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Interactions between lateralized choices of hand and target.

Few studies have examined interactions between hand preference and target laterality preference when subjects are permitted unrestricted choices of both hand and target at the same time. We therefore trained three monkeys to perform a task in which different types of choices were presented in different trials. In some trials the monkey chose between targets presented simultaneously to the right and left, while being required to use a specific hand. In these trials, the monkeys preferentially chose the target ipsilateral to the required hand. In other trials, the monkey chose between its right or left hand to retrieve a single target presented either on the right or on the left. In these trials, each monkey showed a consistent pattern of hand preference whether the target was presented on the right or left. In still other trials, the monkey chose both which hand to use and which target to retrieve. In these trials, the choices made by each monkey reflected its individual pattern of hand preference, plus a tendency to choose the target ipsilateral to the preferred hand, with little additional evidence of preference for target laterality. These patterns of laterality preference were similar regardless of whether a cue instructing which hand(s) the monkey could use preceded or followed a cue indicating on which side(s) the target(s) would appear. If the monkeys were permitted to use a strategy in which retrieving the target on a given side could increase the amount of food retrieved per trial, however, the choices made were biased strongly by that strategy. We conclude that when lateralized targets are equivalent, lateralized choices are biased primarily by hand preference and secondarily by a preference to retrieve a target ipsilateral to the preferred hand.

Animals↗

Corticomotor excitability during a choice-hand reaction time task.

Fourteen neurologically healthy, right-handed subjects performed a choice-hand reaction time (RT) task, which involved wrist flexion or extension of either the left or right hand to one of three fixed target locations corresponding to 45 degrees flexion, 20 degrees flexion, or 20 degrees extension from the starting position. In each trial, a pre-cue provided information regarding the forthcoming target location. The hand was specified by the imperative signal. Focal transcranial magnetic stimulation (TMS) was delivered over the hand motor area of either the right or left hemisphere at set times during the foreperiod, and at random intervals during the RT interval defined by electromyography onset. As expected, an increase in corticomotor excitability was observed in the agonist of the responding hand over the RT interval. When the cue appeared at a location that required flexion with either hand, an increase in excitability was observed following stimulation over the hemisphere ipsilateral to the responding hand, indicating activation of the homologous muscle. However, when the cue appeared at a location at which the response would require flexion with one hand and extension with the other, the modulation of excitability was also based on the direction of the response. This direction-specific effect was only observed for TMS delivered to the left hemisphere during the left-hand movement, and suggested goal-based preparation in the left hemisphere independent of whether the actual movement is made with the right or left hand. These results indicate that both the homologous-muscle and the directional-specific constraints affect the corticomotor excitability of the non-responding hand.

Adult↗

Enhanced MR imaging of tenosynovitis of hand and wrist in inflammatory arthritis.

OBJECTIVE: The purpose of this study is to describe the appearance of tenosynovitis in various tendon groups in the wrist and hand and to compare MR enhanced and non-enhanced imaging evaluation of tenosynovitis of hand and wrist in inflammatory arthritis. DESIGN AND PATIENTS: We reviewed 72 MRI studies of hands and wrists, including coronal, axial and sagittal images in 30 consecutive patients with inflammatory arthritis and tenosynovitis. We compared the degree of synovitis on T2-weighted vs contrast-enhanced T1-weighted images, using a predetermined scale. We also measured the extent of tenosynovitis in three dimensions. The tendons were assigned to volar, dorsal, ulnar and radial groups in the wrist and to extensor, flexor and thumb groups in the hand. Degree of tenosynovitis (graded 0-3), cross-sectional area and volume of the inflamed synovium in various tendon groups were then compared by statistical analysis. RESULTS: Review of the medical records revealed the following diagnoses in our patient population: rheumatoid arthritis (n=16), unspecified inflammatory polyarthritis (n=9), psoriatic arthritis (n=2), CREST syndrome (n=1), systemic lupus erythematosus (n=1), paraneoplastic syndrome with arthritis (n=1). The average T2 brightness scores and post-gadolinium enhancement scores were 1.0 and 1.7, respectively (P<0.001) in the wrist studies. The average T2 brightness scores and post-gadolinium enhancement scores were 0.7 and 1.4, respectively (P<0.001) in the hand studies. The average sensitivity of T2-weighted imaging for detection of tenosynovitis was 40% in the hand and 67% in the wrist tendons, when contrast-enhanced images were used as a reference. Carpal tunnel flexor tendons were the most frequently affected tendons of the wrist. The most frequently affected tendons of the hand were second and third flexor tendons. The hand flexors demonstrated higher degrees of enhancement and larger volumes of the inflamed tenosynovium than did the hand extensors and tendons of the thumb. CONCLUSION: Enhanced MR imaging of the hand and wrist is a superior technique for detection of tenosynovitis. We observed carpal tunnel flexor tendons to be the most frequently affected tendons of the wrist. The flexor tendons of the second and third digits were the most frequently affected tendons of the hands. Higher contrast-enhancement scores and inflammation were noted in the hand flexor than in the extensor tendons.

