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PubMed2002

Hand washing and physicians: how to get them together.

OBJECTIVE: To determine the motivating and behavioral factors responsible for improving compliance with hand washing among physicians. DESIGN: Five unobtrusive, observational studies recording hand washing after direct patient contact, with study results reported to physicians. SETTING: A 450-bed hospital in a health maintenance organization with an 18-bed medical-surgical intensive care unit (ICU) and a 12-bed cardiac care unit. METHODS: An infectious disease physician met individually with participants to report study results and obtain a commitment to hand washing guidelines. Follow-up interviews were conducted to evaluate behavioral factors and educational programs. Hand washing study results were presented to all staff physicians by live and videotaped inservice presentations and electronic mail (e-mail) newsletters. The importance of influencing factors and the educational effectiveness of the hand washing program were evaluated. RESULTS: Five observational hand washing studies were conducted in the ICU between April 1999 and September 2000. Rates of physician compliance with hand washing were 19%, 85%, 76%, 74%, and 68%, respectively. There were 71 initial encounters and 55 follow-up interviews with the same physicians. Physician interviews revealed that 73% remembered the initial encounter, 70% remembered the hand washing inservice presentations, and 18% remembered the e-mail newsletters. Personal commitment and meeting with an infectious disease physician had the most influence on hand washing behavior. Direct inservice presentations (either live or videotaped) had more influence than did e-mail information. Rates of ventilator-associated pneumonia did not significantly change before and during the study periods. A decrease in the rate of central-line-related bloodstream infections from 3.2 to 1.4 per 1,000 central-line days was found, but could not be solely attributed to improved physician compliance with hand washing. CONCLUSIONS: Physician compliance with hand washing can improve. Personal encounters, direct meetings with an infectious disease physician, and videotaped presentations had the greatest impact on physician compliance with hand washing at our medical center, compared with newsletters sent via e-mail. Local data on compliance with hand washing and physician involvement are factors to be considered for physician hand washing compliance programs in other medical centers.

Cross Infection↗
PubMed2001

Hand elevation: a new test for carpal tunnel syndrome.

Hand elevation can reproduce the symptoms of carpal tunnel syndrome. This phenomenon prompted the idea of developing a simple hand elevation test to diagnose carpal tunnel syndrome. A total of 200 hands in 118 patients diagnosed with carpal tunnel syndrome were tested prospectively from September 6, 1999, to February 3, 2000. Three provocative tests (hand elevation test, Phalen's test, and Tinel's test) were performed on each hand for both the experimental group (200 hands) and the control group (200 hands). McNemar chi-squared analysis was used to compare the sensitivity and specificity of the new hand elevation test with those of Phalen's test and Tinel's test. The sensitivity and specificity of the hand elevation test is 75.5% and 98.5% respectively. Phalen's test had 67.5% sensitivity and 91.0% specificity. Tinel's test had 67.5% sensitivity and 90.0% specificity. The difference in sensitivities between the hand elevation test and Phalen's test was significant (p = 0.05). No significant difference was found in the sensitivity between the hand elevation test and Tinel's test. The comparison of specificity of the hand elevation test and Phalen's test was significant (p = 0.001). Significance was also observed in specificity between the hand elevation test and Tinel's test (p = 0.001). In this study, the sensitivity and specificity of the elevation test were higher than those of Phalen's test and Tinel's test. Statistical analysis confirms the eligibility of the hand elevation test as a useful, provocative test.

Adult↗
PubMed1984

Routine hand doses vs monitoring regulations at a nuclear power plant.

