Impact of hand hygiene on the detection of multidrug-resistant organisms and other pathogens of epidemiologic significance after implementation of an automated hand hygiene monitoring system.

OBJECTIVE

To assess the association between hand hygiene adherence, as measured by an automated hand hygiene monitoring system (AHHMS), and multidrug-resistant organisms and other pathogens of epidemiologic significance (MDRO+).

DESIGN

Retrospective cohort study.

SETTING

Acute care hospitals within an academic healthcare system.

PARTICIPANTS

Hand hygiene data was collected from all badged staff January 2021 through September 2022. Adult inpatients on non-maternity units during this period were eligible for inclusion.

METHODS

After implementing an AHHMS, we analyzed correlations between monthly unit-level hand hygiene adherence (proportion of room entry-exit opportunities during which hand hygiene solution was dispensed) and hospital-onset MDRO+ rates from all clinical cultures and Clostridioides difficile stool tests. Mixed-effect negative binomial regression models evaluated associations between monthly unit-level hand hygiene adherence and MDRO+ rates while adjusting for the number of clinical tests ordered, unit type, and average number of inpatient COVID-19 cases.

RESULTS

During the study period, there were 22,767,036 hand hygiene opportunities. Mean hand hygiene adherence improved from 41% (January 2021) to 57% (September 2022). 1,847 MDRO+ detections were observed in 752,341 patient days with a median composite MDRO+ rate of 1.7 per 1,000 patient days (IQR: 0-3.6). The mixed-effect negative binomial regression model found a null association between hand hygiene adherence and MDRO+ rates (rate ratio 1.01; 95% confidence interval: 1.00-1.01).

CONCLUSIONS

Despite an improvement in hand hygiene adherence, we did not find a resultant impact on MDRO+ detection, likely owing to the complex interaction between the two variables and unmeasured confounders.