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11-10-2011 | Medical management | Article

Improved hand hygiene reduces ventilator-associated pneumonia in ICU

Abstract

Free abstract

MedWire News: A novel hand hygiene system used by intensive care unit (ICU) healthcare providers could greatly reduce the rate of ventilator-associated pneumonia (VAP), and to a lesser extent, catheter-related blood stream infections (CRBSIs), say researchers.

The device is worn on the body and has an embedded computer chip to monitor user compliance, explains the team.

Owing to its proximity to the healthcare provider, the hand hygiene device counters barriers to priority of care such as "forgetfulness, insufficient time and high workload," say Matthew Koff (Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA) and co-investigators.

The team has recently shown that intra-operative use of a similar device can reduce anesthesia-related infections, therefore, they examined its utility in the ICU.

A total of 2593 ICU patients were observed during two consecutive 12-month periods, a control period (2006-2007), involving usual care, and a study period (2007-2008), during which time the personalized alcohol-based hand sanitizer (Sprixx GJTM Harbor Medical Inc, Santa Barbara, California) was distributed to healthcare providers.

Voluntary use of the device was monitored at quarterly intervals during the study period.

In all, 1262 patients experienced 6463 central line days and 6171 ventilator days during the control period, and 1331 patients experienced 6850 central line days and 5897 ventilator days in the study period.

After the introduction of the hand hygiene device in the study period, VAPs per 1000 vent-days reduced by a significant 52% compared with the control period (3.7 study vs 6.9 control), despite a respective 887 and 716 patients being at risk for VAP.

Conversely, while there was a trend toward a reduction in CRBIs with the device (1.5 study vs 2.6 control), this association was nonsignificant.

Healthcare provider compliance was steady throughout the study with an average of four uses per day, report the researchers; however, the number of providers using the device fell from approximately 20 per shift (100%) at the start of the study, to approximately 10 uses per shift at 3 months, and eight uses at 6 months.

"The combination of a unique educational program addressing barriers to hand hygiene specific to the ICU environment, an effective alcohol solution in close proximity to the provider, and the ability to provide reliable performance feedback due to the embedded computer chip allows this device to serve as a unique multimodal approach for the improvement of hand hygiene," write Koff and colleagues in the Journal of Critical Care.

"This approach may provide a simple and effective approach to reduce healthcare-associated infections in other clinical settings," they conclude.

By Sarah Guy

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