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Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections

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Antimicrobial-resistant pathogens that cause healthcare-associated infections (HAIs) pose an ongoing and increasing challenge to hospitals, both in the clinical treatment of patients and in the prevention of the cross-transmission of these problematic pathogens.  Describing the magnitude of the problem with respect to these antimicrobial-resistant pathogens is challenging, because the levels of antimicrobial resistance vary for different types of healthcare facilities and for different geographic areas, and some resistance phenotypes are difficult for laboratories to detect. However, the findings from such attempts may help the infection control and public health communities target problems and utilize resources more efficiently.

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August 2008

Volume 29, Number 8
Infect Control Hosp Epidemiol 2008;29:730–735
© 2008 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2008/2908-08$15.00
DOI: 10.1086/590122
Original Article

Controlled Trial Measuring the Effect of a Feedback Intervention on Hand Hygiene Compliance in a Step-Down Unit

Alexandre R. Marra, MD;

Cláudia D'Arco, RN;

Bruno de Arruda Bravim, MD;

Marinês Dalla Valle Martino, MD;

Luci Correa, MD;

Cláudia Vallone Silva, RN;

Luiz Carlos R. Lamblet, RN;

Moacyr Silva Junior, MD;

Gisele de Lima, PharmD;

Luciana Reis Guastelli, RN;

Luciana Barbosa, PharmD;

Oscar Fernando Pavão dos Santos, MD;

Michael B. Edmond, MD, MPH, MPA

From the Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil (A.R.M., C.D., B.d.A.B., M.S.J., G.d.L., L.R.G., O.F.P.d.S.), Microbiology Laboratory, Hospital Israelita Albert Einstein, São Paulo, Brazil (M.D.V.M.), and Infection Control Unit (L.C., C.V.S., L.C.R.L.), Hospital Israelita Albert Einstein, São Paulo, Brazil, and Gojo Latin America (L.B.), São Paulo, Brazil; and the Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia (M.B.E.).

Objective.To evaluate hand hygiene compliance in 2 adult step-down units (SDUs).

Design.A 6-month (from March to September 2007), controlled trial comparing 2 SDUs, one with a feedback intervention program (ie, the intervention unit) and one without (ie, the control unit).

Setting.Two 20-bed SDUs at a tertiary care private hospital.

Methods.Hand hygiene episodes were measured by electronic recording devices and periodic observational surveys. In the intervention unit, feedback was provided by the SDU nurse manager, who explained twice a week to the healthcare workers the goals and targets for the process measures.

Results.A total of 117,579 hand hygiene episodes were recorded in the intervention unit, and a total of 110,718 were recorded in the control unit (P = .63). There was no significant difference in the amount of chlorhexidine used in the intervention and control units (34.0 vs 26.7 L per 1,000 patient-days; P = .36) or the amount of alcohol gel used (72.5 vs 70.7 L per 1,000 patient-days; P = .93). However, in both units, healthcare workers used alcohol gel more frequently than chlorhexidine (143.2 vs 60.7 L per 1,000 patient-days; P < .001). Nosocomial infection rates in the intervention and control units, respectively, were as follows: for bloodstream infection, 3.5 and 0.79 infections per 1,000 catheter-days (P = .18); for urinary tract infection, 15.8 and 15.7 infections per 1,000 catheter-days (P = .99); and for tracheostomy-associated pneumonia, 10.7 and 5.1 infections per 1,000 device-days (P = .13). There were no cases of infection with vancomycin-resistant enterococci and only a single case of infection with methicillin-resistant Staphylococcus aureus (in the control unit).

Conclusions.The feedback intervention regarding hand hygiene had no significant effect on the rate of compliance. Other measures must be used to increase and sustain the rate of hand hygiene compliance.

Received March 12, 2008; accepted May 13, 2008; electronically published July 16, 2008.

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