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Has Improved Hand Hygiene Compliance Reduced the Risk of Hospital-Acquired Infections among Hospitalized Patients in Ontario? Analysis of Publicly Reported Patient Safety Data from 2008 to 2011

Published online by Cambridge University Press:  02 January 2015

Giulio DiDiodato
Giulio DiDiodato*
Affiliation:
Department of Critical Care, Royal Victoria Hospital, Barrie, Ontario, Canada
*
Department of Critical Care, Royal Victoria Hospital, Barrie, Ontario L4M 6M2, Canada (gdidiodato@gmail.com)
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Abstract

Design.

Prospective, observational, ecological, time series, cross-sectional study examining the association between hand hygiene compliance (HHC) rates and the incidence of hospital-acquired infections.

Setting.

Acute care hospitals (N = 166) located in the province of Ontario, Canada.

Methods.

All data were extracted from the Ontario patient safety indicator database (http://www.hqontario.ca/public-reporting/patient-safety). Complete data were available for 166 acute care hospitals from October 1, 2008, to December 31, 2011. The rates of Clostridium difficile infection (CDI) are reported monthly, methicillin-resistant Staphylococcus aureus (MRSA) bacteremia quarterly, and HHC rates yearly. Trends and associations for each indicator were evaluated by ordinary least squares regression (HHC), zero-inflated Poisson regression (MRSA bacteremia), or Poisson regression (CDI). Dependent variables included in the regression analyses were extracted from the same database and included year, healthcare region, and type of hospital (teaching or small or large community).

Results.

Compared to those in 2008, reported HHC rates improved every year both before and after environment/patient contact (range, 10.6%–25.3%). Compared to those in 2008, there was no corresponding change in the rates of MRSA bacteremia; however, the rates of CDI decreased in 2009 but were not statistically significantly decreased from baseline in either 2010 or 2011. No consistent association was demonstrated between changes in the rates of HHC and these two healthcare-associated infections (HAIs).

Conclusions.

