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PubMed1990

Testosterone and hand skill in right-handed men and women.

The relationship between serum testosterone level and hand skill was studied in right-handed young adults. Hand preferences was assessed by the Edinburgh Handedness Inventory. Hand skill was assessed by the peg moving task. Serum testosterone level was determined using tritium-marked-radioimmunoassay. In the total sample, only the right-hand skill showed a direct correlation and an inverse correlation with serum testosterone for men and women, respectively. In male subjects with right-eye preference, both hand skills exhibited a direct relation to serum testosterone. In the total sample, there was a direct and an inverse relationship between the difference in skill between hands and serum testosterone in men and women, respectively. This was, however, affected by right-eye and right-foot preference. It was concluded that the serum testosterone in young adults is associated with hand skill exhibiting fundamental differences between men and women; the left cerebral hemisphere seems to be the main target of testosterone.

Adolescent↗
PubMed2004

Comparing the AUSCAN Osteoarthritis Hand Index, Michigan Hand Outcomes Questionnaire, and Sequential Occupational Dexterity Assessment for patients with rheumatoid arthritis.

OBJECTIVE: The Australian Canadian Osteoarthritis Hand Index (AUSCAN), Michigan Hand Outcomes Questionnaire (MHQ), and the Sequential Occupational Dexterity Assessment (SODA) are assessments of hand function. Investigation of psychometric properties, administration, acceptability, and content of an assessment add strength to the findings of research and treatment. We evaluated the validity and reliability of the AUSCAN, MHQ, and the SODA for assessing disability in patients with rheumatoid arthritis (RA). METHODS: Sixty-two patients with RA completed the AUSCAN (visual analog scale version), the MHQ, and the SODA. Seventeen patients repeated the assessments within one week. RESULTS: The assessments recorded high variability within the sample of 62 patients with RA. The AUSCAN and MHQ provided patient and context-specific information, while the SODA provided more impairment information that could be readily compared between patients. Seventeen patients were tested twice within 5 days, showing good reliability of all assessments. Unlike the MHQ, AUSCAN and SODA do not provide information about individual hands or hand dominance. The physical function scales of the AUSCAN and the SODA were related (r = 0.81), and the AUSCAN and MHQ pain scales were related (r = 0.68). CONCLUSION: Clinicians and researchers should decide whether impairment, ability, or handicap outcome is the goal of assessment, and whether bilateral function or the function of one hand is of interest before choosing a hand assessment. The AUSCAN and MHQ are valid and reliable for assessment of hand disability in patients with RA, and they allow the patients to answer questions about their home environment. The SODA is also valid and reliable for assessing disability in a clinical situation that cannot be generalized to the home.

Activities of Daily Living↗
PubMed2006

Radiation exposure of the hands and thyroid gland during percutaneous wiring of wrist and hand procedures.

The aim of this study was to investigate the radiation exposure of the hands and thyroid glands of orthopaedic surgeon and assistant during procedures involving percutaneous wiring of the hand and wrist. The radiation dose to the hand and thyroid glands was prospectively studied from a total of 30 percutaneous hand and wrist procedures. Four thermolucent densitometers were used to measure the radiation exposure. Cases were divided depending on fracture location (ie. wrist, metacarpal, phalangeal) and surgical experience (i.e. Senior House Officer, Registrar, Consultant). Mean radiation exposure in the hand for the surgeon was 0.80 mSv and 0.87 mSv for the assistant. There was a significant difference in the unshielded thyroid group compared to the shielded thyroid group (p < 0.05). The duration and number of exposure decreases with increasing experience. We also found a trend whereas we operate from proximal to distal (wrist to phalangeal), the total direct hand exposure increases. Radiation exposure in the hands and thyroid glands during percutaneous wiring of hand and wrist procedures were within the recommended limit. However, for the junior orthopaedic trainee, the risk of over radiating oneself is higher as the duration and number of exposure increases. We recommended the use of thyroid shield and adherence to the ALARA principle in any fluoroscopic assisted procedures. Routine monitoring of radiation exposure is essential in preventing radiation related disease.

Fluoroscopy↗
PubMed1997

[Recovery of the "instrument-hand" and the "communication-hand" in the hemiparetic child].

