Title: Preventing Healthcare Associated Infections (HAI) with a System of Persistent Hand Sanitizing and Surface Disinfecting in a Long-Term-Acute-Care Facility

Background: Handwashing and environmental cleaning are priorities for preventing HAIs.  However, attempts to permanently improve hand washing compliance have not been successful and housekeeping remains a low budget item for most facilities.  Hand hygiene and cleaning products with persistent action present an option for improving less-than-optimal hand washing and environmental cleaning.
Objective: Determine if HAI and specifically multi-drug resistant organisms (MDRO) infection rates are reduced by adding the two persistent products. 
Methods: The trial was a before and after comparison of infection rates per 1000 patient days for MDROs during a 6-month baseline and a 6-month comparison period. It evaluated a combination of a 4-hour non-alcohol hand sanitizing lotion and a 30-day environmental disinfectant (Germ Pro Persistent Action Plan).  Staff was instructed to use the Hand Sanitizing Lotion at the start of the day and to reapply every four hours.  Continued compliance to Hand Hygiene Guidelines was encouraged.  The lotion’s hydrophobic layer helps protect the hands from the harsh effects of frequent washing.  The lotion is not easily removed by normal washing or alcohol sanitizers.  Environmental services was instructed to apply the Surface Disinfectant after normal cleaning to touch points every 30 days or at patient discharge, whichever is sooner.  Both products were used in addition to all previously used hygiene products and procedures.

 Results: Chart 1 shows that overall MDRO rates were reduced by 43.5% compared to the baseline.  Rate reductions for individual organisms ranged from 37% to 78%, except extended-spectrum-beta-lactamases (ESBL) where infections increased. Some studies have shown ESBL infection to be related to use of antibiotics for other infections.  This was not examined for this study but should be studied in additional trials.
Conclusions: Germ Pro’s Persistent Action Plan was very effective in reducing all MDRO, except ESBL.   ESBL infections require more study to determine possible association with antibiotics.

 

 Chart 1
 Trial Summary

	Infection Rate	Infection Rate
	6 months	6 months	Percentage
	Before Trial	Trial	Reduction
Acinetobacter
baumanni	8.65	1.88	78.3%
Clostridium
difficile	3.40	1.17	65.6%
Methicillin Resistant
Staphylococcus	2.80	1.20	57.1%
aureus (MRSA)
Extended Spectrum
Beta Lactamases(ESBL)	1.06	4.46	-320.8%
Vancomycin-resistant
Enterococci (VRE)	4.42	2.78	37.1%
TOTAL MDRO	20.33	11.49	43.5%