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Frequency of Hand Decontamination of Intraoperative Providers and Reduction of Postoperative Healthcare-Associated Infections: A Randomized Clinical Trial of a Novel Hand Hygiene System

  • Matthew D. Koff (a1), Jeremiah R. Brown (a2), Emily J. Marshall (a2), A. James O’Malley (a2), Jens T. Jensen (a3), Stephen O. Heard (a4), Karen Longtine (a4), Melissa O’Neill (a4), Jaclyn Longtine (a4), Donna Houston (a3), Cindy Robison (a3), Eric Moulton (a3), Hetal M. Patel (a3) and Randy W. Loftus (a3)...
Abstract
BACKGROUND

Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development.

OBJECTIVE

To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events.

DESIGN

Randomized, prospective study.

SETTING

Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts.

PATIENTS

Patients undergoing surgery.

METHODS

Operating room environments were randomly assigned to usual intraoperative hand hygiene or to a personalized, body-worn hand hygiene system. Anesthesia and circulating nurse provider hourly hand decontamination events were continuously monitored and reported. All patients were followed prospectively for the development of 30-day postoperative healthcare-associated infections.

RESULTS

A total of 3,256 operating room environments and patients (1,620 control and 1,636 treatment) were enrolled. The mean (SD) provider hand decontamination event rate achieved was 4.3 (2.9) events per hour, an approximate 8-fold increase in hand decontamination events above that of conventional wall-mounted devices (0.57 events/hour); P<.001. Use of the hand hygiene system was not associated with a reduction in healthcare-associated infections (odds ratio, 1.07 [95% CI, 0.82–1.40], P=.626).

CONCLUSIONS

The hand hygiene system evaluated in this study increased the frequency of hand decontamination events without reducing 30-day postoperative healthcare-associated infections. Future work is indicated to optimize the efficacy of this hand hygiene improvement strategy.

Infect Control Hosp Epidemiol 2016;37:888–895

Copyright
Corresponding author
Address correspondence to Randy W. Loftus, MD, University of Iowa Hospitals and Clinics, 100 Hawkins Rd, Iowa City, IA 52240 (randy-loftus@uiowa.edu).
Footnotes
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(Present affiliation: Department of Anesthesiology, University of Iowa Hospitals and Clinics [R.W.L.].)

Footnotes
Linked references
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. RW Loftus , MD Koff , CC Burchman , et al. Transmission of pathogenic bacterial organisms in the anesthesia work area. Anesthesiology 2008;109:399407.

2. RW Loftus , MK Muffly , JR Brown , et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg 2011;112:98105.

3. RW Loftus , JR Brown , MD Koff , et al. Multiple reservoirs contribute to intraoperative bacterial transmission. Anesth Analg 2012;114:12361248.

4. JP Rowlands , MP Yeager , HM Patel , RW Loftus . Handwashing compliance may be lower than previously reported: a video observation study. Am J Infect Control 2014;42:698701.

5. C Biddle , J Shah . Quantification of anesthesia providers’ hand hygiene in a busy metropolitan operating room: what would Semmelweis think? Am J Infect Control 2012;40:756759.

6. MD Koff , RW Loftus , CC Burchman , et al. Reduction in intraoperative bacterial contamination of peripheral intravenous tubing through the use of a novel device. Anesthesiology 2009;110:978985.

9. MT van de , R Bourke , L Fillipi , et al. Maximizing hand washing rates in the critical care unit through yearly performance feedback. Aust Crit Care 2000;13:9195.

17. DJ Birnbach , LF Rosen , M Fitzpatrick , PC Carling , LS Munoz-Price . The use of a novel technology to study dynamics of pathogen transmission in the operating room. Anesth Analg 2015;120:844847.

18. DJ Birnbach , LF Rosen , M Fitzpatrick , PC Carling , KL Arheart , LS Munoz-Price . Double gloves to reduce pathogen spread in the operating room. Anesth Analg 2015;120:848852.

19. C Clark , A Taenzer , K Charette , M Whitty . Decreasing contamination of the anesthesia environment. Am J Infect Control 2014;42:12231225.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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