NESS - 2010 Annual Meeting Abstracts: Hand Hygiene and Hospital-Acquired Infection in the Surgical Intensive Care Unit

2010 Annual Meeting Abstracts

Hand Hygiene and Hospital-Acquired Infection in the Surgical Intensive Care Unit
*Dorothy Bird, MD
Boston University Medical Center, Department of Surgery, Boston, MA

Objective
We sought to examine rates of ventilator-associated pneumonia (VAP), catheter-based bloodstream infection (BSI), and foley-catheter-related urinary tract infections (UTI) before, during, and after a hand hygiene task force.

Design
Our 48-month before-and-after retrospective review of prospectively-collected data from infection control surveillance databases includes data from October, 2005 until September, 2009.

Setting
2 surgical intensive care units (ICU) within an urban academic level I trauma center

Patients or Other Participants
Surgical intensive care staff and patients

Intervention(s)
A 33-month multidisciplinary hand hygiene task force (September, 2006 until June, 2009) included visual reminders, small rewards, and weekly feedback based on volume of hand soap and hand sanitizer consumed per patient-day.

Main Outcome Measure(s)
Our main outcomes were hand hygiene compliance, as estimated using monthly consumption of hand soap and sanitizer per ICU patient-day, and incidence of three common hospital-acquired infections (VAP, BSI, UTI) per thousand device days as diagnosed using CDC criteria.

Results
Hand hygiene compliance increased by 415% and 219% (p<0.0001) in each surgical ICU, respectively, during the task force. At the same time total HAI decreased from 7.9 to 1.15 HAI/1000 device days (p=0.0001) (Figure 1). VAP rate decreased from 10.23 to 0.9 VAP/ 1000 ventilator days (p=0.002). BSI rate decreased from 3.52 to 0 BSI/1000 central line days (p=0.02). UTI rate decreased from 7.37 to 2.33 UTI/1000 catheter days (p=0.02). HAI increased following termination of the task force to 3.62 HAI/1000 device days (p=0.02). VAP increased to 3.5 VAP/1000 ventilator days (p=0.2), BSI to 0.71 BSI/1000 line days (p=0.3), and UTI to 6.23 UTI/1000 catheter days (p=0.08).

Conclusions
Hand hygiene surveillance is a critical aspect of infection control in the surgical intensive care unit and must be sustained, even once excellent results have been achieved, to maintain optimal performance.

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