title: Use of ventilator utilization ratio for stratifying alcohol-based hand-rub consumption data to improve surveillance on intensive care units.
abstract: BACKGROUND
  Germany has established a nationwide surveillance system of alcohol-based hand-rub consumption (AHC) per patient-day in hospital settings as a surrogate parameter for hand hygiene (HH) compliance. Analysis of AHC data in intensive care units (ICUs) shows not only a wide range of consumption between units of different specialties, but also within units of one specialty. This seems to reflect variation in the number of HH opportunities per patient-day between ICUs due to variation in complexity of care.
  
  
  OBJECTIVE
  To investigate whether ventilator utilization ratio (VUR) might be a good surrogate for describing complexity and intensity of care on ICUs and whether stratification by VUR works as a new method of setting benchmarks for AHC data.
  
  
  METHODS
  Data from 365 ICUs participating in the German national nosocomial infection surveillance system (KISS) were used. VUR was calculated by dividing the number of ventilator-days per unit by the number of patient-days per unit. AHC was stratified according to VUR in quartiles.
  
  
  RESULTS
  The median AHC was 107mL/patient-day [interquartile range (IQR): 86-134] and the median VUR was 33% (IQR: 22-45%). The Spearman rank correlation coefficient was 0.28 (P<0.0001). After stratifying AHC according to VUR, the AHC in quartile I was significantly lower compared to quartile IV. There was also significant difference between quartile I and quartiles II and III.
  
  
  CONCLUSIONS
  Stratification of AHC data according to VUR is suggested to improve the quality of benchmark parameters based on AHC data as surrogate parameter for HH compliance in ICUs.
authors.affiliation: Charité - Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany. Electronic address: wibke.wetzker@charite.de.
authors.forename: W
authors.initials: W
authors.lastname: Wetzker
authors.affiliation: Charité - Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Bunte-Schönberger
authors.affiliation: Charité - Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Walter
authors.affiliation: Charité - Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Schröder
authors.affiliation: Charité - Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Gastmeier
authors.affiliation: Charité - Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Reichardt
mesh_terms: D000438:Alcohols / Q000008:administration & dosage*; D015415:Biomarkers; D004202:Disinfectants / Q000008:administration & dosage*; D004363:Drug Utilization; D005858:Germany; D006235:Hand Disinfection / Q000379:methods*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D012122:Ventilators, Mechanical / Q000706:statistics & numerical data*
chemical_list: D000438:Alcohols; D015415:Biomarkers; D004202:Disinfectants
keywords: Compliance; Hand hygiene; Hand-rub consumption; Surveillance; Ventilator utilization ratio