1186. Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital Decreased Laboratory-Identified Clostridioides difficile Infections with Implementation of an Electronic Hand Hygiene Monitoring System in a Long-Term Acute Care Hospital

Abstract

BackgroundHand hygiene (HH) is the cornerstone of infection prevention and improved compliance has been associated with reduced healthcare-associated infections (HAIs). However, traditional methods for HH data collection have limitations and may not accurately reflect true compliance. We sought to evaluate whether an electronic hand hygiene monitoring system (HHMS) can improve data collection, compliance, and reduce HAIs.MethodsA HHMS was implemented as part of a pilot at a single facility in June 2018 for all healthcare workers (HCWs) who entered patient rooms. The system prompted HCWs to perform HH with an audible and visual reminder emitted from a badge if a HH event had not been registered within specific timeframes of entering or exiting a patient room. The system captured compliance with preferential handwashing (soap and water) for at least 15 seconds upon exit of Clostridioides difficile (C. difficile) designated rooms. All HH data were collected by the HHMS. Hand hygiene compliance and HAI data were compared for the pre-intervention (June 2017-May 2018) and intervention periods (July 2018-March 2019). No changes were made to environmental cleaning protocols or compliance monitoring, nor in antibiotic stewardship practices.ResultsHH compliance by direct observation in the pre-intervention period was 91% (1,612 observations). HH compliance with the HHMS during the intervention period was 97% (2,778,402 observations). The mean monthly HH opportunities recorded during the pre-intervention period was 134, while the HHMS captured 308,711, a greater than 2,300-fold increase. The incidence of healthcare facility-onset C. difficile infections (HO-CDI) pre-intervention was 9.60 per 10,000 patient-days (41 GDH+/Toxin+ laboratory-identified [labID] events/42,726 patient-days). With the HHMS, HO-CDI decreased 70% (P = 0.0003) to 2.89 per 10,000 patient-days (9 labID events/31,169 patient-days). No policy changes in environmental cleaning of high-touch surfaces were made or observed during the pilot.ConclusionThe use of an HHMS facilitated more comprehensive HH data and improved compliance. The preliminary findings also support an association between more robust HH compliance data and a significant decrease in toxin-producing CDI.Disclosures All authors: No reported disclosures.