Objective:Hand hygiene adherence has been associated with reductions in nosocomial infection. We assessed the effect of improvements in electronically measured hand hygiene adherence on the incidence of hospital-acquired infections.Methods:This quasi-experimental study was conducted in a 555-bed urban safety-net level I trauma center. The preintervention period was January 2015 through June 2016. Baseline electronic hand hygiene data collection took place from April through June 2016. The intervention period was July 2016 through December 2017. An electronic hand hygiene system was installed in 4 locations in our hospital. Performance improvement strategies were implemented that included education, troubleshooting, data dissemination, and feedback. Adherence rates were tracked over time. Rates of hospital-acquired infections were evaluated in the intervention units and in control units selected for comparison. The intervention period was subdivided into the initial and subsequent 9-month periods and were compared to the baseline period.Results:Electronically measured hand hygiene rates improved significantly from baseline to intervention, from 47% 77% adherence. Rates >70% continued to be measured 18 months after the intervention. Interrupted time series analysis indicated a significant effect of hand hygiene on healthcare facility-onset Clostridioides difficile infection rates during the first 9 months of the intervention. This trend continued during the final 9 months of the intervention but was nonsignificant. No effects were observed for other hospital-acquired infection rates.Conclusions:Implementation of electronic hand hygiene monitoring and performance improvement interventions resulted in reductions in hospital-onset Clostridioides difficile infection rates.

中文翻译：

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自动手部卫生监测系统与绩效改进干预相结合对医院获得性感染的影响

目的：手卫生依从性与减少医院感染有关。我们评估了改善电子测量手部卫生依从性对医院获得性感染发生率的影响。方法：这项准实验研究在一个拥有 555 张床位的城市安全网 I 级创伤中心进行。干预前时间为 2015 年 1 月至 2016 年 6 月。基线电子手卫生数据收集时间为 2016 年 4 月至 6 月。干预期为 2016 年 7 月至 2017 年 12 月。我院 4 个地点安装了电子手卫生系统。实施了绩效改进策略，包括教育、故障排除、数据传播和反馈。随着时间的推移跟踪依从率。在选择进行比较的干预单位和控制单位中评估了医院获得性感染的发生率。干预期细分为初始期和随后的 9 个月期，并与基线期进行比较。结果：从基线到干预，电子测量的手部卫生率显着提高，从 47% 提高到 77%。干预后 18 个月继续测量 >70% 的比率。中断的时间序列分析表明手卫生对医疗机构的发病有显着影响 从基线到干预，电子测量的手部卫生率显着提高，从 47% 提高到 77%。干预后 18 个月继续测量 >70% 的比率。中断的时间序列分析表明手卫生对医疗机构的发病有显着影响 从基线到干预，电子测量的手部卫生率显着提高，从 47% 提高到 77%。干预后 18 个月继续测量 >70% 的比率。中断的时间序列分析表明手卫生对医疗机构的发病有显着影响艰难梭菌干预前 9 个月的感染率。这一趋势在干预的最后 9 个月持续，但并不显着。没有观察到其他医院获得性感染率的影响。结论：实施电子手部卫生监测和绩效改进干预措施导致住院发病率降低艰难梭菌感染率。