Adult↗

Benefits of hand-assisted laparoscopic restorative proctocolectomy: a comparative study.

PURPOSE: Hand-assisted laparoscopic colectomy is thought to facilitate colonic mobilization while maintaining the benefits of laparoscopic surgery. Although previous studies of hand-assisted colectomy have focused on segmental colonic resection, the use of hand-assisted laparoscopic restorative proctocolectomy has not been investigated. This study evaluated the effectiveness of hand-assisted laparoscopic approach compared with a conventional laparoscopic method in patients undergoing restorative proctocolectomy. METHODS: From a prospective database, a consecutive series of patients were identified undergoing conventional and hand-assisted laparoscopic restorative proctocolectomy and results were compared. Twenty-three patients, comprising 10 hand-assisted and 13 conventional laparoscopic patients, were identified. Patient characteristics, perioperative parameters, and outcomes were assessed. RESULTS: Both groups were well matched with no differences in age, gender, body mass index, operative indication, diagnosis, comorbidity, or steroid usage. There were no differences among incision size between the hand-assisted (8 (range, 8-20) cm) and conventional laparoscopic cases (8 (range, 5-10) cm). The median operative time was significantly shorter in the hand-assisted group (247 (range, 210-390) minutes) compared with the conventional laparoscopic group (300 (range, 240-400) minutes; P < 0.01). The length of stay was similar between groups (hand-assisted: 4 (range, 3-13) days vs. conventional: 6 (range, 4-17) days). Complications occurred in four hand-assisted patients (40 percent; 2 ileus, mechanical obstruction, and dehydration) and in four patients undergoing conventional laparoscopic method (31 percent; 2 anastomotic leak, ileus, and mechanical obstruction). CONCLUSIONS: Compared with conventional laparoscopic restorative proctocolectomy, the hand-assisted method resulted in a significant reduction in operative time without detriment to bowel function, length of stay, or patient outcome. The hand-assisted approach to restorative proctocolectomy is likely to replace conventional laparoscopic methods as the preferred laparoscopic approach for this technically challenging procedure.

Adolescent↗

Hand preference and performance effects on line bisection.

Right- and left-handed subjects performed a visual line bisection task with each hand. When bisecting horizontal lines, both groups bisected left of true center regardless of hand used. Regardless of hand preference, bisections were significantly left of center only when subjects performed with their left hand. Left-handed subjects using their left hand deviated significantly further left than right-handed subjects using their left hand. Regardless of hand used, right-handers bisected vertical lines significantly above veridical center. Left-handed subjects were not significantly above center with either hand. The results require both hemispheric advantage and lateralized activation effects for a complete explanation.

Adult↗

Visual line bisection in sinistrals and dextrals as a function of hemispace, hand, and scan direction.

