EVIDENCE BASED PRACTICE

Evidence Based Practice



Evidence Based Practice

Background

Hand cleaning is thought to be the lone most important intervention stopping the transmission of nosocomial infections. Few studies in intensive care units however, and none in the neonatal intensive care unit (BGMC) setting have addressed the effects of a hand washing intervention on the outcomes of compliance and positive blood and cerebrospinal fluid (CSF) cultures rates. The reasons of this study were two-fold. We tried to work out whether hand cleaning compliance could be advanced by an intensive informative and behavioral intervention.

Methods

Study Population

All patients nurtured for in the Lucile Packard Children's Hospital intensive care nursery between 1/1/98 and 11/30/99 were encompassed in the study. The Broward General Medical Center is a large academic level III unit supporting a busy high-risk obstetrics service (Voss, 2008). All newborns not classified as a "well baby" are initially admitted to the BGMC for evaluation and therapy.

Study Protocol

This study used a quasi-experimental conceive with chronicled controls. Patient data were assembled for the command time frame (1/1/98 through 5/31/99) and the intervention time border (6/1/99 through 11/30/99). Blood and CSF culture rates were assessed before and after an evidence-based hand cleaning principle and compliance program was introduced. Pulmonary, eye, and skin infections as well as viral infections were not included due to a lack of consistent laboratory evaluations for these in our BGMC. Patient care provider adherence to hand cleaning methods was prospectively considered before and after the June 1, 1999 introduction of this intervention.

Data Collection

Positive blood and CSF cultures from the BGMC were identified for each calendar month pre- and post intervention from routine reports generated from the hospital laboratory. Cultures were prospectively classified by the Infection command group into transplacental and nosocomial classes and into "true-positive" and "false-positive" classes founded on criteria established by the CDC.8 Rates of positive cultures were very resolute by splitting up the number of diseases by the number of persevering days for each month. Surface cultures of infants and caregivers were not presented because demonstration of an effect on superficial colonization would have no clear significances considering patient outcomes or management. Hand cleaning compliance was very resolute through direct fact of the study topics by employees' doctors before the intervention and on three separate events after (2, 3, and 6 months) the intervention was introduced.

Results

Patient Characteristics

Total of 2009 persevering (16,168 persevering days) comprised the "control" group and 676 patients (5779 patient days) the "intervention" group. No difference existed between the two groups for birth weight, gestational age, sex, ETT rates, and TPN rates, length of stay, central line days, or census rates except for more patients with “unknown /other" ethnicity in the intervention group.

Compliance Observations

Forty-six wellbeing care providers from seven kinds of care providers were assessed for between-patient hand washing compliance before the intervention. Thirty-two of these 46 individuals (70.0%) at baseline were compliant. The subgroup of house staff/neonatal nurse practitioners, surgeons, and X-ray technicians had a combined baseline between-patient compliance of ...