BACKGROUND: Rehabilitation techniques have always attached great importance to the recovery of hand functions in the different forms of child cerebral palsy. The human hand has complex structure and functions, and it can be defined as "instrument-hand", "expression-hand", "relation-hand" and "constant challenge to rehabilitation programmes. Among the most common techniques used today, neuromuscular facilitation allows the recovery only of the instrumental function, and cortical facilitation allows only the awareness of the motor learning. The psychomotor approach is aimed at a global recovery of the gesture, i.e. at the restoration of the movement neurophysiologic, relational and interactive aspects. Aim of this paper is to evaluate the possibility of restoring the hand communicative function in children with paresis. METHODS: Ten patients (6 males and 4 females; age range 20 months-8 years) with hemiparesis not associated with other disorders undergoing psychomotor therapy were compared with 10 controls (5 males and 5 females) undergoing traditional therapy (generally following Bobath). RESULTS: The communicative function of the hemiparetic hand was restored in 8 patients compared to 2 patients in the control group. CONCLUSIONS: Even though our series includes few cases and it is not possible to draw any definitive conclusion, it is reasonable to hypothesize that the psychomotor approach is a therapeutic model able to restore the hand complex functions.

Cerebral Palsy↗
PubMed2006

Attitudes of hand surgeons, hand surgery patients, and the general public regarding psychologic influences on illness.

PURPOSE: Psychologic influences on illness are well recognized but infrequently addressed in the interactions of hand surgeons and patients. This study assessed the attitudes of hand surgery patients and hand surgeons regarding psychologic influences on illness and compared their attitudes with those of the general population. METHODS: An 8-question survey regarding participant's attitudes toward psychologic influences on illness was given to the general public (people waiting in an airport), patients presenting to a hand surgery practice, and members of the American Society for Surgery of the Hand. RESULTS: A total of 474 surgeons, 85 patients, and 42 public participants completed the survey. There were no notable differences between patients and the general public, but the surgeons' attitudes were markedly different from both patients and the general public with respect to 4 items: the surgeons underestimated the openness of patients and the general public to discussing psychologic influences and willingness to see a psychologist or psychiatrist; and they were more supportive than the general public or patients regarding the opinion that the placebo effect reflects the strong influence of psychologic factors in healing and that psychologic stress often is expressed as a physical complaint. The distribution of patient responses showed 2 subgroups with respect to the idea that psychologic stress often is expressed as a physical complaint and with regard to willingness to see a mental heath professional, reflecting that a subset of patients with a hand illness may be resistant to these concepts. CONCLUSIONS: Hand surgery patients and the general public are not as aware of the psychologic influences on illness as are hand surgeons, but they are more willing to consider and discuss psychologic factors-and even psychologic treatment-than their surgeons realize. Surgeons' views may be colored by a few negative interactions with challenging patients, but a dialogue with our patients regarding the influence of psychologic issues on illness will be well received by most patients and may facilitate recovery.

Attitude of Health Personnel↗
PubMedDate not supplied

A comparison of "hands off" versus "hands on" techniques for decreasing perineal lacerations during birth.

Our goal was to determine the frequency, degree, and location of perineal lacerations and the neonatal outcomes associated with the use of two techniques of perineal protection--expectant ("hands off") and interventionist ("hands on")--during childbirth. We conducted a randomized controlled trial to compare the effectiveness of two techniques for perineum protection during spontaneous delivery. Study participants included 70 nulliparous expectant mothers, who were divided equally between the "hands off" and "hands on" groups (n = 35 per group). Perineal laceration occurred in 81.4% of the women. Among these, first-degree lacerations were predominant (82.5%). Lacerations in the anterior and posterior regions of the perineum occurred with similar frequencies. Laceration rates did not differ between the "hands off" and "hands on" groups (P > .05). Neonatal outcomes were similar in both groups. The use of "hands off" technique of perineal protection does not alter the frequency or degree of perineal lacerations in childbirth, relative to a "hands on" technique.

Adolescent↗
PubMed2000

Hand preference side and its relation to hand preference switch history among old and oldest-old adults.

