# Presentation: 236104

## Infection:  Don’t Pass It On

- These slides contain interesting facts about hand hygiene you can incorporate into presentation and training.

## Which hand hygiene method is best at killing bacteria, and least drying to your skin? 

- Plain soap and water
- Antimicrobial soap and water
- Alcohol-based hand-rub

**Notes:**
Answer: C

## CDC recommends the use of alcohol-based hand-rubs for hand decontamination:

- 	A. In all situations
- 	B. In a few situations
- 	C. In most situations

**Notes:**
Answer: C

Alcohol works better than soap to kill bacteria and other microorganisms. The cases when antimicrobial soap should be used rather than alcohol-based hand rubs are: 
	1) when hands are visibly soiled or 
	    contaminated with bodily fluids, and 
	2) before eating and after using the 
              restroom.  
Alcohol hand rubs or antimicrobial soap can be used in almost all other situations: e.g., before and after patient contact or before donning and after removing gloves, etc.

- Hospitals must make available hand lotion and pocket-sized alcohol-based hand-rubs to their staff. (True or False)

**Notes:**
Answer: True

 To prevent dermatitis, hospitals must make hand   lotion and pocket-sized alcohol-based hand rubs   available to their staff. There is no requirement that staff have to carry or use these products.
 Hand lotion that is designed for use in a healthcare  setting should be provided.
 Some ordinary hand lotions can reduce the  effectiveness of antimicrobial agents or damage  gloves. 
 Pocket-sized hand rubs have been shown to  increase hand decontamination and CDC  recommends that hospitals supply them to staff –   JCAHO has made this recommendation a  requirement.

**Can Artificial Nails****Harm the Patient?**

## Cost of Infections

- The average cost of a hospital-acquired infection is from $4,800 to $18,700.
- The average cost to purchase pocket-sized hand gel (10,000 containers) is $5,900.

**Notes:**
$4,800 comes from a study of orthopedic surgery patients and takes into account all the infections they might get from urinary tract to surgical site.  Abstract is below.

$18,706 counts just surgical site infections as described in the Patient Safety Indicators data.  This is the difference between $25,291 and $6,585, the cost of hospital stays with and without infection quoted in an unpublished paper by Amy Rosen of the Bedford, VA (Center for Health Quality, Outcomes and Economic research).  I also saw this data on a poster at last summer’s VHA Senior Leadership Conference.

I found another number in a study published in JAMA: $38,565 for “Attributable Charge” for “ Selected Infections due to Medical Care”.  This study states in the abstract: “Infection due to medical care was associated with 9.58 extra days, 38 656 dollars in excess charges, and 4.31% attributable mortality.”  Full abstract below...  

The n will be smaller for the $38k since I bet it only counts really bad infections and misses easy to treat urinary tract infections associated with hospital stays.  Either way is bad: a large n with a smaller average cost, or a smaller n with a larger average cost.   You could say that the data shows that when you count all infections they cost in the neighborhood of $5k on overage, when you look at only the worst ones (from administrative data), it averages somewhere between $18k and $38k depending on who you believe and how they count.

1: Am J Infect Control. 2003 Apr;31(2):109-16.	
Use of alcohol hand sanitizer as an infection control strategy in an acute care facility.Hilburn J, Hammond BS, Fendler EJ, Groziak PA.Texas Society of Infection Control Practitioners, Houston, USA.BACKGROUND: Nosocomial infections are a major problem in health care facilities, resulting in extended durations of care, substantial morbidity and mortality, and excess costs. Since alcohol gel hand sanitizers combine high immediate antimicrobial efficacy with ease of use, this study was carried out to determine the effect of the use of an alcohol gel hand sanitizer by caregivers on infection types and rates in an acute care facility. Patients were educated about the study through a poster on the unit, and teachable patients were given portable bottles of the alcohol hand gel for bedside use, along with an educational brochure explaining how and why to practice good hand hygiene. METHODS: Infection rate and type data were collected in 1 unit of a 498-bed acute care facility for 16 months (February 2000 to May 2001). An alcohol gel hand sanitizer was provided and used by caregivers in the orthopedic surgical unit of the facility during this period. RESULTS: The primary infection types (more than 80%) found were urinary tract (UTI) and surgical site (SSI) infections. Infection types and rates for the unit during the period the alcohol hand sanitizer (intervention) was used were compared with the infection types and rates for the same unit when the alcohol hand sanitizer was not used (baseline); the results demonstrated a 36.1% decrease in infection rates for the 10-month period that the hand sanitizer was used. CONCLUSION: This study indicates that use of an alcohol gel hand sanitizer can decrease infection rates and provide an additional tool for an effective infection control program in acute care facilities.PMID: 12665745 [PubMed - indexed for MEDLINE] 

JAMA. 2003 Oct 8;290(14):1868-74.	
Comment in: 
JAMA. 2003 Oct 8;290(14):1917-9. 
JAMA. 2004 Jan 21;291(3):303-4; author reply 304-5. 
JAMA. 2004 Jan 21;291(3):304; author reply 304-5. 
JAMA. 2004 Jan 21;291(3):304; author reply 304-5. 
Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization.Zhan C, Miller MR.Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, Md 20850, USA. czhan@ahrq.govCONTEXT: Although medical injuries are recognized as a major hazard in the health care system, little is known about their impact. OBJECTIVE: To assess excess length of stay, charges, and deaths attributable to medical injuries during hospitalization. DESIGN, SETTING, AND PATIENTS: The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) were used to identify medical injuries in 7.45 million hospital discharge abstracts from 994 acute-care hospitals across 28 states in 2000 in the AHRQ Healthcare Cost and Utilization Project Nationwide Inpatient Sample database. MAIN OUTCOME MEASURES: Length of stay, charges, and mortality that were recorded in hospital discharge abstracts and were attributable to medical injuries according to 18 PSIs. RESULTS: Excess length of stay attributable to medical injuries ranged from 0 days for injury to a neonate to 10.89 days for postoperative sepsis, excess charges ranged from 0 dollar for obstetric trauma (without vaginal instrumentation) to 57 727 dollars for postoperative sepsis, and excess mortality ranged from 0% for obstetric trauma to 21.96% for postoperative sepsis (P<.001). Following postoperative sepsis, the second most serious event was postoperative wound dehiscence, with 9.42 extra days in the hospital, 40 323 dollars in excess charges, and 9.63% attributable mortality. Infection due to medical care was associated with 9.58 extra days, 38 656 dollars in excess charges, and 4.31% attributable mortality. CONCLUSION: Some injuries incurred during hospitalization pose a significant threat to patients and costs to society, but the impact of such injury is highly variable.

## CDC analysis of published studies established what percentage compliance with hand washing?

- 	A. About 25%
- 	B. About 40%
- 	C. About 60%
- 	D. About 75%

## Infection:  Don’t Pass It On

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