Hand radiation doses to workers at a nuclear power plant were monitored in this study to evaluate compliance with dose limits and to determine whether hand monitoring on a routine basis is necessary. Two hundred in-plant workers at Carolina Power and Light Co.'s H.B. Robinson Steam Electric Generating Plant were monitored with a ring TLD dosimeter on each hand for four months during routine plant operations. Study participants included plant operators, electricians, mechanics, health physics technicians and decontamination personnel. Ring dosimeters were worn, in addition to whole-body TLD dosimeters, at all times workers were in radiation control areas. Hand dosimeters were read on the same monthly schedule as the whole-body dosimeters to ensure correlation of exposure periods. The results of the analysis of hand-dose data obtained for these workers are summarized as follows: (1) No worker's hand dose exceeded 25% of the allowable quarterly dose. (2) Ninety-nine percent of hand doses were less than 600 mrem/month. (3) The highest hand dose observed in any month was 1074 mrem which if received for three months, is below regulatory dose limits and below the dose value where monitoring is required. The highest actual hand dose observed in the last quarter of 1981 was 1335 mrem. (4) Examination of hand dose to whole-body dose ratios revealed that if the whole-body dose limit is approached, hand doses are still below the dose level where monitoring is required. (5) A linear-regression analysis of hand and whole-body dose data provides the ability to predict hand doses from the whole-body doses. From these results, it is concluded that routine monitoring of hand doses is not required at the H.B. Robinson plant. This conclusion should also be applicable to routine operations at other similar nuclear plants.

Environmental Exposure↗
PubMed2001

Tremor in otosurgery: influence of physical strain on hand steadiness.

BACKGROUND: The microscopically small middle ear structures require the otosurgeon to have a steady hand because instrument stability is a critical factor for a successful microsurgical procedure. Hand steadiness is mainly influenced by the tremor movements of the hand. The aim of this study was to measure hand tremor under simulated microsurgical conditions and to estimate the influence of different kinds of physical strain (e.g., physical exertion and hand exercise), as well as food abstinence and coffee consumption. Further, the effect of one-or two-handed manipulation and microsurgical experience was investigated. METHODS: The hand movements of 16 adult subjects were assessed during a defined manual manipulation using a stapes model to simulate microsurgical procedures. A laserinterferometric-based displacement technique was developed to measure tremor amplitude and frequency, as well as maximum displacement, to evaluate the subjects' fine motor skills. RESULTS: The mean tremor frequency across all measurements was 8.1 Hz and did not show any dependence on different kinds of physical strain. Two-handed manipulations showed significantly lower tremor amplitudes than one-handed performances. Tremor amplitude and maximum displacement did not change after hand exercise, food abstinence, and coffee consumption. However, after physical exertion, a significant increase in the tremor amplitude was found. Subjects with advanced microsurgical experience showed smaller tremor amplitudes for one-handed runs. CONCLUSION: The tremor data are interpreted as a recommendation to avoid physical exertion before microsurgery. In cases of absolute necessity for hand steadiness, two-handed manipulations are preferable. Further, hand steadiness might be improved by microsurgical training and experience.

Adult↗
PubMed1999

Assessment of mutilans-like hand deformities in chronic inflammatory joint diseases. A radiographic study of 52 patients.

OBJECTIVES: To evaluate patients with mutilans-like hand deformities in chronic inflammatory joint diseases and to determine radiographic scoring systems for arthritis mutilans (AM). METHODS: A total of 52 patients with severe hand deformities were collected during 1997. A Larsen hand score of 0-110 was formed to describe destruction of the hand joints. Secondly, each ray of the hand was assessed individually by summing the Larsen grade of the wrist and the grades of the MCP and PIP joints. When the sum of these grades was > or = 13, the finger was considered to be mutilated. A mutilans hand score of 0-10 was formed according to the number of mutilans fingers. Surgical treatment and spontaneous fusions were recorded. RESULTS: The study consisted of 22 patients with juvenile rheumatoid arthritis (JRA), nine with rheumatoid factor (RF) positive and 13 with RF negative arthritis, 27 patients with RF positive RA, and three adult patients with other diagnoses. The mean age of patients with adult rheumatic diseases was 27 years at the onset of arthritis. The mean disease duration in all patients was 30 years. The mean Larsen hand score was 93. Four patients had no mutilans fingers and in 15 patients all 10 fingers were mutilated. The Larsen hand score of 0-110 and the mutilans hand score of 0-10 correlated well (rs = 0.90). Fourteen patients showed spontaneous fusions in the peripheral joints. A total of 457 operations were performed on 48 patients. CONCLUSION: Both the Larsen hand score of 0-110 and the mutilans hand score of 0-10 improve accuracy in evaluating mutilans-like hand deformities, but in unevenly distributed hand deformities the mutilans hand score is better in describing deformation of individual fingers.