The last 10 years of research on adult hand preference patterns have generated a controversy over the meaning of the difference in the incidence rates of left- and right-hand preference in older adult samples (> 60 years old) when compared to samples of younger individuals (< 30 years old). Age differences in hand preference prevalence often are studied with large, cross-sectional age samples; however, with 1 notable exception (Gilbert & Wysocki, 1992), these large samples frequently are dominated numerically by individuals below the age of 45 years. This study reports on hand preference data from a sample of 1,277 individuals between the ages of 65 and 100 years. Overall, the participants in this sample displayed an incidence of 93.1% right preference versus 6.9% left preference. However, the occurrence of age differences in right-hand use when the oldest-old adults (> 73 years old) were compared to the others in this sample were only apparent for writing hand preference. Variation in hand preference prevalence was related to whether an individual reported a history of attempts to switch preference toward the right side. These findings support the view that age-related variations in hand preference prevalence are best explained by a number of factors, the interaction of which is still not well understood (Hugdahl, Satz, Mitrushina, & Miller, 1993; Hugdahl, Zaucha, Satz, Mitrushina, & Miller, 1996).

Adult↗
PubMed2005

Interhead distance measurements in myosin VI via SHRImP support a simplified hand-over-hand model.

Myosin VI walks in a hand-over-hand fashion with an average step size of 30 nm, which is much larger than its 10 nm lever arm. Recent experiments suggest that the myosin VI structure has an unfolded and flexible region in the proximal tail which makes such a large step possible. In addition, cryoelectron microscopy images of actomyosin VI show the two heads bound to the actin monomers with a broad distribution of distances, including some as close as a few nanometers. This observation, when combined with the existence of a flexible region in the structure, which takes part in stepping, challenged the hand-over-hand model. In the hand-over-hand model, the lever arm is considered to be rigid and the interhead separation should not be very different from 30 nm. We considered an alternative model in which myosin VI heads sequentially take 60 nm steps whereas the interhead separation alternates between a large and small value (x and 60 - x, where x < 30). To clarify these issues, we used a new technique, SHRImP, to measure the interhead distance of nearly rigor myosin VI molecules. Our data show a single peak at 29.3 +/- 0.7 nm, in agreement with the straightforward hand-over-hand model.

Actins↗
PubMed2003

The effect of hand osteoarthritis on grip and pinch strength and hand function in postmenopausal women.

The aim of the study was to investigate the effect of osteoarthritis on hand function in postmenopausal women. One hundred patients with hand OA and 70 healthy volunteers as controls were evaluated. Grip and pinch strength measurements and Dreiser's functional index were used for hand function. Pain was assessed by a visual analog scale, and tenderness was assessed by palpation and scored, depending on the severity of tenderness, as 0, 1 or 2. Heberden's and Bouchard's nodules and joint involvement were also recorded. The number of patients with only distal interphalangeal joint involvement was 50 (50%), those with distal interphalangeal joint plus proximal interphalangeal joint involvement was 49 (49%), and those with carpometacarpal joint involvement numbered 18 (18%). The incidence of Heberden's and Bouchard's nodules was 85% and 36%, respectively. Eighty-six (86%) patients were suffering from pain and 57 were found to have tenderness. Grip and pinch strength was significantly lower (p<0.05) and Dreiser's functional index score was significantly higher (p<0.001) in the study group (particularly in grade 4 OA). Grip strength was lower in hand OA patients with distal interphalangeal joint plus proximal interphalangeal joint involvement than in those with only distal interphalangeal joint and carpometacarpal joint involvement. Pinch strength was also lower in patients with distal interphalangeal joint plus proximal interphalangeal joint plus carpometacarpal joint involvement. The patients with Heberden's and Bouchard's nodules had lower grip and pinch strength than controls. Also, pain and tenderness had significant (p<0.05) effects on hand function. Dreiser's total score ranged from 0 to 10 in 80 (80%) patients and from 11 to 20 in 20 patients. In conclusion, hand osteoarthritis contributes to hand dysfunction, mainly related to the severity of osteoarthritis, pain, joint involvement and the presence of nodules.

Aged↗
PubMed2000

Successful hand transplantation. One-year follow-up. Louisville Hand Transplant Team.

BACKGROUND: On the basis of positive results in studies of the transplantation of pig extremities and the information exchanged at an international symposium on composite tissue transplantation, we developed a protocol for human hand transplantation. METHODS: After a comprehensive pretransplantation evaluation and informed-consent process, the left hand of a 58-year-old cadaveric donor, matched for size, sex, and skin tone, was transplanted to a 37-year-old man who had lost his dominant left hand 13 years earlier. Immunosuppression consisted of basiliximab for induction therapy and tacrolimus, mycophenolate mofetil, and prednisone for maintenance therapy. RESULTS: The cold-ischemia time of the donor hand was 310 minutes. There were no intraoperative or early postoperative complications. Moderate acute cellular rejection of the skin of the graft developed 6, 20, and 27 weeks after transplantation. All three episodes resolved completely after treatment with intravenous methylprednisolone and topical tacrolimus and clobetasol. Temperature, pain, and pressure sensation had developed in the hand and fingers by one year. At one year, the patient had regained the ability to perform many functional activities with his left hand that he had not been able to perform with his prosthesis, such as throwing a baseball, turning the pages of a newspaper, writing, and tying his shoelaces. CONCLUSIONS: Early success has been achieved in hand transplantation with the use of currently available immunosuppressive drugs.

