title: Effectiveness of a hand hygiene promotion strategy using alcohol-based handrub in 6 intensive care units in Colombia.
abstract: BACKGROUND
  Hand hygiene is an effective strategy for the prevention of health care-associated infection (HAI). We investigated the effect of a hand hygiene promotion strategy introducing alcohol-based handrub (AHBR) on the incidence of HAI in a university hospital in Colombia.
  
  
  METHODS
  A Prospective cohort study was performed in 6 intensive care units from January 2001 to December 2005. HAI were identified using standard US Centers for Disease Control and Prevention definitions. Alcohol-based handrub dispensers were installed between February and June 2002.
  
  
  RESULTS
  Total ABHR consumption was 5,794 L (mean, 28.9 L per 1,000 patient-days) and significantly increased over time (+9.2% per year; P < .001). Of 14,516 patients cumulating 166,498 patient-days, 2,398 (16.5%) acquired a total of 3,490 HAI episodes (20.9 per 1,000 patient-days). Incidence densities for central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia, and urinary tract infections were 7.7, 10.6, and 3.6 episodes per 1,000 device-days, respectively. A significant decrease was observed for CLABSI (-12.7% per year; P < .001) with low nurse-to-patient ratio independently associated with infection (odds ratio, 1.11; 95% confidence interval: 1.07-1.16; P < .001).
  
  
  CONCLUSIONS
  Improved hand hygiene measured by increased ABHR consumption resulted in CLABSI reduction. Low nurse-to-patient ratio is independently associated with HAI in an upper-middle income country.
authors.affiliation: Department of Internal Medicine and School of Public Health, University of Valle, Cali, Colombia; Epidemiology Unit, University Hospital of Valle, Cali, Colombia.
authors.forename: Lena
authors.initials: L
authors.lastname: Barrera
authors.affiliation: Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Walter
authors.initials: W
authors.lastname: Zingg
authors.affiliation: Department of Internal Medicine and School of Public Health, University of Valle, Cali, Colombia.
authors.forename: Fabian
authors.initials: F
authors.lastname: Mendez
authors.affiliation: Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; World Health Organization Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address: didier.pittet@hcuge.ch.
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000293:Adolescent; D000328:Adult; D000438:Alcohols / Q000008:administration & dosage*; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003105:Colombia / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards; D006785:Hospitals, University; D006801:Humans; D006920:Hygiene / Q000592:standards; D015994:Incidence; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000438:Alcohols; D000431:Ethanol