Changes in healthcare-associated infections after the introduction of a national hand hygiene initiative
Adrian G. Barnett A D , Katie Page A , Megan Campbell A , David Brain A , Elizabeth Martin A , Shirley Winters A , Lisa Hall A B , David Paterson B C and Nicholas Graves A BA Institute of Health and Biomedical Innovation, Queensland University of Technology, Qld 4059, Australia.
B Centre for Healthcare Related Infection Surveillance and Prevention, Queensland Health, Qld 4006, Australia.
C The University of Queensland Centre for Clinical Research, Qld 4029, Australia.
D Corresponding author. Email: a.barnett@qut.edu.au
Healthcare Infection 19(4) 128-134 https://doi.org/10.1071/HI14033
Submitted: 18 September 2014 Accepted: 7 October 2014 Published: 10 November 2014
Journal Compilation © Australasian College for Infection Prevention and Control 2014
Abstract
Introduction: Interventions that prevent healthcare-associated infections should lead to fewer deaths and shorter hospital stays. Cleaning hands with soap and water or alcohol rub is an effective way to prevent the transmission of organisms, but compliance is sometimes low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infections.
Methods: We examined if the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for six types of healthcare-associated infections were examined in 38 Australian hospitals across six states. Infection categories were: bloodstream infections, central-line associated bloodstream infections, methicillin-resistant and methicillin-sensitive Staphylococcus aureus, Staphylococcus aureus bacteraemia and surgical site infections.
Results: The National Hand Hygiene Initiative was associated with a statistically significant reduction in infection rates in 11 out of 23 state and infection combinations studied. There was no change in infection rates for nine combinations, and there was an increase in three infection rates in South Australia.
Conclusions: The intervention was associated with reduced infection rates in many cases. The lack of improvement in nine cases may have been because they already had effective initiatives before the national initiative’s introduction.
Additional keywords: intervention, nosocomial.
References
[1] Barnett AG, Page K, Campbell M, Martin E, Rashleigh-Rolls R, Halton K, Paterson D, Hall L, Jimmieson N, White K, Graves N. The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case-control study. BMJ Open 2013; 3| The increased risks of death and extra lengths of hospital and ICU stay from hospital-acquired bloodstream infections: a case-control study.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3sXpvVars74%3D&md5=8a8c2f4c77f642c889b47f8209560b32CAS | 24176795PubMed |
[2] Calfee D, Salgado C, Milstone AM, Harris A, Kuhar D, Moody J, Aureden K, Huang S, Maragakis L, Yokoe D. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35 772–96.
| Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update.Crossref | GoogleScholarGoogle Scholar | 24915205PubMed |
[3] Cantrell D, Shamriz O, Cohen MJ, Stern Z, Block C, Brezis M. Hand hygiene compliance by physicians: marked heterogeneity due to local culture? Am J Infect Control 2009; 37 301–5.
| Hand hygiene compliance by physicians: marked heterogeneity due to local culture?Crossref | GoogleScholarGoogle Scholar | 18834749PubMed |
[4] Pittet D. Compliance with hand disinfection and its impact on hospital-acquired infections. Journal of Hospital Infection 2001; 48 S40–S46.
| Compliance with hand disinfection and its impact on hospital-acquired infections.Crossref | GoogleScholarGoogle Scholar | 11759025PubMed |
[5] Hui S, Ng J, Santiano N, Schmidt H-M, Caldwell J, Ryan E, Maley M. Improving hand hygiene compliance: harnessing the effect of advertised auditing. Healthc Infect 2014; 19 108–13.
| Improving hand hygiene compliance: harnessing the effect of advertised auditing.Crossref | GoogleScholarGoogle Scholar |
[6] Pittet D, Allegranzi B, Boyce J. The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations. Infect Control Hosp Epidemiol 2009; 30 611–22.
| The World Health Organization guidelines on hand hygiene in health care and their consensus recommendations.Crossref | GoogleScholarGoogle Scholar | 19508124PubMed |
[7] World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge. Clean care is safer care. 2009.