Adult↗
PubMed2000

[Study on early repair of destructive hand injury and reconstruction of hand function].

OBJECTIVE: To investigate a clinical method in repairing destructive hand injury and reconstructing hand function in early stage. METHODS: From January 1990 to June 1999, composite tissue transplantation was used to repair destructive hand damage and reconstruct hand function with vascular anastomosis in emergency (33 cases) or subemergency (126 cases). For the radial damage, combined flaps with toes was used to treat cicatricial contracture of thumb-web space. Opposing function of thumb was reconstructed by combined transplantation of short extensor muscle of great toe, short extensor muscle of toes or short abductor muscle of great toe in the same time of freeing the second toe. For no or deficient anastomosing vessels in donor site, "Y"--shaped reversal vein, anterograde bridging, or branches bridging of host vessels were applied. RESULTS: All of tissue transplantation were survived, including combined tissue transplantation in 51 cases, composite tissue transplantation in 4 cases, tissue transplantation after replantation of severed wrist and finger in 4 cases, there were no infection or necrosis in all cases, and hand function recovered well. CONCLUSION: It is an ideal procedure to repair destructive hand injury and reconstruct hand function by combined or composite tissue transplantation with vascular anastomosis in emergency or subemergency.

Adolescent↗
PubMed2004

Excitability changes in resting forearm muscles during voluntary foot movements depend on hand position: a neural substrate for hand-foot isodirectional coupling.

When associating hand and foot voluntary oscillations, isodirectional coupling is preferred irrespective of hand position (prone or supine). To investigate the neural correlates of this coupling modality, excitability of the motor projections innervating the resting forearm was tested during cyclic voluntary flexion-extensions of the ipsilateral foot. H-reflexes, in some experiments facilitated by subliminal Transcranial Magnetic Stimulation (TMS), and Compound Muscle Action Potentials (CMAPs), evoked by supraliminal TMS, were elicited in Flexor Carpi Radialis (FCR) and Extensor Carpi Radialis (ECR) muscles at five intervals during the foot movement cycle. With the hand prone, a sinusoidal excitability modulation was observed in wrist flexors and extensors, but reversed in phase: in FCR, excitability increased during plantar-flexion and decreased during dorsiflexion, while in ECR the opposite occurred. This reciprocal organisation was confirmed by the excitability modulation of CMAPs evoked simultaneously in the two antagonists. When the hand was supinated, the H-reflex modulation reversed in phase, i.e., FCR excitability increased during foot dorsiflexion and decreased during plantar-flexion. In both muscles and hand positions tested, when the muscle-to-movement phase-lag was increased by inertial loading of the foot, H-reflex excitability modulations remained phase linked to muscular contractions, not to movement. Together, these results suggest that the subliminal excitability modulation of hand movers has a common central origin with the parallel overt activation of foot movers, is reciprocally organised, and is direction- not muscle-dependent. It may therefore represent the neural substrate for isodirectional coupling of hand (prone or supine) with the foot.

Action Potentials↗
PubMed2004

Baby hands that move to the rhythm of language: hearing babies acquiring sign languages babble silently on the hands.

