No Correlation between Alcoholic Hand Rub Consumption and Compliance in 73 German ICU's

No Correlation between Alcoholic Hand Rub Consumption and Compliance in 73 German ICU's.

 

Reichardt C, MD, Sroka S, MD, Mönch N, MD, Schwab Frank PHD, Behnke Michael PhD, Gastmeier P, MD

Institute of Hygiene and Environmental Medicine, University Medicine, Charité, Berlin, Germany

 

Background:

 

There are two systems available to determine hand hygiene compliance: the direct measurement by observing of hand hygiene opportunities in clinical practice and the indirect method by measurement of alcoholic hand rub consumption (AHC) as a surrogate parameter. Hospitals participating in the German national hand hygiene campaign are measuring AHC on a mandatory basis, while observation is voluntary.

 

Objective:

 

We correlated the AHC with the observed hand hygiene compliance (OC) of all ICU's providing both data in 2008.

 

Methods:

 

The following data are provided annually per unit: consumption of AHC, the number of annual patient days (PD) per unit and the unit characteristics. The consumption in ml per PD for individual units is fed back to the hospitals together with reference data stratified by type of unit. All participants used defined observation tools and where trained by the campaign team members. The definition of hand hygiene opportunities is based on the WHO Model “My 5 moments of hand hygiene”. A minimum of 200 observations per unit and 20 observations per indication was defined. Spearman correlation coefficient was used in order to define the relationship between the two parameters. Significance was tested using Wilcoxon rank sum test.

 

Results:

 

Both datasets were available for 73 ICU's. The mean OC rate was 62.2% (interquartile range (IQR) 50.5 – 71.7%) and the mean AHC rate was 73 ml/PD (IQR 53 – 94 ml/PD). There was no correlation neither for all units (ρ=0.019) nor for special types of units (surgery ρ=-0.068, internal medicine ρ=0.061, interdisciplinary ρ=0.234, neonatology ρ=-0.131).

 

Conclusions:

 

Based on our data, there is no correlation between AHC and compliance rates. Observations to determine compliance rates are very challenging. Satisfactory inter rater reliability is hard to achieve. Evaluation of observation results revealed an inter rater reliability between 30% and 60%. Observation is an excellent tool to determine quality, e. g. whether hand hygiene opportunities are appropriately detected in clinical practice. However, without extensive training and evaluation, quantitative interpretations of compliance rates should be done very carefully. Measurement of AHC provides a feasible and perhaps more reliable system to detect quantitative changes in hand hygiene behaviour, provided that there is a stable and unit based order system of AH.

 

Figure: Spearman correlation of AHC and compliance in all 73 ICU's