[8] Ryan K, Russo PL, Heard K, Havers S, Bellis K, Grayson ML. Development of a standardised approach to observing hand hygiene compliance in Australia. Healthc Infect 2012; 17 115–21.
| Development of a standardised approach to observing hand hygiene compliance in Australia.Crossref | GoogleScholarGoogle Scholar |
[9] Barnett AG, Page KP, Campbell MB, Brain D, Martin E, Rashleigh-Rolls R, Halton K, Hall L, Jimmieson N, White K, Paterson D, Graves N. Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative. Infect Control Hosp Epidemiol 2014; 35 1029–36.
| Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative.Crossref | GoogleScholarGoogle Scholar | 25026620PubMed |
[10] Mitchell BG, Collignon PJ, McCann R, Wilkinson IJ, Wells A. A major reduction in hospital-onset Staphylococcus aureus bacteremia in Australia—12 years of progress: an observational study. Clin Infect Dis 2014; 59 969–75.
| A major reduction in hospital-onset Staphylococcus aureus bacteremia in Australia—12 years of progress: an observational study.Crossref | GoogleScholarGoogle Scholar | 24973314PubMed |
[11] Marschall J, Mermel L, Fakih M, Hadaway L, Kallen A, O’Grady N, Pettis A, Rupp M, Sandora T, Maragakis L, Yokoe D. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35 753–71.
| Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update.Crossref | GoogleScholarGoogle Scholar | 24915204PubMed |
[12] Anderson D, Podgorny K, Berríos-Torres S, Bratzler D, Patchen Dellinger E, Greene L, Nyquist A-C, Saiman L, Yokoe D, Maragakis L, Kaye K. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35 605–27.
| Strategies to prevent surgical site infections in acute care hospitals: 2014 update.Crossref | GoogleScholarGoogle Scholar | 24799638PubMed |
[13] Dubberke E, Carling P, Carrico R, Donskey C, Loo V, McDonald LC, Maragakis L, Sandora T, Weber D, Yokoe D, Gerding D. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35 628–45.
| Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update.Crossref | GoogleScholarGoogle Scholar | 24799639PubMed |
[14] Graves N, Barnett A, White K, Jimmieson N, Page K, Campbell M, Stevens E, Rashleigh-Rolls R, Grayson L, Paterson D. Evaluating the economics of the Australian National Hand Hygiene Initiative. Healthc Infect 2012; 17 5–10.
| Evaluating the economics of the Australian National Hand Hygiene Initiative.Crossref | GoogleScholarGoogle Scholar |
[15] Page K, Barnett AG, Campbell M, Brain D, Martin E, Fulup N, Graves N. Costing the Australian National Hand Hygiene Initiative. Journal of Hospital Infection 2014;
| Costing the Australian National Hand Hygiene Initiative. Crossref | GoogleScholarGoogle Scholar | 25092619PubMed |
[16] Russo PL, Cheng AC, Richards M, Graves N, Hall L. Healthcare-associated infections in Australia: time for national surveillance. Aust Health Rev 2014; in press.
| 25362241PubMed |
[17] Shardell M, Harris AD, El-Kamary SS, Furuno JP, Miller RR, Perencevich EN. Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies. Clin Infect Dis 2007; 45 901–7.
| Statistical analysis and application of quasi experiments to antimicrobial resistance intervention studies.Crossref | GoogleScholarGoogle Scholar | 17806059PubMed |
[18] Dobson AJ, Barnett AG. An Introduction to Generalized Linear Models . Boca Raton: Chapman & Hall/CRC; 2008.
[19] Burnham KP, Anderson DR. Model Selection and Multi-Model Inference: A Practical Information-Theoretic Approach . Springer; 2002.
[20] Cope C, Wilkinson I. Bloodstream Infection 2012 Annual Report . SA Department for Health and Ageing; 2014.
[21] Reichardt C, Königer D, Bunte-Schönberger K, Mönch N, Schwab F, Behnke M, Gastmeier P. Three years of national hand hygiene campaign in Germany: what are the key conclusions for clinical practice? Journal of Hospital Infection 2013; 83 S11–S16.
| Three years of national hand hygiene campaign in Germany: what are the key conclusions for clinical practice?Crossref | GoogleScholarGoogle Scholar | 23453170PubMed |
[22] Grayson ML, Jarvie LJ, Martin R, Johnson PD, Jodoin ME, McMullan C, Gregory RH, Bellis K, Cunnington K, Wilson FL, Quin D, Kelly AM. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008; 188 633–40.
| 18513171PubMed |