The "ba, ba, ba" sound universal to babies' babbling around 7 months captures scientific attention because it provides insights into the mechanisms underlying language acquisition and vestiges of its evolutionary origins. Yet the prevailing mystery is what is the biological basis of babbling, with one hypothesis being that it is a non-linguistic motoric activity driven largely by the baby's emerging control over the mouth and jaw, and another being that it is a linguistic activity reflecting the babies' early sensitivity to specific phonetic-syllabic patterns. Two groups of hearing babies were studied over time (ages 6, 10, and 12 months), equal in all developmental respects except for the modality of language input (mouth versus hand): three hearing babies acquiring spoken language (group 1: "speech-exposed") and a rare group of three hearing babies acquiring sign language only, not speech (group 2: "sign-exposed"). Despite this latter group's exposure to sign, the motoric hypothesis would predict similar hand activity to that seen in speech-exposed hearing babies because language acquisition in sign-exposed babies does not involve the mouth. Using innovative quantitative Optotrak 3-D motion-tracking technology, applied here for the first time to study infant language acquisition, we obtained physical measurements similar to a speech spectrogram, but for the hands. Here we discovered that the specific rhythmic frequencies of the hands of the sign-exposed hearing babies differed depending on whether they were producing linguistic activity, which they produced at a low frequency of approximately 1 Hz, versus non-linguistic activity, which they produced at a higher frequency of approximately 2.5 Hz - the identical class of hand activity that the speech-exposed hearing babies produced nearly exclusively. Surprisingly, without benefit of the mouth, hearing sign-exposed babies alone babbled systematically on their hands. We conclude that babbling is fundamentally a linguistic activity and explain why the differentiation between linguistic and non-linguistic hand activity in a single manual modality (one distinct from the human mouth) could only have resulted if all babies are born with a sensitivity to specific rhythmic patterns at the heart of human language and the capacity to use them.

Hand↗
PubMed2002

Hand action preparation influences the responses to hand pictures.

The relations between stimuli triggering a hand grasping movement and the subsequent action were studied in normal human participants. Participants were instructed to prepare to grasp a bar, oriented either clockwise or counterclockwise, and to grasp it as fast as possible on presentation of a visual stimulus with their right hand. The visual stimuli were pictures of the right hand as seen in a mirror. In Experiment 1, they represented the mirror image of the hand final posture as achieved in grasping the bar oriented either clockwise or counterclockwise. In Experiment 2, in addition to the pictures of Experiment 1, another two pictures, obtained rotating the hands represented in the previous ones of 90 degrees, were also used. Both experiments showed that the reaction times were faster when there was a similarity between hand position as depicted in the triggering visual stimulus and the grasping hand final position, the fastest responses being those where this similarity was the closest. In addition, Experiment 2 showed that reaction times to not rotated stimuli were faster than reaction times to the rotated stimuli, thus excluding a simple stimulus-response compatibility explanation of the findings. The data are interpreted as behavioral evidence that there is a close link between specific visual stimuli and specific motor actions. A neurophysiological model for this visuo-motor link is presented.

Adult↗
PubMed2003

The fragrance hand immersion study - an experimental model simulating real-life exposure for allergic contact dermatitis on the hands.

Recently, we showed that 10 x 2% of consecutively patch-tested hand eczema patients had a positive patch test to a selection of fragrances containing fragrances relevant to hand exposure. In this study, we used repeated skin exposure to a patch test-positive fragrance allergen in patients previously diagnosed with hand eczema to explore whether immersion of fingers in a solution with or without the patch-test-positive fragrance allergen would cause or exacerbate hand eczema on the exposed finger. The study was double blinded and randomized. All participants had a positive patch test to either hydroxycitronellal or Lyral (hydroxyisohexyl 3-cyclohexene carboxaldehyde). Each participant immersed a finger from each hand, once a day, in a solution containing the fragrance allergen or placebo. During the first 2 weeks, the concentration of fragrance allergen in the solution was low (approximately 10 p.p.m.), whilst during the following 2 weeks, the concentration was relatively high (approximately 250 p.p.m.), imitating real-life exposure to a household product like dishwashing liquid diluted in water and the undiluted product, respectively. Evaluation was made using a clinical scale and laser Doppler flow meter. 3 of 15 hand eczema patients developed eczema on the finger immersed in the fragrance-containing solution, 3 of 15 on the placebo finger and 3 of 15 on both fingers. Using this experimental exposure model simulating real-life exposure, we found no association between immersion of a finger in a solution containing fragrance and development of clinically visible eczema on the finger in 15 participants previously diagnosed with hand eczema and with a positive patch test to the fragrance in question.

Adult↗
PubMed2000

Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic.

