Systematic Review on the Effectiveness of Handwashing -interim report-

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Systematic Review on the Effectiveness of
Handwashing-interim report-

• Hiroshi Ikai
• Stephanie Smith
• Allison McGeer
• Department of Infection Control,
• Mount Sinai Hospital

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Background (1)

• Hand hygiene is historically one of the most
  simple yet effective component of infection
  control activity.
• Guideline for hand hygiene was published in 2002
  by HICPAC/SHEA/APIC/IDSA, where the efficacy of
  hand hygiene is discussed as removal of
  microorganisms from hand.

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Background (2)

• Clinical effectiveness of hand hygiene for the
  prevention of nosocomial infections (NI) varies
  in quantity (effect size) and quality (study
  design) among studies.

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Objective

• To quantify the preventable portion of nosocomial
  infections by the implementation / reinforcement
  of handwashing in hospital settings
• -And its variation across different categories of
  infection
• (2) To quantify the impact of handwashing to the
  society and the health economy
• -through the systemic review of previous studies

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Methods(1) data source

• Systematic database search
• Data source
• MEDLINE
• EMBASE
• Cochrane Database of Systematic Reviews
• CINAHL
• Secondary citations from
• above articles
• Textbook (Mandell, Mayhall)
• Guidelines (WHO/SHEA/HICPAC)

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Methods (2) Search Terms
Absenteeism absenteeism MeSH sick
leave leave of absence absen AND work

• Handwashing
• Handwashing MeSH
• hand was
• hand hygiene
• hand scrub
• hand clean

Length of Hospitalization length of
stay/hospitalization/admission time until
discharge hospital days

• Nosocomial infections
• Cross infection MeSH
• bloodstream infection
• surgical site infection
• urinary tract infection
• gastrointestinal tract infection
• CNS infection / meningitis
• vertical/horizontal transmission

Health economics Economics, Medical
MeSH Health Care Costs MeSH Cost of Illness
MeSH burden of illness economic loss
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Methods (3) Title / abstracts review

• Titles and abstracts are reviewed by at least two
  people
• Inclusion criteria
• Comparative studies before and after handwashing
  program
• OR
• reviews that may mention about such studies
• Hospital setting
• Either retrospective or prospective design
• Peer reviewed journals
• Exclusion criteria
• Article type
• Short (1-3 pages) review with no original data
• Editorials
• Single case reports

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Methods (4) Data collection

• Two independent reviewers extract data on
• Study design
• Before-after / Cohort study / etc.
• Patient population
• Adults / pediatrics / post-surgical
• Care setting
• Ward / ICU / NICU
• Target caregivers
• Physician / nurse / all HCWs /- visitor / family
• Type / content of handwashing program
• Education program / monitoring / overall process
  improvements
• Outcomes
• Improvement of adherence to hand hygiene practice
• Incidence / absenteeism / economics / length of
  stay

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Search results
Nosocomial infections Absenteeism Economics Length of stay
HH-PubMed 2181 43 38 170
HH-EMBASE 791 25 74 59
HH-CINAHL 339 13 11 24
HH-CDSR 184 211 48 102
titles reviewed 2935 244 166 311
abstracts reviewed 1405 12 66 110
articles in review 320 4 10 29
Secondary citations Adding Adding Adding Adding
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Variations of study design / results
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Sample meta-analysis
Hilburn 2003
Swobada 2004
Lam 2004
Rosenthal 2005
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Summary

• Most of current data on the effectiveness of hand
  hygiene are based on before-after studies.
• Most studies show effectiveness of hand hygiene
  for prevention of nosocomial infections.
• Effect size are variable, with relative risk
  ranging from 14 to 94.

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Next step

• Systematic review should also be completed for
  other outcomes, i.e. absenteeism, length of
  hospital stay, and health economics.
• There may be a guideline for reporting
  observational studies in infection control, so
  that each data can contribute to future policy
  making.
• Controlled study design maybe preferred in the
  future, if ethically appropriate.