Impact of a standardized hand hygiene
program on the incidence of nosocomial
infection in very low birth weight infants
Maria Grazia Capretti, MD,a Fabrizio Sandri, MD,a Elisabetta Tridapalli, MD,a Silvia Galletti, MD,a Elisabetta Petracci, MD,b and Giacomo Faldella, PhDa
Background: This study examined the effects of a standardized hand hygiene program on the rate of nosocomial infection (NI) in very low birth weight (VLBW) infants (birth weight , 1500 g) admitted to our neonatal intensive care unit (NICU). Methods: We compared the rate of NI in VLBW infants in 2 separate periods. In the first period, staff were encouraged to perform handwashing using a plain fluid detergent (0.5% triclosan). In the second period, a standardized hand hygiene program was implemented using antimicrobial soap (4% chlorhexidine gluconate) and alcohol-based hand rubs. Results: NI after 72 hours of life was detected in 16 of the 85 VLBW infants in the first period and in 5 of the 80 VLBW infants in the second period. The rate of central venous catheter colonization was significantly lower in the second period (5.8%) than in the first period (16.6%).
Conclusion: In our NICU, the incidence of NI in VLBW infants was significantly reduced after the introduction of a standardized handwashing protocol. In our experience, a proper hand hygiene program can save approximately 10 NI episodes/year, at a cost of $10,000 per episode. Therefore, improving hand hygiene practice is a cost-effective program in the NICU. (Am J Infect Control 2008;36:430-5.)
Nosocomial infection (NI) remains a major problem
in neonatal intensive care units (NICUs), associated
with prolonged morbidity, high mortality, and significant hospital costs.1,2 This complication is inversely related to gestational age (GA) and often involves very
low birth weight (VLBW) infants (birth weight [BW] ,
1500 g); in fact, the average reported rate of NI is
20% in VLBW infants, compared with 0.1% in term
Infection control programs should implement
simple, low-cost procedures, such as hand hygiene.5
Compliance with this recommendation has always
presented problems, however. The use of waterless
alcohol gels can improve the hand hygiene of health
care workers, because these gels are less damaging to
the skin and they efficiently and effectively remove
transient flora from the hands.6 The present study evaluated the effects of a standardized hand hygiene program in health care workers, including the use of
antimicrobial soap (containing 4% chlorhexidine
From the Department of Preventive Pediatrics and Neonatologya and Institute of Cardiology,b St Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy. Address correspondence to Maria Grazia Capretti, MD, Istituto Clinico di Pediatria Preventiva e Neonatologia, Via Massarenti, 11, 40138 Bologna, Italy. E-mail: firstname.lastname@example.org.
Copyright ª 2008 by the Association for Professionals in Infection Control and Epidemiology, Inc.
gluconate) and alcohol-based hand rubs (containing
62% denatured ethyl alcohol), on the rate of NI in
The NICU of St Orsola-Malpighi General Hospital is a
tertiary referral center for newborns in Italy’s EmiliaRomagna region. At the time of the present study, this NICU had facilities for 22 inpatients: 8 cots for
intensive care and 14 cots for intermediate care, covering about 3800 deliveries per year. The sink/bed ratio was 1:1 in the intensive care area and 1:2 to 3 in the intermediate care area. The nurse/bed ratio was 1:2 to 4 in the intensive care area and 1: 4 to 6 in the intermediate care area. All of the newborns with a BW , 1500 g admitted
between August 1, 2003 and May 31, 2006 were included in this study. We did not evaluate infants with BW $ 1500 g, because they were at a lower risk for
NI.4,7 The exclusion criterion was death...
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