Infection control interventions in small rural hospitals with limited resources: results of a cluster-randomized feasibility trial

Antimicrobial Resistance and Infection Control

Matthew H Samore³  Gregory J Stoddard²  Stephan Harbarth¹  John M Boyce⁵  Grace Curry²  Katie Searle²  Kurt B Stevenson⁴ 

[1]Service de Prévention et Contrôle de l'Infection, Hôpitaux Universitaires de Genève, CH-1211 Geneva 14, Switzerland

[2]University of Utah School of Medicine, Salt Lake City, UT, USA

[3]Informatics, Decision Enhancement, and Analytic Science (IDEAS) Center, VA Salt Lake City Health Care System, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA

[4]The Ohio State University Medical Center, N-1122 Doan Hall 410 West 10th Avenue, Columbus, OH 43210, USA

[5]Yale-New Haven Hospital, New Haven, CT, USA

关键词: MRSA;    Clinical trial;    Transmission;    United States;    Epidemiology;    Hand hygiene;   

Others  :  790554
DOI  :  10.1186/2047-2994-3-10

 received in 2013-03-19, accepted in 2013-10-25,  发布年份 2014

【 摘 要 】

Background

There are few reports on the feasibility of conducting successful infection control (IC) interventions in rural community hospitals.

Methods

Ten small rural community hospitals in Idaho and Utah were recruited to participate in a cluster-randomized trial of multidimensional IC interventions to determine their feasibility in the setting of limited resources. Five hospitals were randomized to develop individualized campaigns to promote HH, isolation compliance, and outbreak control. Five hospitals were randomized to continue with current IC practices. Regular blinded observations of hand hygiene (HH) compliance were conducted in all hospitals as the primary outcome measure. Additionally, periodic prevalence studies of patient colonization with resistant pathogens were performed. The 5-months intervention time period was compared to a 4-months baseline period, using a multi-level logistic regression model.

Results

The intervention hospitals implemented a variety of strategies. The estimated average absolute change in “complete HH compliance” in intervention hospitals was 20.1% (range, 7.8% to 35.5%) compared to −3.1% (range −6.3% to 5.9%) in control hospitals (p = 0.001). There was an estimated average absolute change in “any HH compliance” of 28.4% (range 17.8% to 38.2%) in intervention hospitals compared to 0.7% (range −16.7 to 20.7%) in control hospitals (p = 0.010). Active surveillance culturing demonstrated an overall prevalence of MRSA carriage of 9.7%.

Conclusions

A replicable intervention significantly improved hand hygiene as a primary outcome measure despite barriers of geographic distance and lack of experience with study protocols. Active surveillance culturing identified unsuspected reservoirs of MRSA colonization and further promoted IC activity.

【 授权许可】

   
2014 Stevenson et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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