Use of an alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit.
BACKGROUND
Hand hygiene (HH) is critical to infection control, but compliance is low. Alcohol-based antiseptics may improve HH. HH practices in Russia are not well described, and facilities are often inadequate.


METHODS
Four 6-bed units in a neonatal intensive care unit in St. Petersburg, Russia.


METHODS
Prospective surveillance of HH compliance, nosocomial colonization, and antibiotic administration was performed from January until June 2000. In February 2000, alcohol-based hand rub was provided for routine HH use. Eight weeks later, a quality improvement intervention was implemented, consisting of review of interim data, identification of opinion leaders, posting of colonization incidence rates, and regular feedback. Means of compliance, colonization, and antibiotic use were compared for periods before and after each intervention.


RESULTS
A total of 1,027 events requiring HH were observed. Compliance was 44.2% before the first intervention, 42.3% between interventions, and 48% after the second intervention. Use of alcohol rose from 15.2% of HH indications to 25.2% between interventions and 41.5% after the second intervention. The incidence of nosocomial colonization (per 1,000 patient-days) with Klebsiella pneumoniae was initially 21.5, decreased to 4.7, and then was 3.2 in the final period. Rates of antibiotic and device use also decreased.


CONCLUSIONS
HH may have increased slightly, but the largest effect was a switch from soap and water to alcohol which may have been associated with decreased cross-transmission of Klebsiella, although this may have been confounded by lower device use. Alcohol-based antiseptic may be an improvement over current practices, but further research is required.
Brown
Samuel M
SM
Massachusetts General Hospital, Davis Center for Russian Studies, Harvard University, Boston, Massachusetts, USA.
Lubimova
Anna V
AV
Khrustalyeva
Natalya M
NM
Shulaeva
Svetlana V
SV
Tekhova
Iya
I
Zueva
Ludmila P
LP
Goldmann
Donald
D
O'Rourke
Edward J
EJ
D000328:Adult; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000494:pharmacology*; D003428:Cross Infection / Q000517:prevention & control; D000431:Ethanol / Q000008:administration & dosage / Q000494:pharmacology*; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards*; D006776:Hospitals, Pediatric; D006801:Humans; D006920:Hygiene; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D010564:Personnel, Hospital; D011785:Quality Assurance, Health Care; D012426:Russia
D000891:Anti-Infective Agents, Local; D000431:Ethanol