Visual line bisection was investigated in 26 sinistral and 24 dextral subjects as a function of hemispace, hand and scan direction. An ANOVA revealed significant main effects for hand preference, due to the mean bisection errors of dextral subjects being significantly leftward of those of sinistral subjects; for hand, due to the bisection errors of the left hand being significantly to the left of the right hand; and for scan, due to the bisection errors following a left scan being significantly to the left of a right scan. One significant interaction was found, that between hand and direction of scan, due to a significant difference between left and right hands following a scan from the left but not following a scan from the right. For dextral subjects the leftward bisection errors of the left and right hands following a scan from the left, but not for a scan from the right, differed significantly from the midpoint. For sinistral subjects the leftward bisection errors following a scan from the left and rightward bisection errors following a scan from the right differed significantly from the midpoint for the left hand but not for the right hand. No significant main effect or interactions for hemispace were found. This confirms that both sinistral and dextral subjects display pseudoneglect when using their preferred hand and scanning from the left. However, sinistrals, but not dextrals, will display reversed pseudoneglect when using their preferred hand and adopting a scan direction from the right. These results are discussed in terms of the interaction between three factors, whose influence can jointly and severally produce misbisections, hemispheric specialisation for visuospatial function, hemispheric activation for a manual response, and the allocation of visual attention.

Adult↗

Expectation of pain replicates the effect of pain in a hand laterality recognition task: bias in information processing toward the painful side?

BACKGROUND: People in pain, or expecting pain, sometimes bias their attention towards pain-relevant cues. Perhaps they also bias their attention towards the body part in question. AIM: To determine if experimentally induced pain, and the expectation of pain, involve an information processing bias towards the hand in question. METHODS: Seventeen asymptomatic subjects performed a hand laterality recognition task during three conditions: control, during hand pain induced by intramuscular injection of hypertonic saline (pain), and during expectation of hand pain, induced by isotonic saline injection (expectation). Mean response time (RT) was determined for three 45 s epochs within each condition and RT was compared between hands, conditions and epochs using a 2 x 3 x 3 repeated measures multivariate analysis of variance. RESULTS: There was a hand x condition interaction and a hand x condition x epoch interaction (p<0.05 for both). RT to recognise the opposite hand was approximately 600 ms longer during epochs when subjects were in pain or expected pain than during control trials. During those epochs, RT to recognise the opposite hand was approximately 600 ms longer than RT to recognise the injected hand, which was consistent across conditions and across epochs. CONCLUSIONS: Both pain and the expectation of pain increased RT to recognise the opposite hand. The findings are consistent with a bias in information processing toward the painful or impending painful hand.

Adult↗

European norms in hand hygiene.

In the area of hand hygiene, European Norms exist, or are under development, with regard to protective gloves and for assessing the antimicrobial efficacy of hand disinfectants. Important norms for gloves are EN 420 (General requirements), EN 374 (Protective gloves against chemicals and microorganisms) and EN 455 (Medical gloves for single use). A suspension test for the demonstration of bactericidal activity (prEN 12054) is obligatory for hand disinfectants in all fields of application; a test to prove activity against yeasts applies only to hygienic hand rub. (Optional) Claims for virucidal activities can be substantiated by prEN 1476 and, in future, for mycobactericidal capacity by a test which is still under development. In vivo tests exist for post-contamination treatments, hygienic hand wash and hygienic hand rub (EN 1499 and EN 1500 respectively), and for the preoperative surgical hand rub/wash (prEN 12791). The two former tests employ artificially contaminated hands, the latter test is done with clean hands. All in vivo tests use reference hand treatments (with unmedicated soap or 2-propanol 60% (vol.) or 1-propanol 60% (vol.), respectively) against the results of which are compared with those achieved with the product under test and with the same volunteers. An antiseptic soap needs to be significantly more efficacious than unmedicated soap, a product for hygienic hand rub must not be inferior to the reference treatment with 2-propanol, and a surgical hand disinfectant must not cause a smaller bacterial reduction than the reference preparation with 1-propanol, immediately, and after 3 h. An (optional) claim for sustained activity of a surgical disinfectant needs to be demonstrated by achieving a significantly stronger bacterial reduction after 3 h than the reference preparation.

Disinfectants↗

The abdominal flap using scarred skin in the treatment of postburn hand deformities of severe burn patients.

