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Reduction in Surgical Site Infections in Neurosurgical Patients Associated With a Bedside Hand Hygiene Program in Vietnam

Published online by Cambridge University Press:  02 January 2015

Le Thi Arm Thu ,
Michael J. Dibley ,
Vo Van Nho ,
Lennox Archibald ,
William R. Jarvis  and
Annette H. Sohn
Le Thi Arm Thu*
Affiliation:
Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
Michael J. Dibley
Affiliation:
University of Newcastle, New South Wales, Australia
Vo Van Nho
Affiliation:
Infection Control Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
Lennox Archibald
Affiliation:
Division of Infectious Diseases, University of Florida, Gainesville
William R. Jarvis
Affiliation:
Jason and Jarvis Associates, Hilton Head Island, South Carolina
Annette H. Sohn
Affiliation:
Division of Pediatric Infectious Diseases, University of California, San Francisco
*
Infection Control Department, Cho Ray Hospital, 201 B Nguyen Chi Thanh, District 5, Ho Chi Minh City, Vietnam ([email protected])
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Abstract

Objective.

We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam.

Design.

A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention). A hand sanitizer with 70% isopropyl alcohol and 0.5% Chlorhexidine gluconate was introduced, and healthcare workers were trained in its use on ward A in September 2000. No intervention was made in ward B. Centers for Disease Control and Prevention definitions of SSI were used. Patient SSI data were collected on standardized forms and were analyzed using Stata software (Stata).

Results.

A total of 786 patients were enrolled: 377 in the period before intervention (156 in ward A and 221 in ward B) and 409 in the period after intervention (159 in ward A and 250 in ward B). On ward A after the intervention, the SSI rate was reduced by 54% (from 8.3% to 3.8%; P = .09), and more than half of superficial SSIs were eliminated (7 of 13 vs 0 of 6 in ward B; P = .007). On ward B, the SSI rate increased by 22% (from 7.2% to 9.2%; P = .8). In patients without SSI, the median postoperative length of stay and the duration of antimicrobial use were reduced on ward A (both from 8 to 6 days; P <.001) but not on ward B.

Conclusions.

Our study demonstrates that introduction of a hand sanitizer can both reduce SSI rates in neurosurgical patients, with particular impact on superficial SSIs, and reduce the overall postoperative length of stay and the duration of antimicrobial use. Hand hygiene programs in developing countries are likely to reduce SSI rates and improve patient outcomes.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 5 , May 2007 , pp. 583 - 588
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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