Major article
Dissemination of the CDC's Hand Hygiene Guideline and impact on infection rates

https://doi.org/10.1016/j.ajic.2006.10.006Get rights and content

Background

The diffusion of national evidence-based practice guidelines and their impact on patient outcomes often go unmeasured.

Methods

Our objectives were to (1) evaluate implementation and compliance with clinical practices recommended in the new Centers for Disease Control and Prevention (CDC) Hand Hygiene Guideline, (2) compare rates of health care-associated infections (HAI) before and after implementation of the Guideline recommendations, and (3) examine the patterns and correlates of changes in rates of HAI. We used pre- and post-Guideline implementation site visits and surveys in the setting of 40 US hospitals—members of the National Nosocomial Infections Surveillance System—and measured HAI rates 1 year before and after publication of the CDC Guideline and used direct observation of hand hygiene compliance and Guideline implementation scores.

Results

All study hospitals had changed their policies and procedures and provided products in compliance with Guideline recommendations; 89.8% of 1359 staff members surveyed anonymously reported that they were familiar with the Guideline. However, in 44.2% of the hospitals (19/40), there was no evidence of a multidisciplinary program to improve compliance. Hand hygiene rates remained low (mean, 56.6%). Rates of central line-associated bloodstream infections were significantly lower in hospitals with higher rates of hand hygiene (P < .001). No impact of Guideline implementation or hand hygiene compliance on other HAI rates was identified. Other factors occurring over time could affect rates of HAI. Observed hand hygiene compliance rates were likely to overestimate rates in actual practice. The study may have been of too short duration to detect the impact of a practice guideline.

Conclusion

Wide dissemination of this Guideline was not sufficient to change practice. Only some hospitals had initiated multidisciplinary programs; practice change is unlikely without such multidisciplinary efforts and explicit administrative support.

Section snippets

Sample and setting

The sample for this study was obtained from among hospitals that were members of The National Nosocomial Infections Surveillance (NNIS) System, a national reporting network of >300 acute care hospitals representing nearly every state and coordinated by the CDC. The NNIS is the largest and most comprehensive reporting system for HAI in the world9 and has recently been incorporated into the National Healthcare Safety Network (http://www.cdc.gov/ncidod/hip/NNIS/members/members.htm, accessed July

Characteristics of the study hospitals

Among the 40 study hospitals, 75% were in the eastern region of the United States, and 60% were affiliated with an academic health center. The mean number of active beds of participating hospitals was 417, with 10% having 100 to 199 beds, 40% having 200 to 399 beds, and 50% having ≥400 beds. There were 71 ICUs in the study hospitals, including 30 medical-surgical (42%), 18 medical (25%), 13 surgical (18%), and 10 pediatrics (14%). Most infection control directors (85%) had ≥9 years of

Implementation and compliance with Guideline recommendations

The Hand Hygiene Guideline was widely disseminated in all 40 study hospitals, the majority of staff members were familiar with it, and alcohol hand hygiene products were readily available. Implementation scores were high, with a median of 10.5 out of a total possible of 12, but these scores primarily measured “structural” and “process” factors such as the presence of appropriate products on clinical units and the conduct of staff educational programs. Fewer than half of hospitals had

Conclusion

Although the CDC Hand Hygiene Guideline was widely disseminated and hospitals responded by changing written policies and procedures as well as providing recommended products, this was insufficient to effect a change in clinician practice; compliance with hand hygiene recommendations remained low. Many hospitals had no multidisciplinary program or staff feedback mechanisms to improve compliance despite the Guideline recommendation and the fact that such programs have proven effective in other

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    Supported by The National Institutes of Health, National Institute of Nursing Research, Impact of Hand Hygiene Guideline on Infections and Costs, 1 RO1 NR008242.

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