PURPOSE: To present a random-pattern flap technique using scarred skin from the abdominal wall to cover the defect after burn scar was released from the hand and the scarred skin raised from the hand was transferred to the abdominal wall to cover the flap-donor area in patients who suffered from severe burns involving the entire body and had no available healthy skin to be used for coverage. METHODS: Ten hands of 7 patients (5 males, 2 females) were treated in our department between April 1994 and February 2001. The total body surface area involved with second-or third-degree burns was 85% to 96% and there was no available healthy skin to be used for reconstruction. All hands had severe scar contracture on the dorsum and lost most of their function and the patients lost the ability to take care of themselves. The scarred skin on the dorsum of the hand was elevated integrally as a flap based on the ulnar border of the hand. The tendons were released, the stiff metacarpophalangeal joints were mobilized by closed capsulotomies, and the contracture of the thumb web space was released. A random-pattern abdominal flap using scarred skin was designed and elevated to cover the defect of the scar-released hand and the scarred skin raised from the dorsum of the hand was transferred to cover the defect of the abdominal flap donor site. RESULTS: The flaps that were transferred to the dorsum of the hands survived entirely and the defects of the flap donor area were covered perfectly without further skin graft. All patients were evaluated for 0.5 to 4 years after surgery. The range of motion of the metacarpophalangeal joints and the space capacity of the thumb web were improved greatly. All patients regained the ability to take care of themselves. CONCLUSIONS: This method is simple and has satisfactory results. It appears from our experience that the mature postburn scarred skin on the abdomen can be used for a flap procedure for reconstructing the burned hand and that the scarred skin raised from the dorsum of the hand can be transferred to cover the flap donor sites on the abdomen. Under circumstances in which there is no normal skin for reconstruction the function of the burned hand could be improved greatly by this method.

Adolescent↗

Radiation exposure to the hands from mini C-arm fluoroscopy.

PURPOSE: To quantify the level of radiation exposure to the hands of hand surgeons using intraoperative mini C-arm fluoroscopy and to compare the actual level of exposure with predicted levels and acceptable limits. METHODS: Five hand surgeons were given ring dosimeters to measure radiation exposure to their hands during surgery of the finger, hand, and wrist. A total of 81 rings were analyzed. After the clinical study a phantom was used to measure scatter at close range from the mini C-arm. RESULTS: Surgeons' hands were exposed to an average +/- SD of 20 +/- 12.3 mrem/case. For comparison a chest x-ray results in approximately 20 mrem exposure to the patient. Radiation exposure for the group of hand surgeons ranged from 5 to 80 mrem. Surgeons used an average of 51 +/- 36.9 seconds of fluoroscopy time per case. Exposure time for the group ranged from 6 to 170 seconds. The radiation scatter rate decreases precipitously outside the beam or beyond the radius of the intensifier. An average exposure to the hands of 20 mrem/case suggests that surgeons' hands must be entering the beam and getting direct exposure. CONCLUSIONS: Hand surgeons work close to the beam and as a result their hands potentially are exposed to a nontrivial amount of radiation. We recommend that surgeons who use the mini C-arm use precautions to minimize radiation exposure, particularly to their hands.

Fluoroscopy↗

A hand-ergonomics training kit: development and evaluation of a package to support improved awareness and critical thinking.

A need for a hand-ergonomics training kit has been identified to increase critical thinking concerning choice of hand tools. This study deals with the design, use and evaluation of a hand-ergonomics training kit for use in ergonomics training programmes. The effects on awareness of hand ergonomics among training course participants have been evaluated by means of a questionnaire and interviews at a car production plant in Sweden. The evaluation was carried out about one and a half years after training with the hand-ergonomics training kit. The training kit consists of a guide to practical exercises, equipment for measuring hand size and strength, examples of hand tools for use in practical exercises, equipment for testing and evaluating the hand tools and checklists and judgement forms for qualitative evaluation. In addition, the kit contains relevant scientifically based reference reports on hand ergonomics. The evaluation showed that the practical exercises with the hand-ergonomic training kit had, to a remarkable extent, increased individuals' awareness of anthropometric differences and of the importance of ergonomically well-designed hand tools. After the practical exercises with the training kit, communication within the plant when choosing hand tools seems to be based on objective criteria to a higher degree, however, the results indicate that this communication could be further improved.

