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Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System

Published online by Cambridge University Press:  07 June 2016

Matthew D. Koff
Affiliation:
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Jeremiah R. Brown
Affiliation:
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
Emily J. Marshall
Affiliation:
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
A. James O’Malley
Affiliation:
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
Jens T. Jensen
Affiliation:
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Stephen O. Heard
Affiliation:
Department of Anesthesiology, UMass Memorial Medical Center, Worcester, Massachusetts.
Karen Longtine
Affiliation:
Department of Anesthesiology, UMass Memorial Medical Center, Worcester, Massachusetts.
Melissa O’Neill
Affiliation:
Department of Anesthesiology, UMass Memorial Medical Center, Worcester, Massachusetts.
Jaclyn Longtine
Affiliation:
Department of Anesthesiology, UMass Memorial Medical Center, Worcester, Massachusetts.
Donna Houston
Affiliation:
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Cindy Robison
Affiliation:
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Eric Moulton
Affiliation:
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Hetal M. Patel
Affiliation:
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Randy W. Loftus*
Affiliation:
Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
*
Address correspondence to Randy W. Loftus, MD, University of Iowa Hospitals and Clinics, 100 Hawkins Rd, Iowa City, IA 52240 (randy-loftus@uiowa.edu).

Abstract

BACKGROUND

Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development.

OBJECTIVE

To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events.

DESIGN

Randomized, prospective study.

SETTING

Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts.

PATIENTS

Patients undergoing surgery.

METHODS

Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections.

RESULTS

A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); P<.001. Use of the hand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82–1.40], P=.626).

CONCLUSIONS

The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy.

Infect Control Hosp Epidemiol 2016;37:888–895

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

(Present affiliation: Department of Anesthesiology, University of Iowa Hospitals and Clinics [R.W.L.].)

References

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