Adolescent↗
PubMed2003

Hand bone densitometry in rheumatoid arthritis, a five year longitudinal study: an outcome measure and a prognostic marker.

OBJECTIVE: To investigate whether hand bone mineral content (BMC) measurement is an outcome measure for RA and whether the early changes in hand BMC predict functional disability. METHODS: Tender and swollen joints in hands and body, HAQ score, Larsen score on hand radiographs, serum CRP, and hand BMC measurement by DXA were studied every six months for five years in 40 patients with early RA. At the final visit, patients completed the SF-36 and Duruoz hand function questionnaires. RESULTS: All patients completed two years and 29 completed five years' follow up. Hand BMC worsened over the first three years (percentage loss from baseline: mean (SD) -5.5 (7.2), -7.5 (8.4), -9.8 (9.4)) and stabilised over last two years (-9.9 (8.8), -10 (7.8)). Baseline disease activity and function correlated with hand BMC loss at five years (swollen joints in hands: r=-0.38, p=0.043; swollen joints in body: r=-0.47, p=0.01; HAQ: r=-0.52, p=0.004). Percentage change in hand BMC over five years correlated with SF-36 physical function (r=0.61, p<0.01), hand function (r=-0.64, p<0.01), HAQ score (r=-0.63, p<0.01) at five years. Relative risk of bad hand functional outcome at five years was significantly higher for patients with hand BMC loss of >/=1.17 g (smallest detectable difference) than for patients with less bone loss within the first six months (OR=6.9, 95% CI 1.3 to 34.5, p<0.02). CONCLUSION: Early loss of hand BMC in patients with RA is a composite marker of disease activity and functional status and can predict poor functional outcome.

Absorptiometry, Photon↗
PubMed2006

Hand grip strength in the adult Malaysian population.

PURPOSE: To measure the hand grip strength of Malaysians aged 18 to 65 years. METHODS: Between January and April 2003, 412 subjects (200 women and 212 men) were recruited from staff, students, and visitors of the University of Malaya Medical Centre. Socioeconomic, general health, and lifestyle data were collected from each subject using a standard questionnaire. Weight and height were measured prior to testing. Standardised positioning and instructions based on several hand grip protocols were used. Data were collected using the LIDO kinetic work set. RESULTS: 93% of the subjects were right-hand dominant and 7% were left-hand dominant. Hand grip strength was significantly correlated with hand dominance, gender, occupation, height, and weight, but not body mass index. No significant differences in grip strength were noted with regard to race or level of income. Men were stronger than women in all age-groups, with a ratio of 1.75:1. In both right- and left-hand dominant groups, the dominant hand was consistently stronger than the non-dominant side, with a ratio of 1.12:1 in the right-hand dominant group and 1.05:1 in the left-hand dominant group. The strongest hand grip strength in the right-hand dominant group occurred in the age-group of 25 to 34 years; in the left-hand dominant group it was in the age-group of 18 to 24 years. In western populations, the mean grip strength can be as much as 1.5 times greater than in the Malaysian population. CONCLUSION: Data derived from western populations cannot be applied to a comparable Malaysian population. Gender, hand dominance, age, occupation, weight, and height must be considered when establishing normal values for grip strength.

Adolescent↗
PubMed2005

Vascular changes of the hand in professional baseball players with emphasis on digital ischemia in catchers.

