Hostname: page-component-5d59c44645-lfgmx Total loading time: 0 Render date: 2024-02-25T21:28:29.469Z Has data issue: false hasContentIssue false

Changes in Healthcare-Associated Staphylococcus aureus Bloodstream Infections after the Introduction of a National Hand Hygiene Initiative

Published online by Cambridge University Press:  10 May 2016

Adrian G. Barnett*
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
Katie Page
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
Megan Campbell
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
David Brain
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
Elizabeth Martin
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
Rebecca Rashleigh-Rolls
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia Royal Brisbane and Women’s Hospital, Queensland, Australia
Kate Halton
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
Lisa Hall
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Queensland, Australia
Nerina Jimmieson
Affiliation:
Business School, Queensland University of Technology, Queensland, Australia
Katherine White
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
David Paterson
Affiliation:
Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Queensland, Australia University of Queensland Centre for Clinical Research, Queensland, Australia
Nicholas Graves
Affiliation:
Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Queensland, Australia
*
Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia (a.barnett@qut.edu.au).

Extract

Background

Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection.

Methods

We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time.

Results

The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates.

Conclusions

The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative’s introduction or because infection rates were already low and could not be further reduced.

Type
Original Article
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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. Cantrell, D, Shamriz, O, Cohen, MJ, Stern, Z, Block, C, Brezis, M. Hand hygiene compliance by physicians: marked heterogeneity due to local culture? Am J Infect Control 2009;37(4):301305.Google Scholar
2. Pittet, D. Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 2001;48(suppl A):S40S46.CrossRefGoogle ScholarPubMed
3. Song, X, Stockwell, DC, Floyd, T, Short, BL, Singh, N. Improving hand hygiene compliance in health care workers: strategies and impact on patient outcomes. Am J Infect Control 2013;41(10):e101e105.CrossRefGoogle ScholarPubMed
4. Rosenthal, VD, Pawar, M, Leblebicioglu, H, et al. Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach over 13 years in 51 cities of 19 limited-resource countries from Latin America, Asia, the Middle East, and Europe. Infect Control Hosp Epidemiol 2013;34(4):415423.Google Scholar
5. Reichardt, C, Königer, D, Bunte-Schönberger, K, et al. Three years of national hand hygiene campaign in Germany: what are the key conclusions for clinical practice? J Hosp Infect 2013;83(suppl 1):S11S16.Google Scholar
6. Stone, SP, Fuller, C, Savage, J, et al. Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. BMJ 2012;344.e3005.CrossRefGoogle ScholarPubMed
7. Allegranzi, B, Gayet-Ageron, A, Damani, N, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013;13(10):843851.Google Scholar
8. DiDiodato, G. Has improved hand hygiene compliance reduced the risk of hospital-acquired infections among hospitalized patients in Ontario? analysis of publicly reported patient safety data from 2008 to 2011. Infect Control Hosp Epidemiol 2013;34(6):605610.Google Scholar
9. Gould, D, Moralejo, D, Drey, N, Chudleigh, J. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev 2010(9):CD005186.Google Scholar
10. Pittet, D, Allegranzi, B, Boyce, J. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30(7):611622.Google Scholar
11. World Health Organization (WHO). WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care is Safer Care. Geneva: WHO, 2009.Google Scholar
12. Australian Commission on Safety and Quality in Health Care (ACSQHC). Data set specification–surveillance of healthcare associated infections: Staphylococcus aureus bacteraemia and Clostridium difficile infection (version 4.0). Sydney, Australia: ACSQHC, 2012. http://www.safetyandquality.gov.au/publications/data-set-specification-surveillance-of-healthcare-associated-infections-staphylococcus-aureus-bacteraemia-and-clostridium-difficile-infection-version-4-0/. Accessed June 4, 2014.Google Scholar
13. Shardell, M, Harris, AD, El-Kamary, SS, Furuno, JP, Miller, RR, Perencevich, EN. Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies. Clin Infect Dis 2007;45(7):901907.Google Scholar
14. Shadish, WR, Cook, TD, Campbell, DT. Experimental and Quasi-Experimental Designs for Generalized Causal Inference. New York: Houghton Mifflin, 2002.Google Scholar
15. Perry, MB, Pignatiello, JJ Jr, Simpson, JR. Change point estimation for monotonically changing Poisson rates in SPC. Int J Prod Res 2007;45(8):17911813.CrossRefGoogle Scholar
16. Hussey, MA, Hughes, JP. Design and analysis of stepped wedge cluster randomized trials. Contemporary Clin Trials 2007;28(2):182191.CrossRefGoogle ScholarPubMed
17. Dobson, AJ, Barnett, AG. An Introduction to Generalized Linear Models. Boca Raton, FL: Chapman & Hall/CRC, 2008.Google Scholar
18. Burnham, KP, Anderson, DR. Model Selection and Multi-Model Inference: A Practical Information-Theoretic Approach. New York: Springer, 2002.Google Scholar
19. Burnham, KP, Anderson, DR, Huyvaert, KP. AIC model selection and multimodel inference in behavioral ecology: some background, observations, and comparisons. Behav Ecol Sociobiol 2011;65(2):2335.CrossRefGoogle Scholar
20. Rinaldo, A, Bertuzzo, E, Mari, L, et al. Reassessment of the 2010–2011 Haiti cholera outbreak and rainfall-driven multiseason projections. Proc Natl Acad Sci USA 2012;109(17):66026607.CrossRefGoogle ScholarPubMed
21. op den Winkel, M, Nagel, D, Sappl, J, et al. Prognosis of patients with hepatocellular carcinoma: validation and ranking of established staging systems in a large Western HCC-cohort. PLoS ONE 2012;7(10):e45066.Google Scholar
22. Barnett, AG, Koper, N, Dobson, AJ, Schmiegelow, F, Manseau, M. Using information criteria to select the correct variance–covariance structure for longitudinal data in ecology. Meth Ecol Evol 2010;1(1):1524.Google Scholar
23. Johnson, PDR, Martin, R, Burrell, LJ, et al. Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Med J Aust 2005;183(10):509514.Google Scholar
24. Grayson, ML, Jarvie, LJ, Martin, R, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008;188(11):633640.CrossRefGoogle ScholarPubMed