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Use of an Alcohol-Based Hand Rub and Quality Improvement Interventions to Improve Hand Hygiene in a Russian Neonatal Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Samuel M. Brown ,
Anna V. Lubimova ,
Natalya M. Khrustalyeva ,
Svetlana V. Shulaeva ,
Iya Tekhova ,
Ludmila P. Zueva ,
Donald Goldmann  and
Edward J. O'Rourke
Samuel M. Brown*
Affiliation:
Massachusetts General Hospital and the Davis Center for Russian Studies, Harvard University, Boston, Massachusetts
Anna V. Lubimova
Affiliation:
Infection Control Training Center and the Department of Epidemiology, Mechnikov State Medical Academy, St. Petersburg, Russia
Natalya M. Khrustalyeva
Affiliation:
First Children's Hospital, St. Petersburg, Russia
Svetlana V. Shulaeva
Affiliation:
First Children's Hospital, St. Petersburg, Russia
Iya Tekhova
Affiliation:
Infection Control Training Center and the Department of Epidemiology, Mechnikov State Medical Academy, St. Petersburg, Russia
Ludmila P. Zueva
Affiliation:
Infection Control Training Center and the Department of Epidemiology, Mechnikov State Medical Academy, St. Petersburg, Russia
Donald Goldmann
Affiliation:
Children's Hospital, Boston, Massachusetts
Edward J. O'Rourke
Affiliation:
Children's Hospital, Boston, Massachusetts Harvard Medical International, Boston, Massachusetts
*
527 Leverett Mail Center, Cambridge, MA 02138
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Abstract

Background:

Hand hygiene (HH) is critical to infection control, but compliance is low. Alcohol-based antiseptics may improve HH. HH practices in Russia are not well described, and facilities are often inadequate.

Setting:

Four 6-bed units in a neonatal intensive care unit in St. Petersburg, Russia.

Methods:

Prospective surveillance of HH compliance, nosocomial colonization, and antibiotic administration was performed from January until June 2000. In February 2000, alcohol-based hand rub was provided for routine HH use. Eight weeks later, a quality improvement intervention was implemented, consisting of review of interim data, identification of opinion leaders, posting of colonization incidence rates, and regular feedback. Means of compliance, colonization, and antibiotic use were compared for periods before and after each intervention.

Results:

A total of 1,027 events requiring HH were observed. Compliance was 44.2% before the first intervention, 42.3% between interventions, and 48% after the second intervention. Use of alcohol rose from 15.2% of HH indications to 25.2% between interventions and 41.5% after the second intervention. The incidence of nosocomial colonization (per 1,000 patient-days) with Klebsiella pneumoniae was initially 21.5, decreased to 4.7, and then was 3.2 in the final period. Rates of antibiotic and device use also decreased.

Conclusions:

HH may have increased slightly, but the largest effect was a switch from soap and water to alcohol, which may have been associated with decreased cross-transmission of Klebsiella, although this may have been confounded by lower device use. Alcohol-based antiseptic may be an improvement over current practices, but further research is required.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 3 , March 2003 , pp. 172 - 179
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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