title: [A meta analysis of the effect of enhanced hand hygiene on the morbidity of ventilator-associated pneumonia].
abstract: OBJECTIVE
  To determine the effect of enhanced hand hygiene on the morbidity of ventilator-associated pneumonia (VAP).
  
  
  METHODS
  Clinical studies which were related to enhanced hand cleansing to the risk of VAP, which were published between July 1992 and June 2013 in English or Chinese were retrieved via computer and manual screening. Data were extracted according to appropriate inclusion and exclusion criteria and analyzed with RevMan 5.0 software.
  
  
  RESULTS
  A total of 6 studies, all of which were performed with well controlled protocol, involving 28 461 mechanical ventilator days and 32 428 mechanical ventilator days were analyzed. The morbidity of VAP was 39.5 days per 1 000 mechanical ventilator days and 19.5 days per 1 000 mechanical ventilator days before and after enhanced hand cleaning, respectively. The methods of enhancing hand hygiene included feasible hand hygiene apparatus, long-term education, supervision and feedback, as well as increased hand cleaning compliance. All 6 eligible studies reported that enhanced hand washing lowered the risk of VAP, with risk reduction ranging from 29.8% to 65.5% with a mean reduction value of 50.6%. Meta analysis showed that enhanced hand cleaning could protect patients from VAP with odds ratio (OR) varying from 1.43 to 5.82 [pooled OR=2.23, 95% confidence interval (95%CI) 1.62-3.07, P<0.000 01]. It was showed in funnel chart that bias in the published articles was not significant.
  
  
  CONCLUSIONS
  Enhanced hand hygiene has an effect of prevention of VAP morbidity and is associated with lowered morbidity of VAP. However, the reliability of this conclusion is questionable because of poor quality of these studies.
authors.affiliation: Department of Emergency and Critical Care Medicine, Zhongda Hospital, Southeast University, Nanjing 210009, Jiangsu, China. Corresponding author: Huang Yingzi, Email: yz_huang@126.com.
authors.forename: Shaolei
authors.initials: S
authors.lastname: Ma
authors.forename: Songqiao
authors.initials: S
authors.lastname: Liu
authors.forename: Lili
authors.initials: L
authors.lastname: Huang
authors.forename: Changsheng
authors.initials: C
authors.lastname: Xu
authors.forename: Wenge
authors.initials: W
authors.lastname: Liu
authors.forename: Yingzi
authors.initials: Y
authors.lastname: Huang
mesh_terms: D063373:Hand Hygiene; D006801:Humans; D015994:Incidence; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000517:prevention & control