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Alcohol-Based Handrub Improves Compliance With Hand Hygiene in Intensive Care Units
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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