Advertisement

Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility

      Background

      Alcohol-based hand rubs play a key role in reducing the transmission of pathogens in acute care settings, especially as part of a comprehensive hand hygiene program. However, their use in long-term care facilities (LTCFs) has been virtually unstudied.

      Methods

      Infection data, including those meeting McGeer et al and the Pennsylvania Patient Safety Authority’s surveillance definitions, for lower respiratory tract infections (LRTIs) and skin and soft-tissue infections (SSTIs), as well as hospitalization data were collected in a 174-bed LTCF for 22 months (May 2009 to February 2011). In March 2010, a comprehensive hand hygiene program including increased product availability, education for health care personnel (HCP) and residents, and an observation tool to monitor compliance, was implemented.

      Results

      Infection rates for LRTIs were reduced from 0.97 to 0.53 infections per 1,000 resident-days (P = .01) following the intervention, a statistically significant decline. Infection rates for SSTIs were reduced from 0.30 to 0.25 infections per 1,000 resident-days (P = .65). A 54% compliance rate was observed among HCP.

      Conclusion

      This study demonstrates that the use of alcohol-based hand rubs, as part of a comprehensive hand hygiene program for HCP and residents, can decrease infection rates in LTCFs.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Boyce J.M.
        • Pittet D.
        Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force.
        MMWR Morb Mortal Wkly Rep. 2002; 51: 1-45
        • Allegranzi B.
        • Pittet D.
        Role of hand hygiene in healthcare-associated infection prevention.
        J Hosp Infect. 2009; 73: 305-315
        • Conly J.M.
        • Hill S.
        • Ross J.
        • Lertzman J.
        • Louie T.J.
        Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates.
        Am J Infect Control. 1989; 17: 330-339
        • Larson E.
        A causal link between handwashing and risk of infection? Examination of the evidence.
        Infect Control Hosp Epidemiol. 1988; 9: 28-36
        • Won S.P.
        • Chou H.C.
        • Hsieh W.S.
        • Chen C.Y.
        • Huang S.M.
        • Tsou K.I.
        Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit.
        Infect Control Hosp Epidemiol. 2004; 25: 742-746
        • Rosenthal V.D.
        • Guzman S.
        • Safdar N.
        Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina.
        Am J Infect Control. 2005; 33: 392-397
        • Lucet J.C.
        • Rigaud M.P.
        • Mentre F.
        • Kassis N.
        • Deblangy C.
        • Andremont A.
        • et al.
        Hand contamination before and after different hand hygiene techniques: a randomized clinical trial.
        J Hosp Infect. 2002; 50: 276-280
        • Pittet D.
        • Dharan S.
        • Touveneau S.
        • Sauvan V.
        • Perneger T.V.
        Bacterial contamination of the hands of hospital staff during routine patient care.
        Arch Intern Med. 1999; 159: 821-826
        • Kac G.
        • Podglajen I.
        • Gueneret M.
        • Vaupre S.
        • Bissery A.
        • Meyer G.
        Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study.
        J Hosp Infect. 2005; 60: 32-39
        • Girou E.
        • Loyeau S.
        • Legrand P.
        • Oppein F.
        • Brun-Buisson C.
        Efficacy of handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial.
        BMJ. 2002; 325: 362-366
        • Pittet D.
        Hand hygiene: improved standards and practice for hospital care.
        Curr Opin Infect Dis. 2003; 16: 327-335
        • Hilburn J.
        • Hammond B.S.
        • Fendler E.J.
        • Groziak P.A.
        Use of alcohol hand sanitizer as an infection control strategy in an acute care facility.
        Am J Infect Control. 2003; 31: 109-116
        • Pittet D.
        • Hugonnet S.
        • Harbarth S.
        • Mourouga P.
        • Sauvan V.
        • Touveneau S.
        • et al.
        Effectiveness of a hospital-wide programme to improve compliance with hand hygiene.
        Lancet. 2000; 356: 1307-1312
        • Lederer Jr., J.W.
        • Best D.
        • Hendrix V.
        A comprehensive hygiene approach to reducing MRSA health care-associated infections.
        Jt Comm J Qual Patient Saf. 2009; 35: 180-185
        • Grayson M.L.
        • Jarvie L.J.
        • Martin R.
        • Johnson P.D.
        • Jodoin M.E.
        • McMullan C.
        • et al.
        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: 633-640
        • Carboneau C.
        • Benge E.
        • Jaco M.T.
        • Robinson M.
        A lean six sigma team increases hand hygiene compliance and reduces hospital-acquired MRSA infections by 51%.
        J Healthc Qual. 2010; 32: 61-70
        • Johnson P.R.D.
        • Martin R.
        • Burrell L.J.
        • Grabsch E.A.
        • Kirsa S.W.
        • O’Keeffe J.
        • et al.
        Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection.
        Med J Aust. 2005; 183: 509-514
      1. WHO guidelines on hand hygiene in health care. World Health Organization, Geneva, Switzerland2009
        • Smith P.W.
        • Bennett G.
        • Bradley S.
        • Drinka P.
        • Lautenbach E.
        • Marx J.
        • et al.
        SHEA/APIC guideline: infection prevention and control in the long-term care facility.
        Am J Infect Control. 2008; 36: 504-535
        • Mody L.
        Infection control issues in older adults.
        Clin Geriatr Med. 2007; 23 (Available from) (Accessed August 31, 2011): 499-514
        • Nicolle L.E.
        Infection control in long-term care facilities.
        Clin Infect Dis. 2000; 31 (Available from) (Accessed August 31, 2011): 752-756
        • Richards Jr., C.L.
        • Darradji M.
        • Weinberg A.
        • Ouslander J.G.
        Antimicrobial use in post-acute care: a retrospective descriptive analysis in seven long-term care facilities in Georgia.
        J Am Med Dir Assoc. 2005; 6: 109-112
        • Straubaugh L.J.
        Emerging health care-associated infections in the geriatric population.
        Emerg Infect Dis. 2001; 7 (Available from) (Accessed August 30, 2011): 268-270
        • O’Fallon E.
        • Schreiber R.
        • Kandel R.
        • D’Agata E.
        Multidrug-resistant gram-negative bacteria at a long-term care facility: assessment of residents, healthcare workers, and inanimate surfaces.
        Infect Control Hosp Epidemiol. 2009; 30: 1172-1179
        • Simor A.E.
        • Bradley S.F.
        • Strausbaugh L.J.
        • Crossley K.
        • Nicolle L.E.
        SHEA Long-Term-Care Committee. SHEA position paper: Clostridium difficile in long-term-care facilities for the elderly.
        Infect Control Hosp Epidemiol. 2002; 23: 696-703
        • Riggs M.M.
        • Sethi A.K.
        • Zabarsky T.F.
        • Eckstein E.C.
        • Jump R.
        • Donskey C.J.
        Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents.
        Clin Infect Dis. 2007; 45 (Available from) (Accessed September 5, 2011): 992-998
      2. Centers for Disease Control and Prevention. Surveillance for norovirus outbreaks. Available from: http://www.cdc.gov/features/dsNorovirus/. Accessed August 30, 2011.

