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

• Published in: Infection control and hospital epidemiology Vol. 29; no. 8; pp. 730 - 735
• Main Authors: Marra, Alexandre R., D'Arco, Cláudia, Bravim, Bruno de Arruda, Martino, Marinês Dalla Valle, Correa, Luci, Silva, Cláudia Vallone, Lamblet, Luiz Carlos R., Junior, Moacyr Silva, de Lima, Gisele, Guastelli, Luciana Reis, Barbosa, Luciana, Pavão dos Santos, Oscar Fernando, Edmond, Michael B.
• Format: Journal Article
• Language: English
• Published: Thorofare, NJ The University of Chicago Press 01-08-2008; Slack
• Subjects: Alcohols; Alcohols - therapeutic use; Biological and medical sciences; Brazil; Chlorhexidine - therapeutic use; Compliance certificates; Control units; Cross Infection - prevention & control; Electronics; Epidemiology. Vaccinations; Gels; General aspects; Guideline Adherence - statistics & numerical data; Hand Disinfection - methods; Hospital admissions; Hospital Units; Humans; Infections; Infectious diseases; Medical sciences; Miscellaneous; Nurses; Nurses - psychology; Nursing; Original Article; Patient compliance; Personnel, Hospital; Professional Practice - statistics & numerical data; Public health. Hygiene; Public health. Hygiene-occupational medicine; Staphylococcus aureus; Tests of compliance; Brazil; Infection; Compliance; Hand; Hygiene; Public health
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/590122

To evaluate hand hygiene compliance in 2 adult step-down units (SDUs).
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).
Two 20-bed SDUs at a tertiary care private hospital.
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.
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).
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.