title: A multifaceted approach to changing handwashing behavior.
abstract: BACKGROUND
  Few interventions to influence handwashing have had measurable effects. This prospective quasi-experimental study was designed to address predisposing, enabling, and reinforcing factors to improve frequency of handwashing.
  
  
  METHODS
  Over a 12-month time period, a multifaceted intervention including focus group sessions, installation of automated sinks, and feedback to staff on handwashing frequency was implemented in one intensive care unit; a second unit served as a control. Dependent variables observed were handwashing frequency and self-reported practices and opinions about handwashing. Study phases included baseline, three phases of about 2 months each in duration in which sink automation was incrementally increased, and follow-up 2 months after intervention.
  
  
  RESULTS
  During 301 hours of observation, 2624 handwashings were recorded. Proportion of times hands were washed varied by indication, ranging from 38% before invasive procedures to 86% for dirty-to-clean procedures (p < 0.00001). Although there were some significant differences between experimental and control units in handwashing during the study, these differences had returned to baseline by the 2-month follow-up. There were no significant differences in self-reported practices and opinions from before to after intervention nor between units.
  
  
  CONCLUSIONS
  Intensive intervention, including feedback, education, and increased sink automation, had minimal long-term effect on handwashing frequency.
authors.affiliation: Georgetown University School of Nursing, Washington DC 20005, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Larson
authors.forename: J L
authors.initials: JL
authors.lastname: Bryan
authors.forename: L M
authors.initials: LM
authors.lastname: Adler
authors.forename: C
authors.initials: C
authors.lastname: Blane
mesh_terms: D000704:Analysis of Variance; D001331:Automation; D016009:Chi-Square Distribution; D017144:Focus Groups; D006235:Hand Disinfection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D009741:Nursing Staff, Hospital / Q000193:education*; D011446:Prospective Studies; D018709:Statistics, Nonparametric