↗

PubMed2000

The effects of ipsilateral forearm movement and contralateral hand grasp on the spastic hand opened by electrical stimulation.

The purpose of this study was to investigate the effects of ipsilateral arm movement and contralateral hand grasp on the spastic hand opened by open-loop electrical stimulation. The major problem of applying proper electrical stimulation is variable spasticity, the intensity of which changes with posture and movements of other parts of the body. Electrical stimulation was applied to extensor digitorum communis and ulnar nerve to open the affected hand. Different procedures were then used to assess the effects of moving the ipsilateral forearm and contracting the contralateral normal hand. Electrical stimulation opened the spastic hand in more than 95% of trials in all subjects, whether stimulation was applied before or after the movement of the forearm. Moving the ipsilateral forearm did have an effect on opening the hand, and making adjustment of stimulation intensities was necessary in all subjects. The stimulation opened the spastic hand during the contraction of the contralateral normal hand. Electrical stimulation could open the spastic hands most of the time, in the presence of ipsilateral forearm movement and contralateral normal hand contraction. If electrical stimulation was applied before the ipsilateral forearm was moved toward the target, stimulation intensities needed to be adjusted.

Adult↗

PubMedDate not supplied

Hands across the water: clinical observations of hand therapy practices in Great Britain and Norway.

The Evelyn Mackin Traveling Hand Therapist Award is a new award established in 2004 by the American Hand Therapy Foundation. This award was named in honor of Evelyn Mackin, a distinguished leader in hand therapy rehabilitation. Ms. Mackin enthusiastically endorses worldwide networking among hand therapists. She strongly believes in the value of sharing knowledge and technical skills. This award enables members of the ASHT to travel, learn new concepts or skills, and share them with the American hand therapy community. Visits to clinics in Great Britain and Norway revealed similarities and differences between European and American hand therapy practice. Clinical observations explore tendon transfer rehabilitation, cold sensitivity, sensory desensitization and re-education, Dupuytren's contracture, and clinic design. Other highlighted topics include delivery of health care services, hand therapist certification, and the unique contributions of Occupational Therapy and Physiotherapy to the practice of hand therapy. A hand therapy practice survey focuses on treatment and practice issues, continuing education, and challenges facing hand therapist colleagues abroad.

Certification↗

PubMed2005

Mechanical impedance and absorbed power of hand-arm under x(h)-axis vibration and role of hand forces and posture.

The biodynamic responses of the hand-arm system under x(h)-axis vibration are investigated in terms of the driving point mechanical impedance (DPMI) and absorbed power in a laboratory study. For this purpose, seven healthy male subjects are exposed to two levels of random vibration in the 8-1,000 Hz frequency range, using three instrumented cylindrical handles of different diameters (30, 40 and 50 mm), and different combinations of grip (10, 30 and 50 N) and push (0, 25 and 50 N) forces. The experiments involve grasping the handle while adopting two different postures, involving elbow flexion of 90 degrees and 180 degrees, with wrist in the neutral position for both postures. The analyses of the results revealed peak DPMI magnitude and absorbed power responses near 25 Hz and 150 Hz, for majority of the test conditions considered. The frequency corresponding to the peak response increased with increasing hand forces. Unlike the absorbed power, the DPMI response was mostly observed to be insensitive to variations in the excitation magnitude. The handle diameter revealed obvious effects on the DPMI magnitude, specifically at frequencies above 250 Hz, which was not evident in the absorbed power due to relatively low velocity at higher frequencies. The influence of hand forces was also evident on the DPMI magnitude response particularly at frequencies. above 100 Hz, while the effect of hand-arm posture on the DPMI magnitude was nearly negligible. The magnitude of power absorbed within the hand and arm was observed to be strongly dependent upon the excitation level over the entire frequency range, while the influence of hand-arm posture on the total absorbed power was observed to be important. The effect of variations in the hand forces on the absorbed power was relatively small for the bent elbow posture, while an increase in either the grip or the push force coupled with the extended arm posture resulted in considerably higher energy absorption. The results suggested that the handle size, hand-arm posture and hand forces, produce coupled effect on the biodynamic response of the hand-arm system.

Arm↗

PubMed2004

Reliability and concurrent validity of the figure-of-eight method of measuring hand size in patients with hand pathology.

STUDY DESIGN: Methodological study using correlational methods. OBJECTIVE: To determine the intratester and intertester reliability and concurrent validity of the figure-of-eight method of measuring hand size in patients with hand pathology. BACKGROUND: Measuring edema is an important component of the physical examination of patients with conditions affecting the hand. The figure-of-eight method of measuring hand size has been suggested as an alternative to volumetry. The reliability and concurrent validity of the figure-of-eight method has been established in individuals without hand pathology, but not in patients with conditions involving the hand. METHODS AND MEASURES: Participants were 24 patients with conditions affecting the hand, 9 with bilateral involvement. Two testers performed 3 figure-of-eight measurements of hand size each. A third tester performed 2 volumetric measurements. Intraclass correlation coefficient (ICC3,1) was used to determine intratester reliability of both measurement procedures. ICC2,3 was used to examine intertester reliability of the figure-of-eight method. Pearson product moment correlation coefficients examining the association between the 2 methods were used to establish concurrent validity of the figure-of-eight technique. RESULTS: Intratester ICCs for figure-of-eight and volumetric methods were 0.98 to 0.99. The intertester ICC for the figure-of-eight method was 0.99. Pearson correlation coefficients examining the relationship between the 2 methods were 0.92 to 0.94. CONCLUSION: The figure-of-eight method is a reliable and valid measure of hand size in individuals with conditions affecting the hand.

Adult↗