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Clustered Randomized Controlled Trial of a Hand Hygiene Intervention Involving Pocket-Sized Containers of Alcohol-Based Hand Rub for the Control of Infections in Long-Term Care Facilities

Part of: WILLIAM JARVIS AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Wing Kin Yeung ,
Wai San Wilson Tam  and
Tze Wai Wong
Wing Kin Yeung*
Affiliation:
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong
Wai San Wilson Tam
Affiliation:
School of Public Health and Department of Community Medicine, University of Hong Kong, Hong Kong
Tze Wai Wong
Affiliation:
School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong
*
School of Public Health and Primary Care, Chinese University of Hong Kong, 30-32 Ngan Shing Street, Prince of Wales Hospital, Shatin, Hong Kong (ywkj@yahoo.com)
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Abstract

Objective.

To investigate the effectiveness of a multifaceted hand hygiene program involving the use of pocket-sized containers of antiseptic gel in long-term care facilities (LTCFs) with elderly residents.

Methods.

In this clustered randomized controlled trial, Hong Kong LTCFs for elderly persons were recruited via snowball sampling. Staff hand hygiene adherence was directly observed, and residents' infections necessitating hospitalization were recorded. After a 3-month preintervention period, LTCFs were randomized to receive pocket-sized containers of alcohol-based gel, reminder materials, and education for all HCWs (treatment group) or to receive basic life support education and workshops for all healthcare workers (HCWs) (control group). A 2-week intervention period (April 1-15, 2007) was followed by 7 months of postintervention observations.

Results.

In the 3 treatment LTCFs, adherence to hand rubbing increased from 5 (1.5%) of 333 to 233 (15.9%) of 1,465 hand hygiene opportunities (P = .001) and total hand hygiene adherence increased from 86 (25.8%) of 333 to 488 (33.3%) of 1,465 opportunities (P = .01) after intervention; the 3 control LTCFs showed no significant change. In the treatment group, the incidence of serious infections decreased from 31 cases in 21,862 resident-days (1.42 cases per 1,000 resident-days) to 33 cases in 50,441 resident-days (0.65 cases per 1,000 resident-days) (P = .002), whereas in the control group, it increased from 16 cases in 32,726 resident-days (0.49 cases per 1,000 resident-days) to 85 cases in 81,177 resident-days (1.05 cases per 1,000 resident-days) (P = .004). In the treatment group, the incidence of pneumonia decreased from 0.91 to 0.28 cases per 1,000 resident-days (P = .001) and the death rate due to infection decreased from 0.37 to 0.10 deaths per 1,000 resident-days (P = .01); the control group revealed no significant change.

Conclusions.

A hand hygiene program involving the use of pocket-sized containers of antiseptic gel and education could effectively increase adherence to hand rubbing and reduce the incidence of serious infections in LTCFs with elderly residents.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 1 , January 2011 , pp. 67 - 76
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356(9238):1307–1312.CrossRefGoogle ScholarPubMed
2.Rosenthal, VD, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005;33(7):392–397.CrossRefGoogle ScholarPubMed
3.Lam, BC, Lee, J, Lau, YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics 2004;114(5):e565–e571.CrossRefGoogle Scholar
4.Zafar, AB, Butler, RC, Reese, DJ, Gaydos, LA, Mennonna, PA. Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. Am J Infect Control 1995;23:200–208.CrossRefGoogle Scholar
5.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
6.Picheansathian, W. A systematic review on the effectiveness of alcohol based solutions for hand hygiene. Int J Nurs Pract 2004;10(1):3–9.CrossRefGoogle ScholarPubMed
7.Smith, PW, Rusnak, PG. Infection prevention and control in the long-term care facility. Infect Control Hosp Epidemiol 1997;18:831–849.CrossRefGoogle ScholarPubMed
8.Smith, A, Carusone, SC, Loeb, M. Hand hygiene practices of health care workers in long-term care facilities. Am J Infect Control 2008;36(7):492–494.CrossRefGoogle ScholarPubMed
9.Alvaran, MS, Butz, A, Larson, E. Opinions, knowledge, and self-reported practices related to infection control among nursing personnel in long term care settings. Am J Infect Control 1994;22:367–370.CrossRefGoogle ScholarPubMed
10.Nicolle, LE, Garibaldi, R, Strausbaugh, LJ. Infections and antibiotic resistance in nursing homes. Clin Microbiol Rev 1996;9:1–17.CrossRefGoogle ScholarPubMed
11.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121(2):159–167.CrossRefGoogle Scholar
12.Moher, D, Schulz, KF, Altman, DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. Ann Intern Med 2001;134(8):657–662.CrossRefGoogle Scholar
13.World Health Organization (WHO). WHO guidelines on hand hygiene in health care (advanced draft). Geneva, Switzerland: WHO, 2006.Google Scholar
14.Nicolle, LE. Infection control in long-term care facilities. Clin Infect Dis 2000;31:752–756.CrossRefGoogle ScholarPubMed
15.Makris, AT, Morgan, L, Gaber, DJ, Richter, A, Rubino, JR. Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities. Am J Infect Control 2000;28:3–7.CrossRefGoogle ScholarPubMed
16.Rosenthal, VD, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005;33:392–397.CrossRefGoogle ScholarPubMed
17.Strausbaugh, LJ. Emerging health care-associated infections in the geriatric population. Emerg Infect Dis 2001;7(2):268–271.CrossRefGoogle ScholarPubMed
18.Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330–339.CrossRefGoogle Scholar
19.Roup, BJ, Roche, JC, Pass, M. Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006;34(3):122–127.CrossRefGoogle ScholarPubMed
20.Naikoba, S, Hayward, A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers—a systematic review. J Hosp Infect 2001;47:173–180.CrossRefGoogle ScholarPubMed
21.Leventhal, H, Cameron, L. Behavioural theories and the problem of compliance. Patient Educ Couns 1987;10:117–138.CrossRefGoogle Scholar