Impact of an Infection Control Program on the Prevalence of Nosocomial Infections at a Tertiary Care Center in Switzerland

Abstract

OBJECTIVE. To study the impact of a multimodal infection control program on the rate of nosocomial infections at a 550-bed tertiary care center.METHODS. Before and after the implementation of an infection control program, the rate of nosocomial infection was recorded in timeinterval prevalence studies. Hand hygiene compliance was studied before and after the intervention. As a surrogate marker of compliance, the amount of alcohol-based hand rub consumed before the intervention was compared with the amount consumed after the intervention. The intervention included additional staff for infection control, repeated instructions for hand hygiene, new guidelines for preoperative antibiotic prophylaxis, and isolation of patients infected or colonized with multidrug-resistant bacteria.RESULTS. The rate of nosocomial infection decreased from approximately 11.7% to 6.8% in 2 years. The rate of hand hygiene compliance increased by 20.0%; it was 59.0% before the intervention and increased to 79.0% afterward. These results correlate with data on the consumption of alcohol-based hand rub, but not with data on the use of antibiotics.CONCLUSION. Within 2 years, a multimodal infection control program intervention such as this one may reduce the rate of nosocomial infection at a tertiary care center by more than one-third and improve both the quality of care and patient outcomes. It may also generate considerable savings. Therefore, such programs should be promoted not only by hospital epidemiologists but also by hospital administrators.

Impact of observing hand hygiene in practice and research: a methodological reconsideration

“…Product uptake has been used as an indicator of hand hygiene compliance in a number of studies either as a secondary outcome measure to corroborate the results of direct observation 44,45,46,47,48,49 or as the main audit method 50, 51, 52, 53, . There is some evidence 54 that it might be a more sensitive indicator of the impact of alcohol-based antiseptics on HCAI rates than direct observation providing that uptake can be restricted to health workers only.…”

Hand Hygiene

“…60,217,334,429,485,486,613,648,651,663,666,667,670,680,682,684,686,687,713,714,803,804,851,852 Recent studies have further enriched the scientific literature. 140,428,493,494,655,657,694,698,699,701,705,[707][708][709][710][715][716][717][718]728,853 In general, most studies differed greatly in their duration and intervention approach. Moreover, the outcome measure of hand hygiene compliance varied in terms of the definition of a hand hygiene opportunity and assessment of hand hygiene by means of direct observation 60,217,…”

“…Despite different methodologies, most interventions have been associated with an increase in hand hygiene compliance, but a sustainable improvement demonstrated by a followup evaluation of two years or more after implementation has rarely been documented. 60,490,494,657,714,715,717,718 Most studies used multiple strategies, which included: HCWs' education, 60,140,334,429,485,486,613,651,663,666,667,670,676,682,684,686,687,698,705,707,708,713,716,717,813,814,819,834,851 performance feedback, 60,334,485,486,651,657,663,666,667,670,…”

“…738 To overcome these barriers, education is one of the cornerstones of improvement in hand hygiene practices. 58,60,140,334,429,485,486,613,648,651,663,666,667,670,676,682,684,686,687,698,705,707,708,[713][714][715][716][717]750,813,814,819,834,851 However, lack of knowledge of infection control measures has been repeatedly shown after training. 789 Audits of hand hygiene practices (see also Part III, Section 1.1) and performance feedback have comprised several multifaceted promotion campaigns and are valued as one of the most effective strategies.…”

“…60,429,469,493,648,651,684,705,709,851,852,858 Make alcohol-based handrub available 60,140,429,485,486,494,645,686,687,698,701,707,714,717,718,855,856 Make water and soap continuously available 633,659 Install voice prompts 699,710,852,853 2. Hand hygiene education 60,140,334,429,648,651,666,676,684,686,687,698,705,707,708,…”