Background: A new national surveillance system (HAND-KISS) of alcohol based hand rub consumption (AHC) in hospitals was implemented to the German national nosocomial infection surveillance system (KISS) in the year 2008.
Objective: We analyzed the differences of AHC increase of hospitals with low and high baseline AHC.
Methods: All hospitals participating in HAND-KISS send annually unit based AHC data to the HAND-KISS module. HAND-KISS is calculating AHC in Milliliter per patient day (ml/PD) stratified by specialty and by intensive care units (ICU's) and Non-ICU's. Reference data and the AHC distribution of 129 hospitals that provided baseline data in 2007 and follow up data in 2008 and 2009 were calculated. We grouped AHC baseline data of 2007 in quartiles and tested changes of AHC over three years between these groups using the Kruskal-Wallies-test. The following settings were analyzed: whole hospitals, ICU's only and Non-ICU's.
Results: 129 hospitals including 1659 units have consequently provided AHC data for the years 2007 to 2009. The median AHC in 129 hospitals including all units was 13.8 ml/PD (17.9 ml/PD 25th percentile, 22.4 ml/PD 75th percentile). The median AHC in ICU's only was 65 ml/PD (50.5 ml/PD 25th percentile, 90.6 ml/PD 75th percentile) and 14.7 ml/PD (11.9 ml/PD 25th percentile, 18.1 ml/PD 75th percentile) in Non-ICU's. We did find significant difference in AHC change between the defined quartiles analyzing ICU's only (p<0.001) in contrast to whole hospitals (p=0.21) and Non-ICU's (p=0.173).
Conclusions: AHC is a surrogate parameter to characterize hand hygiene behaviour in different settings. ICU's starting at a low level of AHC achieved a significant higher increase of AHC. Overall, our results show that there is room for improvement in all analyzed settings, irrespective of level of baseline AHC.
Figure: Changes in AHC in 129 hospitals from 2007 to 2009 grouped in quartiles depending on baseline AHC in 2007