BACKGROUND: Repetitive trauma to the hand is a concern for baseball players. The present study investigated the effects of repetitive trauma and the prevalence of microvascular pathological changes in the hands of minor league professional baseball players. In contrast to previous investigators, we documented the presence of abnormalities in younger, asymptomatic individuals. METHODS: Thirty-six baseball players on active minor league rosters underwent a history and physical examination of both hands as well as additional specialized tests, including Doppler ultrasound, a timed Allen test, determination of digital brachial pressure indices, and ring sizing of fingers. Data were compared between gloved hands and throwing hands, hitters and nonhitters, and players at four different positions (catcher [nine subjects], outfielder [seven subjects], infielder [five subjects], and pitcher [fifteen subjects]). RESULTS: Digital brachial indices in the ring fingers of the gloved (p < 0.05) and throwing hands (p < 0.02) of catchers were significantly diminished compared with those in all other players. Doppler testing showed a significantly greater prevalence of abnormal flow in the ulnar artery at Guyon's canal when catchers were compared with other position players (p < 0.01). Doppler abnormalities were significantly more common in the gloved hand compared with the throwing hand (p < 0.05). Seven of nine catchers (and only catchers) were found to have index finger hypertrophy (average change, two ring sizes; p < 0.01); the hypertrophy occurred at the proximal phalanx and the proximal interphalangeal joint of the gloved hand. Catchers had a significantly higher prevalence of subjective hand symptoms (specifically, weakness in the gloved hand) compared with pitchers and infielders/outfielders (44% compared with 7% and 17%, respectively; p < 0.05). CONCLUSIONS: Microvascular changes are present in the hands of otherwise healthy professional baseball players in all positions, with a significantly higher prevalence in catchers, prior to the development of clinically important ischemia. Repetitive trauma resulting from the impact of the baseball also leads to digital hypertrophy in the index finger of the gloved hand of catchers. Gloves currently used by professional catchers do not adequately protect the hand from repetitive trauma.

Adult↗
PubMed1979

Analysis of reasons and locations of burns on hands.

During the period 1971-76, 1055 patients with fresh burns were treated at our hospital. Of these, 461 (88 females, 373 males) had sustained burns on altogether 783 hands. This amounts to 45% of the total number of fresh burns. In 322 cases both hands were involved, amounting to 31% of all cases of fresh burns, or 70% of all patients with burned hands. Whereas 82% of patients with hand burns had injuries to both hands, only 10% had sustained an injury to the right hand alone and 8% to the left hand alone. Cases of burns limited to the hands alone accounted for only 4.7% of all burn injuries. The main cause of burn injuries was thermal accident--most often steam explosions and the spraying of scalding liquids. The total number of hands injured by thermal agents totalled 707, i.e. 90% of all burned hands. Most of these were deep skin burns. Chemical agents were mainly responsible for this type of burn, whereas electrical burns were chiefly full thickness skin injuries. Analysis of the location of burns showed that 643 (82%) hands of the altogether 783 injuries sustained involved the wrist, 620 (79%) the metacarpus, 684 (87%) of the fingers. Some 321 hand burns (41%) were of a circumferential nature. A majority of burned hands were injured on the dorsal surface. The burn injuries of hands in 246 (53%) persons were connected with their professional work.

Accidents, Occupational↗
PubMed2005

Cross-sectional survey of hand-hygiene compliance and attitudes of health care workers and visitors in the intensive care units at King Chulalongkorn Memorial Hospital.

BACKGROUND: Hand hygiene is the most important and effective measure to prevent cross-infection in hospitals. Hand-hygiene campaign must be implemented as a part of infection control program at King Chulalongkorn Memorial Hospital (KCMH). The behavior attitudes, and beliefs of health care workers (HCWs) and visitors regarding hand-hygiene practices have never been studied in KCMH. OBJECTIVES: To determine the baseline compliance and assess the attitudes and beliefs regarding hand hygiene of HCWs and visitors in intensive care units (ICUs) at KCMH. MATERIAL AND METHOD: We observed hand-hygiene compliance of HCWs and visitors in ICUs before patient contact for eight hours. A self-administered questionnaire was employed to measure attitudes and beliefs about hand hygiene for two-week period. RESULTS: Overall hand-hygiene compliance obtained from this observational study was less than 50% and differed markedly among various professional categories of HCWs and visitors. In questionnaire-based study, patient needs perceived as a priority (51.2%) was the most common reason for non-compliance, followed by forgetfulness (35.7%), and skin irritation by hand-hygiene agents (15.5%). Subjects believed to improve their compliance by multiple strategies including available low irritating hand-hygiene agents (53.4%), information of current nosocomial infection rate (49.1%), and easily accessed hand-hygiene supplies (46.3%). Almost all subjects (99.7%) claimed to know correct hand-hygiene techniques. Handwashing with medicated soap was perceived to be the best mean of hand decontamination (37.8%). CONCLUSION: Hand-hygiene compliance of HCWs and visitors is unacceptably low. Their knowledge, behavior attitudes, and beliefs toward hand hygiene need to be improved by the multimodal and multidisciplinary approach.

