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Use of ‘rigorous’ hand hygiene practice urged in care homes

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Rigorous hand hygiene-intervention practices can lower mortality, antibiotic prescription rates in nursing homes, according to findings from a French study.

The researchers behind the new study noted that infection prevention practices centred on hand hygiene protocols could save lives across all healthcare facilities, not just hospital settings.

“Our study is changing the narrative, underscoring that we can take a proven intervention practice”

Laura Temime

Their findings are published in the latest issue of the American Journal of Infection Control, the journal of the Association for Professionals in Infection Control and Epidemiology (APIC).

The researchers reviewed the impact of implementing a multicomponent hand hygiene programme among nursing homes.

Incorporating consistent measures that prompted staff, residents and visitors to wash their hands were linked to lower mortality and antibiotic prescription rates, and higher overall hand cleaner use.

The study is believed to be among the first to assess hand hygiene practices outside of the hospital setting through a randomised controlled trial.

For 12 months from April 2014, researchers assessed 26 French nursing homes, randomly assigning 13 to an intervention group and 13 to a control group.

“It is crucial that we increase efforts to bolster infection prevention programs in nursing homes”

Janet Haas

The programme included access to hand-rub solution using pocket-sized containers and new dispensers, a campaign to promote hand hygiene with posters and events, and the formation of local work groups in each home to focus on guidelines and staff education.

Staff were given online quizzes at the programme’s end and those who did not score high enough were invited to redo the education portion at a later date.

The intervention group reported lower mortality – 2.10 per 100 residents per month versus 2.65 in the control group. Antibiotic prescription rates were also lower in the intervention group – five daily doses per 100 resident days versus 5.8 for controls.

Notably, researchers recorded a 30% lower mortality rate in the intervention group in January-March 2015, during which France recorded a large influenza epidemic. This finding underlined the importance of increased hand hygiene compliance during epidemic periods, they said.

It took three to six months for results of the intervention to begin emerging, said the study authors, based on the quizzes and communication between participants and the nurse who led the training.

Association for Professionals in Infection Control and Epidemiology (APIC)

Janet Haad

Janet Haas

Lead study author Laura Temime, a professor at the Conservatoire National des Arts et Métiers in Paris, said: “Hand hygiene protocols have traditionally focused on acute care settings.

“Our study is changing this narrative, underscoring that we can take a proven intervention practice and make it work outside of the hospital space, by specifically adapting it to long-term settings,” she said.

APIC president and nurse Janet Haas added: “This research demonstrates that a sustained educational programme focused on hand hygiene can improve practices and may reduce the risk of infection among nursing home patients.

“It is crucial that we increase efforts to bolster infection prevention programs in nursing homes, because residents of these facilities have more underlying health conditions and are more vulnerable to serious complications from infections,” she said.

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