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Isolation Status and Voice Prompts Improve Hand Hygiene

Says Researcher Presenting at the 32nd Critical Care Congress of the Society of Critical Care Medicine

(San Antonio, TX, January 31, 2003) - Infections that occur in healthcare facilities (nosocomial infections) take place in approximately eight to 10 percent of all hospital admissions, according to a study presented at the 32nd Critical Care Congress of the Society of Critical Care Medicine.

"Hand hygiene is the most basic form of infection control and has been directly correlated to nosocomial infection rates, however compliance with hand hygiene is poor and ranges anywhere from 28 to 74 percent," said Sandy Swoboda, RN, MS.

Other infection control measures aimed to decrease the incidence of nosocomial infections include but are not limited to: antibiotic regulation, the use of barrier precautions such as gowns and gloves, and the use of specially designed "isolation rooms" to prevent the risk of cross transmission of pathogens. Isolation rooms are single patient rooms, which act as a "physical reminder" of infection control.

Sandy Swoboda, RN, MS, and colleagues at the Johns Hopkins Medical Institutions in conjunction with Amron Corporation and McLean Virginia examined the use of Prompts for Handwashing (PFH). PFH is a computer based device that delivers automated verbal messages in the healthcare setting to do what mom always told us: "please wash your hands!" The authors presented data that PFH can improve hand hygiene and that behavior was associated with an overall decrease in nosocomial infection rates in a surgical intermediate care unit.

In an effort to determine if there was an additive impact of the use of "isolation rooms" with electronic devices to improve hand hygiene practices, the authors examined the data further. During the 15-month three-phase study in a busy intermediate intensive care unit with 14 beds (nine patient rooms, three of which were isolation and six were non-isolation rooms) entry and exits were monitored electronically and assessed for hand hygiene compliance. The three phases included 1) a phase of observation (Phase I); 2) an active intervention for hand hygiene in which PFH delivered verbal message reminders to "please wash your hands", if hand hygiene did not occur after exit from a patients room (Phase II); 3) and a follow up phase without voice prompts (Phase III).

When combining the effect of all phases, personnel exiting isolation rooms were 49 percent more likely to wash their hands when compared to a non-isolation room. In non-isolation rooms, baseline hand hygiene compliance was 16.9 percent, which increased to 24 and 20 percent respectively in Phase II and III respectively. On the other hand, in isolation rooms, baseline hand hygiene compliance was 23 percent, which increased to 33 percent and 36 percent respectively. Thus, during all phases of this study personnel were more likely to perform hand hygiene in isolation rooms, but the effect of the automated voice prompts was greater and more long lasting in isolation rooms when compared with non-isolation rooms.

"With the addition of a voice prompt to remind personnel to wash their hands in conjunction with the use of isolation rooms, hand hygiene practices improved, further suggesting that not only physical but also auditory reminders to wash your hands help improve behavior," said Swoboda.

The Society of Critical Care Medicine is the leading professional organization dedicated to ensuring excellence and consistency in the practice of critical care medicine. With over 10,000 members worldwide, the Society is the only professional organization devoted exclusively to the advancement of multidisciplinary, multiprofessional intensive care through excellence in patient care, professional education, public education, research and advocacy. Members of the Society include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory care practitioners and other professionals with an interest in critical care, which may include physician assistants, social workers, dieticians, and members of the clergy.

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