Hostname: page-component-8448b6f56d-tj2md Total loading time: 0 Render date: 2024-04-23T22:32:01.569Z Has data issue: false hasContentIssue false
  • English
  • Français

Use of an Alcohol-Based Hand Rub and Quality Improvement Interventions to Improve Hand Hygiene in a Russian Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Samuel M. Brown ,
Anna V. Lubimova ,
Natalya M. Khrustalyeva ,
Svetlana V. Shulaeva ,
Iya Tekhova ,
Ludmila P. Zueva ,
Donald Goldmann  and
Edward J. O'Rourke
Samuel M. Brown*
Affiliation:
Massachusetts General Hospital and the Davis Center for Russian Studies, Harvard University, Boston, Massachusetts
Anna V. Lubimova
Affiliation:
Infection Control Training Center and the Department of Epidemiology, Mechnikov State Medical Academy, St. Petersburg, Russia
Natalya M. Khrustalyeva
Affiliation:
First Children's Hospital, St. Petersburg, Russia
Svetlana V. Shulaeva
Affiliation:
First Children's Hospital, St. Petersburg, Russia
Iya Tekhova
Affiliation:
Infection Control Training Center and the Department of Epidemiology, Mechnikov State Medical Academy, St. Petersburg, Russia
Ludmila P. Zueva
Affiliation:
Infection Control Training Center and the Department of Epidemiology, Mechnikov State Medical Academy, St. Petersburg, Russia
Donald Goldmann
Affiliation:
Children's Hospital, Boston, Massachusetts
Edward J. O'Rourke
Affiliation:
Children's Hospital, Boston, Massachusetts Harvard Medical International, Boston, Massachusetts
*
527 Leverett Mail Center, Cambridge, MA 02138
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Hand hygiene (HH) is critical to infection control, but compliance is low. Alcohol-based antiseptics may improve HH. HH practices in Russia are not well described, and facilities are often inadequate.

Setting:

Four 6-bed units in a neonatal intensive care unit in St. Petersburg, Russia.

Methods:

Prospective surveillance of HH compliance, nosocomial colonization, and antibiotic administration was performed from January until June 2000. In February 2000, alcohol-based hand rub was provided for routine HH use. Eight weeks later, a quality improvement intervention was implemented, consisting of review of interim data, identification of opinion leaders, posting of colonization incidence rates, and regular feedback. Means of compliance, colonization, and antibiotic use were compared for periods before and after each intervention.

Results:

A total of 1,027 events requiring HH were observed. Compliance was 44.2% before the first intervention, 42.3% between interventions, and 48% after the second intervention. Use of alcohol rose from 15.2% of HH indications to 25.2% between interventions and 41.5% after the second intervention. The incidence of nosocomial colonization (per 1,000 patient-days) with Klebsiella pneumoniae was initially 21.5, decreased to 4.7, and then was 3.2 in the final period. Rates of antibiotic and device use also decreased.

Conclusions:

