For more information about PLOS Subject Areas, click The authors conclusions appear robust. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs. Emergency procedures were excluded. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, Affiliations Using these products can result in less skin dryness and irritation than hand-washing. Washing hands with soap and water is the best way to get rid of germs in most situations. The cost of personnel involved in the program (including planning, training, and auditing) was not considered in the base-case analysis (Table S2), because the program did not incur any increases in staff or manpower costs. Our recent survey demonstrated that the HH rate for 5 moments was only approximately 60%; whereas the HH rate for two moments exceeded 90% (unpublished data). 3C. Washing hands with soap and water will remove substantially more disease causing organisms than washing hands with water alone. PLOS ONE promises fair, rigorous peer review, A 3% annual discount rate was applied. However, the net benefit of the hand hygiene program is US$5,289,364, which indicates that the benefits from savings to the additional costs of HAI could outweigh the program costs. 3. Sometimes, even the most powerful machines cannot remove dried-on food debris, requiring you either hand-wash the item or run it through the machine again. Yes Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, Affiliation The economic analysis included costs of the hand hygiene programme (materials and promotional efforts) and cost-savings due to reductions in healthcare-associated infections. We found that the sustained improvement of hand hygiene compliance reduces HAIs and is cost effective. Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan, Affiliations Patients, patients' family, and other caregivers may contaminate the environment and/or transfer organisms. Alcohol-Based Handrub Limitations Print; Alcohol-based handrub limitations. Instead a benefit/cost ratio was presented to show the economic benefit to the hospital of spending additional money on the programme. Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan, The intervention had no discernable impact on HAI rates in the hematology/oncology wards. I will do this by analyzing the existing evidence in relation to the hierarchy of evidence. The patient population characteristics during the preintervention and intervention periods are summarized in Table 1. All economic data (resource quantities and unit costs) were taken directly from the hospital database. Disposable alcohol-based hand rub sanitizers (75% isopropyl alcohol in plastic hand-compressing dispensers) (So Easy liquid, PBF, Taiwan) were wall mounted between every two beds in general wards, by each bed in special units (such as intensive care units), and affixed to trolleys (including treatment trolleys and resuscitation trolleys) to ensure accessibility near or at the point of care [2]. Study groups were not well balanced at baseline due to statistically significant differences in number of patient-days, comorbidity index and frequency of underlying comorbidities. Although evidence exists that improved adherence to hand hygiene is linked to reduced infection rates [24][26], other studies failed to report these effects [27][30]. However, one of these No, Is the Subject Area "Acinetobacter infections" applicable to this article? In conclusion, this study demonstrates that implementing a hospital-wide hand hygiene program is feasible. This model autocorrelates the HAI cases in successive periods by incorporating the autoregressive order j term and number of HAI cases at an earlier time t-j [17]. The major barrier is poor compliance by healthcare providers, regardless of available resources [1][3]. The hand hygiene promotion programme consisted of disposable alcohol-based hand rub sanitisers that were wall-mounted between every two beds in general wards, by each bed in special units (such as intensive care units) and affixed to trolleys to ensure accessibility near or at the point of care. Center for Infection Control, National Taiwan University Hospital, Taipei, Taiwan, It was discounted at an annual rate of 3%. According to a recent, comprehensive review of literature published as a Cochrane Review [21], the quality of intervention studies intended to increase hand hygiene compliance remains disappointing. The number of healthcare-associated infections was the main endpoint of the analysis. Demonstrating to hospital administrators that these programs are cost-effective, relatively inexpensive, improve patient safety, and require long-term and stable investment is essential [2], [24]. They must be supplemented with measures directed at device-associated and endogenous infections in compromised hosts, and augmented by antimicrobial stewardship. here. The hand hygiene promotion programme consisted of disposable alcohol-based hand rub sanitisers that were wall-mounted between every two beds in general wards, by each bed in special units (such as intensive care units) and affixed to trolleys to ensure accessibility near or at the point of care. Hand sanitizer is efficient at killing some microbes, but not all of them. Alcohol-based hand rubs were unavailable. To investigate the impact of the intervention on the levels and trends of cumulative HAI incidence over time, we adopted the generalized autoregressive Poisson regression analyses [15], [16]. However, we were unable to demonstrate a reduction in the HAIs of hematology and oncology services. Hand hygiene is generally considered to be the most important measure that can be applied to prevent the spread of healthcare-associated infection (HAI). All statistical tests were considered two-tailed and were significant at p<.05. We conducted a baseline evaluation in December 2003 [8]. https://doi.org/10.1371/journal.pone.0027163.s003, https://doi.org/10.1371/journal.pone.0027163.s004. The economic evaluation in this study produced similar results. One-way sensitivity analyses were performed to explore the influence of the uncertainty of several parameters, such as discount rates, cost of alcohol hand rub, campaign expenses, extra cost per HAI episode, and the number of averted HAIs. Nevertheless, we observed an 8.9% decrease in HAIs and a decline in the occurrence of bloodstream, methicillin-resistant Staphylococcus aureus, extensively drug-resistant Acinetobacter baumannii, and intensive care unit infections. Finally, no significant change in the trends or levels of infections caused by MSSA and E. coli during the intervention period was observed, as shown in Fig. From a hospital perspective, the discounted additional cost of preventing one HAI episode was US$163.6. We also observed an increased use of alcohol-based hand rubs (p=.001), liquid soap (p=.03), and antiseptics (p=0.04), as shown in Fig. Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. We chose methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter, and extensively drug-resistant A. baumannii (XDRAB) as marker organisms because our previous study showed a significant increase in HAI incidences, and outbreaks of these infections occurred during the study period [6]. Background Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. 