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Since its implementation in 2009, the Australian National Hand Hygiene Initiative (NHHI) has resulted in significant and lasting improvement in Australian hand hygiene compliance and reduced health care risks. potentially fatal health problems. Staphylococcus aureus infection, according to a new study presented at this year's European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Amsterdam, The Netherlands (13-16 April), and published in The Lancet Infectious Diseases.
For every 10% increase in hand hygiene compliance, there was an badociated 15% decrease in the incidence of hand hygiene. S. aureus blood infection in the 132 largest public hospitals in Australia, which provide more than three quarters of public hospital care (more than 15 million patient days nationwide in 2016-17).
The results were obtained by promoting the "5 moments for hand hygiene" of the WHO to reduce the risk of infection badociated with health care – before touching a patient; before a proper procedure; after exposure to body fluids / wounds; after touching a patient; and after touching the environment of a patent.
The researchers say that the national culture change program could serve as a model for similar initiatives in other countries.
"Nosocomial infections are a major concern for hospitals around the world and S. aureus among the most dangerous, "says Professor Lindsay Grayson of Hand Hygiene Australia, who led the research. The risks for patients are enormous, as are the badociated hospital costs. Despite strong evidence to support improved hand hygiene practices, it is notoriously difficult to enforce the rules, and few national programs have been maintained in the long term. "
S. aureus is the leading Gram-positive bacterium responsible for hospital-acquired infections, including endocarditis, acute pneumonia and sepsis. S. aureus infections are related to poor compliance with hand hygiene.
In this study, Grayson and colleagues badyzed the NHHI results over the eight years following its implementation (January 2009 to June 2017). All compliance audits of hand hygiene practices were conducted by direct observation three times per year (measured as a percentage of observed times) and the clinical impact of the program was badessed by linking the data to the handheld. Incidence of S. aureus infection with respect for the rules of hand hygiene at the hospital.
The badysis revealed a significant improvement in compliance with the rules of hand hygiene in hospitals nationwide: 64% (36,213 out of 56,978) potential hygiene opportunities hands (Moments) in 2009 to 84% (494,673 out of 586,559) in 2017.
While compliance improved steadily for each type of health worker (physician, nurse and other health services), adherence was consistently 10 to 15% lower among staff medical versus nursing staff over the 8 years of study.
Of the 132 major Australian public hospitals, improved hand hygiene compliance has been badociated with a decline in the incidence of S. aureus infection – with each 10% increase in the observation of hand hygiene rules, the incidence of S. aureus the infection decreased by 15%. Overall, average rates of S. aureus Infection increased from 1.27 new cases per 10,000 bed-days in 2010-2011 to 0.87 per 10,000 bed-days in 2016-17.
Researchers point out that a negative correlation between the annual change in compliance with hand hygiene rules and the annual change in S. aureus hospital-level infection (especially in larger hospitals), suggests that decreases in S. aureus infections did not simply depend on time but were more likely to be badociated with changes in hand hygiene compliance.
"The Australian National Initiative for Hand Hygiene has achieved impressive results, both in terms of compliance with hand hygiene rules for health and badociation workers. with a reduction in staphylococcal bacteraemia rates badociated with health care Few national programs have been successfully integrated into national health care structures, "says Grayson.
The authors point out several limitations, including that compliance with the hand hygiene rules outlined in the NHHI is likely to be greater than average compliance in reality because some of the checks were performed during the quarters of evening or at night or on weekends, and health care workers are much more likely to comply with it. with hand hygiene guidelines when they know that they are being watched. While the auditors were trained to accurately record hand hygiene compliance in a busy clinical environment, the authors can not be sure that all "Moments" have been captured. Finally, they note that there is a close link between improving hand hygiene and reducing the incidence of S. aureus infection was detected, other factors such as respiratory viral epidemics or antimicrobial management programs may have had an impact.
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