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Patient Handwashing Cuts C. difficile Rate in Hospital
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Education on patient hand hygiene significantly reduced the incidence of Clostridium difficile infection at University of Pittsburgh Medical Center Mercy Hospital.
“Despite evidence to suggest that [hand hygiene] is important in preventing infection, hospitalized patients are often not provided the opportunity to clean their hands,” due to mobility and cognitive obstacles as well as lack of education, investigators wrote.
They therefore aimed to improve patient hand hygiene through staff education and patient assistance, and to determine if such an intervention would reduce the rate of C. difficile infection (CDI) in their 495-bed facility.
First, they conducted baseline surveys to assess patient hand hygiene, which showed patients needed more opportunities to wash their hands. Then nurse educators provided staff with an educational presentation on the importance of patient hand hygiene for preventing infection, which included specific times they should encourage and assist patients with hand hygiene. Staff then provided education and assistance to newly admitted patients, and researchers conducted additional surveys after implementation of this intervention.
During the first phase of the study involving just four medical-surgical nursing units, patient hand hygiene education increased significantly after the intervention (P < .0001). Overall, 97 follow-up surveys showed the proportion of those who received hand hygiene education increased from 34% to 64%, the opportunities provided for hand hygiene increased from 60% to 86%, and the average number of times hand hygiene was performed daily increased from 2.7 to 3.75.
After expanding the intervention to the whole hospital in the second phase of the study, 189 follow-up surveys showed that patient hand hygiene education increased from 48% to 53%. Meanwhile, overall opportunities for hand hygiene remained unchanged from 68%, and daily frequency of patient hand hygiene did not change significantly (mean, 2.4 vs. 2.6 times per day).
Notably, CDI rates dropped significantly during the 6 months following hospital-wide implementation.
“[Standardized infection ratio] P values for Q2 and W3 (0.0157 and 0.0103, respectively) were significantly lower than expected (P .05),” investigators wrote. “The Q4 SIR, however, showed an increase to 0.3844 over the 2 preceding quarters.”
They concluded that these findings showed patient hand hygiene “should be considered a potential addition to CDI prevention measures in hospitalized patients.” – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Sahil Khanna, MBBS
Prevention is key to decreasing incidence of CDI and hand hygiene plays an important role in the prevention of CDI. There is data on patient isolation and provider hand hygiene to decrease CDI transmission. Patients serve as a reservoir for transmission and patient hand hygiene is potentially an underused preventive measure for CDI. Patients are encouraged to perform hand hygiene in the outpatient setting but inpatients are less frequently able to comply due to immobility and cognitive issues despite adequate education, according to Srigley and colleagues. These measures are important not only for CDI but prevention of other hospital-acquired infections.
In a single center study, authors of the current article studied the effect of patient hand hygiene on CDI incidence. Patient surveys were conducted to assess patient hand hygiene practices. Participating patient units were provided with an educational presentation including the relationship of hand hygiene to infection prevention in health care and specified times that staff should encourage and assist patients’ hygiene (ie, prior to meals, after using the toilet or bedpan, prior to touching dressings and incisions, after returning from testing or a procedure, before and after having visitors). Verbal education, screen savers of computer screens, laminated signs, easy access to alcohol wipes and soap and water were implemented to all newly admitted patients to encourage hygiene. There were no changes to existing CDI prevention bundles. This intervention bundle led to a decrease in hospital onset CDI for the first 6 months after implementation of the program but was not sustained to the quarter after this time frame.
More studies and infection prevention bundles are needed not only for patients but also patient visitors in hospitals to help reduce hospital-onset CDI.
Reference:
Srigley JA, et al. Infect Control Hosp Epidemiol. 2014;doi:10.1086/678419.
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