Comparative Efficacy of Alternative Hand-Washing Agents in Reducing Nosocomial Infections in Intensive Care Units

Doebbeling, Bradley N.; Stanley, G.L.; Sheetz, Carol T.; Pfaller, Michael A.; Houston, A.; Annis, Linda; Li, Ning; Wenzel, Richard P.

doi:10.1056/nejm199207093270205

Cited by 466 publications

(166 citation statements)

References 39 publications

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“…Compliance rates for basic infection control measures, such as hand washing, have been reported to vary from 20% to 40%, but may be higher for well-motivated nursing and other medical staff (16)(17)(18). By using transmission data for VRE in an endemic setting, we estimate that the basic or case reproductive number R 0 , which provides a quantitative measure of transmission, lies in the range 3-4.…”

Section: Discussionmentioning

confidence: 99%

“…Barrier precautions, such as the use of gowns and gloves, and hand washing serve to reduce the likelihood that HCWs will become contaminated with VRE (16)(17)(18). If the probability of compliance is P per patient contact, and precautions are 100% effective in removing VRE contamination, then HCWs have a reduced probability of transmitting VRE to their next patient.…”

Section: The Impact Of Infection Controlmentioning

confidence: 99%

See 1 more Smart Citation

Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs

Austin

Bonten

Weinstein

et al. 1999

Proc. Natl. Acad. Sci. U.S.A.

333

276

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Vancomycin-resistant enterococci (VRE) recently have emerged as a nosocomial pathogen especially in intensive-care units (ICUs) worldwide. Transmission via the hands of health-care workers is an important determinant of spread and persistence in a VRE-endemic ICU. We describe the transmission of nosocomial pathogens by using a microepidemiological framework based on the transmission dynamics of vector-borne diseases. By using the concept of a basic reproductive number, R 0 , defined as the average number of secondary cases generated by one primary case, we show quantitatively how infection control measures such as hand washing, cohorting, and antibiotic restriction affect nosocomial cross-transmission. By using detailed molecular epidemiological surveillance and compliance monitoring, we found that the estimated basic reproductive number for VRE during a study at the Cook County Hospital, Chicago, was approximately 3-4 without infection control and 0.7 when infection control measures were included. The impact of infection control was to reduce the prevalence from a predicted 79% to an observed 36%. Hand washing and staff cohorting are the most powerful control measures although their efficacy depends on the magnitude of R 0 . Under the circumstances tested, endemicity of VRE was stabilized despite infection control measures, by the constant introduction of colonized patients. Multiple stochastic simulations of the model revealed excellent agreement with observed pattern. In conjunction with detailed microbiological surveillance, a mathematical framework provides a precise template to describe the colonization dynamics of VRE in ICUs and impact of infection control measures. Our analyses suggest that compliance for hand washing significantly in excess of reported levels, or the cohorting of nursing staff, are needed to prevent nosocomial transmission of VRE in endemic settings.

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Section: Discussionmentioning

confidence: 99%

Section: The Impact Of Infection Controlmentioning

confidence: 99%

Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs

Austin

Bonten

Weinstein

et al. 1999

Proc. Natl. Acad. Sci. U.S.A.

333

276

View full text Add to dashboard Cite

show abstract

“…Even if washing hands is 100% e¡ective, the threshold compliance rate can be very high for modest values of R 0 . Studies show reported compliance rates of 20^40% (Albert & Condie 1981;Simmons et al 1990;Doebbelling et al 1992). If R 0 is in excess of 1.25^1.67, hand-washing measures alone are unlikely to be su¤cient for controlling endemic transmission.…”

Section: (I) Hand-washingmentioning

confidence: 99%

Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models

Austin

Anderson

1999

Phil. Trans. R. Soc. Lond. B

172

127

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The emergence of antibiotic resistance in a wide variety of important pathogens of humans presents a worldwide threat to public health. This paper describes recent work on the use of mathematical models of the emergence and spread of resistance bacteria, on scales ranging from within the patient, in hospitals and within communities of people. Model development starts within the treated patient, and pharmacokinetic and pharmacodynamic principles are melded within a framework that mirrors the interaction between bacterial population growth, drug treatment and the immunological responses targeted at the pathogen. The model helps identify areas in which more precise information is needed, particularly in the context of how drugs in£uence pathogen birth and death rates (pharmacodynamics). The next area addressed is the spread of multiply drug-resistant bacteria in hospital settings. Models of the transmission dynamics of the pathogen provide a framework for assessing the relative merits of di¡erent forms of intervention, and provide criteria for control or eradication. The model is applied to the spread of vancomycin-resistant enterococci in an intensive care setting. This model framework is generalized to consider the spread of resistant organisms between hospitals. The model framework allows for heterogeneity in hospital size and highlights the importance of large hospitals in the maintenance of resistant organisms within a de¢ned country. The spread of methicillin resistant Staphylococcus aureus (MRSA) in England and Wales provides a template for model construction and analysis. The ¢nal section addresses the emergence and spread of resistant organisms in communities of people and the dependence on the intensity of selection as measured by the volume or rate of drug use. Model output is ¢tted to data for Finland and Iceland and conclusions drawn concerning the key factors determining the rate of spread and decay once drug pressure is relaxed.

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“…Semmelweis decreased the rate of maternal mortality from 22% to 3% by requiring the physicians to wash their hands before the delivery (3). In the studies conducted recently, compliance with hand hygiene among health workers was lower than 50% (4)(5)(6)(7). Although the methods and study groups of these studies are different from each other, it is a fact that hand-hygiene compliance rate is low globally (8).…”

Section: Introductionmentioning

confidence: 99%

Assessment of Knowledge and Behavior on Hand Hygiene in Health Care Workers

Kaya¹,

Kaçmaz²,

Çetinkaya³

et al. 2015

Erciyes Med J

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Objective: Hand hygiene is a basic measure for the control of hospital-acquired infections. However, sustained compliance with hand hygiene in health care workers is poor. The purpose of this study was to investigate the practices and knowledge level about hand hygiene among health care workers in our hospital. Materials and Methods:This study was performed in Diyarbakir Training and Research Hospital in May 2013. A total of 179 health care workers (HCWs) were included in the study. A questionnaire was administered to HCWs to assess their knowledge and practices on hand hygiene. Statistical Package for the Social Sciences (SPSS) 16.0 program was used for the evaluation of data.Results: Of 179 patients in the study, 123 (68.7%) were male and 56 (31.3%) were female. The mean age was 28.7 years (18-56 years). A hundred and thirty-three (74.3%) of HCWs had received training on hand hygiene. However, it was determined that the knowledge levels and practices of HCWs on hand hygiene were inadequate.

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Comparative Efficacy of Alternative Hand-Washing Agents in Reducing Nosocomial Infections in Intensive Care Units

Cited by 466 publications

References 39 publications

Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs

Vancomycin-resistant enterococci in intensive-care hospital settings: Transmission dynamics, persistence, and the impact of infection control programs

Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models

Assessment of Knowledge and Behavior on Hand Hygiene in Health Care Workers

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