Analysis of Variance↗

Potential confounding effect of hand-warming on the measurement of insulin sensitivity.

1. Hand-warming is employed during metabolic studies to "arterialize' venous blood, but also has systemic haemodynamic effects. Study 1 aimed to determine if hand-warming affects the value for whole-body insulin sensitivity derived from the hyperinsulinaemic euglycaemic clamp technique. Study 2 was designed to assess the effect of hand-warming on contralateral forearm blood flow. 2. In study 1, eight healthy male subjects attended for four modified euglycaemic clamp studies, during which the right hand was placed in a heated-air hand box (55 degrees C), and the glucose infusion rate was adjusted according to blood samples from a cannula in either an ipsilateral dorsal hand vein or a contralateral antecubital vein with the box switched either on or off. In study 2, five healthy subjects attended two study days when the effect of 2 h of hand-warming (or control) on contralateral forewarm blood flow was measured. 3. Study 1; when clamps were performed according to samples taken from the contralateral antecubital vein, insulin sensitivity values were significantly lower during box-on versus box-off clamps (mean +/- SD 10.2 +/- 3.0 versus 13.0 +/- 3.8 mg min-1 kg-1, P < 0.05, 95% confidence interval -0.2, -5.3). When clamps were performed according to samples taken from the ipsilateral hand, there was no difference in insulin sensitivity during box-on versus box-off clamps (9.2 +/- 2.1 versus 9.0 +/- 1.7 mg min-1 kg-1, P not significant, 95% confidence interval -0.5, +0.9). There was a mean increase in heart rate of 6 beats/min in the box-on conditions (P < 0.05, analysis of variance). Study 2; forearm blood flow in the contralateral arm during hand-warming was significantly higher than in the control condition (P < 0.05, analysis of variance), although heart rate was similar on both study days. 4. Hand-warming had a detectable effect on insulin sensitivity when clamps were performed according to samples withdrawn from the contralateral arm, but no measurable effect when clamps were performed in the conventional manner. In addition, hand-warming increased heart rate during hyperinsulinaemia and contralateral FBF under basal conditions. These findings raise concern about unwanted (potentially confounding) systemic haemodynamic effects of hand-warming on the measurement of insulin sensitivity and insulin-mediated vasodilation.

Blood Glucose↗

Hygienic hand antiseptics: should they not have activity and label claims against viruses?

Enteric and respiratory viruses are among the most frequent causes of human infections, and hands play an important role in the spread of these and many other viral diseases. Regular and proper hand hygiene by caregivers and food handlers in particular is essential to decontaminate hands and potentially interrupt such spread. What would be considered a proper decontamination of hands? Handwashing with regular soap and water is often considered sufficient, but what of hygienic handwash and handrub antiseptic products? Are they more effective? The evidence suggests that some clearly are. Activity against bacteria may not reflect the ability of hygienic hand antiseptics to deal with viruses, especially those that are nonenveloped. In spite of the acknowledged importance of hands as vehicles for viruses, there is a lack of suitable regulatory mechanism for handwash or handrub products to make claims of efficacy against viruses. This is in contrast with the ability of general-purpose disinfectants to make antiviral claims, although transmission of viruses from surfaces other than those of reusable medical devices may play only a minor role in virus transmission. This review discusses the (1). recent information on the relative importance of viruses as human pathogens, particularly those causing enteric and respiratory infections; (2). the survival of relevant viruses on human hands in comparison with common gram-negative and gram-positive bacteria; (3). the potential of hands to transfer or receive such contamination on casual contact; (4). role of hands in the spread of viruses; (5). the potential of hygienic measures to eliminate viruses from contaminated hands; (6). relative merits of available protocols to assess the activity of hygienic hand antiseptics against viruses; and (7). factors considered crucial in any tests to assess the activity of hygienic hand antiseptics against viruses. In addition, this review proposes surrogate viruses in such testing and discusses issues for additional consideration by researchers, manufacturers, end-users, and regulators.

Anti-Infective Agents, Local↗

Nicotine exposure and decontamination on tobacco harvesters' hands.