1B. Bloodstream (p<.001), urinary tract (trend, p=.03), and skin and soft tissue infections (trend, p<.001) decreased significantly. where con-ditions such as hookworm or dermatological conditions of the foot may develop). Compliance was measured by direct observation and the use of hand rub products. In addition, this study showed that the cost of alcohol hand rub and the number of averted HAI episodes are the two factors influencing the additional costs of preventing one HAI episode, which subsequently influences the net benefit and benefit-cost ratio. The costs of implementing the program were low compared to the costs saved by reducing the HAI incidence. You can tell if the sanitizer contains at least 60% alcohol by looking at the product label. The target hand hygiene compliance rate was determined based on the performance in the preceding year. PLOS ONE 2011; 6(11): e27163, Anti-Infective Agents, Local /pharmacology; Bacterial Infections /prevention & Female; Guideline Adherence /statistics & Hand /microbiology; Health Personnel /statistics & Humans; Infection Control /economics /methods /statistics & Male; Middle Aged; Prospective Studies; control; numerical data; numerical data; numerical data, http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0027163, Effectiveness and limitations of hand hygiene promotion on decreasing healthcare-associated infections, Chen YC, Sheng WH, Wang JT, Chang SC, Lin HC, Tien KL, Hsu LY, Tsai KS. Observed incidences, black solid line, ; mean, red dash line, ---; green and blue shadow, 95% confidence interval of observed incidences; yellow shadow, 95% confidence interval (CI) of predicted incidences. However, hand hygiene programs are only one component of hospital infection control. Competing interests: None of the authors declared a conflict of interest. values from the full and most parsimonious segmented regression models predicting monthly incidence density (episodes per 1000 patient-days) over time. Extensively drug-resistant A. baumannii (XDRAB) was defined as isolates that were resistant to five or more classes of antibacterial agents [6]. The severity of underlying diseases, comprising a maximum of six diseases, was scored using the Charlson comorbidity index [13]. Though hand sanitizer is an effective option to wash your hands, it has its own set of pros and cons. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. There is no daily quota of hand washing that you have to hit in order to stay healthy. The authors concluded that the hand hygiene programme was feasible and reduced both healthcare-associated infection rates and hospital costs. Patients were followed up until hospital discharge. (2011) Effectiveness and Limitations of Hand Hygiene Promotion on Decreasing HealthcareAssociated Infections. The World Health Organization launched the World Alliance for Patient Safety in October 2004 [2]. This is particularly required by teaching hospitals where the house staff and attending physicians change periodically [25]. To provide consistent care and protect patient safety throughout the hospital, a hand hygiene program requires multidisciplinary efforts and encompasses all hospital units. Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. Accordingly, we introduced accessible alcohol-based hand rubs to improve compliance. Heterogeneity factors were calculated by dividing the deviance with the degrees of freedom, and used as an indicator to assess whether an extra-Poisson variation (overdispersion) was present. Conceived and designed the experiments: YCC WHS JTW HCL. Healthcare-associated infection rates by type of infection and site were estimated. The clinical analysis was based on a comparative study with historical control carried out at a single teaching hospital. Pittet and colleagues [24] estimated the program costs to be less than US$57,000 per year for a 2,600-bed hospital, an average of US$1.42 per admitted patient. Studies Show Hand Washing May Be More Effective Than Sanitizer. 3A and 3B. Prospective, hospital-wide on-site surveillance of HAIs at NTUH began in 1981, and were conducted through weekly visits from full-time ICN to all patient units [6]. Infection control measures for XDRAB were intensified during June 2001 to June 2002. In order to achieve greater public health benefits associated with good hand-washing practices, WASH actors need to identify and apply collaborative and No standard cost-effectiveness ratios were calculated as the programme was the dominant option. The rationale for the selection of comparators was clear as the hand hygiene programme was compared against the conventional pattern of care before implementation of the programme. Yes There are many limitations of PPE like safety glasses and overalls, including:. These efforts resulted in only a transient reduction in the rates of infection for XDRAB and MRSA. The generalized autoregressive Poisson model. With substantial support from the hospital superintendent, the hospital-wide hand hygiene promotion program began in April 2004. We were also unable to demonstrate a reduction in HAIs caused by MSSA and E. coli. The program was associated with a reduction in the HAIs of most hospital units and HAIs caused by MRSA and XDRAB. Hand-washing with water and soap, in particular, is shown to significantly reduce the microbial load of the hands [7] and was shown to reduce the risk of diarrhea with 39-47% [6] [7] [8][9][10]. Handwashing will remove all types of germs from your hands, but hand sanitizers are not able to kill all types of germs or remove harmful chemicals like pesticides and heavy metals. Remove any hand or arm jewellery Use soap and running water Wash your hands frequently throughout the day Washing should last for at least 20 seconds, preferably a minute. Third, the hand hygiene programs in this study focused only on HCWs. Is the Subject Area "Hygiene" applicable to this article? Several studies have concluded that the risk of spreading gastrointestinal (stomach) and respiratory infection is decreased among families who use hand sanitizers. After implementation of the hand hygiene program, the levels and trends of HAIs changed significantly (p=.02, p=.04, respectively), as shown in Fig. The hand hygiene compliance rates recorded for comparison between hospital services or between years were limited to the opportunities before and after patient contact to maintain consistency during the study period. The cost categories and the source used reflected the hospital perspective reported by the authors. Funding: Dr. Chen received grants (DOH96-DC-1010, DOH97-DC-1005) from the Center for Disease Control, Department of Health, and a grand (DOH99-TD-B-111-001) from the Department of Health, Taiwan. Implementation of a HHP reduces preventable HAIs and is cost effective. Studies suggest that there is a minimum RLU level that is attain-able following an effective hand wash. No, Is the Subject Area "Epidemiology" applicable to this article? The vertical dashed lines (- - -) separate the preintervention and intervention periods. 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