title: Effectiveness and limitations of hand hygiene promotion on decreasing healthcare-associated infections.
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, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs.
  
  
  RESULTS
  A 4-year hospital-wide HHP, with particular emphasis on using an alcohol-based hand rub, was implemented in April 2004 at a 2,200-bed teaching hospital in Taiwan. Compliance was measured by direct observation and the use of hand rub products. Poisson regression analyses were employed to evaluate the densities and trends of HAIs during the preintervention (January 1999 to March 2004) and intervention (April 2004 to December 2007) periods. The economic impact was estimated based on a case-control study in Taiwan. We observed 8,420 opportunities for hand hygiene during the study period. Compliance improved from 43.3% in April 2004 to 95.6% in 2007 (p<.001), and was closely correlated with increased consumption of the alcohol-based hand rub (r = 0.9399). The disease severity score (Charlson comorbidity index) increased (p = .002) during the intervention period. Nevertheless, we observed an 8.9% decrease in HAIs and a decline in the occurrence of bloodstream, methicillin-resistant Staphylococcus aureus, extensively drug-resistant Acinetobacter baumannii, and intensive care unit infections. The intervention had no discernable impact on HAI rates in the hematology/oncology wards. The net benefit of the HHP was US$5,289,364, and the benefit-cost ratio was 23.7 with a 3% discount rate.
  
  
  CONCLUSIONS
  Implementation of a HHP reduces preventable HAIs and is cost effective.
authors: Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan. yeechunchen@gmail.com
authors: Yee-Chun
authors: YC
authors: Chen
authors: Wang-Huei
authors: WH
authors: Sheng
authors: Jann-Tay
authors: JT
authors: Wang
authors: Shan-Chwen
authors: SC
authors: Chang
authors: Hui-Chi
authors: HC
authors: Lin
authors: Kuei-Lien
authors: KL
authors: Tien
authors: Le-Yin
authors: LY
authors: Hsu
authors: Keh-Sung
authors: KS
authors: Tsai
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D001424:Bacterial Infections / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006225:Hand / Q000382:microbiology*; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000891:Anti-Infective Agents, Local