hand-rub consumption doubled in german hospitals 871
table 1. Change in Alcohol-Based Hand-Rub Consumption From 2007 to 2015 Among 132 Hospitals Participating Continuously in HAND-KISS (Krankenhaus Infections Surveillance System)
Unit Type No. of No. of
ICUs 2007 2015
Non-ICUs 2007 2015
All
2007 2015
132 132
102 102
120 120
Patient Median AHC and Year Hospitals Units AHC, L Days 179 49,881 693,558 64.9 (48.7–90.8)
179 91,358 732,504 113.6 (88.4–141.7) 49 53 55 44 30 75 143 100 57 27 913 119,419 7,685,322 14.2 (11.5–17.2)
913 231,578 7,660,873 28.6 (24.0–33.0) 14 14 14 15 12 101 158 109 94 57 1092 169,301 8,378,880 18.5 (13.9–25.4)
1092 322,936 8,393,377 35.9 (28.6–45.7) 17 16 16 16 22 94 142 98 74 60
NOTE. ICU, intensive care unit. aQ1 (≤25%), Q2 (>25% to ≤50%), Q3 (>50% to ≤75%), Q4 (>75%).
Difference in AHC Relative to 2007, mL/PDa
Difference in AHC Relative to 2007, %
(IQR), mL/PD Total Q1 Q2 Q3 Q4 Total Q1 Q2 Q3 Q4
figure 1. Changes in alcohol-based hand-rub consumption in milliliters (mL) per patient day (PD) between 2007 and 2015 baseline levels of hospitals and units (intensive care units and non–intensive care units). o = top outliers; * = extreme top outliers.
discussion
The evaluation of AHC data collected through the surveillance module HAND-KISS established 2 key findings: First, AHC nearly doubled in 132 German hospitals from 2007 to 2015. Second, units that started with a low AHC at baseline and units who recorded a high AHC ab initio both achieved a significant increase of AHC in the long term. These results highlight the strength of a long-term surveillance program accompanying multimodal intervention (and follow-up) such as the ASH national hand-hygiene campaign. Because benchmarking is one of the main purposes of HAND-KISS, AHC data were stratified by ICUs and non-ICUs
and by medical specialty. AHC per patient day in ICU settings usually exceeded that in non-ICU settings due to a larger number of indications for hand disinfection in ICUs. For medical specialties, AHC was highest in neonatal and pediatric units in 2015. Above-average hand-hygiene compliance in pediatric care has been described previously.4,5 Figure 1 shows a lack of bottom outliers compared to the
high number of top outliers and even extreme top outliers in AHC. An interpretation of those remarkably high values and their variance is difficult without further characterization of the respective units (which could be a future goal of AHC surveillance within HAND KISS). The lack of bottom outliers speaks for itself: Continuous engagement in infection control
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