Green tobacco sickness is an illness associated with nicotine exposures among tobacco harvesters. Agricultural workers manually harvest tobacco and thus have the potential for skin exposure to nicotine, particularly on the hands. Often gloves are not worn as it hinders the harvesters' ability to harvest the tobacco leaves. The purposes of this study were to measure the concentration of nicotine residue on the hands of tobacco harvesters and the effectiveness of hand washing at removing the residue. Wipe samples from the hands of 12 tobacco harvesters were collected at the end of morning and afternoon work periods over two consecutive days. Each harvester had one hand wiped before washing his hands, and the other hand wiped after washing his hands with soap and water. Eight samples per worker were collected over the two days for a total of 96 samples collected. In addition to the hand-wipe samples, leaf-wipe samples were collected from 15 tobacco plants to estimate the amount of nicotine residue on the plants. The average nicotine level in leaf-wipe samples was 1.0 microg cm(-2). The geometric mean pre-wash and post-wash nicotine levels on the hands were 10 and 0.38 microg cm(-2), respectively. Nicotine leaf-wipe level, right or left hand and time of sampling did not significantly influence exposure. Job position-working on the bottom versus the top of the tobacco harvesting machine-was associated with nicotine levels. Pre-wash nicotine levels were higher for workers on the bottom of the harvester but not significantly higher (P = 0.17). Post-wash nicotine levels were significantly higher for workers on the bottom of the harvester (P = 0.012). A substantial amount of nicotine was transferred to the hands, but washing with soap and water in the field significantly reduced nicotine levels by an average of 96% (P < 0.0001).

Agriculture↗

Temporal evolution and strength of neural activity in parietal cortex during eye and hand movements.

The role of area 7a in eye-hand movement was studied by recording from individual neurons while monkeys performed 7 different tasks, aimed at assessing the relative influence of retinal, eye, and hand information on neural activity. Parietal cell activity was modulated by visuospatial signals about target location, as well as by information concerning eye and/or hand movement, and position. The highest activity was elicited when the hand moved to the fixation point. The population activities across different memory tasks showed common temporal peaks when aligned to the visual instruction (visuospatial peak) or Go signal (motor peak) for eye, hand, and coordinated eye-hand movement. The motor peak was higher for coordinated eye-hand movement, and it was absent in a No-Go task. Two activation maxima were also observed during visual reaching. They had the same latency of the visuospatial and motor peaks seen in the memory tasks. Therefore, area 7a seems to operate through a common neural mechanism underlying eye, hand, or combined eye-hand movement. This mechanism is revealed by invariant temporal activity profiles and is independent from the effector selected and from the presence or absence of a visible target during movement. For comparative purposes, we have studied the temporal evolution of the population activity in the superior parietal lobule (SPL) during the same reaching tasks and during a saccade task. In SPL, the population activity was characterized by a single peak, time locked to the Go signal for eye, hand, or combined eye-hand movement. As in IPL, the time of occurrence of this peak was effector independent. The population activity remained unchanged when the position of the eye changed, suggesting that SPL is mostly devoted to the hand motor behavior.

Animals↗

A multicentric survey of the practice of hand hygiene in haemodialysis units: factors affecting compliance.

BACKGROUND: This study intended to investigate the degree of compliance with hand hygiene and use of gloves by health workers in haemodialysis (HD) units, and the factors that influenced adherence to hand hygiene protocols. METHODS: During the month of November 2003, one person observed the health care staff in each of nine different dialysis units, during 495 randomly distributed 30 min observation periods that covered all steps of a haemodialysis session (connection, dialysis and disconnection). The observers noted the number of potential opportunities to implement standard precautions and the number of occasions on which the precautions were actually taken. Adherence to standard precautions was evaluated, analysing the influence of the following variables: the patient-to-nurse ratio, the number of HD shifts scheduled per day, acute HD units vs chronic, whether or not infectious patients were isolated and in-house vs contract cleaning personnel. RESULTS: There were a total of 977 opportunities to wear gloves for, and to wash the hands following, a patient-oriented activity, and 1902 opportunities to wash hands before such an activity. Gloves were actually used on 92.9% of these occasions. Hands were washed only 35.6% of the time after patient contact, and only 13.8% of the time before patient contact. Poor adherence to hand washing was associated with the number of shifts per HD unit per day and with higher patient-to-nurse ratios. In the acute HD units, there was greater adherence to standard precautions than in the chronic units, although there too it was substandard. The personnel's knowledge of patients' infectious status did not modify their adherence to hand hygiene practices. A higher patient-to-nurse ratio independently influenced hand washing both before and after patient contact. CONCLUSIONS: The overall adherence of health care workers to recommended hand washing practices is low. Whether or not programmes promoting higher hand hygiene standards and the potential use of alcohol-based hand cleansers will improve hand hygiene practices in HD units requires further investigation.

