Effect of antiseptic handwashing vs alcohol sanitizer on health care-associated infections in neonatal intensive care units

Elaine L. Larson, Jeannie Cimiotti, Janet Haas, Michael K. Parides, Mirjana Nesin, Phyllis Della-Latta, Lisa Saiman

Research output: Contribution to journalArticle

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Abstract

Background: The Centers for Disease Control and Prevention, Atlanta, Ga, recommend use of waterless alcohol hand products in lieu of traditional handwashing for patient care, but there are few data demonstrating the impact of this recommendation on health care-associated infections. Objective: To compare the effect of 2 hand hygiene regimens on infection rates and skin condition and microbial counts of nurses' hands in neonatal intensive care units. Design, Setting, and Participants: Clinical trial using a crossover design in 2 neonatal intensive care units in Manhattan, NY, from March 1, 2001, to January 31, 2003, including 2932 neonatal hospital admissions (51760 patient days) and 119 nurse participants. Intervention: Two hand hygiene products were tested: a traditional antiseptic handwash and an alcohol hand sanitizer. Each product was used for 11 consecutive months in each neonatal intensive care unit in random order. Results: After adjusting for study site, birth weight, surgery, and follow-up time, there were no significant differences in neonatal infections between the 2 products; odds ratios for alcohol compared with handwashing were 0.98 (95% confidence interval [CI], 0.77-1.25) for any infection, 0.99 (95% CI, 0.77-1.33) for bloodstream infections, 1.61 (95% CI, 0.57-5.54) for pneumonia, 1.73 (95% CI, 0.94-3.37) for skin and soft tissue infections, and 1.26 (95% CI, 0.42-3.76) for central nervous system infections. The skin condition of participating nurses was significantly improved during the alcohol phase (P = .02 and P = .049 for observer and self-assessments, respectively), but there were no significant differences in mean microbial counts on nurses' hands (3.21 and 3.11 log 10 colony-forming units for handwashing and alcohol, respectively; P = .38). Conclusions: Infection rates and microbial counts on nurses' hands were equivalent during handwashing and alcohol phases, and nurses' skin condition was improved using alcohol. However, assessing the impact on infection rates of a single intervention is challenging because of multiple contributory factors such as patient risk, unit design, and staff behavior. Other practices such as frequency and quality of hand hygiene are likely to be as important as product in reducing risk of cross-transmission.

Original languageEnglish (US)
Pages (from-to)377-383
Number of pages7
JournalArchives of Pediatrics and Adolescent Medicine
Volume159
Issue number4
DOIs
StatePublished - Apr 1 2005
Externally publishedYes

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Hand Disinfection
Local Anti-Infective Agents
Neonatal Intensive Care Units
Cross Infection
Alcohols
Hand Hygiene
Nurses
Confidence Intervals
Hand
Infection
Skin
Hand Sanitizers
Central Nervous System Infections
Soft Tissue Infections
Patient Admission
Centers for Disease Control and Prevention (U.S.)
Birth Weight
Cross-Over Studies
Pneumonia
Patient Care

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Effect of antiseptic handwashing vs alcohol sanitizer on health care-associated infections in neonatal intensive care units. / Larson, Elaine L.; Cimiotti, Jeannie; Haas, Janet; Parides, Michael K.; Nesin, Mirjana; Della-Latta, Phyllis; Saiman, Lisa.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 159, No. 4, 01.04.2005, p. 377-383.

