[show abstract][hide abstract] ABSTRACT: Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel.
We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant.
We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001).
The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.
The Lancet 11/2000; 356(9238):1307-12. · 39.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: Nosocomial infection is a leading complication in intensive care units. Although hand hygiene is the single most efficient preventive measure, compliance with this simple action remains low.
To assess the effect of an intervention to promote hand hygiene and to investigate risk factors for noncompliance in intensive care units.
We performed 7 observational surveys and implemented a promotional campaign after baseline in medical, surgical, and pediatric intensive care units of a teaching hospital. Health care workers were observed during routine patient care. The intervention consisted of a hospitalwide promotional campaign, including observation and performance feedback, posters display, and distribution of individual bottles of alcohol-based handrub. The main outcome measure was compliance with hand hygiene through handwashing or handrubbing.
We observed 2743 opportunities for hand hygiene distributed over 248 periods. Overall compliance increased from 38.4% to 54.5% during the study (P<.001). Although recourse to handwashing remained stable at around 30%, handrubbing increased from 5.4% at baseline to 21.7% at the last survey (P<.001). Compliance increased among nurses and nursing assistants, but remained stable among physicians. Handwashing compliance decreased, on average, by 4.7% for an increase of 10 opportunities for hand hygiene per hour of patient care (P<.001), whereas no such association existed for handrubbing.
Our intervention induced a marked and sustained increase in compliance with hand hygiene. In intensive care units, less time-consuming handrubbing might replace standard handwashing and overcome the barrier of time constraints.
Archives of Internal Medicine 05/2002; 162(9):1037-43. · 11.46 Impact Factor
[show abstract][hide abstract] ABSTRACT: Hand hygiene is a core element of patient safety for the prevention of healthcare-associated infections and the spread of antimicrobial resistance. Its promotion represents a challenge that requires a multi-modal strategy using a clear, robust and simple conceptual framework. The World Health Organization First Global Patient Safety Challenge 'Clean Care is Safer Care' has expanded educational and promotional tools developed initially for the Swiss national hand hygiene campaign for worldwide use. Development methodology involved a user-centred design approach incorporating strategies of human factors engineering, cognitive behaviour science and elements of social marketing, followed by an iterative prototype test phase within the target population. This research resulted in a concept called 'My five moments for hand hygiene'. It describes the fundamental reference points for healthcare workers (HCWs) in a time-space framework and designates the moments when hand hygiene is required to effectively interrupt microbial transmission during the care sequence. The concept applies to a wide range of patient care activities and healthcare settings. It proposes a unified vision for trainers, observers and HCWs that should facilitate education, minimize inter-individual variation and resource use, and increase adherence. 'My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices.
Journal of Hospital Infection 10/2007; 67(1):9-21. · 2.86 Impact Factor
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