title: Effect of an evidence-based hand washing policy on hand washing rates and false-positive coagulase negative staphylococcus blood and cerebrospinal fluid culture rates in a level III NICU.
abstract: OBJECTIVE
  To determine the effect of implementing an evidence-based hand washing policy on between-patient hand washing compliance and on blood and cerebrospinal fluid (CSF) culture rates in a level III neonatal intensive care unit (NICU).
  
  
  METHODS
  An evidence-based hand washing policy, supported by an intensive education program, was introduced in a regional NICU. A total of 2009 preintervention neonates (16,168 patient days) over 17 months were compared to 676 postintervention neonates (5779 patient days) over 6 months. Hand washing compliance and rates of blood and CSF cultures yielding coagulase negative staphylococci (CONS) were compared before and after intervention.
  
  
  RESULTS
  Compliance with appropriate between-patient hand washing improved (from 47.4% to 85.4%, p=0.001) after the hand washing policy was introduced. The rate of cultures positive for CONS declined from 6.1+/-2.3 to 3.2+/-1.6 per 1000 patient days (p=0.005). Most of this reduction was attributable to a reduction in false-positive cultures, from 4.2+/-2.4 to 1.9+/-1.8 per 1000 patient days (p=0.042), but there was a trend toward decreased true-positive cultures (from 2.1+/-1.2 to 1.2+/-1.0 per 1000 patient days, p=0.074) as well. Potential confounders and demographics factors were similar between the control and intervention subjects.
  
  
  CONCLUSIONS
  Implementation of an evidence-based hand washing policy resulted in a significant increase in hand washing compliance and a significant decrease in false-positive coagulase negative staphylococcal blood and CSF culture rates. Exploratory data analysis revealed a possible effect on true-positive coagulase negative staphylococcal blood and CSF culture rates, but these results need to be confirmed in future studies.
authors.affiliation: Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Sharek
authors.forename: William E
authors.initials: WE
authors.lastname: Benitz
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Abel
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Freeburn
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Mayer
authors.forename: David A
authors.initials: DA
authors.lastname: Bergman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D016009:Chi-Square Distribution; D003030:Coagulase / Q000378:metabolism; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control; D019317:Evidence-Based Medicine; D005189:False Positive Reactions; D005260:Female; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D008875:Middle Aged; D011050:Policy Making; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000097:blood* / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D018709:Statistics, Nonparametric
chemical_list: D003030:Coagulase