Despite significant improvements in reported rates of HHC among healthcare personnel in Ontario's hospitals, we could not demonstrate a positive ecological impact on rates of these two HAIs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 6 , June 2013 , pp. 605 - 610
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1. Ontario Ministry of Health and Long-Term Care. Just Clean Your Hands for Health Care Professionals. http://www.health.gov.on.ca/en/ms/handhygiene/background.aspx.Google Scholar
2.Sax, H, Allegranzi, B, Chraiti, MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37(10):827–834.CrossRefGoogle ScholarPubMed
3.Raboud, J, Saskin, R, Simor, A, et al.Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital. Infect Control Hosp Epidemiol 2005;26(7):607–615.Google Scholar
4.Zorzi, R, McGuire, M, Engman, A, Lauzon, G, McGuire, M, Powadiuk, K. Evaluation of a Pilot Test of the Provincial Hand Hygiene Improvement Program for Hospitals: Final Report, http://www.health.gov.on.ca/en/ms/handhygiene/docs/14_7_Cathexis_MOHLTC_Hand_Hygiene_Final_Report.pdf.Google Scholar
5. Ontario Ministry of Health and Long-Term Care. Patient Safety Indicator Reporting. http://patientsafetyontario.net/Reporting/en/searchselection.aspx.Google Scholar
6. STATA/IC 10.1 for Macintosh, http://www.stata.com/.Google Scholar
7.Eveillard, M, Hitoto, H, Raymond, F, et al.Measurement and interpretation of hand hygiene compliance rates: importance of monitoring entire care episodes. J Hosp Infect 2009;72(3):211–217.CrossRefGoogle ScholarPubMed
8.Boyce, JM. Measuring healthcare worker hand hygiene activity: current practices and emerging technologies. Infect Control Hosp Epidemiol 2011;32(10):1016–1028.Google Scholar
9.Kohli, E, Ptak, J, Smith, R, Taylor, E, Talbot, EA, Kirkland, KB. 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(3):222–225.CrossRefGoogle ScholarPubMed
10.Muller, MP, Detsky, AS. Public reporting of hospital hand hygiene compliance: helpful or harmful? JAMA 2010;304(10):1116–1117.Google Scholar
11.Steed, C, Kelly, JW, Blackhurst, D, et al.Hospital hand hygiene opportunities: where and when (HOW2)? the HOW2 bench-mark study. Am J Infect Control 2011;39(1):19–26.CrossRefGoogle Scholar
12.Ketelaar, NA, Faber, MJ, Flottorp, S, Rygh, LH, Deane, KH, Eccles, MP. Public release of performance data in changing the behaviour of healthcare consumers, professionals or organisations. Cochrane Database Syst Rev 2011;(11):CD004538.Google Scholar
13.Grayson, ML, Russo, PL, Cruickshank, M, et al.Outcomes from the first 2 years of the Australian national hand hygiene initiative. Med J Aust 2011;195(10):615–619.CrossRefGoogle ScholarPubMed
14.Stone, SP, Fuller, C, Savage, J, et al.Evaluation of the national Clean Your Hands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. BMJ 2012;344:e3005.Google Scholar
15.Daneman, N, Stukel, TA, Ma, X, Vermeulen, M, Guttmann, A. Reduction in Clostridium difficile infection rates after mandatory hospital public reporting: findings from a longitudinal cohort study in Canada. PLoS Med 2012;9(7):e1001268.Google Scholar
16.Polgreen, PM, Yang, M, Bohnett, LC, Cavanaugh, JE. A time-series analysis of Clostridium difficile and its seasonal association with influenza. Infect Control Hosp Epidemiol 2010;31(4):382–387.Google Scholar
17.Pittet, D, Hugonnet, S, Harbarth, S, et al.Effectiveness of a hospital-wide programme to improve compliance with hand hygiene infection control programme. Lancet 2000;356(9238):1307–1312.Google Scholar
18.Kirkland, KB, Homa, KA, Lasky, RA, Ptak, JA, Taylor, EA, Splaine, ME. Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series. BMJ Qual Saf 2012;21(12):1019–1026.CrossRefGoogle ScholarPubMed
19.Kaier, K, Frank, U, Hagist, C, Conrad, A, Meyer, E. The impact of antimicrobial drug consumption and alcohol-based hand rub use on the emergence and spread of extended-spectrum beta-lactamase-producing strains: a time-series analysis. J Antimicrob Chemother 2009;63(3):609–614.Google Scholar
20.Vernaz, N, Sax, H, Pittet, D, Bonnabry, P, Schrenzel, J, Harbarth, S. Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile. J Antimicrob Chemother 2008;62(3):601–607.CrossRefGoogle ScholarPubMed
21.Beggs, CB, Shepherd, SJ, Kerr, KG. How does healthcare worker hand hygiene behaviour impact upon the transmission of MRSA between patients? an analysis using a Monte Carlo model. BMC Infect Dis 2009;9:64.Google Scholar
22.Beggs, CB, Shepherd, SJ, Kerr, KG. Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward. BMC Infect Dis 2008;8:114.Google Scholar
23.DiDiodato, G. An alternative methodology for interpretation and reporting of hand hygiene compliance data. Am J Infect Control 2012;40(4):332–335.CrossRefGoogle ScholarPubMed
24.Creamer, E, Shore, AC, Rossney, AS, et al.Transmission of endemic ST22-MRSA-IV on four acute hospital wards investigated using a combination of spa, dru and pulsed-field gel electrophoresis typing. Eur J Clin Microbiol Infect Dis 2012;31(11):3151–3161.Google Scholar
25.Vos, MC, Behrendt, MD, Melles, DC, et al.5 years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands. Infect Control Hosp Epidemiol 2009;30(10):977–984.Google Scholar
26.van Rijen, MM, Bosch, T, Heck, ME, Kluytmans, JA. Methicillin-resistant Staphylococcus aureus epidemiology and transmission in a dutch hospital. J Hosp Infect 2009;72(4):299–306.Google Scholar
27.Walker, AS, Eyre, DW, Wyllie, DH, et al.Characterisation of Clostridium difficile hospital ward-based transmission using extensive epidemiological data and molecular typing. PLoS Med 2012;9(2):e1001172.CrossRefGoogle ScholarPubMed
28.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital: infection control program. Ann Intern Med 1999;130(2):126–130.Google Scholar