317. Association between Hand Hygiene Compliance (HHC) and Rates of Hospital Acquired Infections (HAI), Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococcus (VRE), and Clostridium Difficile (C diff)
Session: Poster Abstract Session: Hand Hygiene in Healthcare Settings
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 317_IDWPOSTER.pdf (686.5 kB)
  • Background: The National Patient Safety Goals program of TJC mandates measuring HHC; however, the impact of HHC on HAI and pathogen transmission has been mixed. We sought to determine the association between HHC and HAI, MRSA, VRE, and C diff rates at our academic hospital.

    Methods: HHC was prospectively followed from 7/2011- 10/2012 using two auditing methods, secret shopper (SS) and unit based (UB). The association between HHC and rates of HAI (central line associated bloodstream infections (CLABSI) and ventilator associated pneumonia (VAP), as well as nosocomial MRSA, VRE, and C Diff were assessed housewide (HW), in ICUs and in nonICU settings using linear and logistic regression.

    Results: 439 monthly rates of HHC, HAI, MRSA, VRE and C Diff, from units throughout the hospital were available for analysis. Mean SS HHC was 73.6% HW (range 10%-100%), 74.7% in ICUs (14%-100%) and 73.1% in nonICUs (10%-100%). Mean UB HHC was 94.6% HW (61%-100%), 94.8% in ICUs (72%-100%) and 94.5% in nonICUs (61%-100%). The mean difference between SS and UB HHC was 21% (-19%-85%). HW HHC was not associated with MRSA, VRE, C Diff or HAI rates; however, HW UB HHC in the prior month was significantly associated with VRE (p=0.009)(Fig 1) and CLABSI (p=0.04) (Fig 2). HW SS HHC < 90% was significantly associated with higher VRE (OR 3.00, p=0.0001) and < 80% was significantly associated with higher CLABSI (OR 2.64, p=0.004). There was no association between HW SS HHC and MRSA or C Diff. ICU SS HHC < 90% was significantly associated with higher VRE (OR 3.55, p=0.02), and C Diff (OR 3.03, p=0.04) and < 80% was significantly associated with higher CLABSI (OR 4.71, p=0.02). There was no association between ICU SS HHC and MRSA or VAP. NonICU SS HHC < 90% was significantly associated with higher VRE (OR 2.80, p=0.002). There was no association between nonICU SS HHC and MRSA, C diff or CLABSI.

    Conclusion: UB HHC was almost always higher than SS HHC with mean reported differences of ~ 20%. Despite this, both auditing methods had value. UB HW HHC in the prior month was significantly associated with VRE and CLABSI. SS HHC < 90% was associated with higher VRE rates no matter where it was assessed (HW, ICU and nonICU settings) and higher C Diff rates HW and in the ICU. SS HHC < 80% was associated with higher CLABSI rates in the ICU.

    Fig 1. HW VRE Rate by HHC in Prior Month

    Fig 2. HW CLABSI Rate by HHC in Prior Month

     

    Soe Win, MD1, Charmaine Wilson2, Linda Formby, RN2 and Cassandra Salgado, MD, MS1, (1)Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, (2)Infection Control, Medical University of South Carolina, Charleston, SC

    Disclosures:

    S. Win, None

    C. Wilson, None

    L. Formby, None

    C. Salgado, AHRQ: Investigator, Research grant

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