Feasibility of hand disinfection in paediatric advanced life support (PALS): A simulation study

Summary: Background: Hand disinfection is often omitted during emergencies because it may delay life-saving treatments. As healthcare-associated infections significantly worsen patient outcomes, the categorical omission of hand disinfection in emergencies should be re-evaluated. Real-world observations on this subject tentatively indicate compliance rates of 50% of scenarios. However, no comparable data have been published regarding emergencies in infants or children. Aim: This observational study aimed to assess the feasibility of hand disinfection in simulated paediatric patients requiring advanced life support (PALS). Methods: We observed 32 simulations of life-threatening conditions. Two observers counted all possible moments for administering hand hygiene, according to the World Health Organization protocol, and assessed them for time-neutral feasibility. Results: In the 32 scenarios, the feasibility of hand disinfection for all WHO moments ranged from 78.3 to 100%. Of all 573 hand disinfection moments, 552 (96.3%) were deemed feasible.Altogether 208 (36.3%) occurred before aseptic tasks. Of these, 187 (89.9%) were considered feasible. Hand disinfection for WHO-2 moments feasibility showed to be at least 50% in the cases. A total of 189 (90.9%) of all WHO-2 hand disinfections were applied by the role of the “iv-manager”. Scenarios with shockable rhythms and peri-arrest showed higher feasibility ratios than those without. Conclusions: The categorical omission of hand disinfection in PALS seems to be no longer acceptable or appropriate. The feasibility of hand hygiene should be re-evaluated in real-world scenarios.