Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance
作者:
STEPHAN HARBARTH,
DIDIER PITTET,
LYNNE GRADY,
ANNE ZAWACKI,
GAIL POTTER-BYNOE,
MATTHEW SAMORE,
DONALD GOLDMANN,
期刊:
The Pediatric Infectious Disease Journal
(OVID Available online 2002)
卷期:
Volume 21,
issue 6
页码: 489-495
ISSN:0891-3668
年代: 2002
出版商: OVID
关键词: Cross-infection;guideline adherence;handwashing standards;health personnel;intervention;pediatric critical care;prevention;prospective study
数据来源: OVID
摘要:
Objective.To evaluate the effects of the introduction of an alcohol-based hand gel and multifaceted quality improvement (QI) interventions on hand hygiene (HH) compliance.Design.Interventional, randomized cohort study with four study phases (baseline; limited intervention in two units; full intervention in three units; washout phase), performed in three intensive care units at a pediatric referral hospital.Methods.During 724 thirty-minute daytime monitoring sessions, a nonidentified observer witnessed 12 216 opportunities for HH and recorded compliance.Interventions.Introduction of an alcohol-based hand gel; multifaceted QI interventions (educational program, opinion leaders, performance feedback).Results.Baseline compliance decreased after the first 2 weeks of observation from 42.5% to 28.2% (presumably because of waning of a Hawthorne effect), further decreased to 23.3% in the limited intervention phase and increased to 35.1% after the introduction of a hand gel with QI support in all three units (P< 0.001). The rise in compliance persisted in the last phase (compliance, 37.2%); however, a gradual decline was observed during the final weeks. Except for the limited intervention phase, compliance achieved through standard handwashing and glove use remained stable around 20 and 10%, respectively, whereas compliance achieved through gel use increased to 8% (P< 0.001). After adjusting for confounding, implementation of the hand gel with QI support remained significantly associated with compliance (odds ratio, 1.6; 95% confidence interval, 1.4 to 1.8). In a final survey completed by 62 staff members, satisfaction with the hand gel was modest (45%).Conclusions.We noted a statistically significant, modest improvement in compliance after introduction of an alcohol-based hand gel with multifaceted QI support. When appropriately implemented, alcohol-based HH may be effective in improving compliance.
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