Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices

Sickbert-Bennett, Emily E.; DiBiase, Lauren; Willis, Tina M. Schade; Wolak, Eric; Weber, David J.; Rutala, William A.

doi:10.3201/eid2209.151440

Cited by 117 publications

(88 citation statements)

References 10 publications

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“…The intervention described in this study is complementary to prior interventions shown to reduce HO-CDI rates (20,21) and is independent of the diagnostic method used for testing. It is also an alternative approach to the multistep testing algorithms recommended by the European guidelines, which do not require three unformed stools but instead base treatment on detection of C. difficile toxins in stool of symptomatic patients (12).…”

Section: Discussionmentioning

confidence: 98%

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

et al. 2017

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Health care-onset health care facility-associated Clostridium difficile infection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence of C. difficile colonization and the inability of hospitals to limit testing to patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 to 30 June 2016 on consecutive inpatients with C. difficile test orders at an academic hospital. Real-time electronic patient data tracking was used by the laboratory to enforce testing criteria (defined as the presence of diarrhea [Ն3 unformed stools in 24 h] and absence of laxative intake in the prior 48 h). Outcome measures included C. difficile test utilization, HO-CDI incidence, oral vancomycin utilization, and clinical complications. During the intervention, 7.1% (164) and 9.1% (211) of 2,321 C. difficile test orders were canceled due to absence of diarrhea and receipt of laxative therapy, respectively. C. difficile test utilization decreased upon implementation from an average of 208.8 tests to 143.0 tests per 10,000 patient-days (P Ͻ 0.001). HO-CDI incidence rate decreased from an average of 13.0 cases to 9.7 cases per 10,000 patient-days (P ϭ 0.008). Oral vancomycin days of therapy decreased from an average of 13.8 days to 9.4 days per 1,000 patient-days (P ϭ 0.009). Clinical complication rates were not significantly different in patients with 375 canceled orders compared with 869 episodes with diarrhea but negative C. difficile results. Realtime electronic clinical data tracking is an effective tool for verification of C. difficile clinical testing criteria and safe reduction of inflated HO-CDI rates.KEYWORDS Clostridium difficile, data tracking, evidence-based medicine, verification C lostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea (1). Clostridium difficile infection (CDI) is estimated to be the most expensive health care-associated infection, costing the U.S. health system $5.4 billion annually (2). A major challenge with accurate diagnosis of CDI is the high prevalence of C. difficile colonization. Studies indicate that 4.4% to 21% of hospitalized patients are asymptomatically colonized with toxigenic C. difficile (3-10, 30). In the absence of disease-specific

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Section: Discussionmentioning

confidence: 98%

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

et al. 2017

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“…Hand hygiene prevents the spread of germs and reduces resistance to antibiotics. US studies found, on average, healthcare providers spend fewer than 15 seconds washing their hands (Borchgrevink et al ; Sickbert‐Bennett et al ) . Nair et al () found nursing students demonstrated significantly ( P < 0.05) better hand hygiene practices (62.1%) compared to medical students (19.6%) (Nair et al ) .…”

Section: Literature Reviewmentioning

confidence: 99%

Hand hygiene of nursing and midwifery students in Cambodia

Tem

Kong

Him

et al. 2019

International Nursing Review

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Aim To determine the relationship between knowledge, attitude and the practice of hand hygiene by nursing and midwifery students in Cambodia. Background Hand hygiene is the most cost‐effective means to prevent hospital‐acquired infections. Techniques of hand hygiene are simple; however, many researchers have found hand hygiene knowledge, attitude and practice to be poor in many healthcare settings worldwide, especially in developing countries. Cambodia is a developing country in Southeast Asia and data regarding hand hygiene are limited. Methods A cross‐sectional descriptive study was conducted to assess the level of knowledge, attitude and practice of hand hygiene. Students in nursing and midwifery programmes were the target population (n = 300). Survey data were collected from January to May 2017. Descriptive statistics, t‐tests and correlation coefficients were calculated to assess relationships between student knowledge, attitude and hand hygiene practice. Result The level of knowledge, attitude and practice of hand hygiene in nursing and midwifery students was moderate. A majority of students had received hand hygiene training. There was no significant difference between nursing and midwifery students in knowledge, attitude and practice of hand hygiene. However, a Pearson correlation of attitude and practice had a weak positive relationship. Conclusion Both nursing and midwifery students demonstrated moderate levels of knowledge, attitudes and practice of hand hygiene. Implication for nursing and health policy This study identified a need for hand hygiene training. Developing training programmes to improve attitudes about hand hygiene is strongly recommended. Effective training may contribute to change behaviours of hand hygiene (attitude), improve practice and ultimately reduce hospital‐acquired infections.

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“…While interventions are often multimodal, and direct causal benefits difficult to prove, there is substantial epidemiological evidence to support the role of hand hygiene in reducing HAI. 13,49,50 For example, between 2002-2013, the annual incidence of Australian hospital onset S. aureus bacteraemia (SAB) (MRSA and MSSA) decreased by 63% 13 and similar reductions have been demonstrated overseas. 51 These reductions in HAI have paralleled national initiatives resulting in widespread adoption of successful hand hygiene programmes.…”

Section: The Role Of Hand Hygienementioning

confidence: 99%

Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

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Reduction of Healthcare-Associated Infections by Exceeding High Compliance with Hand Hygiene Practices

Cited by 117 publications

References 10 publications

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

Hand hygiene of nursing and midwifery students in Cambodia

Healthcare‐acquired infections: prevention strategies

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