title: Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.
abstract: OBJECTIVE
  To evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement.
  
  
  METHODS
  Prospective, ecological, interrupted time series study from 1 July 2004 to 30 June 2008.
  
  
  METHODS
  187 acute trusts in England and Wales.
  
  
  METHODS
  Installation of bedside alcohol hand rub, materials promoting hand hygiene and institutional engagement, regular hand hygiene audits, rolled out nationally from 1 December 2004.
  
  
  METHODS
  Quarterly (that is, every three months) rates for each trust of hospital procurement of alcohol hand rub and liquid soap; Staphylococcus aureus bacteraemia (meticillin resistant (MRSA) and meticillin sensitive (MSSA)) and Clostridium difficile infection for each trust. Associations between procurement and infection rates assessed by mixed effect Poisson regression model (which also accounted for effect of bed occupancy, hospital type, and timing of other national interventions targeting these infections).
  
  
  RESULTS
  Combined procurement of soap and alcohol hand rub tripled from 21.8 to 59.8 mL per patient bed day; procurement rose in association with each phase of the campaign. Rates fell for MRSA bacteraemia (1.88 to 0.91 cases per 10,000 bed days) and C difficile infection (16.75 to 9.49 cases). MSSA bacteraemia rates did not fall. Increased procurement of soap was independently associated with reduced C difficile infection throughout the study (adjusted incidence rate ratio for 1 mL increase per patient bed day 0.993, 95% confidence interval 0.990 to 0.996; P < 0.0001). Increased procurement of alcohol hand rub was independently associated with reduced MRSA bacteraemia, but only in the last four quarters of the study (0.990, 0.985 to 0.995; P < 0.0001). Publication of the Health Act 2006 was strongly associated with reduced MRSA bacteraemia (0.86, 0.75 to 0.98; P = 0.02) and C difficile infection (0.75, 0.67 to 0.84; P < 0.0001). Trust visits by Department of Health improvement teams were also associated with reduced MRSA bacteraemia (0.91, 0.83 to 0.99; P=0.03) and C difficile infection (0.80, 0.71 to 0.90; P=0.01), for at least two quarters after each visit.
  
  
  CONCLUSIONS
  The Cleanyourhands campaign was associated with sustained increases in hospital procurement of alcohol rub and soap, which the results suggest has an important role in reducing rates of some healthcare associated infections. National interventions for infection control undertaken in the context of a high profile political drive can reduce selected healthcare associated infections.
authors.affiliation: Royal Free Campus, University College London Medical School, London NW3 2PF, UK. s.stone@medsch.ucl.ac.uk
authors.forename: Sheldon Paul
authors.initials: SP
authors.lastname: Stone
authors.forename: Christopher
authors.initials: C
authors.lastname: Fuller
authors.forename: Joan
authors.initials: J
authors.lastname: Savage
authors.forename: Barry
authors.initials: B
authors.lastname: Cookson
authors.forename: Andrew
authors.initials: A
authors.lastname: Hayward
authors.forename: Ben
authors.initials: B
authors.lastname: Cooper
authors.forename: Georgia
authors.initials: G
authors.lastname: Duckworth
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.forename: Miranda
authors.initials: M
authors.lastname: Murray
authors.forename: Annette
authors.initials: A
authors.lastname: Jeanes
authors.forename: J
authors.initials: J
authors.lastname: Roberts
authors.forename: Louise
authors.initials: L
authors.lastname: Teare
authors.forename: Andre
authors.initials: A
authors.lastname: Charlett
mesh_terms: D000438:Alcohols / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control; D016360:Clostridioides difficile; D003428:Cross Infection / Q000517:prevention & control*; D004739:England / Q000453:epidemiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000517:prevention & control; D004865:Equipment and Supplies, Hospital / Q000706:statistics & numerical data* / Q000639:trends; D019983:Guideline Adherence / Q000592:standards; D006235:Hand Disinfection / Q000379:methods / Q000592:standards*; D006801:Humans; D006920:Hygiene / Q000592:standards; D017053:Infection Control / Q000379:methods / Q000592:standards*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D012044:Regression Analysis; D012915:Soaps / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D013997:Time Factors; D014852:Wales / Q000453:epidemiology
chemical_list: D000438:Alcohols; D000891:Anti-Infective Agents, Local; D012915:Soaps