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Infection rates in care homes – effect of alcohol based hand products

Infection rates in care homes – effect of alcohol based hand products. Carol Roberts Health Protection Nurse North Wales October 2008. Infection rate and ABHPs in care home settings.

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Infection rates in care homes – effect of alcohol based hand products

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  1. Infection rates in care homes – effect of alcohol based hand products Carol Roberts Health Protection Nurse North Wales October 2008

  2. Infection rate and ABHPs in care home settings ABHPs are advocated as a method of hand decontamination1,2 but have not been assessed in care home environments 20,965 adult care home services in Eng +Wales 1. Pratt RJ, Pellowe CM, Loveday HP, Robinson N, Smith GW, and the epic guidelines development team: Barrett S, et al. The epic Project: Developing national evidence-based guidelines for preventing healthcare associated infections. J Hosp Infect 2001; 47: S1-S82. doi:10.1053/jhin.2000.0886. 2. Pellowe CM, Pratt RJ, Harper P, Loveday HP, Robinson N, Jones SRLJ, et al. Evidence-based guidelines for preventing healthcare-associated infections in primary and community care in England. Br J Infect Control 2003;4:1-119.

  3. Infection rate and ABHPs in care home settings Purpose: To assess the impact on nursing home infection rates where care staff use personal alcohol based hand foam dispensers with and without instruction on appropriate application.

  4. Infection rate and ABHPs in care home settings Sept 2006 – Feb 2007 Sample drawn from all nursing homes in N Wales (n=97) Exclusion criteria: Homes of <10 beds Homes with more residential than nursing beds Homes using personal hand held ABHPs extensively or > 5 free standing units

  5. Infection rate and ABHPs in care home settings 19 homes responded 15 entered into the study Three groups A B and C each of 5 homes: x1 home (11-26 beds) x3 homes (27-43 bed) x1 home (44 beds or more)

  6. Infection rate and ABHPs in care home settings

  7. Infection rate and ABHPs in care home settings Preparation (all homes) • Lead person Training • Daily record form • Individual record form • Guidance notes

  8. Infection rate and ABHPs in care home settings Post intervention • Basic information about product (Group B and C) • Instruction from Rep of HH company (Group C) Product Hand held Cutan Foam Hand Sanitiser

  9. Study Results – the sample • Distribution of beds after allocation Gp A 32.6% (177 beds, N(127),EMIN(23),R(27)) Gp B 33.5% (182 beds, N(130, EMIN(44), R(8)) Gp C 33.9% (184 beds, N(118), EMI(53), R(13))

  10. Study Results – total study period 449 Infections recorded total study period Part of an outbreak n=35 N/K if part of an outbreak n=18 Total records analysed n=396

  11. Study Results – infections recorded

  12. Study Results – infections recorded

  13. Phase 1 (1-9 weeks) – All Groups Average rate of infection 6.04/1,000 bed days (range 5.04 -6.99) Four main categories of infection: Respiratory (2.52) Urinary (1.87) Skin and Soft Tissue (1.57) Gastrointestinal (0.41)

  14. Phase 1 (1-9 weeks) – All Groups Home size and rate of infection Small 4.64 (range 1.95 -6.51) Medium 5.9 (range 0.49 -10.76) Large 7.79 (5.79 -9.39) • Rate of infection as home size increases Not statistically significant

  15. Rate of resp infection and home size Phase 1 (1-9 weeks) – All Groups

  16. Phase 1 (1-9 weeks) – All Groups Statistical significance between type of infection and category of resident(P=0.017) and gender(P=0.005); but not for age(P=0.346) Note: • Resp infection and EMIN (male) • Resp infection and male gender • UTI and female gender

  17. Infection rates Phase 1 and 2 Phase 2 (11 -20 weeks)

  18. Group B Phase 2 (11 -20 weeks) Infection rates fell in all homes except one (0.49 up to 0.51) Statistical significance NOT demonstrated between Phase 1 and 2 for Gp B (P=0.097) BUT Statistical significance WAS demonstrated between Gp A and B in Phase 2 (P=0.035)

  19. Group C Phase 2 (11 -20 weeks) Infection rates rose in all homes in Phase 2 Statistical significance NOT demonstrated between Phase 1 and 2 for Gp C (P=0.072) AND Statistical significance was NOT demonstrated between Gp A and C in Phase 2 (P=0.765)

  20. Limitations of the study • Compliance with hand hygiene not monitored during study • Five homes using <5 free standing units of ABHP • Sample size may have limited results • N=13 homes had an ICLP on site

  21. Outcome • Infection rates fell in GpB after intervention • Infection rates rose in Gp C after intervention Possible explanations for the outcome:

  22. Influencing factors (a selection) • Training (content/provider/enforcement) • Leadership on site • Communication between staff • Infection rate in the home • Correct use of product

  23. Use of ABHPs in care home settings -Considerations • Advice from organisations such as NPSA required to “fit” the healthcare setting (CYHC) • If ABHPs are used in care home settings should be a risk assessed intervention • Infection rate in care home • Cost effectiveness of intervention

  24. Acknowledgements • The North Wales nursing homes who participated in the study • Members of the North Wales Health Protection Team for their support and assistance during the study • Deb Limited for providing the supply of ABHP throughout the study • NEWI for academic support

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