Attitude of Health Personnel↗
PubMed1992

Maternal influences on infant hand-use during play with toys.

Infant hand-use preferences are related to mother's, but not father's, handedness. Since infants match mother's hand-use during toy play, maternal handedness can affect infant hand-use. Twenty-eight mother-infant pairs (14 left-handed and 14 right-handed infants but all right-handed mothers) were videotaped while playing with six toys on the infant's 7-, 9-, and 11-month birthdays. Play was analyzed for five kinds of hand-use biasing situations, but maternal hand-use was the dominant influence. Infant matching of maternal hand-use increased with age and right-handed infants and female infants matched maternal hand-use more frequently. Concordance of hand-use preference between mother and infant seemed to account for both the matching and the stronger preferences of the right-handed compared to the left-handed infants.

Female↗
PubMed2001

Bone loss from the hand in women following distal forearm fracture.

Bone loss occurs after distal forearm fracture, but it is unclear if this bone loss is fully recovered. We designed a cross-sectional study to evaluate the time course of the bone loss from the hand after distal forearm fracture. We identified 40 women who had a fracture of the distal forearm within the previous 4.5 years. Their ages ranged from 42 to 81 (mean 64 years) and time since fracture 6 to 54 (mean 28 months). These were compared with 95 women (mean age 67, range 57 to 80 years) from a population-based cohort. Lumbar spine (LS) and hand bone mineral density (BMD) were measured in all subjects using a Hologic QDR 1000/W densitometer. Ultrasound of the fingers of both hands was measured in the forearm fracture group using a DBM Sonic 1200 R model. Compared to controls, LS BMD was decreased by 6.4% (p<0.001), non-fractured hand by 3.2% (p<0.001) and the fractured hand by 6.1% (p<0.001) in the forearm fracture group. The mean difference in bone density between the fractured and non-fractured hand was 0.0207 g/cm2, the average value for the non-fractured hand being 0.304 g/cm2. The decement in hand BMD was equivalent to 6.2% (p<0.0001). The difference in hand BMD between the fractured and non-fractured side was greatest when the time since fracture was short; there was no further difference in hand BMD after 2 years. Ultrasound showed a mean difference of 18.7 m/s in amplitude-dependent speed of sound (AD-SoS) with the average value being 1893 m/s. A 1.0% decrease was observed in the fractured hand AD-SoS (p<0.05). A strong relationship was observed between AD-SoS and BMD in both hands (r = 0.70, p<0.001). We conclude that distal forearm fracture results in a significant decrease in hand BMD that is partially reversible. The decrease in hand BMD is reflected in the ultrasound properties of the finger phalanx.

Absorptiometry, Photon↗
PubMed1995

Predictors of hand function in patients with rheumatoid arthritis.

OBJECTIVES: The aims of this study were to determine: (1) what factors predict patient self-estimated hand function; (2) what factors predict actual hand function; and (3) the relationship among actual hand function, patient estimates of hand function, and self-assessed activities of daily living (ADL). METHODS: Fifty-two patients with rheumatoid arthritis completed wrist and hand mobility measures, grip strength, pain, stiffness, and estimated hand function tests, along with the Sollerman Grip Function Test (actual hand function), Health Assessment Questionnaire (HAQ), and subscales of the Arthritis Impact Measurement Scales (AIMS). RESULTS: Grip strength and stiffness were the strongest predictors of self-estimated hand function. Flexion and extension deficits in digits II through V were the strongest predictors of actual hand function. Actual hand function and self-estimated hand function were significantly correlated with each other and with the HAQ and AIMS subscales. CONCLUSIONS: Measures of deficit are the most useful in predicting actual hand function, whereas measures of strength and flexibility are most useful for estimated hand function.

