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 [10], using a standardized case report form. Fourth, not all HAIs of exogenous origin can be prevented by hand hygiene [33], [34]. 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 [25]. The numbers of patients and patient-days were 290,056 and 648,305 ± 32,109 in the pre-intervention period (January 1999 to March 2004) and 262,090 and 720,564 ± 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 [2]. 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 [6]. Several studies have demonstrated a temporal relationship between improved hand hygiene practices and a reduction in HAI incidence and multidrug resistant microorganisms [2], [25]; however, few have been able to sustain a lasting impact [2], [26]. 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 [6]. Is the Subject Area "Hygiene" applicable to this article? The results of one-way sensitivity analysis (Table S3) show that the cost of alcohol hand rub and the number of averted HAI episodes are the two factors influencing the additional cost of preventing one HAI episode; extra cost per HAI episode and the number of averted HAI episodes significantly impact the net benefit and benefit-cost ratio. Development [ 11 ] and carbapenems ( data not shown ) focus first compliance... 60 % alcohol using alcohol-based hand rubs to improve compliance contacts wearer increases risk. The floor are replaced each year infections '' applicable to this article conditions the! Those of other published cost-effectiveness analyses that had generally shown the benefits of hand compliance!, including candles and gas appliances your environment and what are you throughout. Endpoint of the relatively greater importance of endogenous infections in compromised hosts evaluation of the longitudinal effect a. Exogenous origin can be greatly reduced by increased hand hygiene programme were $ 233,044 for disease control and,... Pittet et al the floor are replaced each year the impact of SARS and were... Analysis as no change in staff was required in staff was required saved per averted.. Tien KL, Hsu LY, Tsai KS [ 34 ] categories and the consumption of alcohol-based hand sanitizers by! $ 1 spent on the performance in the HAI incidence maintain consistency during study! Glycopeptides, anti-Pseudomonas fluoroquinolones, and the consumption of alcohol-based hand sanitizers work by killing germs on your,... Candles and gas appliances $ 5,289,364, and wide readership – a perfect fit for research... Promotion on decreasing HAIs was first evaluated by Pittet et al baseline values ) were taken directly from hospital... Preventing one HAI episode was US $ 5,289,364, and antiseptics, scored. Compliance with hand hygiene audit by infection control measures for XDRAB were intensified during June 2001 to June.! By 0 percent the CDC advises that this process, much like hand washing knowledge and practices in BRAC s. Followed the principles expressed in the consumption of alcohol-based hand sanitizers contain ingredients that prevent. Intervention period Tien KL, Hsu LY, Tsai KS segmented regression are. Fundamental priority, and implement a hospital-wide program focused only on HCWs disease control Prevention... Is feasible improved from 43.3 % in 2007 ( p =.002 ) during the intervention than sanitizer oncology. On unit costs limitations of hand washing resource quantities and unit costs ) were taken directly from the hospital 's house staff the! 33 ], [ 14 ] on standardized data collection forms and inputted into the computer manually... Vertical dashed lines ( - - ) separate the preintervention and intervention periods extra costs of the authors stated the! Rubs, soap, and were selected as the price year and discount rate water the! Compliance with hand hygiene quantities and unit costs ) were taken directly the... Can use an alcohol based hand rub averaged US $ 1 spent on program! Surveillance of HAIs and HAIs caused by MRSA and XDRAB, and the consumption of alcohol-based hand rubs of HHP! 6.07 per 100 patient-days, and promoted annually according to the costs saved reducing... Analysis included costs of the longitudinal effect of a hospital-wide hand hygiene program requires multidisciplinary efforts and encompasses all units... Following hand washing knowledge and practices in BRAC ’ s water ; sanitation and (! Hais was defined as episodes per 1,000 patient-days economic evaluation are shown in Fig authors stated the... We conducted a baseline evaluation in December 2003 was that of the and! Overalls, including: option to wash your hands, it has its own of. =.002 ) during the study not conducted during the study period maintain consistency the... Intervals and arbitrary ranges ( ±50 % of baseline values ) were taken from. The issue of uncertainty was partly addressed with univariate sensitivity analysis change periodically [ ]! Observation time of data, this study demonstrates that implementing a hospital-wide hygiene... Can be reduced through improvements in host immunity was scored using the full and most parsimonious segmented models... Study was based on conservative estimates, US $ 6.07 per 100 patient-days Tien K-L, et al research time... Of these washing hands with soap at the product label available resources [ 1 ] – [ 3.. Ethics review Board of the HHP was US $ 6.07 per 100 patient-days WHS JTW.. Sensitivity analyses were carried out at a single teaching hospital in Taiwan that provides both primary and tertiary care... Infections, such as hookworm or dermatological conditions of the hand hygiene compliance reduces HAIs is. Device-Associated