HH may have increased slightly, but the largest effect was a switch from soap and water to alcohol, which may have been associated with decreased cross-transmission of Klebsiella, although this may have been confounded by lower device use. Alcohol-based antiseptic may be an improvement over current practices, but further research is required.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 3 , March 2003 , pp. 172 - 179
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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.Semmelweis, I. The etiology, concept and prophylaxis of childbed fever [excerpts]. In: Buck, C, Llopis, A, Najera, E, Terris, M, eds. The Challenge of Epidemiology: Issues and Selected Readings. Washington, DC: PAHO Scientific Publication; 1988:46–59.Google Scholar
2.Rotter, ML. Hand washing and hand disinfection. In: Mayhall, G, ed. Hospital Epidemiology and Infection Control. Baltimore: Williams & Wilkins; 1996:1052–1068.Google Scholar
3.Jarvis, WR. Handwashing: the Semmelweis lesson forgotten? Lancet 1994;344:1311–1312.CrossRefGoogle ScholarPubMed
4.Pittet, D. Improving adherence to hand hygiene practice: a multidisci-plinary approach. Emerg Infect Dis 2001;7:234–240.Google Scholar
5.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital: infection control program. Ann Intern Med 1999;130:126–130.CrossRefGoogle Scholar
6.Boyce, JM. It is time for action: improving hand hygiene in hospitals. Ann Intern Med 1999;130:153–155.CrossRefGoogle ScholarPubMed
7.Albert, RK, Condie, F. Hand-washing patterns in medical intensive-care units. N Engl J Med 1981;304:1465–1466.Google Scholar
8.Dubbert, PM, Dolce, J, Richter, W, Miller, M, Chapman, SW. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191–193.Google Scholar
9.Larson, E, Killien, M. Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:93–99.CrossRefGoogle ScholarPubMed
10.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
11.Khatib, M, Jamaleddine, G, Abdallah, A, Ibrahim, Y. Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest 1999;116:172–175.CrossRefGoogle ScholarPubMed
12.McGuckin, M, Waterman, R, Porten L, et al.Patient education model for increasing handwashing compliance. Am J Infect Control 1999;27:309–314.Google Scholar
13.Preston, GA, Larson, EL, Stamm, WE. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641–645.CrossRefGoogle Scholar
14.Kaplan, LM, McGuckin, M. Increasing handwashing compliance with more accessible sinks. Infect Control 1986;7:408–410.Google Scholar
15.Harbarth, S, Pittet, D, Grady, L, et al.Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J 2002;21:489–495.Google Scholar
16.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.Google Scholar
17.Graham, M. Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:77–81.Google Scholar
18.Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;76:330–339.Google Scholar
19.Donowitz, LG. Handwashing technique in a pediatric intensive care unitam J Dis Child 1987;141:683–685.Google Scholar
20.Larson, E, McGeer, A, Quraishi, ZA, et al.Effect of an automated sink on handwashing practices and attitudes in high-risk units. Infect Control Hosp Epidemiol 1991;12:422–428.CrossRefGoogle ScholarPubMed
21.Wurtz, R, Moye, G, Jovanovic, B. Handwashing machines, handwashing compliance, and potential for cross-contamination. Am J Infect Control 1994;22:228–230.Google Scholar
22.Larson, EL, Early, E, Cloonan, P, Sugrue, S, Parides, M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 2000;26:14–22.Google Scholar
23.Pittet, D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol 2000;21:381–386.Google Scholar
24.Larson, EL. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.CrossRefGoogle ScholarPubMed
25.Garner, JS. Guideline for isolation precautions in hospitals: The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:53–80.Google Scholar
26.Larson, EL, Eke, PI, Laughon, BE. Efficacy of alcohol-based hand rinses under frequent-use conditions. Antimicrob Agents Chemother 1986;30:542–544.Google Scholar
27.Meers, PD, Yeo, GA, Shedding of bacteria and skin squames after handwashing. Journal of Hygiene (London) 1978;81:99–105.CrossRefGoogle ScholarPubMed
28.Rotter, ML. Hygienic hand disinfection. Infect Control 1984;5:18–22.Google Scholar
29.Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:1287–1294.Google Scholar
30.Boyce, JM. Using alcohol for hand antisepsis: dispelling old myths. Infect Control Hosp Epidemiol 2000;21:438–441.CrossRefGoogle ScholarPubMed
31.Rotter, ML. Arguments for alcoholic hand disinfection. J Hosp Infect 2001;48(suppl A):S4–S8.Google Scholar
