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Preventing the Transmission of Multidrug-Resistant Organisms: Modeling the Relative Importance of Hand Hygiene and Environmental Cleaning Interventions

Published online by Cambridge University Press:  10 May 2016

Sean L. Barnes ,
Daniel J. Morgan ,
Anthony D. Harris ,
Phillip C. Carling  and
Kerri A. Thom
Sean L. Barnes*
Affiliation:
Robert H. Smith School of Business, University of Maryland, College Park, Maryland
Daniel J. Morgan
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Phillip C. Carling
Affiliation:
Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
Kerri A. Thom
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
University of Maryland, College Park, MD 20742 (sbarnes@rhsmith.umd.edu).
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Extract

Objective

Hand hygiene and environmental cleaning are essential infection prevention strategies, but the relative impact of each is unknown. This information is important in assessing resource allocation.

Methods

We developed an agent-based model of patient-to-patient transmission—via the hands of transiently colonized healthcare workers and incompletely terminally cleaned rooms—in a 20-patient intensive care unit. Nurses and physicians were modeled and had distinct hand hygiene compliance levels on entry and exit to patient rooms. We simulated the transmission of Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci for 1 year using data from the literature and observed data to inform model input parameters.

Results

We simulated 175 parameter-based scenarios and compared the effects of hand hygiene and environmental cleaning on rates of multidrug-resistant organism acquisition. For all organisms, increases in hand hygiene compliance outperformed equal increases in thoroughness of terminal cleaning. From baseline, a 2∶1 improvement in terminal cleaning compared with hand hygiene was required to match an equal reduction in acquisition rates (eg, a 20% improvement in terminal cleaning was required to match the reduction in acquisition due to a 10% improvement in hand hygiene compliance).

Conclusions

Hand hygiene should remain a priority for infection control programs, but environmental cleaning can have significant benefit for hospitals or individual hospital units that have either high hand hygiene compliance levels or low terminal cleaning thoroughness.

Infect Control Hosp Epidemiol 2014;35(9):1156-1162

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 9 , 01 September 2014 , pp. 1156 - 1162
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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