title: Infection control interventions in small rural hospitals with limited resources: results of a cluster-randomized feasibility trial.
abstract: BACKGROUND
  There are few reports on the feasibility of conducting successful infection control (IC) interventions in rural community hospitals.
  
  
  METHODS
  Ten small rural community hospitals in Idaho and Utah were recruited to participate in a cluster-randomized trial of multidimensional IC interventions to determine their feasibility in the setting of limited resources. Five hospitals were randomized to develop individualized campaigns to promote HH, isolation compliance, and outbreak control. Five hospitals were randomized to continue with current IC practices. Regular blinded observations of hand hygiene (HH) compliance were conducted in all hospitals as the primary outcome measure. Additionally, periodic prevalence studies of patient colonization with resistant pathogens were performed. The 5-months intervention time period was compared to a 4-months baseline period, using a multi-level logistic regression model.
  
  
  RESULTS
  The intervention hospitals implemented a variety of strategies. The estimated average absolute change in "complete HH compliance" in intervention hospitals was 20.1% (range, 7.8% to 35.5%) compared to -3.1% (range -6.3% to 5.9%) in control hospitals (p = 0.001). There was an estimated average absolute change in "any HH compliance" of 28.4% (range 17.8% to 38.2%) in intervention hospitals compared to 0.7% (range -16.7 to 20.7%) in control hospitals (p = 0.010). Active surveillance culturing demonstrated an overall prevalence of MRSA carriage of 9.7%.
  
  
  CONCLUSIONS
  A replicable intervention significantly improved hand hygiene as a primary outcome measure despite barriers of geographic distance and lack of experience with study protocols. Active surveillance culturing identified unsuspected reservoirs of MRSA colonization and further promoted IC activity.
authors.affiliation: The Ohio State University Medical Center, N-1122 Doan Hall 410 West 10th Avenue, Columbus, OH 43210, USA. kurt.stevenson@osumc.edu.
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Stevenson
authors.forename: Katie
authors.initials: K
authors.lastname: Searle
authors.forename: Grace
authors.initials: G
authors.lastname: Curry
authors.forename: John M
authors.initials: JM
authors.lastname: Boyce
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Samore