32.Boyce, JM, Kelliher, S, Vallande, N. Skin irritation and dryness associated with two hand-hygiene regimens: soap-and-water hand washing versus hand antisepsis with an alcoholic hand gel. Infect Control Hosp Epidemiol 2000;21:442–448.CrossRefGoogle ScholarPubMed
33.Larson, E, Silberger, M, Jakob, K, et al.Assessment of alternative hand hygiene regimens to improve skin health among neonatal intensive care unit nurses. Heart Lung 2000;29:136–142.CrossRefGoogle ScholarPubMed
34.Paulson, DS, Fendler, EJ, Dolan, MJ, Williams, RA. A close look at alcohol gel as an antimicrobial sanitizing agent. Am J Infect Control 1999;27:332–338.Google Scholar
35.Maki, DG. The use of antiseptics for handwashing by medical personnel. J Chemother 1989;1(suppl 1):3–11.Google Scholar
36.Teare, EL, Cookson, B, French, GL, A et al.UK handwashing initiative. J Hosp Infect 1999;43:1–3.Google Scholar
37.Larson, E. Hygiene of the skin: when is clean too clean? Emerg Infect Dis 2001;7:225–230.Google Scholar
38.Boyce, JM, Rotter, ML. Hospital hygiene procedures: areas of consensus and ongoing controversies. J Hosp Infect 2001;48(suppl A):S1–S92.Google Scholar
39.Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene: infection control programme. Lancet 2000;356:1307–1312.CrossRefGoogle ScholarPubMed
40.Harbarth, S, Martin, Y, Rohner, P, Henry, N, Auckenthaler, R, Pittet, D. Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2000;46:43–49.CrossRefGoogle ScholarPubMed
41.Nettleman, MD, Mcintosh, SL, Mcintosh, TJ, Wenger, J, Geerdes, H. Infection control in the Russian Federation: review of a tertiary care hospital. Infect Control Hosp Epidemiol 1994;15:200–202.Google Scholar
42.DiCarlo, JV, Zaitseva, TA, Khodateleva, TV, et al.Comparative assessment of pediatric intensive care in Moscow, the Russian Federation: a prospective, multicenter study. Crit Care Med 1996;24:1403–1407.Google Scholar
43.Pittet, D, Dharan, S, Touveneau, S, Sauvan, V, Perneger, TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 1999;159:821–826.Google Scholar
44.Harbarth, S, Pittet, D, Grady, L, Goldmann, DA. Compliance with hand hygiene practice in pediatric intensive care. Pediatr Crit Care Med 2002;2:311–314.Google Scholar
45.Casewell, M, Phillips, I. Hands as route of transmission for Klebsiella species. Br Med J 1977;2:1315–1317.Google Scholar
46.Larson, EL, McGinley, KJ, Foglia, A, et al.Handwashing practices and resistance and density of bacterial hand flora on two pediatric units in Lima, Peru. Am J Infect Control 1992;20:65–72.Google Scholar
47.Robinton, ED, Mood, EW. A study of bacterial contaminants of cloth and paper towels. Am J Public Health 1968;58:1452–1459.Google Scholar
48.Haley, RW, Bregman, DA. The role of understaffing and overcrowding in recurrent outbreaks of staphylococcal infection in a neonatal special-care unit. J Infect Dis 1982;145:875–885.Google Scholar
49.Pettinger, A, Nettleman, MD. Epidemiology of isolation precautions. Infect Control Hosp Epidemiol 1991;12:303–307.CrossRefGoogle ScholarPubMed
50.Larson, E, McGinley, KJ, Grove, GL, Leyden, JJ, Talbot, GH. Physiologic, microbiologic, and seasonal effects of handwashing on the skin of health care personnel. Am J Infect Control 1986;14:51–59.Google Scholar
51.de Carvalho, M, Lopes, JM, Pellitteri, M. Frequency and duration of handwashing in a neonatal intensive care unit. Pediatr Infect Dis J 1989;8:179–180.Google Scholar
52.Tenorio, AR, Badri, SM, Sahgal, NB, et al.Effectiveness of gloves in the prevention of hand carriage of vancomycin-resistant enterococcus species by health care workers after patient care. Clin Infect Dis 2001;32:826–829.CrossRefGoogle ScholarPubMed
53.Freeman, J, Epstein, MF, Smith, NE, Platt, R, Sidebottom, DG, Goldmann, DA. Extra hospital stay and antibiotic usage with nosocomial coagu-lase-negative staphylococcal bacteremia in two neonatal intensive care unit populations. Am J Dis Child 1990;144:324–329.Google Scholar
54.Townsend, TR, Wenzel, RP. Nosocomial bloodstream infections in a newborn intensive care unit: a case-matched control study of morbidity, mortality and risk. Am J Epidemiol 1981;114:73–80.CrossRefGoogle Scholar
55.Jarvis, WR, Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996;17:552–557.Google Scholar
56.Craig, CP, Connelly, S. Effect of intensive care unit nosocomial pneumonia on duration of stay and mortality. Am J Infect Control 1984;12:233–238.Google Scholar
57.Leu, HS, Kaiser, DL, Mori, M, Woolson, RF, Wenzel, RP. Hospital-acquired pneumonia: attributable mortality and morbidity. Am J Epidemiol 1989;129:1258–1267.Google Scholar