      3. Medicare and Medicaid programs. Fire safety requirements for certain health care facilities; amendment. Final rule. Centers for Medicare & Medicaid Services.
        Fed Regist. 2006; 71 (Available from) (Accessed September 5, 2011): 55326-55341
        • Schweon S.J.
        • Kirk J.
        A realistic approach towards hand hygiene for long-term care residents and health care personnel.
        Am J Infect Control. 2011; 39: 336-338
      4. Department of Health and Human Services and Center for Medicare & Medicaid Services. 2009. Transmittal 48: revisions to Appendix PP, “Guidance to Surveyors of Long Term Care Facilities, Tag F 255.” Available from: https://www.cms.gov/transmittals/downloads/R48SOMA.pdf. Accessed November 9, 2011.

        • Strausbaugh L.J.
        • Joseph C.L.
        The burden of infection in long-term care.
        Infect Control Hosp Epidemiol. 2000; 21: 674-679
        • O’Fallon E.
        • Opo-Vicas A.
        • D’Agata E.
        The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities.
        J Gerontol. 2009; 64A (Available from) (Accessed August 31, 2011): 138-141
        • Furuno J.P.
        • Hebden J.N.
        • Standiford H.C.
        • Perencevich E.N.
        • Miller R.R.
        • Moore A.C.
        • et al.
        Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility.
        Am J Infect Control. 2008; 36: 468-471
        • Mylotte J.M.
        • Tayara A.
        • Goodnough S.
        Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes.
        Clin Infect Dis. 2002; 35: 1484-1490
        • Mody L.
        • Kauffman C.A.
        • Donabedian S.
        • Zervos M.
        • Bradley S.F.
        Epidemiology of Staphylococcus aureus colonization in nursing home residents.
        Clin Infect Dis. 2008; 46 (Available from) (Accessed August 31, 2011): 1368-1373
        • Mody L.
        • McNeil S.A.
        • Sun R.
        • Bradley S.F.
        • Kauffman C.A.
        Introduction of a waterless alcohol-based hand rub in a long-term-care facility.
        Infect Control Hosp Epidemiol. 2003; 24: 165-171
        • Yeung W.K.
        • Tam W.S.W.
        • Wong T.W.
        Clustered randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities.
        Infect Control Hosp Epidemiol. 2011; 32: 67-76
        • Fendler E.J.
        • Ali Y.
        • Hammond B.S.
        • Lyons M.K.
        • Kelley M.B.
        • Vowell N.A.
        The impact of alcohol hand sanitizer use on infection rates in an extended care facility.
        Am J Infect Control. 2002; 30: 226-233
        • Makris A.T.
        • Morgan L.
        • Gaber D.J.
        • Richter A.
        • Rubino J.R.
        Effect of a comprehensive infection control program on the incidence of infections in long-term care facilities.
        Am J Infect Control. 2000; 28: 3-7
        • Weber D.J.
        • Rutala W.A.
        • Miller M.B.
        • Huslage K.
        • Sickbert-Bennett E.
        Role of hospital surfaces in the transmission of emerging health care-associated pathogens: norovirus, Clostridium difficile, and Acinetobacter species.
        Am J Infect Control. 2010; 38: S25-S33
        • Hota B.
        Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection?.
        Clin Infect Dis. 2004; 39 (Available from) (Accessed September 16, 2011): 1182-1189
      5. Istenes N, Hazelett S, Kirk J, Bingham J, Fleming E. Hand hygiene in healthcare: the role of the patient. Poster session presented at: APIC Annual Conference. Baltimore, MD; 2011.

