title: Hand rub consumption and hand hygiene compliance are not indicators of pathogen transmission in intensive care units.
abstract: The objective of this study was to investigate whether nosocomial infection (NI) rates, hand hygiene compliance rates and the amount of alcohol-based hand rub used for hand disinfection are useful indicators of pathogen transmission in intensive care units (ICUs), and whether they could be helpful in identifying infection control problems. All isolates of 10 of the most frequent pathogens from patients who were hospitalized in an ICU for >48 h were genotyped to identify transmission episodes in five ICUs. The incidence of transmission was correlated with hand hygiene compliance, hand rub consumption and NI rates. The incidence of transmission episodes varied between 2.8 and 6.8 in the five ICUs. The NI rate was 8.6-22.5 per 1000 patient-days, hand hygiene compliance was 30-47% and hand rub consumption was 57-102 L per 1000 patient-days. There was no correlation between the incidence of transmission episodes and hand rub consumption or hand hygiene compliance. The correlation between transmission rates and NI rates was 0.4 (P = 0.5), and with the exclusion of one ICU, it was 1 (P < 0.01). The incidence of NI is a relatively good indicator for the identification of pathogen transmissions, but hand rub consumption and hand hygiene compliance, at least with the relatively low level of compliance found in this study, are not indicators of pathogen transmission.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité, University Medicine Berlin, Germany. tim.eckmanns@charite.de
authors.forename: T
authors.initials: T
authors.lastname: Eckmanns
authors.forename: F
authors.initials: F
authors.lastname: Schwab
authors.forename: J
authors.initials: J
authors.lastname: Bessert
authors.forename: R
authors.initials: R
authors.lastname: Wettstein
authors.forename: M
authors.initials: M
authors.lastname: Behnke
authors.forename: H
authors.initials: H
authors.lastname: Grundmann
authors.forename: H
authors.initials: H
authors.lastname: Rüden
authors.forename: P
authors.initials: P
authors.lastname: Gastmeir
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000592:standards* / Q000706:statistics & numerical data; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D007362:Intensive Care Units; D017410:Practice Guidelines as Topic / Q000592:standards
chemical_list: D000891:Anti-Infective Agents, Local