Abstract
BackgroundLimited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs.Methods and FindingsA 4-year hospital-wide HHP, with particular emphasis on using an alcohol-based hand rub, was implemented in April 2004 at a 2,200-bed teaching hospital in Taiwan. Compliance was measured by direct observation and the use of hand rub products. Poisson regression analyses were employed to evaluate the densities and trends of HAIs during the preintervention (January 1999 to March 2004) and intervention (April 2004 to December 2007) periods. The economic impact was estimated based on a case-control study in Taiwan. We observed 8,420 opportunities for hand hygiene during the study period. Compliance improved from 43.3% in April 2004 to 95.6% in 2007 (p<.001), and was closely correlated with increased consumption of the alcohol-based hand rub (r = 0.9399). The disease severity score (Charlson comorbidity index) increased (p = .002) during the intervention period. Nevertheless, we observed an 8.9% decrease in HAIs and a decline in the occurrence of bloodstream, methicillin-resistant Staphylococcus aureus, extensively drug-resistant Acinetobacter baumannii, and intensive care unit infections. The intervention had no discernable impact on HAI rates in the hematology/oncology wards. The net benefit of the HHP was US$5,289,364, and the benefit-cost ratio was 23.7 with a 3% discount rate.ConclusionsImplementation of a HHP reduces preventable HAIs and is cost effective.
Highlights
Healthcare-associated infections (HAIs) cause significant concern regarding the safety and quality of healthcare quality worldwide [1,2]
Following the SARS epidemic in 2003, we reviewed the strengths and weaknesses of infection control strategies at the National Taiwan University Hospital in anticipation of other infectious diseases emerging [4,5]
We chose methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter, and extensively drug-resistant A. baumannii (XDRAB) as marker organisms because our previous study showed a significant increase in healthcare-associated infections (HAIs) incidences, and outbreaks of these infections occurred during the study period [6]
Summary
Healthcare-associated infections (HAIs) cause significant concern regarding the safety and quality of healthcare quality worldwide [1,2]. HAIs have been identified as a fundamental priority, and were selected as the topic of the first Global Patient Safety Challenge. An unannounced hand hygiene audit by infection control nurses was conducted of hospital wards in December 2003. We found that of the 226 opportunities presented, hospital staff washed their hands for only 16.6%. This finding led us to introduce alcohol-based hand rubs, and implement a hospital-wide program promoting hand hygiene through using alcohol-based hand rubs. Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs
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