Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. Finally, not all HAI were preventable. This study was approved by the Institutional Ethics Review Board of the National Taiwan University Hospital (No. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs. We found that the sustained improvement of hand hygiene compliance reduces HAIs and is cost effective. National Taiwan University Hospital (NTUH) is a 2,200-bed major teaching hospital in Taiwan that provides both primary and tertiary medical care. Patients were followed up until hospital discharge. One-way sensitivity analyses were performed to explore the influence of the uncertainty of several parameters, such as discount rates, cost of alcohol hand rub, campaign expenses, extra cost per HAI episode, and the number of averted HAIs. Cost-benefit analyses were also conducted to examine the net benefit and benefit-cost ratio of the program. However, one of these Hand hygiene compliance was assessed by direct observation during day shifts (8 a.m. to 5 p.m.) on weekdays according to the U.S.A. CDC criteria , using a standardized case report form. Fourth, not all HAIs of exogenous origin can be prevented by hand hygiene , . Proper Method of Hand Washing. This represented another good feature of the study. Use of a more definitive and generalisable measure would have been more appropriate. In order to achieve greater public health benefits associated with good hand-washing practices, WASH actors need to identify and apply collaborative and The costs of implementing the program were low compared to the costs saved by reducing the HAI incidence. This is particularly required by teaching hospitals where the house staff and attending physicians change periodically . The numbers of patients and patient-days were 290,056 and 648,305 Â± 32,109 in the pre-intervention period (January 1999 to March 2004) and 262,090 and 720,564 Â± 9,543 in the intervention period (April 2004 to December 2007). There was an extensive description of the programme. Wash with soap and water when visibly dirty or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids, or if exposure to potential spore forming organisms is strongly suspected or proven, or after using the bathroom. Extensive statistical analyses were carried out to identify the potential impact of confounders and isolate the effect of the intervention from other factors (such as historical trends or changes in epidemiological/organisational variables). Hand sanitizer is efficient at killing some microbes, but not all of them. Affiliations Disposable alcohol-based hand rub sanitizers (75% isopropyl alcohol in plastic hand-compressing dispensers) (So Easy liquid, PBF, Taiwan) were wall mounted between every two beds in general wards, by each bed in special units (such as intensive care units), and affixed to trolleys (including treatment trolleys and resuscitation trolleys) to ensure accessibility near or at the point of care . The factors considered by the model (see Text S1) include the levels and trends in the preintervention period, the changes in levels and trends during the intervention period, and autoregressive terms. Always wash your hands before putting in contacts, as being a contacts wearer increases your risk of having pink eye. However, alcohol-based hand rubs were unavailable. Use an alcohol based hand rub for all clinical situations where hands are visibly clean. Discover a faster, simpler path to publishing in a high-quality journal. At that time, hands-free washing facilities with unmedicated liquid soap (not refilled) and paper towels were located in every room of the wards and by every intensive care unit (ICU) bed. Every time hands are washed the skin loses moisture, and the protective layer is stripped away. Alcohol-Based Handrub Limitations Print; Alcohol-based handrub limitations. The study was based on sophisticated methodology that was used to overcome some issues related to the clinical design of the study. The study examined the cost-effectiveness of a hand hygiene programme to reduce the burden of healthcare-associated infections. Whether these findings were relevant for other settings was unclear. broad scope, and wide readership – a perfect fit for your research every time. Based on conservative estimates, US$100 was saved per averted infection. No standard cost-effectiveness ratios were calculated as the programme was the dominant option. 5. 3. Implementation of a HHP reduces preventable HAIs and is cost effective. Prospective, hospital-wide on-site surveillance of HAIs at NTUH began in 1981, and were conducted through weekly visits from full-time ICN to all patient units . Several studies have demonstrated a temporal relationship between improved hand hygiene practices and a reduction in HAI incidence and multidrug resistant microorganisms , ; however, few have been able to sustain a lasting impact , . Sensitivity analyses showed that the programme remained cost saving in all alternative scenarios. The hand hygiene program was associated with an estimated reduction of 1,504 (95% confidence interval: 526 to 2,544) HAI episodes (8.9%) during the intervention period without discounting (Table 2). Contributed reagents/materials/analysis tools: LYH. Yes Though hand sanitizer is an effective option to wash your hands, it has its own set of pros and cons. However, hand hygiene programs are only one component of hospital infection control. 2C. Panel A shows significant increases in percent of adherence to hand hygiene before and after patient contact for all healthcare workers in in-patient service units (p<0.001), by doctors (p<0.001), nurses (p<0.001), and other healthcare workers (p<0.001). Funding: Dr. Chen received grants (DOH96-DC-1010, DOH97-DC-1005) from the Center for Disease Control, Department of Health, and a grand (DOH99-TD-B-111-001) from the Department of Health, Taiwan. Alcohol-based handrub is not always the recommended hand hygiene product, there are some situations when washing hands with soap and water is preferred: Bacterial spores. We chose to superimpose the hand hygiene program on a well-established infection control program using standardized surveillance methods. Lather for 15 seconds Wash the front and back of your hands, as well as between your fingers and under your nails No, Is the Subject Area "Taiwan" applicable to this article? We decided to focus first on compliance with hand hygiene. During the intervention period, the total patient days (p = .004), mean Charlson comorbidity index (p = .002), and frequency of underlying illnesses, such as hematological malignancies and solid tumors (p<.001), increased significantly. Extensively drug-resistant A. baumannii (XDRAB) was defined as isolates that were resistant to five or more classes of antibacterial agents . Is the Subject Area "Hygiene" applicable to this article? 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