Abstract
We analyzed the effect of antimicrobial use and implementation of a hand hygiene program on the incidence of healthcare-associated infections (HAIs) and healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections at the Chung Shan Medical University Hospital (Taichung, Taiwan). Monthly data were retrospectively reviewed from January 2004 to December 2010. Use of antimicrobials and alcohol-based hand cleaner were separately regressed against the incidences of HAIs and HA-MRSA infections. Infection incidence was expressed as persons per 1000 patient days (PDs), monthly use of i.v. antibiotics was expressed as defined daily doses per 1000 PDs and monthly alcohol-based hand cleaner use was expressed as bottle per 1000 PDs. Multivariate analysis indicated that use of hand cleaner was associated with reduced incidence of HAIs (P=0.0001) and HA-MRSA infections (P<0.0001). Time-series analysis indicated that increased use of hand cleaner was significantly associated with significant decreases in the incidences of HAIs and HA-MRSA infections. Total antibiotic use had no significant effect on HAIs, but was associated with more HA-MRSA infections. In addition, the use of J01CR01 antibiotics (combinations of penicillins, including β-lactamase inhibitors) in particular was correlated with significantly increased incidence of HA-MRSA infections. Our forecasting model demonstrates the efficacy of a hand hygiene program and the need to limit the use of certain restricted antimicrobials in order to reduce the incidence of HAIs and HA-MRSA infections.
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Acknowledgements
The study was supported by the Chung Shan Medical University Hospital Grant No. CSH-2009-C-004.
Author contributions: We declare that all the listed authors have participated actively in the study and all meet the requirements of the authorship. Dr YT Lee designed the study and wrote the protocol, Dr HC Hung and SM Tsao performed the study, Dr MC Lee and HJ Huang managed the literature searches and analyses, Dr SC Chen and HC Lin undertook the statistical analysis and Dr YT Lee wrote the first draft of the manuscript.
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Lee, YT., Chen, SC., Lee, MC. et al. Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections. J Antibiot 65, 311–316 (2012). https://doi.org/10.1038/ja.2012.20
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DOI: https://doi.org/10.1038/ja.2012.20
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