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Effect of an Evidence-Based Hand Washing Policy on Hand Washing Rates and False-Positive Coagulase Negative Staphylococcus Blood and Cerebrospinal Fluid Culture Rates in a Level III NICU

Journal of Perinatology volume 22, pages 137–143 (2002)Cite this article

Abstract

OBJECTIVE: To determine the effect of implementing an evidence-based hand washing policy on between-patient hand washing compliance and on blood and cerebrospinal fluid (CSF) culture rates in a level III neonatal intensive care unit (NICU).

METHODS: An evidence-based hand washing policy, supported by an intensive education program, was introduced in a regional NICU. A total of 2009 preintervention neonates (16,168 patient days) over 17 months were compared to 676 postintervention neonates (5779 patient days) over 6 months. Hand washing compliance and rates of blood and CSF cultures yielding coagulase negative staphylococci (CONS) were compared before and after intervention.

RESULTS: Compliance with appropriate between-patient hand washing improved (from 47.4% to 85.4%, p=0.001) after the hand washing policy was introduced. The rate of cultures positive for CONS declined from 6.1±2.3 to 3.2±1.6 per 1000 patient days (p=0.005). Most of this reduction was attributable to a reduction in false-positive cultures, from 4.2±2.4 to 1.9±1.8 per 1000 patient days (p=0.042), but there was a trend toward decreased true-positive cultures (from 2.1±1.2 to 1.2±1.0 per 1000 patient days, p=0.074) as well. Potential confounders and demographics factors were similar between the control and intervention subjects.

CONCLUSION: Implementation of an evidence-based hand washing policy resulted in a significant increase in hand washing compliance and a significant decrease in false-positive coagulase negative staphylococcal blood and CSF culture rates. Exploratory data analysis revealed a possible effect on true-positive coagulase negative staphylococcal blood and CSF culture rates, but these results need to be confirmed in future studies.

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Acknowledgements

This work was undertaken as a single-site quality improvement project by the Lucile Packard Children's Hospital NICQ/2000 Steering Committee, and represents application of quality improvement methods adopted as a result of our participation in the Vermont Oxford Network NIC/Q 2000 Evidence-Based Quality Improvement Collaborative for Neonatology.

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Authors and Affiliations

  1. Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA

    Paul J Sharek MD, MPH, William E Benitz MD, Michelle L Mayer PhD, MPH, RN & David A Bergman MD

  2. Lucile Packard Children's Hospital, Palo Alto, CA, USA

    Nancy J Abel RN, BSN & Mary Jane Freeburn RN, CIC

Authors
  1. Paul J Sharek MD, MPH
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  2. William E Benitz MD
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  3. Nancy J Abel RN, BSN
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  4. Mary Jane Freeburn RN, CIC
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  6. David A Bergman MD
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We gratefully acknowledge financial support for this study from the David and Lucile Packard Foundation.

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Sharek, P., Benitz, W., Abel, N. et al. Effect of an Evidence-Based Hand Washing Policy on Hand Washing Rates and False-Positive Coagulase Negative Staphylococcus Blood and Cerebrospinal Fluid Culture Rates in a Level III NICU. J Perinatol 22, 137–143 (2002). https://doi.org/10.1038/sj.jp.7210661

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