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Stéphane Hugonnet, MD, MSc; Thomas V. Perneger, MD, PhD; Didier Pittet, MD, MS

Arch Intern Med. 2002;162:1037-1043.

Background  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.

Objectives  To assess the effect of an intervention to promote hand hygiene and to investigate risk factors for noncompliance in intensive care units.

Methods  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.

Results  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.

Conclusions  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.

From the Infection Control Program, Department of Internal Medicine (Drs Hugonnet and Pittet), Quality of Care Unit and Institute of Social and Preventive Medicine (Dr Perneger), University of Geneva Hospitals, Geneva, Switzerland.

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