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403 Sustained increase in use of alcohol-based hand rubs in long-term care facilities

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Maija-Liisa Rummukainen, MD , Central Finland Health Care District, Jyväskylä, Finland
Aino Jakobsson, RN , Central Finland Health Care District, Jyväskylä, Finland
Maire Matsinen, RN , Central Finland Health Care District, Jyväskylä, Finland
Pertti Karppi, MD, PhD , Etelä-Savo Health Care District, Mikkeli, Finland
Salme Järvenpää, MSc , Medcare, Äänekoski, Finland
Outi Lyytikäinen, MD, PhD , National Institute for Health and Welfare, Helsinki, Finland
Background:

Long-term care facilities (LTCF) may serve as a reservoir for multi-resistant bacteria. Hand disinfection with alcohol-based rubs is a simple tool for controlling cross-transmission between patients and preventing healthcare-associated infections. Reference data on hand rub consumption per patient-days in LTCFs is scarce.

Objective:

We wanted promote hand hygiene in LTCFs in order to control cross-transmission of multi-resistant bacteria and prevent healthcare-associated infections.

Methods:

Multidisciplinary team (infectious diseases consultant, infection control nurse, and geriatrician) visited all LTCFs (n=123) in Central Finland Healthcare District (population, 265,000) between September 2004 and October 2005. In each unit, head nurses and often also general practitioners answered structured questions, covering information on monthly amount of alcohol-based hand rubs used in liters and patient-days. The facility environment, especially opportunities for hand disinfection, was evaluated, and new locations for additional hand rub containers were proposed. During 2006-2008, 3 postal surveys were annually conducted.

Results:

A total of 119 units with around 3500 residents participated in all 4 steps (site visit and 3 postal surveys): 25 health center care hospitals, 29 nursing homes, 10 dementia units and 55 sheltered care units. In all units, the amount of hand rubs used increased by 42%, from the median of 6.6 liters/1000 patient-days to 9.4. In health center care hospitals, the median amount of hand rub used was 9.4 liters/1000 patient-days (25th percentile 7.9, 75th percentile 12.7) at the visit and during postal surveys 2006, 2007 and 2008 the corresponding figures were 15.2 (9.7, 18.0), 17.3 (11.1, 22.4) and 14.5 (11.8, 21.5). In nursing homes, the median amount of hand rub used was 8.2 liters/1000 patient-days (5.5, 11.1) at the visit and during postal surveys 2006, 2007 and 2008 the figures were 10.6 (7.5, 13.7), 12.2 (6.9, 16.4) and 11.1 (7.3, 15.7).  In dementia units, the median amount of hand rub used was 2.8 liters/1000 patient-days (1.6, 6.6), and during postal surveys 2006, 2007 and 2008 the figures were 8.0 (4.3, 12.3), 6.0 (3.7, 15.6) and 8.6. (6.6, 13.2). In sheltered care units, the median use of hand rub used was 3.8 liters/1000 patient-days (2.7, 6.6), and during postal surveys 2006, 2007 and 2008 the figures were 6.0 (3.9, 9.8), 6.3 (3.3, 8.2) and 6.4 (4.0, 9.4).

Conclusions:

Our results show that the multidisciplinary team succeeded in promoting hand hygiene in LTCFs. In all types of settings, the use of alcohol-based hand rubs increased, however, there was a lot of variation between the units.