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Controlled Trial Measuring the Effect of a Feedback Intervention on Hand Hygiene Compliance in a Step-Down Unit

Published online by Cambridge University Press:  02 January 2015

Alexandre R. Marra ,
Cláudia D'Arco ,
Bruno de Arruda Bravim ,
Marinês Dalla Valle Martino ,
Luci Correa ,
Cláudia Vallone Silva ,
Luiz Carlos R. Lamblet ,
Moacyr Silva Junior ,
Gisele de Lima  and
Luciana Reis Guastelli
...Show all authors
Alexandre R. Marra*
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Cláudia D'Arco
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Bruno de Arruda Bravim
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Marinês Dalla Valle Martino
Affiliation:
Microbiology Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil
Luci Correa
Affiliation:
Infection Control Unit, São Paulo, Brazil
Luiz Carlos R. Lamblet
Affiliation:
Infection Control Unit, São Paulo, Brazil
Moacyr Silva Junior
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Gisele de Lima
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Luciana Reis Guastelli
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Luciana Barbosa
Affiliation:
Hospital Israelita Albert Einstein, São Paulo, Braziland Gojo Latin America, São Paulo, Brazil
Oscar Fernando Pavão dos Santos
Affiliation:
Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Michael B. Edmond
Affiliation:
Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
*
Av. Albert Einstein, 627/701, Intensive Care Unit, 5th floor, Morumbi, Sao Paulo 05651-901, Brazil (a.marra@uol.com.br)
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Abstract

Objective.

To evaluate hand hygiene compliance in 2 adult step-down units (SDUs).

Design.

A 6-month (from March to September 2007), controlled trial comparing 2 SDUs, one with a feedback intervention program (ie, the intervention unit) and one without (ie, the control unit).

Setting.

Two 20-bed SDUs at a tertiary care private hospital.

Methods.

Hand hygiene episodes were measured by electronic recording devices and periodic observational surveys. In the intervention unit, feedback was provided by the SDU nurse manager, who explained twice a week to the healthcare workers the goals and targets for the process measures.

Results.

A total of 117,579 hand hygiene episodes were recorded in the intervention unit, and a total of 110,718 were recorded in the control unit (P = .63). There was no significant difference in the amount of chlorhexidine used in the intervention and control units (34.0 vs 26.7 L per 1,000 patient-days; P = .36) or the amount of alcohol gel used (72.5 vs 70.7 L per 1,000 patient-days; P = .93). However, in both units, healthcare workers used alcohol gel more frequently than chlorhexidine (143.2 vs 60.7 L per 1,000 patient-days; P < .001). Nosocomial infection rates in the intervention and control units, respectively, were as follows: for bloodstream infection, 3.5 and 0.79 infections per 1,000 catheter-days (P = .18); for urinary tract infection, 15.8 and 15.7 infections per 1,000 catheter-days (P = .99); and for tracheostomy-associated pneumonia, 10.7 and 5.1 infections per 1,000 device-days (P = . 13). There were no cases of infection with vancomycin-resistant enterococci and only a single case of infection with methicillin-resistant Staphylococcus aureus (in the control unit).

Conclusions.

The feedback intervention regarding hand hygiene had no significant effect on the rate of compliance. Other measures must be used to increase and sustain the rate of hand hygiene compliance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 730 - 735
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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