Download Anaerobe Reference Unit Remit

Infection rates in care homes –
effect of alcohol based hand
products
Carol Roberts
Health Protection Nurse
North Wales
October 2008
Infection rate and ABHPs in care home
settings
ABHPs are advocated as a method of
hand decontamination1,2 but have not been
assessed in care home environments
20,965 adult care home services in Eng
+Wales
1. Pratt RJ, Pellowe CM, Loveday HP, Robinson N, Smith GW, and the epic guidelines development team: Barrett S, et al. The epic Project: Developing national evidence-based
guidelines for preventing healthcare associated infections. J Hosp Infect 2001; 47: S1-S82. doi:10.1053/jhin.2000.0886.
2. Pellowe CM, Pratt RJ, Harper P, Loveday HP, Robinson N, Jones SRLJ, et al. Evidence-based guidelines for preventing healthcare-associated infections in primary and
community care in England. Br J Infect Control 2003;4:1-119.
Infection rate and ABHPs in care home
settings
Purpose:
To assess the impact on nursing home
infection rates where care staff use
personal alcohol based hand foam
dispensers with and without instruction on
appropriate application.
Infection rate and ABHPs in care home
settings
Sept 2006 – Feb 2007
Sample drawn from all nursing homes in N Wales (n=97)
Exclusion criteria:
Homes of <10 beds
Homes with more residential than nursing beds
Homes using personal hand held ABHPs extensively or
> 5 free standing units
Infection rate and ABHPs in care home
settings
19 homes responded 15 entered into the
study
Three groups A B and C each of 5 homes:
x1 home (11-26 beds)
x3 homes (27-43 bed)
x1 home (44 beds or more)
Infection rate and ABHPs in care home
settings
Phase 1
(weeks 1-9)
Group A
Group B
Group C
No intervention
No intervention
No intervention
Intervention introduced
Intervention introduced
Intervention
- personal alcohol based
hand foam dispensers
(minimal guidance
provided)
Intervention
personal alcohol
based hand foam
dispensers
(guidance and
training provided)
Introduction
of intervention
(week 10)
Phase 2
(weeks 11-20)
No intervention
Infection rate and ABHPs in care home
settings
Preparation (all homes)
• Lead person
Training
• Daily record form
• Individual record form
• Guidance notes
Infection rate and ABHPs in care home
settings
Post intervention
• Basic information about product (Group B and
C)
• Instruction from Rep of HH company (Group C)
Product Hand held Cutan Foam Hand Sanitiser
Study Results – the sample
• Distribution of beds after allocation
Gp A 32.6% (177 beds, N(127),EMIN(23),R(27))
Gp B 33.5% (182 beds, N(130, EMIN(44), R(8))
Gp C 33.9% (184 beds, N(118), EMI(53), R(13))
Study Results – total study period
449 Infections recorded total study period
Part of an outbreak n=35
N/K if part of an outbreak n=18
Total records analysed n=396
Study Results – infections recorded
Graph 1 Distribution of residents by sex in each study group
120
Number of Residents
100
80
Male
60
Female
40
20
0
Group A (Control)
Group B (+ Product)
Research Group
Group C (+ Product/Training)
Study Results – infections recorded
Graph 2 Distribution of age in each study group
Number of Residents
70
60
0-50
50
51-60
61-70
40
71-80
30
81-90
20
91-100
10
100+
0
Group A (Control)
Group B (+Product)
Research Group
Group C (+Product/Training)
Phase 1 (1-9 weeks) – All
Groups
Average rate of infection
6.04/1,000 bed days
(range 5.04 -6.99)
Four main categories of infection:
Respiratory (2.52)
Urinary (1.87)
Skin and Soft Tissue (1.57)
Gastrointestinal (0.41)
Phase 1 (1-9 weeks) – All
Groups
Home size and rate of infection
Small 4.64 (range 1.95 -6.51)
Medium 5.9 (range 0.49 -10.76)
Large 7.79 (5.79 -9.39)
↑ Rate of infection as home size increases
Not statistically significant
Phase 1 (1-9 weeks) – All
Groups
↑ Rate of resp infection and home size
Size
Resp
UTI
Skin ST
Gastro
Small
1.88
1.89
0.87
0
Medium
2.22
1.88
1.69
0.13
Large
4.08
1.82
1.90
0
Phase 1 (1-9 weeks) – All
Groups
Statistical significance between type of
infection and category of
resident(P=0.017) and gender(P=0.005);
but not for age(P=0.346)
Note:
• Resp infection and EMIN (male)
• Resp infection and male gender
• UTI and female gender
Phase 2 (11 -20 weeks)
Infection rates Phase 1 and 2
Group
Phase 1
Phase 2
A
6.99
7.16
B
6.08
3.46
C
5.04
6.78
Group B Phase 2 (11 -20 weeks)
Infection rates fell in all homes except one
(0.49 up to 0.51)
Statistical significance NOT demonstrated
between Phase 1 and 2 for Gp B
(P=0.097)
BUT
Statistical significance WAS demonstrated
between Gp A and B in Phase 2 (P=0.035)
Group C Phase 2 (11 -20 weeks)
Infection rates rose in all homes in Phase 2
Statistical significance NOT demonstrated
between Phase 1 and 2 for Gp C (P=0.072)
AND
Statistical significance was NOT demonstrated
between Gp A and C in Phase 2 (P=0.765)
Limitations of the study
• Compliance with hand hygiene not
monitored during study
• Five homes using <5 free standing units of
ABHP
• Sample size may have limited results
• N=13 homes had an ICLP on site
Outcome
• Infection rates fell in GpB after
intervention
• Infection rates rose in Gp C after
intervention
Possible explanations for the
outcome:
Influencing factors (a selection)
•
•
•
•
•
Training (content/provider/enforcement)
Leadership on site
Communication between staff
Infection rate in the home
Correct use of product
Use of ABHPs in care home
settings -Considerations
• Advice from organisations such as NPSA
required to “fit” the healthcare setting (CYHC)
• If ABHPs are used in care home settings should
be a risk assessed intervention
- Infection rate in care home
- Cost effectiveness of intervention
Acknowledgements
• The North Wales nursing homes who
participated in the study
• Members of the North Wales Health
Protection Team for their support and
assistance during the study
• Deb Limited for providing the supply of
ABHP throughout the study
• NEWI for academic support