Main Menu Browse by Day or Program Author Keywords

141 Hand Hygiene Compliance and the Impact on Methicillin Resistant Staphylococcus aureus (MRSA) and Vancomycin Resistant Enterococcus (VRE) on Transmission in Adult Intensive Care Units

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Hanan Aboumatar, MD, MPH , The Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD
Polly Ristaino , The Johns Hopkins Hospital, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
John Shepard , The Johns Hopkins Hospital, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Bonnie Wong , The Johns Hopkins Hospital, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Aaron Milstone , The Johns Hopkins Hospital, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Richard Davis, PhD , The Johns Hopkins Hospital, Baltimore, MD
Trish M. Perl, MD, MSc , The Johns Hopkins Hospital, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
Background: Hand hygiene (HH) is a key strategy to prevent healthcare associated infections including transmission of MRSA and VRE.  Data examining the impact of improved HH compliance on MRSA and VRE transmissions may reinforce HH improvement efforts.  

Objective: To determine the relationship between HH compliance in adult ICUs and MRSA and VRE transmissions.

Methods: In November 2007, The Johns Hopkins Hospital (n=940 beds) augmented its HH campaign.  We engaged leadership, added visuals, provided managers a toolkit to support improvement efforts, identified champions, educated healthcare workers, installed additional hand hygiene dispensers, and increased HH compliance observations.  We used an online dashboard to feed back data real time.  In Nov 2008 to encourage further improvement, we set a new HH compliance goal to engage staff, recognized teams for their efforts and added incentives. Trained “secret shoppers” measured HH compliance on entry and egress of the room, or “bed space” in multi bedded rooms. Most observations occurred during the day shift and we aimed to collect 40 observations per unit per month. Patients admitted to all 6 adult ICU’s (n=99 beds) were cultured for VRE (peri-rectal) and MRSA (nasal) upon admission and weekly thereafter. Transmissions were defined in ICU patients with no previous history of VRE/MRSA and admitted at least 48 hours whose admission culture did not grow or was not obtained but a subsequent culture grew one of the organisms of interest.  Rates were aggregated across all ICUs to calculate a monthly MRSA and VRE transmission rate. They were plotted using a u statistical process control chart.  A baseline period January 2007 to October 2008 was compared to the post intervention period November 2008 to September 2010 and examined for special cause variation. Medians for both time periods were compared using non-parametric tests.

Results: Overall, 11,418 HH opportunities were captured in 102,321 ICU patient days.   A mean of 43 HH opportunities were captured per month, per ICU.  Mean monthly HH compliance across the ICUs increased from 38% pre intervention to 70% after the intensified HH promotion intervention (p<0.001).  No special cause variation was identified in the pre intervention period, the MRSA and VRE transmission control charts. After the intervention, MRSA rates decreased from a baseline of 2.59/1,000 patient days to 1.72/1,000 patient days (p <0.01, 95 % CI (0.21, 1.58)).  Similarly, VRE transmissions decreased from 4.14/1,000 patient days to 3.16/1,000 patient days (p < 0.005, 95% CI (0.52, 2.40)).

Conclusions: Our multi-pronged program to improve HH compliance reduced MRSA and VRE transmissions among adult patients in our ICUs.  While, this likely translates to decreased MRSA and VRE infections, this is an avenue for future research.