The Effect of Hand Washing Improving Programs on the Adherence of Hand Washing and Nosocomial Infections in a Surgical Intensive Care Unit

Jeong, Jae Sim; Choe, Mynung Ae

Abstract

BACKGROUND: This study was designed to examine the effect of a hand washing improving program on the adherence of hand washing of health care workers in a surgical intensive care unit (SICU) and to test the hypothesis that improved hand washing adherence would help reduce nosocomial infection rates and MRSA colonization rates.
METHODS
The study was conducted from March to December, 2001, at the SICU of a 2,200-bed university-affiliated hospital in Seoul. The hand washing improving program, developed by the investigator, a multi-fauceted program, was provided beginning August until October for medical personnel at the SICU. Hand washing adherence was monitored through direct observations for one hour everyday from mid-June through October. Nosocomial infections were monitored for the to month period from March to December. MRSA colonization rates were monitored during the four-month period from July to October by taking nares cultures from the patients who stayed at the SICU for three days or longer.
RESULTS
Hand washing adherence rates increased from 33.5% at the pre-intervention to 58.4% at the post intervention period (p<.001). Nosocomial infection rates were 11.0 at the pre-intervention period and 11.6 per 1,000 patient-days at the post intervention period. When surgical site infections were excluded, the rates tended to decrease from 6.8 at the pre-intervention period to 6.0 per 1,000 patient-days at the nest-intervention period. MRSA colonization rates were 14.3% and 13.0% at the pre- and post-intervention period, respectively. But the differences were not statistically significant. The mean days from SICU admission to MRSA colonization were 2.9 in pre-intervention period and 6.5 at the post-intervention period. The differences between the pre- and post-intervention period were statistically significant (p=.001).
CONCLUSION
The hand washing improving program was found to be effective in increasing the hand washing adherence of the healthcare workers at the SICU. In spite of the improved hand washing practices, however, nosocomial infection rates were found not changed significantly, although MRSA colonization by the patients, which is considered as a high risk factor for nosocomial infections, was delayed significantly. To demonstrate the causal relationship between hand washing and nosocomial infections, further studies are warranted with a larger number of patients during an extended study period.