title: Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections.
abstract: We analyzed the effect of antimicrobial use and implementation of a hand hygiene program on the incidence of healthcare-associated infections (HAIs) and healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections at the Chung Shan Medical University Hospital (Taichung, Taiwan). Monthly data were retrospectively reviewed from January 2004 to December 2010. Use of antimicrobials and alcohol-based hand cleaner were separately regressed against the incidences of HAIs and HA-MRSA infections. Infection incidence was expressed as persons per 1000 patient days (PDs), monthly use of i.v. antibiotics was expressed as defined daily doses per 1000 PDs and monthly alcohol-based hand cleaner use was expressed as bottle per 1000 PDs. Multivariate analysis indicated that use of hand cleaner was associated with reduced incidence of HAIs (P=0.0001) and HA-MRSA infections (P<0.0001). Time-series analysis indicated that increased use of hand cleaner was significantly associated with significant decreases in the incidences of HAIs and HA-MRSA infections. Total antibiotic use had no significant effect on HAIs, but was associated with more HA-MRSA infections. In addition, the use of J01CR01 antibiotics (combinations of penicillins, including β-lactamase inhibitors) in particular was correlated with significantly increased incidence of HA-MRSA infections. Our forecasting model demonstrates the efficacy of a hand hygiene program and the need to limit the use of certain restricted antimicrobials in order to reduce the incidence of HAIs and HA-MRSA infections.
authors.affiliation: Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Yuan-Ti
authors.initials: YT
authors.lastname: Lee
authors.forename: Shiuan-Chih
authors.initials: SC
authors.lastname: Chen
authors.forename: Meng-Chih
authors.initials: MC
authors.lastname: Lee
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Hung
authors.forename: Huey-Jen
authors.initials: HJ
authors.lastname: Huang
authors.forename: Hui-Chih
authors.initials: HC
authors.lastname: Lin
authors.forename: Der-Jinn
authors.initials: DJ
authors.lastname: Wu
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Tsao
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage*; D006235:Hand Disinfection; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods* / Q000592:standards; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000890:Anti-Infective Agents