Activities of Daily Living↗
PubMed2002

Optimal hand locations for safe scaffold-end-frame disassembly.

Overexertion and fall injuries comprise the largest category of injuries among scaffold workers. A significant portion of these injuries is associated with scaffold-end-frame dismantling tasks, which require both muscle strength and postural balance skills. The commonly used tubular scaffold end frame is 1.52-m wide x 2-m high and weighs 23 kg. Previous studies have indicated that a great muscle strength can be generated when scaffold workers placed their hands symmetrically at knuckle height. However, adequate postural stability can only be reached when the workers placed their hands at the chest or shoulder height, which is near to the height of scaffold-end-frame center-of-mass. A reasonable approach to solve this dilemma is to develop an assistive lifting device, such as a light-weight clip-and-lift bar, that allows workers to place their hands at the height of the center-of-mass of end frames and concurrently allows an optimal hand separation for them to generate an adequate maximum isometric muscle force to safely accomplish the task. This study was conducted to determine the optimal hand location for a conceptual assistive lifting device to mitigate potential postural imbalance while reducing overexertion hazards during scaffold disassembly. This location would be within a window defined by a vertical hand placement between shoulder height and knuckle height and by a horizontal hand separation distance of shoulder width to end-frame width. The whole-body maximum isometric strength of 54 construction workers was measured in nine symmetric scaffold-end-frame disassembly postures, defined by a combination of three vertical hand placements by three horizontal hand separation distances within the aforementioned window. The study apparatus include a computer-controlled data-acquisition system, a custom-fabricated scaffold fixture, and two Bertec force platforms. An analysis of variance showed that the interaction effect of vertical hand placement and hand separation on workers' maximum isometric strength was significant (p < 0.004). A hand location between elbow height and chest height with a hand separation distance of 46 cm (a conceptual, light-weight assistive bar) would allow workers to generate sufficient isometric strength (about twice that of the scaffold weight) to disassemble the typical 23 kg scaffolds while concurrently allowing them to mitigate the likelihood of postural imbalance.

Accidental Falls↗
PubMed2002

Face or hand, not both: perceptual correlates of reafferentation in a former amputee.

The topography of the somatosensory maps of our body can be largely shaped by alterations of peripheral sensory inputs. Following hand amputation, the hand cortical territory becomes responsive to facial cutaneous stimulation. Amputation-induced remapping, however, reverses after transplantation, as the grafted hand (re)gains its sensorimotor representation. Here, we investigate hand tactile perception in a former amputee by touching either grafted hand singly or in combination with another body part. The results showed that tactile sensitivity recovered rapidly, being remarkably good 5 months after transplant. In the right grafted hand, however, the newly acquired somatosensory awareness was strikingly hampered when the ipsilateral face was touched simultaneously, i.e., right face perception extinguished right hand perception. Ipsilateral face-hand extinction was present in the formerly dominant right hand 5 months after transplant and eventually disappeared 6 months afterwards. Control conditions' results showed that right hand tactile awareness was not extinguished either by contralateral left face and left hand stimulation or ipsilateral stimulation of the arm, which is bodily close to, but cortically far from, the hand. We suggest that ipsilateral face-hand extinction is a perceptual counterpart of the remapping that occurs after allograft and eyewitnesses the inherently competitive nature of sensory representations.

Adult↗
PubMed1996

Determinants of hand function in patients with rheumatoid arthritis.

