infection control & hospital epidemiology july 2017, vol. 38, no. 7 concise communication
Hand Rub Consumption Has Almost Doubled in 132 German Hospitals Over 9 Years
Wibke Wetzker, MA; Janine Walter, MSc; Karin Bunte- Schönberger, BA; Frank Schwab, PhD; Michael Behnke, PhD; Petra Gastmeier, MD; Christiane Reichardt, MD
Annual surveillance data (2007–2015), collected continuously in 132 German hospitals, was evaluated for development of alcohol-based hand-rub consumption (AHC) as a surrogate parameter for hand hygiene adherence. Overall, the median increase in AHC was 94%. The increases over 9 years were significant in all units and quartiles of AHC at baseline.
Infect Control Hosp Epidemiol 2017;38:870–872 methods
Annual AHC data were derived in each individual hospital from hand-rub procurement data. These data were collected on the unit level, aggregated and stratified for intensive care units (ICUs) and non–intensive care units (non-ICUs). Further stratification was conducted according to medical specialty (eg, surgical, neonatal, pediatric, etc). Some hospitals gathered data on both ICUs and non-ICUs, while others participants provided data for only 1 functional area (either ICU or non-ICU). The method of AHC surveillance with HAND-KISS and the calculation of reference data have been described in detail elsewhere.2,3 Only hospitals providing data continuously from 2007 to
Healthcare settings such as hospitals are high-risk environ- ments for the spread of infectious pathogens. The impact of multidrug-resistant organisms on the burden of healthcare- associated infections is increasing. To reduce transmission of pathogens and thereby prevent infections, compliance with hand hygiene is considered the single most effective measure.1 In January 2008, the German national hand-hygiene campaign
Aktion Saubere Hände (ASH) was launched as part of a strategy of multiple interventions based on the framework of theWorld Health Organization’s Clean Care is Safer Care program to improve hand-hygiene adherence in healthcare settings. A sub- stantial element of the German approach was to implement a surveillance tool to measure alcohol-based hand-rub consump- tion (AHC) at the unit level or in functional areas as a component of the national surveillance system for nosocomial infections known as KISS (Krankenhaus Infections Surveillance System). As of February 2017, 1,216 hospitals were participating inASHby transmitting their AHC data annually using the HAND-KISS tool. Hospitals not engaged in AHC can also use HAND-KISS on a voluntary basis for internal quality management. The objective of our evaluation of AHC data was to provide
information on the development of AHC as a surrogate para- meter for hand disinfection adherence by healthcare workers (HCWs). In Germany, hospital surveillance data do not include soap or other hand-hygiene solutions (eg, gels) because alcohol-based hand rub is the main hand-hygiene product and national guidelines recommend its use for all hand disinfection opportunities (except in caring for patients with Clostridium difficile diarrhea, when the use of alcohol- based hand rub followed by hand washing with soap and water is recommended).
2015 were included. The median value for annual change in AHC was calculated as the difference in milliliters (mL) per patient day (PD) and percentage difference relative to the baseline. To examine changes between 2007 and 2015 for ICUs and non-ICUs, AHC data were grouped in quartiles: Q1, ≤25%; Q2, >25 to ≤50%; Q3, >50 to ≤75%; Q4 >75%. The significance of a change in AHC was determined using the Wilcoxon rank-sum test for paired samples in quartiles. P<.05 was considered significant.
results
significant for almost every year in Q1, Q2, and Q3, except in Q3 in the first year (2007 vs 2008; P=.316). ICUs pooled in Q4 achieved a significant increase in AHC compared to baseline from 2012 onward (2007 vs 2012; P=.037). For non-ICUs, the annual increases in AHC were significant year after year and in all quartiles except in Q4 for the first year (2007 vs 2008; P=.159). For the units that started with an AHC below the median in
2007, the increase in AHC was distributed evenly over 9 years with hardly any bottom outliers (Figure 1). Hospitals and units with a higher AHC (above the median) showed greater sample variance and more top outliers and extreme top outliers. Especially for non-ICUs, extreme top outliers stood out in Q4 (ie, >75%).
In total, 132 hospitals with 1,092 units (913 non-ICUs and 179 ICUs) provided AHC data continuously over 9 years. Most of these hospitals participated in the ASH; only 6 of the 132 hos- pitals were not affiliated with the campaign. An overall median increase in AHC of 94% was observed between 2007 and 2015 (Table 1). For the 913 non-ICUs, the increase in AHC relative to baseline was 101%; for the 179 ICUs, this increase was 75%. Among all units grouped in quartiles (Q1–Q4), units with the lowest AHC at baseline (Q1) showed the greatest increase in from 2007 to 2015 (142%), followed by Q2 and Q3 with increases of 98% and 74%, respectively. Units with the highest AHC at baseline (Q4) showed an increase of 60%. Within the group of ICUs, the annual increase in AHC was
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