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Improving healthcare worker hand hygiene adherence before patient contact: a before-and-after five-unit multimodal intervention in Tuscany
  1. S Saint1,2,3,
  2. A Conti3,
  3. A Bartoloni3,
  4. G Virgili3,
  5. F Mannelli4,
  6. S Fumagalli3,
  7. P di Martino5,
  8. A A Conti3,6,
  9. S R Kaufman2,
  10. M A M Rogers2,
  11. G F Gensini3,6
  1. 1
    Ann Arbor VA Medical Center, Ann Arbor, Michigan, USA
  2. 2
    University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3
    University of Florence Medical School, Florence, Italy
  4. 4
    Meyer Hospital, Florence, Italy
  5. 5
    Tuscan-American Safety Collaborative, Florence, Italy
  6. 6
    Don Carlo Gnocchi Foundation, Florence, Italy
  1. Correspondence to Dr Sanjay Saint, Division of General Medicine, University of Michigan Health System, Room 7E08, 300 N Ingalls, Ann Arbor, MI 48109-0429, USA; saint{at}


Background: Despite the importance of hand hygiene in reducing infection, healthcare worker compliance with hand hygiene recommendations remains low. In a previous study, we found a generally low level of compliance at baseline, with substantial differences between doctors and nurses and between hospital units. We describe here the results of our multimodal intervention intended to improve levels of healthcare worker hand hygiene.

Methods: A 6-month, before-and-after, multimodal interventional study in five hospital units in Florence, Italy. We used direct observation to assess hand hygiene rates for doctors and nurses, focusing on hygiene before touching the patient. We explored reasons for unit variability via interviews of doctor and nurse leaders on the units.

Results: Overall healthcare worker hand hygiene increased from 31.5% to 47.4% (p<0.001). Hand hygiene adherence among nurses increased from 33.7% to 47.9% (p<0.001); adherence among doctors increased from 27.5% to 46.6% (p<0.001). Improvement was statistically significant in three out of five units, and units differed in the magnitude of their improvement. Based on the interviews, variability appeared related to the “champion” on each unit, as well as the level of motivation each physician leader exhibited when the preintervention results were provided.

Conclusions: Although overall healthcare worker adherence with hand hygiene procedures before patient contact substantially increased after the multimodal intervention, considerable variability—for both nurses and doctors and across the 5 units—was seen. Although adherence substantially increased, overall hand hygiene in these units could still be greatly improved.

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  • Competing interests None.

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