title: Sequential hand hygiene promotion contributes to a reduced nosocomial bloodstream infection rate among very low-birth weight infants: an interrupted time series over a 10-year period.
abstract: BACKGROUND
  Sustained high compliance with hand hygiene (HH) is needed to reduce nosocomial bloodstream infections (NBSIs). However, over time, a wash out effect often occurs. We studied the long-term effect of sequential HH-promoting interventions.
  
  
  METHODS
  An observational study with an interrupted time series analysis of the occurrence of NBSI was performed in very low-birth weight (VLBW) infants. Interventions consisted of an education program, gain-framed screen saver messages, and an infection prevention week with an introduction on consistent glove use.
  
  
  RESULTS
  A total of 1,964 VLBW infants admitted between January 1, 2002, and December 31, 2011, were studied. The proportion of infants with ≥1 NBSI decreased from 47.6%-21.2% (P < .01); the number of NBSIs per 1,000 patient days decreased from 16.8-8.9 (P < .01). Preintervention, the number of NBSIs per 1,000 patient days significantly increased by 0.74 per quartile (95% confidence interval [CI], 0.27-1.22). The first intervention was followed by a significantly declining trend in NBSIs of -1.27 per quartile (95% CI, -2.04 to -0.49). The next interventions were followed by a neutral trend change. The relative contributions of coagulase-negative staphylococci and Staphylococcus aureus as causative pathogens decreased significantly over time.
  
  
  CONCLUSIONS
  Sequential HH promotion seems to contribute to a sustained low NBSI rate.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands. Electronic address: o.helder@erasmusmc.nl.
authors.forename: Onno K
authors.initials: OK
authors.lastname: Helder
authors.affiliation: EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
authors.affiliation: Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital, AMC, Amsterdam, The Netherlands.
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.affiliation: Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Caspar W N
authors.initials: CW
authors.lastname: Looman
authors.affiliation: Division of Neonatology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Irwin K M
authors.initials: IK
authors.lastname: Reiss
authors.affiliation: Division of Neonatology, Department of Pediatrics, Erasmus MC - Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: René F
authors.initials: RF
authors.lastname: Kornelisse
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D065186:Interrupted Time Series Analysis; D011446:Prospective Studies; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000302:isolation & purification
keywords: Hand disinfection; Infant; Infection control; Interrupted time series; Nursing intervention