Background: Healthcare associated infections (HCAIs) affect the quality of care and are the most frequent adverse consequences of health care worldwide. Hand hygiene is considered to be the most effective tool in HCAI control. Vigorous handwashing for 40-60 seconds, or the use of alcohol hand rub before and after every patient contact is recommended to prevent transmission of pathogenic organisms from one patient to the other. Compliance is however, suboptimal and alcohol hand rub has been suggested in busy settings like the intensive care units (ICUs) to improve compliance. There is no evidence on the comparative effectiveness between handwash and handrub strategies.
Objective: To assess the effectiveness of handwash versus handrub for preventing nosocomial infection in hospital intensive care units (ICU).
Methods: Studies conducted in ICUs and indexed in PubMed comparing the clinical effectiveness and adverse events between handwash and handrub groups were included in a systematic review. The primary outcome was nosocomial infection rates. Secondary outcomes included microbial counts on healthcare providers’ hands, mortality rates, patient/hospital cost of treatment of HCAIs, length of ICU/hospital stay, and adverse events. Studies were independently screened and data-extracted by at least two authors. Meta-analyses of risk ratios (RR), incidence rate ratios (IRR), odds ratios (OR) and mean differences (MD), were conducted using the RevMan 5.3 software.
Results: Seven studies involving a total of 11,663 patients were included. Five studies (10,981 patients) contributed data to the ICU-acquired nosocomial infection rates. The pooled IRR was 0.71 (95% CI 0.61, 0.82; I2 = 94%) in favour of handrub. On sensitivity analysis, pooled IRR was 0.39 (95% CI 0.32, 0.48; 4 studies; 8,247 patients; I2 = 0%) in favour of handrub. The pooled OR for mortality was 0.95 (95% CI 0.78, 1.61; 4 studies; 3,475 patients; I2 = 39%). The pooled MD for length of hospital stay was -0.74 (95% CI -2.83, 1.34; 3 studies; 741 patients; I2 = 0%) days, in favour of handrub. The pooled OR for an undesirable skin effect was 0.37 (95% CI 0.23, 0.60; 3 studies; 1504 patients; I2 = 0%) in favour of handrub. Overall quality of evidence was low.
Conclusion: Handrub appeared more effective compared to handwash in ICUs.