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High Levels of Hand-Hygiene Compliance Are a Worthwhile Pursuit

Published online by Cambridge University Press:  12 July 2017

Emily E. Sickbert-Bennett*
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, North Carolina Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, North Carolina.
Lauren M. DiBiase
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, North Carolina Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, North Carolina.
David J. Weber
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, North Carolina Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, North Carolina.
*
Address correspondence to Emily Sickbert-Bennett, PhD, MS, 1063 West Wing, CB#7600, Hospital Epidemiology, UNC Hospitals, 101 Manning Drive, Chapel Hill, NC 27514 (esickber@unch.unc.edu).
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Abstract

Type
Letters to the Editor
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

To the Editor—We read with great interest the excellent review of evidence-based recommendations for the prevention of Clostridium difficile infection (CDI) by Louh et al.Reference Louh, Greendyke and Hermann 1 In this article, the authors reviewed 4 studies that assessed the impact of hand-hygiene campaigns to reduce CDI. Based on these papers, the authors did not recommend any hand-hygiene interventions to reduce CDI.

In their discussion section, Louh et al stated, “Although older studies have shown a significant reduction in nosocomial infections by observing good hand hygiene, further benefit from promoting hand hygiene is unlikely, as the margin for improvement diminishes. Therefore, if any institution has adequate hand-hygiene processes, incremental efforts to improve hand hygiene may not be as beneficial as other interventions.” We have 2 concerns with this statement and their conclusion. First, the authors did not define a level of “adequate hand hygiene.” Second, their conclusion that moving from high to very high levels of hand-hygiene compliance offer diminishing benefits is not supported by the literature. We have previously demonstrated that an improvement in hand-hygiene compliance from a high baseline level (>80%) to an even higher level (>95%) led to a significantly decreased healthcare-associated infection rate (P=.0066).Reference Sickbert-Bennett, DiBiase, Willis, Wolak, Weber and Rutala 2 Based on our data, we believe that achieving very high levels of hand-hygiene compliance is both feasible and worthwhile to reduce healthcare-associated infections.

ACKNOWLEDGMENTS

Financial support: No financial support was provided relevant to this article.

Potential conflicts of interest: All authors report no conflicts of interest relevant to this article.

References

1. Louh, IK, Greendyke, WG, Hermann, EA, et al. Clostridium difficile infection in acute care hospitals: systematic review and best practices for prevention. Infect Control Hosp Epidemiol 2017;38:476482.CrossRefGoogle Scholar
2. Sickbert-Bennett, EE, DiBiase, LM, Willis, TM, Wolak, ES, Weber, DJ, Rutala, WA. Reduction of healthcare-associated infections by exceeding high compliance with hand hygiene practices. Emerg Infect Dis 2016;22:16281630.CrossRefGoogle ScholarPubMed
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