      6. Department of Health and Human Services and Center for Medicare & Medicaid Services. 2009. Transmittal 55: revisions to Appendix PP, “Interpretive Guidelines for Long Term Care Facilities, Tag F 441.” Available from: http://www.cms.gov/transmittals/downloads/R55SOMA.pdf. Accessed January 22, 2012.

        • McAteer J.
        • Stone S.
        • Fuller C.
        • Charlette A.
        • Cookson B.
        • Slade R.
        • et al.
        Development of an observational measure of healthcare worker hand-hygiene behavior: the hand-hygiene observation tool (HHOT).
        J Hosp Infect. 2008; 68: 222-229
        • Kohli E.
        • Ptak J.
        • Smith R.
        • Taylor E.
        • Talbot E.A.
        • Kirkland K.B.
        Variability in the Hawthorne effect with regard to hand hygiene performance in high- and low-performing inpatient care units.
        Infect Control Hosp Epidemiol. 2009; 30: 222-225
        • McGeer A.
        • Campbell B.
        • Emori T.G.
        • Hierholzer W.J.
        • Jackson M.M.
        • Nicolle L.E.
        Definitions of infection for surveillance in long-term care facilities.
        Am J Infect Control. 1991; 19: 1-7
      7. Commonwealth of Pennsylvania Patient Safety Authority. Training manual and users’ guide. Available from: https://www.papsrs.state.pa.us/PSA/. Accessed September 27, 2011.

        • Roup B.J.
        • Scaletta J.M.
        How Maryland increased infection prevention and control activity in long-term care facilities, 2003-2008.
        Am J Infect Control. 2011; 39: 292-295
        • Kaier K.
        • Hagist C.
        • Frank U.
        • Conrad A.
        • Meyer E.
        Two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection.
        Infect Control Hosp Epidemiol. 2009; 30: 346-353
        • Blaney D.D.
        • Daly E.R.
        • Kirkland K.B.
        • Tongren J.E.
        • Taller Kelso P.
        • Talbot E.A.
        Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007.
        Am J Infect Control. 2011; 39: 296-301
        • Thompson B.L.
        • Dwyer D.M.
        • Ussery X.T.
        • Derman S.
        • Vacek P.
        • Schwartz B.
        Handwashing and glove use in a long-term-care facility.
        Infect Control Hosp Epidemiol. 1997; 18: 97-103
        • Smith A.
        • Carusone S.C.
        • Loeb M.
        Hand hygiene practices of health care workers in long-term care facilities.
        Am J Infect Control. 2008; 36: 492-494
        • Zerr D.M.
        • Allpress A.L.
        • Heath J.
        • Bornemann R.
        • Bennett E.
        Decreasing hospital-associated rotavirus infection: a multidisciplinary hand hygiene campaign in a children’s hospital.
        Pediatr Infect Dis J. 2005; 24: 397-403
        • MacDonald A.
        • Dinah F.
        • MacKenzie D.
        • Wilson A.
        Performance feedback of hand hygiene, using alcohol gel as the skin decontaminant, reduces the number of inpatients newly affected by MRSA and antibiotic costs.
        J Hosp Infect. 2004; 56: 56-63
        • Bischoff W.E.
        • Reynolds T.M.
        • Sessler C.N.
        • Edmond M.B.
        • Wenzel R.P.
        Handwashing compliance by health care workers.
        Arch Intern Med. 2000; 160: 1017-1021
        • Sakamoto F.
        • Yamada H.
        • Suzuki C.
        • Sugiura H.
        • Tokuda Y.
        Increased use of alcohol-based hand sanitizers and successful eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit: a multivariate time series analysis.
        Am J Infect Control. 2010; 38: 529-534
        • Pittet D.
        Compliance with hand disinfection and its impact on hospital-acquired infections.
        J Hosp Infect. 2001; 48: S40-S46
        • Ashraf M.S.
        • Hussain S.W.
        • Ashraf S.
        • Hussain R.
        • Haller N.
        • Sison C.
        • et al.
        Hand hygiene in long-term care facilities: a multicenter study of knowledge, attitudes, practices, and barriers.
        Infect Control Hosp Epidemiol. 2010; 31: 758-762