Combined use of alcohol hand rub and gloves reduces the incidence of late onset infection in very low birthweight infants

Abstract

Objective: To assess the incidence of late onset (. 72 hours) infection and necrotising enterocolitis (NEC) in very low birthweight (VLBW) infants in two 36 month periods using two hand hygiene protocols: conventional handwashing (HW; first 36 month period); an alcohol hand rub and gloves technique (HR; second 36 month period). Method: VLBW infants admitted to the neonatal intensive care unit during the period December 1993-November 1999 were eligible. A new hand hygiene protocol using alcohol handrub and gloves was introduced in December 1996. Each patient's case record was reviewed retrospectively by two independent investigators using a standard data collection form. The incidence of NEC and systemic infections, including bacterial or fungal septicaemia, meningitis, and peritonitis, in the two periods were compared. Results: The HW and HR groups contained 161 and 176 VLBW infants respectively. The incidence of late onset systemic infection decreased from 13.5 to 4.8 episodes (including NEC)/1000 patient days after introduction of the HR regimen, representing a 2.8-fold reduction. Similarly, the incidence of Gram positive, Gram negative, and fungal infections decreased 2.5-fold, 2.6-fold, and 7-fold respectively. There was also a significant reduction in the incidence of NEC in the HR group (p , 0.0001). Subgroup analysis revealed that the incidence of methicillin resistant Staphylococcus aureus (MRSA) septicaemia was significantly decreased in the second 36 month period (p = 0.048). The clinical data suggest that infants in the HW group had significantly earlier onset of sepsis (p , 0.05) and required oxygen supplementation for longer (p , 0.05) than those in the HR group. Significantly more VLBW infants were discharged from the neonatal intensive care unit without ever being infected (p , 0.0001), and also significantly fewer infants had more than one episode of infection in the HR group (p , 0.0001). Conclusion: The introduction of the HR protocol was associated with a 2.8-fold reduction in the incidence of late onset systemic infection, and also a significant decrease in the incidence of MRSA septicaemia and NEC in VLBW infants. This decrease in infection rate was maintained throughout the second 36 month period. L ate onset neonatal infection is a serious complication of prematurity and a significant cause of morbidity and mortality.1-4 A recent survey of 15 major neonatal centres in the United States indicated that infants who developed late onset sepsis had a significantly longer hospital stay and higher mortality than patients who were not infected.

IP-10 Is an Early Diagnostic Marker for Identification of Late-Onset Bacterial Infection in Preterm Infants

“…Preterm infants who developed NEC had threefold increased risk of mortality (4). As the immunologic defense of preterm infants is considered to be immature and/or deficient (5), this category of patients is particularly vulnerable to developing severe and opportunistic infections in the immediate postnatal period (1,3,4). However, early warning signs and symptoms of systemic infection and NEC are often nonspecific and inconspicuous and can easily be confused with noninfective causes such as apnea of prematurity, gastrointestinal dysmotility, and acute exacerbation of bronchopulmonary dysplasia (6 -8).…”

“…and NEC are important risk factors that predispose to increased morbidity and mortality in preterm VLBW infants (1)(2)(3)(4). A recent multicenter survey suggested that 21% of VLBW infants who survived Ͼ72 h of age had at least one episode of septicemia (1).…”

Hand Hygiene

“…890 In several other studies in which hand hygiene compliance was not monitored, multidisciplinary programmes that involved the introduction of an alcohol-based handrub were associated with a decrease in HCAI and cross-transmission rates. 429,489,645,735 The beneficial effects of hand hygiene promotion on the risk of cross-transmission have also been reported in surveys conducted in schools or day-care centres, 454,[891][892][893][894][895][896] as well as in community settings. 248,249,449,754,815,830,[897][898][899][900] While none of the studies conducted in the health-care setting represented randomized controlled trials, they provide substantial evidence that increased hand hygiene compliance is associated with reduced HCAI rates.…”

An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care–associated infections

“…Three studies demonstrated a decrease in infection rates with the hand sanitizer. 21,24,25 Two other studies 22,23 reported no significant differences in HCAI rates between handwashing and the introduction of a hand sanitizer. Another study 26 reported a decrease in MRSA rates postintervention.…”

“…In 5 of these studies, one before and after design with no control group 21 and 4 cohort studies with control groups [22][23][24][25] compared handwashing with the introduction of an alcohol hand sanitizer. Another before and after study with control group 26 compared the 4% antiseptic solution with the introduction of a 1% antiseptic solution.…”