Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections 英文参考文献.docVIP

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Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections 英文参考文献.doc

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Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing Healthcare–Associated Infections 英文参考文献

EffectivenessandLimitationsofHandHygiene PromotiononDecreasingHealthcare–Associated Infections Yee-ChunChen1,2,3*,Wang-HueiSheng1,2,Jann-TayWang1,2,Shan-ChwenChang2,3,Hui-ChiLin2 ,Kuei- LienTien2,Le-YinHsu2,Keh-SungTsai1,3 1CenterforInfectionControl,NationalTaiwanUniversityHospital,Taipei,Taiwan,2DepartmentofInternalMedicine,NationalTaiwanUniversityHospital,Taipei,Taiwan, 3DepartmentofMedicine,NationalTaiwanUniversityCollegeofMedicine,Taipei,Taiwan Abstract Background: Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. We use a quasi-experimental, before and after,studydesignwithprospectivehospital-widesurveillanceofHAIstoassessthecosteffectivenessofHHPs. Methods and Findings: A 4-year hospital-wide HHP, with particular emphasis on using an alcohol-based hand rub, was implementedinApril2004ata2,200-bedteachinghospitalinTaiwan.Compliancewasmeasuredbydirectobservationand theuseofhandrubproducts.PoissonregressionanalyseswereemployedtoevaluatethedensitiesandtrendsofHAIsduring thepreintervention(January1999toMarch2004)andintervention(April2004toDecember2007)periods.Theeconomic impactwasestimatedbasedonacase-controlstudyinTaiwan.Weobserved8,420opportunitiesforhandhygieneduringthe studyperiod.Complianceimprovedfrom43.3%inApril2004to95.6%in2007(p,.001),andwascloselycorrelatedwith increasedconsumptionofthealcohol-basedhandrub(r=0.9399).Thediseaseseverityscore(Charlsoncomorbidityindex) increased(p=.002)duringtheinterventionperiod.Nevertheless,weobservedan8.9%decreaseinHAIsandadeclineinthe occurrenceofbloodstream,methicillin-resistantStaphylococcusaureus,extensivelydrug-resistantAcinetobacterbaumannii, and intensive care unit infections. The intervention had no discernableimpact on HAI rates in the hematology/oncology wards.ThenetbenefitoftheHHPwasUS$5,289,364,andthebenefit-costratiowas23.7witha3%discountrate. Conclusions:ImplementationofaHHPreduces