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Prospective, Controlled, Cross-Over Trial of Alcohol-Based Hand Gel in Critical Care Units

Published online by Cambridge University Press:  02 January 2015

Mark E. Rupp ,
Teresa Fitzgerald ,
Susan Puumala ,
James R. Anderson ,
Rita Craig ,
Peter C. Iwen ,
Dawn Jourdan ,
Janet Keuchel ,
Nedra Marion  and
Delayne Peterson
...Show all authors
Mark E. Rupp*
Affiliation:
Department of Internal Medicine, University of Nebraska Medical Center, Omaha Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha
Teresa Fitzgerald
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha
Susan Puumala
Affiliation:
Department of Societal and Preventive Medicine, University of Nebraska Medical Center, Omaha
James R. Anderson
Affiliation:
Department of Societal and Preventive Medicine, University of Nebraska Medical Center, Omaha
Rita Craig
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha
Peter C. Iwen
Affiliation:
Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha
Dawn Jourdan
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha
Janet Keuchel
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha
Nedra Marion
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha
Delayne Peterson
Affiliation:
Department of Pulmonary and Critical Care Medicine, University of Nebraska Medical Center, Omaha
Lee Sholtz
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha
Valerie Smith
Affiliation:
Department of Healthcare Epidemiology, Nebraska Medical Center, Omaha
*
984031 Nebraska Medical Center, Omaha, NE 68198-4031 ([email protected])
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Abstract

Background.

There are limited data from prospective studies to indicate whether improvement in hand hygiene associated with the use of alcohol-based hand hygiene products results in improved patient outcomes.

Design.

A 2-year, prospective, controlled, cross-over trial of alcohol-based hand gel.

Setting.

The study was conducted in 2 medical-surgical ICUs for adults, each with 12 beds, from August 2001 to September 2003 at a university-associated, tertiary care teaching hospital.

Methods.

An alcohol-based hand gel was provided in one critical care unit and not provided in the other. After 1 year, the assignment was reversed. The hand hygiene adherence rate and the incidence of nosocomial infection were monitored. Samples for culture were obtained from nurses' hands every 2 months.

Results.

During 17,994 minutes of observation, which included 3,678 opportunities for hand hygiene, adherence rates improved dramatically after the introduction of hand gel, increasing from 37% to 68% in one unit and from 38% to 69% in the other unit (P < .001). Improvement was observed among all groups of healthcare workers. Hand hygiene rates were better at higher workloads when hand gel was available in the unit (P = .02). No substantial change in the rates of device-associated infection, infection due to multidrug-resistant pathogens, or infection due to Clostridium difficile was observed. Culture of samples from the hands of nursing staff revealed that an increased number of microbes and an increased number of microbe species was associated with longer fingernails (ie, more than 2 mm long), the wearing of rings, and/or lack of access to hand gel.

Conclusions.

The introduction of alcohol-based gel resulted in a significant and sustained improvement in the rate of hand hygiene adherence. Fingernail length greater than 2 mm, wearing rings, and lack of access to hand gel were associated with increased microbial carriage on the hands. This improvement in the hand hygiene adherence rate was not associated with detectable changes in the incidence of healthcare-associated infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 1 , January 2008 , pp. 8 - 15
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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