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Randomized Controlled Trial
. 2021 May 20;10(1):80.
doi: 10.1186/s13756-021-00946-3.

The effect of a hand hygiene intervention on infections in residents of nursing homes: a cluster randomized controlled trial

G R Teesing  1   2 , J H Richardus  3   4 , D Nieboer  3 , M Petrignani  5 , V Erasmus  3 , A Verduijn-Leenman  6 , J M G A Schols  7 , M P G Koopmans  8 , M C Vos  9 , H A C M Voeten  3   4
Affiliations
Randomized Controlled Trial

The effect of a hand hygiene intervention on infections in residents of nursing homes: a cluster randomized controlled trial

G R Teesing et al. Antimicrob Resist Infect Control. .

Abstract

Background: The primary goal of hand hygiene is to reduce infectious disease rates. We examined if a nursing home's participation in a hand hygiene intervention resulted in residents having fewer healthcare associated infections (HAIs) when compared to nursing homes without the hand hygiene intervention.

Methods: This study is a part of a cluster randomized controlled trial (RCT) in 33 nursing homes to improve hand hygiene (HANDSOME). The incidence of five illnesses was followed over 13 months: gastroenteritis, influenza-like illness, pneumonia, urinary tract infections and infections from methicillin-resistant Staphylococcus aureus (MRSA). Incidence rates per study arm were reported for baseline (October-December 2016) and two follow-up periods (January-April 2017, May-October 2017). HAI rates were compared in a Poisson multilevel analysis, correcting for baseline differences (the baseline infection incidence and the size of the nursing home), clustering of observations within nursing homes, and period in the study.

Results: There was statistically significantly more gastroenteritis (p < 0.001) and statistically significantly less influenza-like illness (p < 0.01) in the intervention arm when compared to the control arm. There were no statistically significant differences or pneumonia, urinary tract infections, and MRSA infections in the intervention arm when compared to the control arm. In a sensitivity analysis, gastroenteritis was no longer statistically significantly higher in the intervention arm (p = 0.92).

Conclusions: As in comparable studies, we could not conclusively demonstrate the effectiveness of an HH intervention in reducing HAIs among residents of nursing homes, despite the use of clearly defined outcome measures, a standardized reporting instrument, and directly observed HH in a multicenter cluster RCT. Trial registration Netherlands Trial Register, trial NL6049 (NTR6188). Registered October 25, 2016, https://www.trialregister.nl/trial/6049 .

Keywords: Hand hygiene; Healthcare associated infections; Nursing homes.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Infection incidence per 1000 resident days in nursing homes by month1 (n = 640,486 resident days). 1For comparison, incidence registered by the Dutch surveillance network for infectious diseases in nursing homes (SNIV) is also depicted (grey dotted line). The dashed vertical lines indicate the three study periods (Baseline, Follow-up 1, and Follow-up 2). 2SNIV did not provide data for MRSA
Fig. 2
Fig. 2
Infection incidence per 1000 resident days in nursing homes by study period1 (n = 640,486 resident days). Baseline: October 2016–December 2016, Follow-up 1: January 2017–April 2017, Follow-up 2: May 2017–October 2017. 1For comparison, incidence registered by the Dutch surveillance network for infectious diseases in nursing homes (SNIV) is also depicted (grey dotted line). FU: Follow-up
See this image and copyright information in PMC

References

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