Nosocomial
and Surgical Infections, and Clinical Epidemiology - Hand Hygiene: Ruba-Dub-Dub
Abstract: K-1098
Citation: 42nd ICAAC Abstracts, American Society for Microbiology, September 27 - 30, 2002, San Diego, CA, page 323.
The Evidence: Hand Hygiene Impacts Nosocomial Infection Rates.
S. SWOBODA1, S. LANE2, K. STRAUSS2,
P. LIPSETT1
1Johns Hopkins, Balt, MD, 2Amron Corp, McLean, VA.
Background: Nosocomial infections (NI) occur in 8-10%
of all hospital admissions and can be related to poor infection control
procedures such as hand hygiene (HH). We hypothesized that a HH intervention
would result in decreased rates of NI on a surgical intermediate care unit
(IMC).
Methods: A 3 phase study with electronic monitoring
of HH behavior. Phase I baseline observation, Phase II intervention with
voice prompts for HH, Phase III post intervention observation. This is a
9 patient room, 14 bed unit caring for general postoperative patients. All
patients with a 48 hour IMC length of stay (LOS) were followed specifically
for IMC acquired NI (IMCacqNI). NI definitions were strictly defined per
hospital and CDC guidelines and included bacteremia, vascular catheter colonization,
urinary tract infection, respiratory and surgical site infection.
Results: NI in Phase II and III compared to Phase I (baseline).
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Overall NI rate
# NI/total admits
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Overall IMC acq NI rate = # IMC acq NI/total admits
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Overall NI adjusted for pt days
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Overall IMC acq NI adjusted for pt days
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Phase I
|
103/790
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74/790
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103/1616
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74/1616
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(6 mo)
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1.0
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1.0
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1.0
|
1.0
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Phase II
|
80/784
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59/784
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80/1390
|
59/1390
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(6 mo)
|
0.75 (0.55, 1.03)
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0.78 (0.54, 1.11)
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0.89(0.66, 1.21)
|
0.92(0.65 ,1.3)
|
Phase III
|
20/301
|
17/301
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20/543
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17/543
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(2.5 mo)
|
0.49 (0.29, 0.81)
|
0.58 (0.33, 1.00)
|
0.56 (0.34, 0.92)
|
0.66 (0.39, 1.14)
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NI rates decreased in the active intervention and continued to decrease
in the post intervention. For overall NI rate, IMCacqNI and NI adjusted for
patient days, the point estimates fell during Phase II and III. A significant
decrease occurred during Phase III. Wide CI were most likely an effect of
sample size.
Conclusions: Overall NI infection rates can decrease
with HH intervention. NI rates continued to decrease over time suggesting
a lasting effect (>2.5mo) of the intervention. Supported by Amron Corporation
and NIH grant 2 R44MH57562.
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