Abstract
Participation in European surveillance for bloodstream infection (BSI) commenced in Ireland in 1999 with all laboratories (n = 39) participating by 2014. Observational hand hygiene auditing (OHHA) was implemented in 2011. The aim of this study was to evaluate the impact of OHHA on hand hygiene compliance, alcohol hand rub (AHR) procurement and the incidence of sensitive and resistant Staphylococcus aureus and Enterococcus faecium and faecalis BSI. A prospective segmented regression analysis was performed to determine the temporal association between OHHA and outcomes. Observed hand hygiene improved from 74.7% (73.7-75.6) in 2011 to 90.8% (90.1-91.3) in 2016. AHR procurement increased from 20.1 l/1000 bed days used (BDU) in 2009 to 33.2 l/1000 BDU in 2016. A pre-intervention reduction of 2% per quarter in the ratio of methicillin sensitive Staphylococcus aureus BSI/BDU stabilized in the time period after the intervention (P < 0.01). The ratio of Methicillin resistant Staphylococcus aureus (MRSA) BSI/BDU was decreasing by 5% per quarter pre-intervention, this slowed to 2% per quarter post intervention, (P < 0.01). There was no significant change in the ratio of vancomycin sensitive (P = 0.49) or vancomycin resistant (P = 0.90) Enterococcus sp. BSI/BDU post intervention. This study shows national OHHA increased observed hand hygiene compliance and AHR procurement, however there was no associated reduction in BSI.
Highlights
Bloodstream infection (BSI) is a serious complication of healthcare with mortality estimated at 15.3% of cases in Ireland [1]
In Europe between 2013 and 2016 the reported prevalence of methicillin resistant Staphylococcus aureus (MRSA) BSI reduced significantly while there was no significant change in the overall prevalence of vancomycin resistant enterococci (VRE) BSI [8]
In this study we describe the impact of Observational hand hygiene auditing (OHHA) on the rate of hand hygiene compliance, alcohol hand rub (AHR) procurement and the prevalence of methicillin sensitive Staphylococcus aureus (MSSA), MRSA, vancomycin sensitive enterococci (VSE) and VRE BSIs in Irish hospitals over an 8-year period
Summary
Bloodstream infection (BSI) is a serious complication of healthcare with mortality estimated at 15.3% of cases (95% CI: 14.8–15.8) in Ireland [1]. Participation in European surveillance for BSI commenced in Ireland in 1999 [2] National engagement with this surveillance was enthusiastic with complete coverage by 2007 and all laboratories (n = 37) continuing to participate in 2016 with an estimated overall population coverage of 99% [3]. Public reporting of hospital specific BSI data commenced in 2008 on the recommendation of the Health Service Executive strategy for the prevention and control of healthcare-associated infection (HCAI), with the first report published in 2009 [4]. While Staphylococcus aureus and enterococci have different reservoirs they are common causes of hospital acquired BSI [5]. In Europe between 2013 and 2016 the reported prevalence of methicillin resistant Staphylococcus aureus (MRSA) BSI reduced significantly while there was no significant change in the overall prevalence of vancomycin resistant enterococci (VRE) BSI [8]
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