Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections

Abstract

We analyzed the effect of antimicrobial use and implementation of a hand hygiene program on the incidence of healthcareassociated infections (HAIs) and healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections at the Chung Shan Medical University Hospital (Taichung, Taiwan). Monthly data were retrospectively reviewed from January 2004 to December 2010. Use of antimicrobials and alcohol-based hand cleaner were separately regressed against the incidences of HAIs and HA-MRSA infections. Infection incidence was expressed as persons per 1000 patient days (PDs), monthly use of i.v. antibiotics was expressed as defined daily doses per 1000 PDs and monthly alcohol-based hand cleaner use was expressed as bottle per 1000 PDs. Multivariate analysis indicated that use of hand cleaner was associated with reduced incidence of HAIs (P ¼ 0.0001) and HA-MRSA infections (Po0.0001). Time-series analysis indicated that increased use of hand cleaner was significantly associated with significant decreases in the incidences of HAIs and HA-MRSA infections. Total antibiotic use had no significant effect on HAIs, but was associated with more HA-MRSA infections. In addition, the use of J01CR01 antibiotics (combinations of penicillins, including b-lactamase inhibitors) in particular was correlated with significantly increased incidence of HA-MRSA infections. Our forecasting model demonstrates the efficacy of a hand hygiene program and the need to limit the use of certain restricted antimicrobials in order to reduce the incidence of HAIs and HA-MRSA infections.

Comparative efficacy of interventions to promote hand hygiene in hospital: systematic review and network meta-analysis

“…Of 3639 studies screened, 142 studies met initial inclusion criteria and 41 of these met EPOC criteria. Among these 41 studies, six were randomised controlled trials (including three cluster randomised controlled trials),31 32 33 34 35 36 32 were interrupted time series,28 29 30 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 one was a non-randomised trial,66 and two were controlled before-after studies 6768 Appendix 5 give details of the reasons for exclusion.…”

“…Clinical outcomes were reported in 19 studies 2829 30 35 42 46 47 48 49 52 55 56 57 59 62 63 66 67 69 Appendix 6 provides full study characteristics including study design, setting, intervention, and comparison groups.…”

Håndhygiene og antibiotikaresistens

“…We are aware that strategies to combat the spread of these microorganisms are more complex and comprehensive, but hand hygiene remains a cornerstone. Patient education was included in only one study (22); the role of patients and the civil society in combating AMR is crucial at different levels and hand hygiene is one simple yet key measure that can be practiced and advocated for by them.…”

Methods of Disinfecting Stethoscopes: Systematic Review

“…It has been shown that more than 32% of HAI are avoidable [6,7] through hand washing and proper disinfection of medical devices between patients. The hands of healthcare professionals are the main vehicle for the transmission of microbes [3,8], but it is known that also contaminated medical devices (stethoscopes, otoscopes, and thermometers) can transmit microorganisms to patients [1, 2,5]. In particular, stethoscopes, which are considered the symbol of medicine, are widely used medical devices but, if they are not disinfected, they can cause cross-contamination [9,10].…”