Determinants of hand hygiene non-compliance in a cardiac center in Saudi Arabia.

OBJECTIVE: To evaluate the baseline hand hygiene non-compliance rate, and identify the factors associated with non-compliance in a cardiac center in Saudi Arabia. METHODS: This observational study was conducted in Prince Sultan Cardiac Center, Riyadh, Saudi Arabia, a 176 beds specialized cardiac center. In total, 6,022 observations were recorded by using the Infection Control Link Nurse program from all the high and non-high risk areas from October to December 2012. The data was collected from different healthcare workers (HCW) for World Health Organization 5 indications of hand hygiene. Non-compliance rate was calculated, and univariate and multivariate analysis was performed using logistic regression to identify factors significantly associated with non-compliance. RESULTS: The overall hand hygiene non-compliance rate was observed to be approximately 34%. Factors significantly associated with non-compliance included physicians (OR=2.71, 95% confidence intervals [CI]=2.33-3.13), after touching the patient's surrounding (OR=4.8, 95% CI=3.98-5.78), before touching a patient (OR=3.3, 95% CI=2.87-3.86), and high-risk areas (OR=1.16, 95% CI=1.03-1.31). Morning shifts were significantly associated (OR=1.13, 95% CI=1.00-1.29) with non-compliance as compared to the evening shifts. CONCLUSION: Stratified analysis indicated that non-compliance is still a noticeable concern. The results suggest that broad spectrum educational activities and behavioral modification strategies should be advocated to include all HCW, particularly physicians, and should emphasize on performing hand hygiene during all the indications and not just the `after` indications.

Cost analysis of multiplex PCR testing for diagnosing respiratory virus infections.

We performed a cost analysis study using decision tree modeling to determine whether the use of multiplex PCR testing for respiratory viruses (xTAG RVP test) is a more or less costly strategy than the status quo testing methods used for the diagnosis of respiratory virus infections in pediatric patients. The decision tree model was constructed by using four testing strategies for respiratory virus detection, viz., direct fluorescent-antibody staining (DFA) alone, DFA plus shell vial culture (SVC), the xTAG RVP test alone, or DFA plus the xTAG RVP test. A review of the charts of 661 pediatric patients was used to determine the length of hospital stay, the number of days in isolation, antibiotic usage, and all other medical procedures performed. The cost of hospitalization by diagnostic status was determined on the basis of the average cost per patient and the number of patients in each arm of the decision tree. The cost per case was the highest for DFA plus SVC at $3,914 (in Canadian dollars), and the lowest was for the xTAG RVP test alone at $3,623, while the costs of DFA alone ($3,911) and DFA plus RVP ($3,849) were intermediate. When all four diagnostic strategies were compared, the least costly strategy was the xTAG RVP test alone when the prevalence of infection was 11% or higher and DFA alone when the prevalence was under 11%. These data indicate a savings of $291 per case investigated if the strategy of using the xTAG RVP test alone was used to replace the status quo test of DFA plus SVC, resulting in a savings of $529,620 per year in direct costs for the four Hamilton, Ontario, Canada, hospitals on the basis of the testing of specimens from 1,820 pediatric inpatients. We conclude that the use of the xTAG RVP test is the least costly strategy for the diagnosis of respiratory virus infections in children and would generate a significant savings for hospitals.