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Hand hygiene intervention effective in nursing homes
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Hand hygiene protocols reduced mortality and antibiotic prescriptions in nursing homes, according to researchers in France.
“Although epidemiological studies show a high prevalence of infections in nursing homes, with major consequences in terms of morbidity, mortality and costs, most of the infection prevention measures that are currently implemented in these settings have simply been adapted from those designed for acute care, without being assessed in long-term care,” Laura Temime, PhD, professor at the Conservatoire National des Arts et Metiers, told Infectious Disease News. “In particular, the effectiveness of hand hygiene to reduce the infectious risk in nursing homes is not well documented, and compliance to hand hygiene recommendations remains very low among nursing home staff.”
Temime and colleagues performed a two-arm cluster randomized trial of 26 French nursing homes. Half of the facilities were assigned to a 1-year hand hygiene intervention that included increased access to hand rub; staff education in the form of online quizzes; promotional measures, such as posters and special events; and local work groups focusing on education and protocol. The other half served as a control group. The main outcomes were the incidence of gastroenteritis and acute respiratory infections reported as clustered case episodes, and the secondary outcomes were hospitalization rates, antibiotic prescription rates and mortality.
There were insufficient data for analysis of the main outcomes, Temime and colleagues wrote. However, the intervention group showed greater consumption of antimicrobial hand rub.
The intervention group also demonstrated a lower mortality rate than the control group, the researchers reported (2.10 vs. 2.65 per 100 residents per month; P = .003), as well as fewer antibiotic prescriptions (5 vs. 5.8 daily doses per 100 resident days; P < .001).
This reduction in mortality was not sustained after the end of the intervention; although the mortality rate was 2.53 per 100 residents in the final 3 months of the study period, it rose to 2.87 in the 3 months following the end of the study. Temime and colleagues wrote that this could possibly be a result of the “harvesting effect” of winter epidemics, such as influenza.
The researchers confirmed these results using a longitudinal multivariate analysis that adjusted for patient and facility characteristics, as well as seasonality (mortality rate ratio, 0.76).
There was no difference in hospitalizations between groups.
“Our results suggest that such an intervention may have a strong impact, as the mortality rate was reduced by 30% during the winter period in intervention nursing homes,” Temime said. “To our knowledge, ours is the first randomized trial to show an impact of hand hygiene on all-cause mortality in nursing homes, making our results of potentially high interest to healthcare professionals and decision makers both inside and outside long-term care settings.”
Janet Haas, PhD, RN, CIC, FSHEA, FAPIC, 2018 president of APIC, said the study showed how a long-term intervention could improve infection control in nursing homes.
“This research demonstrates that a sustained educational program focused on hand hygiene can improve practices and may reduce the risk of infection among nursing home patients,” Haas said in a press release accompanying the study. “It is crucial that we increase efforts to bolster infection prevention programs in nursing homes because residents of these facilities have more underlying health conditions and are more vulnerable to serious complications from infections.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
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