Research output: Contribution to journalArticle

Larson, Elaine L. ; Cimiotti, Jeannie ; Haas, Janet ; Parides, Michael K. ; Nesin, Mirjana ; Della-Latta, Phyllis ; Saiman, Lisa. / Effect of antiseptic handwashing vs alcohol sanitizer on health care-associated infections in neonatal intensive care units. In: Archives of Pediatrics and Adolescent Medicine. 2005 ; Vol. 159, No. 4. pp. 377-383.
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abstract = "Background: The Centers for Disease Control and Prevention, Atlanta, Ga, recommend use of waterless alcohol hand products in lieu of traditional handwashing for patient care, but there are few data demonstrating the impact of this recommendation on health care-associated infections. Objective: To compare the effect of 2 hand hygiene regimens on infection rates and skin condition and microbial counts of nurses' hands in neonatal intensive care units. Design, Setting, and Participants: Clinical trial using a crossover design in 2 neonatal intensive care units in Manhattan, NY, from March 1, 2001, to January 31, 2003, including 2932 neonatal hospital admissions (51760 patient days) and 119 nurse participants. Intervention: Two hand hygiene products were tested: a traditional antiseptic handwash and an alcohol hand sanitizer. Each product was used for 11 consecutive months in each neonatal intensive care unit in random order. Results: After adjusting for study site, birth weight, surgery, and follow-up time, there were no significant differences in neonatal infections between the 2 products; odds ratios for alcohol compared with handwashing were 0.98 (95{\%} confidence interval [CI], 0.77-1.25) for any infection, 0.99 (95{\%} CI, 0.77-1.33) for bloodstream infections, 1.61 (95{\%} CI, 0.57-5.54) for pneumonia, 1.73 (95{\%} CI, 0.94-3.37) for skin and soft tissue infections, and 1.26 (95{\%} CI, 0.42-3.76) for central nervous system infections. The skin condition of participating nurses was significantly improved during the alcohol phase (P = .02 and P = .049 for observer and self-assessments, respectively), but there were no significant differences in mean microbial counts on nurses' hands (3.21 and 3.11 log 10 colony-forming units for handwashing and alcohol, respectively; P = .38). Conclusions: Infection rates and microbial counts on nurses' hands were equivalent during handwashing and alcohol phases, and nurses' skin condition was improved using alcohol. However, assessing the impact on infection rates of a single intervention is challenging because of multiple contributory factors such as patient risk, unit design, and staff behavior. Other practices such as frequency and quality of hand hygiene are likely to be as important as product in reducing risk of cross-transmission.",
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AU - Parides, Michael K.

AU - Nesin, Mirjana

AU - Della-Latta, Phyllis

AU - Saiman, Lisa

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N2 - Background: The Centers for Disease Control and Prevention, Atlanta, Ga, recommend use of waterless alcohol hand products in lieu of traditional handwashing for patient care, but there are few data demonstrating the impact of this recommendation on health care-associated infections. Objective: To compare the effect of 2 hand hygiene regimens on infection rates and skin condition and microbial counts of nurses' hands in neonatal intensive care units. Design, Setting, and Participants: Clinical trial using a crossover design in 2 neonatal intensive care units in Manhattan, NY, from March 1, 2001, to January 31, 2003, including 2932 neonatal hospital admissions (51760 patient days) and 119 nurse participants. Intervention: Two hand hygiene products were tested: a traditional antiseptic handwash and an alcohol hand sanitizer. Each product was used for 11 consecutive months in each neonatal intensive care unit in random order. Results: After adjusting for study site, birth weight, surgery, and follow-up time, there were no significant differences in neonatal infections between the 2 products; odds ratios for alcohol compared with handwashing were 0.98 (95% confidence interval [CI], 0.77-1.25) for any infection, 0.99 (95% CI, 0.77-1.33) for bloodstream infections, 1.61 (95% CI, 0.57-5.54) for pneumonia, 1.73 (95% CI, 0.94-3.37) for skin and soft tissue infections, and 1.26 (95% CI, 0.42-3.76) for central nervous system infections. The skin condition of participating nurses was significantly improved during the alcohol phase (P = .02 and P = .049 for observer and self-assessments, respectively), but there were no significant differences in mean microbial counts on nurses' hands (3.21 and 3.11 log 10 colony-forming units for handwashing and alcohol, respectively; P = .38). Conclusions: Infection rates and microbial counts on nurses' hands were equivalent during handwashing and alcohol phases, and nurses' skin condition was improved using alcohol. However, assessing the impact on infection rates of a single intervention is challenging because of multiple contributory factors such as patient risk, unit design, and staff behavior. Other practices such as frequency and quality of hand hygiene are likely to be as important as product in reducing risk of cross-transmission.

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