Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-25T13:40:48.785Z Has data issue: false hasContentIssue false
  • English
  • Français

Controlled Trial Measuring the Effect of a Feedback Intervention on Hand Hygiene Compliance in a Step-Down Unit

Published online by Cambridge University Press:  02 January 2015

Alexandre R. Marra ,
Cláudia D'Arco ,
Bruno de Arruda Bravim ,
Marinês Dalla Valle Martino ,
Luci Correa ,
Cláudia Vallone Silva ,
Luiz Carlos R. Lamblet ,
Moacyr Silva Junior ,
Gisele de Lima  and
Luciana Reis Guastelli
...Show all authors
Alexandre R. Marra*
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Cláudia D'Arco
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Bruno de Arruda Bravim
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Marinês Dalla Valle Martino
Affiliation:
Microbiology Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil
Luci Correa
Affiliation:
Infection Control Unit, São Paulo, Brazil
Luiz Carlos R. Lamblet
Affiliation:
Infection Control Unit, São Paulo, Brazil
Moacyr Silva Junior
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Gisele de Lima
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Luciana Reis Guastelli
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Luciana Barbosa
Affiliation:
Hospital Israelita Albert Einstein, São Paulo, Braziland Gojo Latin America, São Paulo, Brazil
Oscar Fernando Pavão dos Santos
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Michael B. Edmond
Affiliation:
Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
*
Av. Albert Einstein, 627/701, Intensive Care Unit, 5th floor, Morumbi, Sao Paulo 05651-901, Brazil (a.marra@uol.com.br)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate hand hygiene compliance in 2 adult step-down units (SDUs).

Design.

A 6-month (from March to September 2007), controlled trial comparing 2 SDUs, one with a feedback intervention program (ie, the intervention unit) and one without (ie, the control unit).

Setting.

Two 20-bed SDUs at a tertiary care private hospital.

Methods.

Hand hygiene episodes were measured by electronic recording devices and periodic observational surveys. In the intervention unit, feedback was provided by the SDU nurse manager, who explained twice a week to the healthcare workers the goals and targets for the process measures.

Results.

A total of 117,579 hand hygiene episodes were recorded in the intervention unit, and a total of 110,718 were recorded in the control unit (P = .63). There was no significant difference in the amount of chlorhexidine used in the intervention and control units (34.0 vs 26.7 L per 1,000 patient-days; P = .36) or the amount of alcohol gel used (72.5 vs 70.7 L per 1,000 patient-days; P = .93). However, in both units, healthcare workers used alcohol gel more frequently than chlorhexidine (143.2 vs 60.7 L per 1,000 patient-days; P < .001). Nosocomial infection rates in the intervention and control units, respectively, were as follows: for bloodstream infection, 3.5 and 0.79 infections per 1,000 catheter-days (P = .18); for urinary tract infection, 15.8 and 15.7 infections per 1,000 catheter-days (P = .99); and for tracheostomy-associated pneumonia, 10.7 and 5.1 infections per 1,000 device-days (P = . 13). There were no cases of infection with vancomycin-resistant enterococci and only a single case of infection with methicillin-resistant Staphylococcus aureus (in the control unit).

Conclusions.