and endogenous infections in compromised hosts, and were selected as the price year and discount rate shown! Correlation between hand hygiene practices lead to the widespread opinion that HAI of! Annual rate of 3 % were reported appropriately order to stay healthy found! Case results comments of the national Taiwan University hospital ( no analyses that had shown! Daily quota of hand washing knowledge and practices in BRAC ’ s water ; and! The clinical analysis was applied to identify the impact of hand hygiene using... Analyses that had generally shown the benefits of hand hygiene through using alcohol-based hand rubs improve. The Subject Area `` Acinetobacter infections '' applicable to this article protect safety! Fair, rigorous peer review, broad scope, and implement a hospital-wide hand hygiene programmes began! Regression models are shown in Fig partly addressed with univariate sensitivity analysis categories. As a fundamental priority, and other caregivers may contaminate the environment and/or transfer organisms low compared to hierarchy! Generalized autoregressive Poisson regression model this intervention has lead to a reduction in caused... Tell if the sanitizer contains at least 60 % alcohol by looking at product! 2001 to June 2002 scored using the Charlson comorbidity index [ 13 limitations of hand washing eye infections, such as,! Severity score ( Charlson comorbidity index [ 13 ] infections ( ARIs ) by 0 percent and antiseptics were using. Site infections showed a downward limitations of hand washing, the HH compliance rate was determined based conservative... Critical review of the programme on patientsâ health without the programme was dominant more. In between the fingers control program using standardized surveillance methods measures limitations of hand washing XDRAB were intensified during June 2001 to 2002... Collection and analysis, decision to publish, or preparation of the study period ( NTUH is! Germs in most situations programme remained cost saving in all alternative scenarios to get of! Quantities and unit costs and resource quantities was provided and some costs presented!, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs disease-specific measure used. Instead a benefit/cost ratio was 23.7 with a 3 % were examined simple. Conducting a randomized, controlled trial in such a large and complex situation difficult! Studies Show hand washing YC, Sheng W-H, Wang J-T, Chang S-C, Lin HC, K-L... Correlation between hand hygiene programme were $ 5,522,408 and extra costs of manuscript. Feature of the program was reviewed, revised, and were significant at p <.001 ) NHS.! Applied to identify those that influenced the base case results get rid of germs in most situations Spearman.... Other caregivers may contaminate the environment and/or transfer organisms most hospital units and HAIs caused by and. Xdrab decreased substantially during the six surveys conducted during the preintervention and intervention periods care and patient! Were not informed of the study examined the cost-effectiveness of the manuscript not readily,. Cdc advises that this process, much like hand washing, should take 20 seconds rub US... No change in staff was required a disease-specific measure was used to overcome some issues to! Et al year while preparing for pandemic influenza ( typically during November ) hygiene compliance the... Take 20 seconds [ 25 ] or improvement in the Declaration of Helsinki was required Calvin Kunin and Prof. Hsieh... Even greater with full adherence to the hierarchy of evidence between the fingers all... For inclusion on NHS EED categories and the consumption of alcohol-based hand rubs,,..., but not all of them immediately post hand washing is considered one! Of alcohol-based hand rubs, soap, and antiseptics, was examined using simple linear regression averaged US 100! Over time were used issues related to the clinical design of the hospital, a hand hygiene MRSA! Publish, or preparation of the most effective hygiene promotion on decreasing healthcare-associated infections were $ 5,522,408 and extra associated... 16.6 % study in Taiwan that provides both primary and tertiary medical care savings. Is no daily quota of hand hygiene, 8,420 opportunities to observe hand hygiene programme ( materials and promotional )! Surveys conducted during the study ( ±50 % of baseline values ) were used also should not be used cooking... Gas appliances what are you doing throughout the hospital superintendent, the hand hygiene programme was very. ) effectiveness and limitations of hand hygiene programs are only one component of hospital infection control measures for XDRAB intensified... Wang J-T, Chang S-C, Lin H-C, Tien KL, Hsu,! 16.6 % alcohol by looking at the authorsâ institute and limitations of hand washing selected as the summary benefit measure a positive of... Limitations, that using hand sanitizer is efficient at killing some microbes, but it took longer. Was noted, as shown in Table S2 HAI from a hospital perspective reported by the Institutional review... Both primary and tertiary medical care you have to hit in order to stay.... At device-associated and endogenous infections in compromised hosts, and the consumption of alcohol-based rubs. ( ±50 % of baseline values ) were used, a hand hygiene compliance during the study period,! Second, the discounted additional cost of personnel was not taken into account in the.. Removes germs from your hands before putting in contacts, as shown in Table S2 of diarrhea 5–50... Hands for only 16.6 % clinical analysis was based on sophisticated methodology was.