OBJECTIVE: To investigate which clinical variables contribute to the function of the hand in activities of daily living (ADL) in patients with rheumatoid arthritis (RA). METHODS: In 50 patients with RA hand function in ADL was assessed by (1) the dexterity items of the Arthritis Impact Measurement Scales (AIMS), (2) direct observation of the same items by an occupational therapist, and (3) the Jebsen hand function test. A combined hand function factor was constructed by principal component analysis of the 3 hand function measures. Further assessments included measurements of muscle strength, deformity and destruction, range of motion, and local arthritis activity. After bivariate analyses, variables that correlated significantly with the measures of hand function were entered into stepwise multiple regression analyses. RESULTS: The variables having a significant correlation with most of the hand function measures were: pinch and grip strength, patient's assessment of pain and stiffness of the hands, flexion of the thumb and fingers, range of motion of the wrist, alignment of the metacarpophalangeal (MCP) joints, swan neck and Z deformities, and the Larsen erosion score. 78% of the variance of the combined hand function factor could be explained by pinch strength, stiffness of the hands, and the presence of Z deformity and ulnar deviation. CONCLUSION: Pinch and grip strength should be carefully considered in setting goals for conservative or surgical treatment of the rheumatoid hand. In addition, reported stiffness of the hands, malalignment of the MCP joints, and flexion and deformity of the thumb were the most consistent indicators of impaired hand function.

Activities of Daily Living↗
PubMed1999

Bacterial contamination of the hands of hospital staff during routine patient care.

BACKGROUND: Cross-transmission of microorganisms by the hands of health care workers is considered the main route of spread of nosocomial infections. OBJECTIVE: To study the process of bacterial contamination of health care workers' hands during routine patient care in a large teaching hospital. METHODS: Structured observations of 417 episodes of care were conducted by trained external observers (S.T. and V.S.). Each observation period started after a hand-cleansing procedure and ended when the health care worker proceeded to clean his or her hands or at the end of a coherent episode of care. At the end of each period of observation, an imprint of the 5 fingertips of the dominant hand was taken and bacterial colony counts were quantified. Regression methods were used to model the intensity of bacterial contamination as a function of method of hand cleansing, use of gloves during patient care, duration and type of care, and hospital ward. RESULTS: Bacterial contamination increased linearly with time on ungloved hands during patient care (average, 16 colony-forming units [CFUs] per minute; 95% confidence interval, 11-21 CFUs per minute). Patient care activities independently (P<.05 for all) associated with higher contamination levels were direct patient contact, respiratory care, handling of body fluid secretions, and rupture in the sequence of patient care. Contamination levels varied with hospital location; the medical rehabilitation ward had higher levels (49 CFUs; P=.03) than did other wards. Finally, simple hand washing before patient care, without hand antisepsis, was also associated with higher colony counts (52 CFUs; P=.03). CONCLUSIONS: The duration and type of patient care affect hand contamination. Furthermore, because hand antisepsis was superior to hand washing, intervention trials should explore the role of systematic hand antisepsis as a cornerstone of infection control to reduce cross-transmission in hospitals.

Bacteria↗
PubMed2000

Seeing or not seeing where your hands are.

Previous findings have demonstrated the existence of a visual peripersonal space centered on the hand in humans and its modulatory effects on tactile perception. A strong modulatory effect of vision on touch perception was found when a visual stimulus was presented near the hand. In contrast, when the visual stimulus was presented far from the hand, only a weak modulatory effect was found. The aim of the present study was to verify whether such cross-modal links between touch and vision in the peripersonal space centered on the hand could be mediated by proprioceptive signals specifying the current hand positions or if they directly reflect an interaction between two sensory modalities, i.e., vision and touch. To this aim, cross-modal effects were studied in two different experiments: one in which patients could see their hands and one in which vision of their hands was prevented. The results showed strong modulatory effects of vision on touch perception when the visual stimulus was presented near the seen hand and only mild effects when the vision of the hand was prevented. These findings are explained by referring to the activity of bimodal neurons in premotor and parietal cortex of macaque, which have tactile receptive fields on the hand, and corresponding visual receptive fields in the space immediately adjacent to the tactile fields. One important feature of these bimodal neurons is that their responsiveness to visual stimuli delivered near the body part is reduced or even extinguished when the view of the body part is prevented. This implies that, at least for the hand, the vision of the hand is crucial for determining the spatial mapping between vision and touch that takes place in the peripersonal space. In contrast, the proprioceptive signals specifying the current hand position in space do not seem to be relevant in determining the cross-modal interaction between vision and touch.

Aged↗