|Title||Effect of an evidence-based hand washing policy on hand washing rates and false-positive coagulase negative staphylococcus blood and cerebrospinal fluid culture rates in a level III NICU.|
|Publication Type||Journal Article|
|Year of Publication||2002|
|Authors||Sharek PJ, Benitz WE, Abel NJ, Freeburn MJane, Mayer ML, Bergman DA|
|Date Published||2002 Mar|
|Keywords||Adult, Case-Control Studies, Cerebrospinal Fluid, Chi-Square Distribution, Coagulase, Cohort Studies, Cross Infection, Evidence-Based Medicine, False Positive Reactions, Female, Hand Disinfection, Humans, Incidence, Infant, Newborn, Intensive Care Units, Neonatal, Male, Middle Aged, Policy Making, Probability, Reference Values, Risk Assessment, Risk Factors, Staphylococcal Infections, Staphylococcus aureus, Statistics, Nonparametric|
OBJECTIVE: To determine the effect of implementing an evidence-based hand washing policy on between-patient hand washing compliance and on blood and cerebrospinal fluid (CSF) culture rates in a level III neonatal intensive care unit (NICU).
METHODS: An evidence-based hand washing policy, supported by an intensive education program, was introduced in a regional NICU. A total of 2009 preintervention neonates (16,168 patient days) over 17 months were compared to 676 postintervention neonates (5779 patient days) over 6 months. Hand washing compliance and rates of blood and CSF cultures yielding coagulase negative staphylococci (CONS) were compared before and after intervention.
RESULTS: Compliance with appropriate between-patient hand washing improved (from 47.4% to 85.4%, p=0.001) after the hand washing policy was introduced. The rate of cultures positive for CONS declined from 6.1+/-2.3 to 3.2+/-1.6 per 1000 patient days (p=0.005). Most of this reduction was attributable to a reduction in false-positive cultures, from 4.2+/-2.4 to 1.9+/-1.8 per 1000 patient days (p=0.042), but there was a trend toward decreased true-positive cultures (from 2.1+/-1.2 to 1.2+/-1.0 per 1000 patient days, p=0.074) as well. Potential confounders and demographics factors were similar between the control and intervention subjects.
CONCLUSION: Implementation of an evidence-based hand washing policy resulted in a significant increase in hand washing compliance and a significant decrease in false-positive coagulase negative staphylococcal blood and CSF culture rates. Exploratory data analysis revealed a possible effect on true-positive coagulase negative staphylococcal blood and CSF culture rates, but these results need to be confirmed in future studies.
|Alternate Journal||J Perinatol|