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

American Journal of Infection Control Written by: Steven J. Schwoen, Sara L. Edmonds, Jane Kirk, Douglas Y. Rowland, Carmen Acosta

PRESENTATION BY LILY NG IFEYINWA NNAJIOFOR ESTHER SCHANOWITZ ALINA SHRESTHA

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

Quantitative study

Abstract/overview
Aim: Determine the impact

of a hand hygiene program using alcohol based hand rubs on infection rates in long term care facilities.

Background
Hand hygiene, specifically ABHR, associated

with a decrease in hospital acquired infections. LTCF are a unique environment. *Higher acuity *Transferring between hospital and LTCF Lots of opportunity for person-to-person transmission Balance between home-like environment and enforcing infection control 1.6-3.8 million infections in LTCF every year, caused by SSTI, MRSA, VRE among others Emphasis on hand hygiene of HCP in hospitals, but not on patients and LTCF

Methodology

Research design: A quantitative experimental design.

Independent Variable: Performing hand hygiene using soap and water compared to touchfree dispenser containing Purell.
Dependent Variable: Infection rate Duration of Experiment: -May 2009- February 2010: Pre-intervention period. Hand hygiene with soap and water. -March 2010 : Training and implementation period; Installation of Purell dispensers; Hand hygiene education for all health care personnel -April 2010 February 2011: Post intervention period. Setting: located in the pleasant Valley Manor Nursing home Stroudsburg, Pennsylvania. Facility comprises of 3 wings with a 174-bed capacity. Population and sample characteristics: - 250 employees consisting of: health care personnel (Registered Nurses, Licensed Practicing Nurses, Certified Nursing Assistants and Therapists and House keepers. - Residents who were older adults.

Data Collection
Lower Respiratory Tract infections (LRTIs) and Skin & Soft-Tissue

Infections (SSTIs) were identified and classified according to the McGeer et al definitions for surveillance in Long-Term Care Facilities (LTCFs).

Data collection for MRSA and VRE colonization were adapted from

the SHEA/APIC guidelines for infection prevention and control in LTCFs. were used for identifying gastrointestinal infections, including C. difficule. summary diagnosis was reviewed; all cases indicating infectionrelated hospitalizations were included.

Pennsylvania Patient Safety Reporting System infection definitions

To determine hospitalizations related to infection, the discharge

Data Analysis
Used the residency equivalent model, power

calculations to detect significant decreases in rates of key adverse events.

Multivariate Poisson regression models were used to

compare rates of events of interest.

P< .05 was taken as statistically significant The

statistical analysis were performed using SAS software, PASW Statistics 19, and EXCEL spreadsheets.

Results

Results
A statistically signicant decline in infection rates for LRTIs were reduced from 0.97

to 0.53 infections per 1,000 resident. resident-days

Infection rates for SSTIs were reduced from 0.30 to 0.25 infections per 1,000

The C difcile rates were reduced by half from 0.08 infections per 1,000 resident-

days prior to the intervention to 0.04 infections per 1,000 resident-days following the intervention infections, which were 0.10 infections per 1,000 resident-days prior to the intervention and 0.09 infections per 1,000 resident-days following the intervention signicant association between MRSA and VRE infection rates and the intervention.

The study also showed a non signicant decrease in the rates of gastrointestinal

The results for MRSA and VRE incidence were inconclusive because there is no

A 54% compliance rate was observed among HCP.

Discussion
Conclusion is consistent with previous studies on ABHR in removing pathogens

from hands of health care providers and reducing infection rates in long term care facilities. led to significant reduction in lower respiratory tract infections.

Promoting awareness of hand hygiene, respiratory etiquette and social distancing

The non-significant reduction of reportable SSTIs may be due to overall low baseline

infection rates at this particular facility.

This study contradicts a previous study stated that the preference for ABHR might

be associated with an increased risk of gastrointestinal illness caused by norovirus in LTCFs.

Studies have shown very low hand hygiene adherence rates. One study showed

adherence to hand hygienic practices of 27% before patient contact and 63% after patient contact. Another study reported an adherence rate of only 14.7 in 2 LTCFs. This study showed a rate of 54%, a 2 fold difference that can be attributed to assess to the ABHR and training.

Overall Questions
Nurses and other health care providers can become vectors for

infection in any health care setting, therefore, the findings from this study can be used in hospitals as well. exposure to pathogens may be greater. The importance of hand hygiene is essential.

The hospital is an acute setting compared to LTCF and the risk of

The population in the hospital is more diverse, but still includes

residents that may be admitted from LTCF. We have to be cautious of who we can potentially infect outside of the hospital. hygienic practices can promote health and reduce the spread of infection.

Results can be generalized to show that overall awareness of

References
Langford, R. & Young, A. (2013). Making a difference with nursing research. Boston: Pearson. Steven J. Schweon, S., Edmonds, K., Jane, R, Douglas. (2013). Effectiveness of a comprehensive hand hygiene program for reduction of infection rates in a long-term care facility. American Journal of Infection Control, 41(1), 39-44. doi: 10.1016/j.ajic.2012.02.010