N a specific form.MethodsThe ORION statement for transparent reporting of intervention studies concerning healthcare-acquired infections was followed [36].SettingDelfos Medical Center is a private 200-bed hospital with teaching nursing activity, with about 12,000 admissions and 50,000 patient-days each year. Almost 90 of the rooms are single. There are eight medical-surgical wards and a polyvalent intensive care unit (ICU) with 11 beds attending nearly 500 patients each year. A Nosocomial Infection Control Unit (NICU) was created in 2002 as part of the Infection Committee, which is formed by a full-time specialist in epidemiology and infectious diseases and by an infection control nurse.Outcomes variablesThe primary outcome was HH compliance calculated by dividing the number of HH episodes by the number of potential opportunities. The data was stratified by type of indications, working areas and professional category. Our retrospective control data included three sessions of HH audits performed over a week in October 2007, January 2008 and April 2008.These audits were performed following a similar procedure as that used during the intervention period (with the exception that the moment “after touching surroundings” was not evaluated) and were conducted also by nosocomial infection control and nursing supervisors’ staff.Study DesignWe developed a “pre-post intervention” study through statistical comparison of HH performance at baseline and the two intervention phases. Furthermore, we performed prospective time series analysis through statistical process control (SPC) on HH during phase 2, alcohol hand rub solution (AHRs) consumption, and rate of healthcare-acquired MRSA colonization or infection (as detected by means of clinical samples only).The Ethics Committee from Delfos Medical Center approved conduct ofPLOS ONE | www.plosone.orgHospital Wide Hand Hygiene InterventionTable 1. Main characteristics of a 2 phase multifaceted Isovaleryl-Val-Val-Sta-Ala-Sta-OH site hospital-wide hand hygiene intervention, Delfos Medical Center (2010?2011).Periods and data Preintervention period (March 2007 ecember 2009)Description Promotion of hand hygiene (HH) was performed but it was neither structured nor sustained on time. A limited HH campaign based on staff education, reminders (March 2007 ctober 2007) followed by limited six-month HH audit by direct observations (October 2007?April 2008) over a week (basal, and on month 3 and 6) was conducted. The alcohol hand rub solution (AHRs) was changed on June 2008 (SterilliumH gel, Bode GS-5816MedChemExpress Velpatasvir Chemie, Hamburg, Germany); at this point, AHRs dispensers were located outside each room (corridor) and in the nursing carts. Isolation practices and HH promotion was reinforced during pandemic H1N1 threat (June2009-September 2009). Phase 2 (January 2011 ecember 2011) Continuous Quality Improvement (CQI) Promotion locally developed by Infection Control Unit and Supervisor’s Nursing Department. AHRs were placed at all patient beds in conventional wards while maintaining those at corridors. At this point the ratio AHRs dispensers/bed was 1.56 (340/217).Hospital Wide Intervention Phase 1 (January 2010 ecember 2010) Epidemiological context Catalonian Regional Campaign promoted by the “Alliance for Patient Safety” supported by WHO educational resources. AHRs were placed at all bedsides on high risk areas (Emergency Department and Intensive Care Unit). At this point the ratio AHRs dispensers/bed was 0.57 (123/217).1, Promotion of easy access to hand-rub solution.N a specific form.MethodsThe ORION statement for transparent reporting of intervention studies concerning healthcare-acquired infections was followed [36].SettingDelfos Medical Center is a private 200-bed hospital with teaching nursing activity, with about 12,000 admissions and 50,000 patient-days each year. Almost 90 of the rooms are single. There are eight medical-surgical wards and a polyvalent intensive care unit (ICU) with 11 beds attending nearly 500 patients each year. A Nosocomial Infection Control Unit (NICU) was created in 2002 as part of the Infection Committee, which is formed by a full-time specialist in epidemiology and infectious diseases and by an infection control nurse.Outcomes variablesThe primary outcome was HH compliance calculated by dividing the number of HH episodes by the number of potential opportunities. The data was stratified by type of indications, working areas and professional category. Our retrospective control data included three sessions of HH audits performed over a week in October 2007, January 2008 and April 2008.These audits were performed following a similar procedure as that used during the intervention period (with the exception that the moment “after touching surroundings” was not evaluated) and were conducted also by nosocomial infection control and nursing supervisors’ staff.Study DesignWe developed a “pre-post intervention” study through statistical comparison of HH performance at baseline and the two intervention phases. Furthermore, we performed prospective time series analysis through statistical process control (SPC) on HH during phase 2, alcohol hand rub solution (AHRs) consumption, and rate of healthcare-acquired MRSA colonization or infection (as detected by means of clinical samples only).The Ethics Committee from Delfos Medical Center approved conduct ofPLOS ONE | www.plosone.orgHospital Wide Hand Hygiene InterventionTable 1. Main characteristics of a 2 phase multifaceted hospital-wide hand hygiene intervention, Delfos Medical Center (2010?2011).Periods and data Preintervention period (March 2007 ecember 2009)Description Promotion of hand hygiene (HH) was performed but it was neither structured nor sustained on time. A limited HH campaign based on staff education, reminders (March 2007 ctober 2007) followed by limited six-month HH audit by direct observations (October 2007?April 2008) over a week (basal, and on month 3 and 6) was conducted. The alcohol hand rub solution (AHRs) was changed on June 2008 (SterilliumH gel, Bode Chemie, Hamburg, Germany); at this point, AHRs dispensers were located outside each room (corridor) and in the nursing carts. Isolation practices and HH promotion was reinforced during pandemic H1N1 threat (June2009-September 2009). Phase 2 (January 2011 ecember 2011) Continuous Quality Improvement (CQI) Promotion locally developed by Infection Control Unit and Supervisor’s Nursing Department. AHRs were placed at all patient beds in conventional wards while maintaining those at corridors. At this point the ratio AHRs dispensers/bed was 1.56 (340/217).Hospital Wide Intervention Phase 1 (January 2010 ecember 2010) Epidemiological context Catalonian Regional Campaign promoted by the “Alliance for Patient Safety” supported by WHO educational resources. AHRs were placed at all bedsides on high risk areas (Emergency Department and Intensive Care Unit). At this point the ratio AHRs dispensers/bed was 0.57 (123/217).1, Promotion of easy access to hand-rub solution.