OBJECTIVE: The objective of the study was to improve health care workers' compliance with hand hygiene after patient contact by use of an alcohol-based hand antiseptic. DESIGN AND METHODS: Six commercially available alcohol-based hand antiseptics were evaluated. The one most pleasing to the evaluators' hands was selected for the study. Baseline handwashing rates were assessed on 2 medical wards. Alcohol dispensers were mounted by every door on the 2 wards. An educational campaign was conducted with 4 weekly visits to these floors to remind and reinstruct staff about the use of the alcohol dispensers and to address questions. After 2 months handwashing rates were reassessed. SETTING: The study was set in a university hospital. RESULTS: The baseline handwashing rate was 60% (76/126). Physicians were most compliant (83%), followed by nurses (60%), technologists (56%), and housekeepers (36%). Two months later overall hand hygiene rates had decreased to 52% (P = .26). Nurses were most compliant (67%), followed by technologists (57%), physicians (29%), and housekeepers (25%). Physician compliance was associated with compliance by attending physicians whose example was usually followed by all other physicians on rounds. CONCLUSIONS: A brief educational campaign and installation of dispensers containing a rapidly acting hand hygiene product near hospital rooms did not affect hand hygiene compliance. The behavior of attending physicians was predictive of handwashing rates for all others in the attending's retinue. Compliance with handwashing after half of all patient contacts was a result of perfect compliance by some and total noncompliance by others being observed.

Anti-Infective Agents, Local↗
PubMed2005

Selective impairment of hand mental rotation in patients with focal hand dystonia.

Mental rotation of body parts determines activation of cortical and subcortical systems involved in motor planning and execution, such as motor and premotor areas and basal ganglia. These structures are severely impaired in several movement disorders, including dystonia. Writer's cramp is the most common form of focal hand dystonia. This study investigates whether patients affected by writer's cramp present with difficulties in tasks involving mental rotation of body parts and whether any impairments are specific to the affected hand or generalized to other body parts. For this purpose we tested 15 patients with right writer's cramp (aged 21-68 years, 8 women) and 15 healthy control subjects (10 women, age and education matched). Stimuli consisted of realistic photographs of hands and feet presented on a computer monitor in different orientations with respect to the upright canonical orientation. In each trial, subjects gave a laterality judgement by reporting verbally whether the presented body part was left or right. Two main results of the study are, firstly, writer's cramp patients are slower than controls in mentally rotating hands [F (1,28) = 5.4; P = 0.028] but not feet, and secondly, the pattern of response times to stimuli at various orientations suggests that the mental motor imagery of controls and patients reflects the type of processes and mechanisms called into play during actual execution of the same movements. In particular, increased difficulty in rotating right-sided stimuli at 120 degrees and left-sided stimuli at 240 degrees would suggest that mental rotation of body parts reflects the anatomical constraints of real hand movements. In conclusion, patients with writer's cramp presented mental rotation deficits specific to the hand. Importantly, deficits were present during mental rotation of both the right (affected) and the left (unaffected) hand, thus suggesting that the observed alterations may be independent and even exist prior to overt manifestations of dystonia.

Adult↗
PubMed2002

Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance.

OBJECTIVE: To evaluate the effects of the introduction of an alcohol-based hand gel and multifaceted quality improvement (QI) interventions on hand hygiene (HH) compliance. DESIGN: Interventional, randomized cohort study with four study phases (baseline; limited intervention in two units; full intervention in three units; washout phase), performed in three intensive care units at a pediatric referral hospital. METHODS: During 724 thirty-minute daytime monitoring sessions, a nonidentified observer witnessed 12,216 opportunities for HH and recorded compliance. INTERVENTIONS: Introduction of an alcohol-based hand gel; multifaceted QI interventions (educational program, opinion leaders, performance feedback). RESULTS: Baseline compliance decreased after the first 2 weeks of observation from 42.5% to 28.2% (presumably because of waning of a Hawthorne effect), further decreased to 23.3% in the limited intervention phase and increased to 35.1% after the introduction of a hand gel with QI support in all three units (P < 0.001). The rise in compliance persisted in the last phase (compliance, 37.2%); however, a gradual decline was observed during the final weeks. Except for the limited intervention phase, compliance achieved through standard handwashing and glove use remained stable around 20 and 10%, respectively, whereas compliance achieved through gel use increased to 8% (P < 0.001). After adjusting for confounding, implementation of the hand gel with QI support remained significantly associated with compliance (odds ratio, 1.6; 95% confidence interval, 1.4 to 1.8). In a final survey completed by 62 staff members, satisfaction with the hand gel was modest (45%). CONCLUSIONS: We noted a statistically significant, modest improvement in compliance after introduction of an alcohol-based hand gel with multifaceted QI support. When appropriately implemented, alcohol-based HH may be effective in improving compliance.

Alcohols↗