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Limited Impact of Sustained Simple Feedback Based on Soap and Paper Towel Consumption on the Frequency of Hand Washing in an Adult Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Marvin J. Bittner*
Affiliation:
Section of Infectious Disease, Veterans Affairs Medical Center, Omaha, Nebraska Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
Eugene C. Rich
Affiliation:
Medical Department, Veterans Affairs Medical Center, Omaha, Nebraska Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
Paul D. Turner
Affiliation:
Department of Internal Medicine, Creighton University School of Medicine, Omaha, Nebraska
William H. Arnold Jr.
Affiliation:
Section of Infectious Disease, Veterans Affairs Medical Center, Omaha, Nebraska
*
VA Medical Center (HID), 4101 Woolworth Ave., Omaha, NE 68105-1873

Abstract

Objective:

To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption.

Design:

Prospective trial with a nonequivalent control group.

Setting:

Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU).

Subjects:

Unit staff.

Intervention:

Every weekday from May 26 through December 8,1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks.

Results:

Directly counted hand washing fell in the SICU from a baseline of 2.68 ± 0.72 (mean ± standard deviation) episodes per occupied bed per hour to 1.92 ± 1.35 in the follow-up period. In the MICU, episodes fell from 2.58 ± 0.95 (baseline) to 1.74 ± 0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36 ± 0.49 at baseline to 1.01 ± 0.36, with a return to 1.16 ± 0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r = -0.35 for the MICU, r = -0.46 for the SICU).

Conclusions:

Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:12871294.Google Scholar
2.Doebbeling, BN, Stanley, GL, Sheetz, CT, et al. Comparative efficacy of alternative handwashing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:8893.Google Scholar
3.Handwashing Liaison Group. Hand washing. BMJ 1999;318:686.Google Scholar
4.Albert, RK, Condie, F. Handwashing patterns in medical intensive care units. N Engl J Med 1981;304:14651466.Google Scholar
5.Larson, E, Kretzer, EK. Compliance with handwashing and barrier precautions. J Hosp Infect 1995;30(suppl):88106.Google Scholar
6.Jarvis, WR. Handwashing: the Semmelweis lesson forgotten? Lancet 1994;344:13111312.CrossRefGoogle ScholarPubMed
7.Kretzer, EK, Larson, EL. Behavioral interventions to improve infection control practices. Am J Infect Control 1998;26:245253.Google Scholar
8.Boyce, JM. It is time for action: improving hand hygiene in hospitals. Ann Intern Med 1999;130:153155.Google Scholar
9.Pittet, D, Mourouga, P, Perneger, TV. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126130.Google Scholar
10.Pittet, D, Hugonnet, S, Harbarth, S, Mourouga, P, Sauvan, V, Touveneau, S. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:13071312.Google Scholar
11.Falsey, AR, Criddle, MM, Kolassa, JE, McCann, RM, Brower, CA, Hall, WJ. Evaluation of a handwashing intervention to reduce respiratory illness rates in senior day-care centers. Infect Control Hosp Epidemiol 1999;20:200202.Google Scholar
12.Tibballs, J. Teaching hospital medical staff to handwash. Med J Aust 1996;164:395398.Google Scholar
13.Mayer, JA, Dubbert, PM, Miller, M, Burkett, PA, Chapman, SW. Increasing handwashing in an intensive care unit. Infect Control 1986;7:259262.Google Scholar
14.Larson, EL, Bryan, JL, Adler, LM, Blane, C. A multifaceted approach to changing handwashing behavior. Am J Infect Control 1997;25:310.Google Scholar
15.Avila-Agüero, ML, Umaña, MA, Jiménez, AL, Faingezicht, I, París, MM. Handwashing practices in a tertiary-care, pediatric hospital and the effect on an educational program. Clinical Performance and Quality Health Care 1998;6:7072.Google Scholar
16.Larson, EL and 1992,1993, and 1994 APIC Guidelines Committee. APIC guidelines for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251269.Google Scholar
17.Quraishi, Z, McGuckin, M, Zakhireh, B. Compliance in duration of handwashing in critical care units: a comparison of educational and electronic intervention strategies. Am J Infect Control 1986;14:93.Google Scholar
18.Broughall, JM, Marshman, C, Jackson, B, Bird, P. An automatic monitoring system for measuring handwashing frequency in hospital wards. J Hosp Infect 1984;5:447453.Google Scholar
19.McGuckin, M, Waterman, R, Porten, L, et al. Patient education model for increasing handwashing compliance. Am J Infect Control 1999;27:309314.Google Scholar
20.Bittner, MJ, Rich, EC. Surveillance of handwashing episodes in adult intensive-care units by measuring an index of soap and paper towel consumption. Clinical Performance and Quality Health Care 1998;6:179182.Google Scholar
21.Stevens, J. Applied Multivariate Statistics fir the Social Sciences, 3rd ed. Hillsdale, NJ: Lawrence Erlbaum Associates; 1996.Google Scholar
22.Rich, EC, Hillson, SD, Dowd, B, Morris, N. Specialty differences in the ‘July Phenomenon’ for Twin Cities teaching hospitals. Med Care 1993;31:7383.Google Scholar
23.Bond, CA, Raehl, CL, Pitterle, ME, Franke, T. Health care professional staffing, hospital characteristics, and hospital mortality rates. Pharmacotherapy 1999;19:130138.CrossRefGoogle ScholarPubMed
24.Kovner, C, Gergen, PJ. Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image J Nurs Sch 1998;30:315321.Google Scholar
25.Goldmann, DA, Durbin, WA Jr, Freeman, J. Nosocomial infections in a neonatal intensive care unit. J Infect Dis 1981;144:449459.Google Scholar
26.Archibald, LK, Manning, ML, Bell, LM, Banerjee, S, Jarvis, WR. Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit. Pediatr Infect Dis J 1997;16:10451048.Google Scholar
27.Harbarth, S, Sudre, P, Dharan, S, Cadenas, M, Pittet, D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 1999;20:598603.CrossRefGoogle ScholarPubMed
28.Kidd, F, Heitkemper, P, Kressel, AB. A neonatal intensive care unit outbreak of S. aureus associated with inadequate staffing. Presented at the Ninth Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 18-20,1999; San Francisco, CA Abstract S74.Google Scholar
29.Fridkin, SK, Pear, SM, Williamson, TH, Galgiani, JN, Jarvis, WR. The role of understaffing in central venous catheter-associated bloodstream infections. Infect Control Hosp Epidemiol 1996;17:150158.Google Scholar
30.Farr, BM. Understaffing: a risk factor for infection in the era of downsizing? Infect Control Hosp Epidemiol 1996;17:147149.CrossRefGoogle ScholarPubMed
31.Kirkland, KB, Weinstein, JM. Adverse effects of contact isolation. Lancet 1999;354:11771178.CrossRefGoogle ScholarPubMed
32.Voss, A, Widmer, AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205208.Google Scholar
33.Berwick, DM. Sounding board: continuous improvement as an ideal in health care. N Engl J Med 1989;320:5356.CrossRefGoogle Scholar