Influence of a hygiene promotion programme on infection control in an intensive-care unit

The objectives of this study were to determine the risk factors associated with nosocomial infection (NI) in the intensive-care unit and to assess the influence of a hand-washing promotion programme on the NI rate. Over a 6-month study period (P1), a prospective study of NI cases was performed, and risk factors for NI were analysed. Data were compared with those corresponding to a second period (P2), during which a health workers' hand-washing promotion programme was carried out; alcohol-based solution was also placed at the patients' headboard. Eight hundred and six patients were included (395 patients in P1 and 411 in P2). The mean APACHE II score was 11.41; there were no statistically significant differences in epidemiological or clinical variables between P1 and P2, and there were no differences in risk factors for NI. The rate of infection in P1 was 26%, and that in P2 was 16% (p < 0.05). The hand-washing rate was higher in P2 than in P1 (before patient care, 45% and 35%, respectively; after contact with the patient, 63% and 51%, respectively). In the multivariate analysis, only central venous catheterization (> 5 days) and tracheostomy were statistically significant risk factors for NI; having been included in the study during P1 or P2 was not statistically associated with NI. In conclusion, there was a significant increase in hand-washing frequency in P2; the incidence of NI during P1 was significantly higher than during P2, but having been included in the study in P1 was not significantly associated with a higher rate of NI; only central venous catheterization (> 5 days) and tracheostomy were significantly associated with NI.