A multicenter study using positive deviance for improving hand hygiene compliance

BACKGROUND

Positive deviance (PD) can be a strategy for the improvement of hand hygiene (HH) compliance.

METHODS

This study was conducted in 8 intensive care units and 1 ward at 7 tertiary care, private, and public hospitals. Phase 1 was a 3-month baseline period (from August to October 2011) in which HH counts were performed by observers using iPods (iScrub program). From November 2011 to July 2012, phase 2, a PD intervention was performed in all the participating centers. We evaluated the consumption of HH products (alcohol gel and chlorhexidine) and the incidence density of health care-associated infections.

RESULTS

There was a total of 5,791 HH observations in the preintervention phase and 11,724 HH observations in the intervention phase (PD). A statistically significant difference was found in overall HH compliance with 46.5% in the preintervention phase and 62.0% in the PD phase (P < .001). There was a statistically significant reduction in the incidence of density of device-associated infections per 1,000 patient-days and also in the median of length of stay between the preintervention phase and the PD phase (13.2 vs 7.5 per 1,000 patient-days, respectively, P = .039; and 11.0 vs 6.8 days, respectively, P < .001, respectively).

CONCLUSION

PD demonstrated great promise for improving HH in multiple inpatient settings and was associated with a decrease in the median length of stay and the incidence of device-associated HAIs.

Ertapebem disk performance to predict Klebsiella pneumoniae carbapenemase produced by Gram-negative bacilli isolated in a São Paulo city public hospital

OBJECTIVE: To evaluate ertapenem disk performance to predict Klebsiella pneumonie carbapenemase production by Gram-negative bacilli. METHODS: All Gram-negative bacilli isolated between January 2010 and June 2011 were tested by disk diffusion (OxoidTM) for sensitivity to ertapenem, meropenem and imipenem. Resistant or intermediate sensitivity strains (diameter <22 mm for ertapenem) were also tested for the blaKPC gene by polymerase chain reaction. Disk predictive positive value for Klebsiella pneumoniae carbapenemase and specificity were calculated. RESULTS: Out of the 21839 cultures performed, 3010 (13.78%) were positive, and Gram-negative bacilli were isolated in 708 (23.52%) of them. Zone of inhibition diameter for ertapenem disk was <22 mm for 111 isolates, representing 15.7% of all Gram-negative isolates. The PCR assay for blaKPC detected 40 Klebsiella pneumoniae carbapenemase-producing strains. No strains intermediate or resistant to meropenem and imipenem were sensitive to ertapenem. The ertapenem disk presented a positive predictive value of 36% to predict blaKPC and 89% specificity. CONCLUSION: The resistance of Gram-negative bacilli detected by disk diffusion against ertapenem does not predict Klebsiella pneumoniae carbapenemase production. Other mechanisms, such as production of other betalactamases and porin loss, may be implicated. The need to confirm the presence of the blaKPC is suggested. Therefore, ertapenem was a weak predictor for discriminating strains that produce Klebsiella pneumoniae carbapenemase.