Abstract
BackgroundThe primary goal of hand hygiene is to reduce infectious disease rates. We examined if a nursing home’s participation in a hand hygiene intervention resulted in residents having fewer healthcare associated infections (HAIs) when compared to nursing homes without the hand hygiene intervention.MethodsThis study is a part of a cluster randomized controlled trial (RCT) in 33 nursing homes to improve hand hygiene (HANDSOME). The incidence of five illnesses was followed over 13 months: gastroenteritis, influenza-like illness, pneumonia, urinary tract infections and infections from methicillin-resistant Staphylococcus aureus (MRSA). Incidence rates per study arm were reported for baseline (October–December 2016) and two follow-up periods (January–April 2017, May–October 2017). HAI rates were compared in a Poisson multilevel analysis, correcting for baseline differences (the baseline infection incidence and the size of the nursing home), clustering of observations within nursing homes, and period in the study.ResultsThere was statistically significantly more gastroenteritis (p < 0.001) and statistically significantly less influenza-like illness (p < 0.01) in the intervention arm when compared to the control arm. There were no statistically significant differences or pneumonia, urinary tract infections, and MRSA infections in the intervention arm when compared to the control arm. In a sensitivity analysis, gastroenteritis was no longer statistically significantly higher in the intervention arm (p = 0.92).ConclusionsAs in comparable studies, we could not conclusively demonstrate the effectiveness of an HH intervention in reducing HAIs among residents of nursing homes, despite the use of clearly defined outcome measures, a standardized reporting instrument, and directly observed HH in a multicenter cluster RCT. Trial registration Netherlands Trial Register, trial NL6049 (NTR6188). Registered October 25, 2016, https://www.trialregister.nl/trial/6049.
Highlights
Healthcare associated infections (HAIs) are a major cause of morbidity and mortality in nursing homes
We present the secondary outcome of the HANDSOME trial: the incidence of selected Healthcare-associated infection (HAI) in residents of the nursing homes
The outcome measures of this paper are the incidence of gastroenteritis, influenza-like illness (ILI), assumed pneumonia, urinary tract infections (UTIs), and infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in nursing home residents. We investigated these HAIs based on the four most prevalent HAIs reported in nursing homes in Europe [1]
Summary
Healthcare associated infections (HAIs) are a major cause of morbidity and mortality in nursing homes. Infection prevention measures, including improving hand hygiene (HH). While increased HH compliance of health care workers has been shown to decrease HAIs in hospitals, nursing homes, and the community setting, study outcomes are inconsistent [3,4,5,6]. Thirty-five studies (63%) reported results in favor of the HH intervention regarding infections of residents and/or staff. The authors concluded that future interventional studies should enhance methodological rigor by using clearly defined outcome measures, standardized reporting, and a relevant HH observation tool. We examined if a nursing home’s participation in a hand hygiene intervention resulted in residents having fewer healthcare associated infec‐ tions (HAIs) when compared to nursing homes without the hand hygiene intervention
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