Cross Infection↗

Decreasing hospital-associated rotavirus infection: a multidisciplinary hand hygiene campaign in a children's hospital.

OBJECTIVE: Hand hygiene is an effective means of preventing hospital-associated infection, but compliance among health care workers is poor. Few studies aimed at increasing hand hygiene in the hospital setting have shown sustained improvement and concurrent decreases in hospital-associated infections, and even fewer have been performed in the pediatric setting. METHODS: We implemented a hand hygiene program with the hopes of improving hand hygiene and decreasing hospital-associated rotavirus infection rates. A multidisciplinary group developed a hospital supported, house-wide campaign. Opportunities for hand hygiene were observed during 5 periods. The frequency of hospital-associated rotavirus infection was tracked over time by review of laboratory records. Correlates of hand hygiene were investigated with the use of multivariate logistic regression. RESULTS: Overall hand hygiene compliance improved from 62% in period 1 to 81% in period 5 (P < 0.001). Soap and water was the most common method for practicing hand hygiene, and alcohol hand gel use increased from 4% to 29% between the first and last observation periods (P < 0.001). The rate of hospital-associated rotavirus infection decreased from 5.9 episodes per 1000 discharged patients in 2001 to 2.2 episodes per 1000 discharged patients in 2004 (P = 0.01). Period of observation, hospital ward, type of care provider and type of care performed were all independently associated with hand hygiene (adjusted P < or = 0.02 for all). CONCLUSION: Improving hand hygiene is an important goal for health care institutions. These data can be useful for development of interventions aimed at improving hand hygiene.

Age Distribution↗

Arsenic on the hands of children after playing in playgrounds.

Increasing concerns over the use of wood treated with chromated copper arsenate (CCA) in playground structures arise from potential exposure to arsenic of children playing in these playgrounds. Limited data from previous studies analyzing arsenic levels in sand samples collected from CCA playgrounds are inconsistent and cannot be directly translated to the amount of children's exposure to arsenic. The objective of this study was to determine the quantitative amounts of arsenic on the hands of children in contact with CCA-treated wood structures or sand in playgrounds. We compared arsenic levels on the hands of 66 children playing in eight CCA playgrounds with levels of arsenic found on the hands of 64 children playing in another eight playgrounds not constructed with CCA-treated wood. The children's age and duration of playtime were recorded at each playground. After play, children's hands were washed in a bag containing 150 mL of deionized water. Arsenic levels in the hand-washing water were quantified by inductively coupled plasma mass spectrometry. Our results show that the ages of the children sampled and the duration of play in the playgrounds were similar between the groups of CCA and non-CCA playgrounds. The mean amount of water-soluble arsenic on children's hands from CCA playgrounds was 0.50 microg (range, 0.0078-3.5 microg). This was significantly higher (p < 0.001) than the mean amount of water-soluble arsenic on children's hands from non-CCA playgrounds, which was 0.095 microg (range, 0.011-0.41 microg). There was no significant difference in the amount of sand on the children's hands and the concentration of arsenic in the sand between the CCA and non-CCA groups. The higher values of arsenic on the hands of children playing in the CCA playgrounds are probably due to direct contact with CCA-treated wood. Washing hands after play would reduce the levels of potential exposure because most of the arsenic on children's hands was washed off with water. The maximum amount of arsenic on children's hands from the entire group of study participants was < 4 microg, which is lower than the average daily intake of arsenic from water and food.

Arsenates↗