Objectives
Healthcare associated infection (HCAI) is a worldwide patient safety hazard. Compliance with hand hygiene guidelines has been demonstrated to be an effective method of reducing HCAI however it remains suboptimal and poorer amongst physicians than that of other categories of healthcare workers. The utilisation of evidence based audit and feedback to inform practice is recommended. The aim of this study is to determine the relation between a multimodal quality improvement intervention, incorporating observational hand hygiene auditing with individualised feedback to physicians, and the incidence of surgical site infection.
Method
The research design is a quasi-experimental retrospective before and after study design. The aim was to test the hypothesis that the multimodal intervention would lead to at least a 1% drop (to 0.44%) in SSIs.
The intervention was multimodal and incorporated; provision of alcohol based hand rub at every point of care; targeted hand hygiene educational sessions; targeted observational hand hygiene auditing (OHHA) of all consultant medical staff; piloting of OHHA of all orthopaedic consultants with written individual feedback regarding compliance and the introduction and implementation of a surgical site care bundle in October 2011.
The outcome measures include; the rate of surgical site infection in patients who received an orthopaedic implant surgery, total knee and total hip replacement during the study period and the proportion of observed hand hygiene compliance in the overall staff population and in consultant medical staff.
The χ2 statistic was used to analyse the findings comparing proportions from both pre and post intervention periods.
Results (provisional analysis)
Surgical site surveillance data regarding three thousand four hundred and ten patients were included in the before (n= 1,806) and after (n= 1,604) study. The risk of a patient developing an orthopaedic SSI decreased from 1.44%, (n=26), 95% CI (0.89 – 1.99) in the pre-intervention phase to 0.7%, (n= 12) 95% CI (0.29 - 1.11) in the post-intervention phase,2 (1, N = 3,410) = 3.68, p = 0.054.
There was a statistically significant increase in observed hand hygiene compliance overall to 91%, 95% CI (0.90 – 0.91), p < 0.01 and a 17% increase in compliance amongst consultant medical staff, p < 0.01.
Conclusion
While the reduction in SSI not statistically significant the data are trending towards infection rates being reduced by a half in the post intervention period. There are statistically significant increases in observed compliance with hand hygiene guidelines both for overall staff and consultant medical staff.