ArticlesEffectiveness of a hospital-wide programme to improve compliance with hand hygiene
Introduction
Hand hygiene, either by handwashing or hand disinfection, remains the single most important measure to prevent nosocomial infections.1 The importance of this simple procedure is not sufficiently recognised by health-care workers (HCWs),2 and poor compliance has been documented repeatedly.3, 4, 5 Although some previous interventions to improve compliance have been successful, none has achieved lasting improvement.2, 6, 7 This situation led to the creation of a Handwashing Liaison Group8 in the UK in 1997, whose mission is “to modify the behaviour of HCWs to produce sustained improvement in compliance with agreed handwashing standards and so improve the quality of patient care”.8
In our hospital, we documented disappointing levels of hand hygiene compliance and identified several risk factors for non-compliance.5 The observed relation between increased workload and reduced compliance suggested that promotion of bedside hand disinfection, less timeconsuming than handwashing, may improve compliance.5, 9 Hence, we implemented a hospital-wide campaign to promote hand hygiene and, in particular, the use of alcoholbased handrubs.7 We hypothesised that our programme would not only increase compliance with hand hygiene, but also diminish meticillin-resistant Staphylococcus aureus (MRSA) transmission and nosocomial infection rates. We describe the programme and its effectiveness.
Section snippets
Procedure
The University of Geneva Hospitals (UGH) is a large acute-care teaching hospital serving residents of Geneva, Switzerland, and the surrounding area. Handwashing facilities are available everywhere with one to three sinks in every patient's room together with unmedicated soap and paper towels.
The hand-hygiene promotion programme started in January 1995 after a baseline survey.5 The most prominent component was a visual display with A3-size colour posters that emphasised the importance of
Results
Between 1994 and 1997, data were collected from 2629 scheduled observation periods, of which 120 (4·6%) produced no data, mostly during the night when no handhygiene opportunities occurred. The remaining 2509 periods totalled 833 h and 52 min of observation and lasted between 5 and 45 min, most being of 20 min duration (2384 [95%] of observations). We obtained data on 20082 opportunities for hand hygiene in total.
Hand-cleansing opportunities were spread evenly among the seven surveys, between
Discussion
Compliance with hand-hygiene recommendations improved significantly following a hospital-wide education programme, coinciding with a reduction of nosocomial infections and MRSA transmission. The programme was mainly based on a poster campaign together with a generalised promotion of alcoholic handrubs as an alternative to soap-and-water handwashing. Improved adherence was sustained and observed across most hospital locations, in all types of patient-care activities, and among most HCWs present
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