The feedback intervention regarding hand hygiene had no significant effect on the rate of compliance. Other measures must be used to increase and sustain the rate of hand hygiene compliance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 730 - 735
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Pittet, D, Mourouga, P, Perneger, TV; Members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;30:126–130.Google Scholar
2.Boyce, JM, Pittet, D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30:S1–S46.Google Scholar
3.Miyachi, H, Furuya, H, Umezawa, K, et al.Controlling methicillin-resistant Staphylococcus aureus by stepwise implementation of preventive strategies in a university hospital: impact of a link-nurse system on the basis of multidisciplinary approaches. Am J Infect Control 2007;35:115–121.Google Scholar
4.Harris, AD, Lautenbach, E, Perencevich, E. A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance. Clin Infect Dis 2005;41:77–82.Google Scholar
5.Gould, DJ, Chudleigh, JH, Moralejo, D, Drey, N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2007;2:CD005186.Google Scholar
6.Berhe, M, Edmond, MB, Bearman, GM. Practices and an assessment of health care workers' perceptions of compliance with infection control knowledge of nosocomial infections. Am J Infect Control 2005;33:55–57.CrossRefGoogle Scholar
7.Bischoff, WE, Reynolds, TM, Sessler, CN, Edmond, MB, Wenzel, RP. Handwashing compliance by health care workers. The impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000;160:1017–1021.CrossRefGoogle ScholarPubMed
8.Muto, CA, Sistrom, MG, Farr, BM. Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control 2000;28:273–276.CrossRefGoogle ScholarPubMed
9.Kinsella, G, Thomas, AN, Taylor, RJ. Electronic surveillance of wall-mounted soap and alcohol gel dispensers in an intensive care unit. J Hosp Infect 2007;66:34–39.Google Scholar
10.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections (published correction appears in Am J Infect Control 1988;16:177). Am J Infect Control 1988;16:128–140.Google Scholar
11.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
12.Keene, AR, Cullen, DJ. Therapeutic Intervention Scoring System: update 1983. Crit Care Med 1983;11:1–3.Google Scholar
13.Bittner, MJ, Rich, EC, Turner, PD, Arnold, WH Jr. Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit. Infect Control Hosp Epidemiol 2002;23:120–126.Google Scholar
14.Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Perencevich, EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004;38:1586–1591.Google Scholar
15.Haas, JP, Larson, EL. Measurement of compliance with hand hygiene. J Hosp Infect 2007;66:6–14.CrossRefGoogle ScholarPubMed
16.Gould, DJ, Chudleigh, J, Drey, NS, Moralejo, D. Measuring handwashing performance in health service audits and research studies. J Hosp Infect 2007;66:109–115.CrossRefGoogle ScholarPubMed
17.Rupp, ME, Fitzgerald, T, Puumala, S, et al.Prospective, controlled, crossover trial of alcohol-based hand gel in critical care units. Infect Control Hosp Epidemiol 2008;29:8–15.Google Scholar
18.Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital wide programme to improve compliance with hand antisepsis. Lancet 2000;356:1307–1312.Google Scholar
19.Warren, DK, Guth, RM, Coopersmith, CM, Merz, LR, Zack, JE, Fraser, VJ. Impact of a methicillin-resistant Staphylococcus aureus active surveillance program on contact precaution utilization in a surgical intensive care unit. Crit Care Med 2007;35:430–434.Google Scholar
20.Lucet, JC, Paoletti, X, Lolom, I, et al.Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:1051–1017.Google Scholar
21.Davis, KA, Stewart, JJ, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004;39:776–782.CrossRefGoogle ScholarPubMed
22.Edwards, JR, Peterson, KD, Andrus, ML, et al.National Healthcare Safety Network (NHSN) Report, data summary for 2006, issued June 2007. Am J Infect Control 2007;35:290–301.Google Scholar
23.Broughall, JM, Marshman, C, Jackson, B, Bird, P. An automatic monitoring system for measuring handwashing frequency in hospital wards. J Hosp Infect 1984;5:447–453.Google Scholar
24.Larson, EL, Eke, PI, Wilder, MP, Laughon, BE. Quantity of soap as a variable in handwashing. Infect Control 1987;8:371–375.Google Scholar
25.Moret, L, Tequi, B, Lombrial, P. Should self-assessment methods be used to measure compliance with handwashing recommendations? A study carried out in a French university hospital. Am J Infect Control 2004;32:384–390.Google Scholar
26.Ojajärvi, J, Mäkelä, P, Rantasalo, I. Failure of hand disinfection with frequent hand washing: a need for prolonged field studies. J Hyg (Lond) 1977;79:107–119.Google Scholar
27.Winnefeld, M, Richard, MA, Drancourt, M, Grobb, JJ. Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use. Br J Dermatol 2000;143:546–550.Google Scholar
28.Gawande, A. Better: A Surgeon's Notes on Performance. 1st ed. New York: Metropolitan Books; 2007.Google Scholar