title: Limited impact of sustained simple feedback based on soap and paper towel consumption on the frequency of hand washing in an adult intensive care unit.
abstract: OBJECTIVE
  To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption.
  
  
  METHODS
  Prospective trial with a nonequivalent control group.
  
  
  METHODS
  Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU).
  
  
  METHODS
  Unit staff.
  
  
  METHODS
  Every weekday from May 26 through December 8, 1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks.
  
  
  RESULTS
  Directly counted hand washing fell in the SICU from a baseline of 2.68+/-0.72 (mean +/- standard deviation) episodes per occupied bed per hour to 1.92+/-1.35 in the follow-up period. In the MICU, episodes fell from 2.58+/-0.95 (baseline) to 1.74+/-0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36+/-0.49 at baseline to 1.01+/-0.36, with a return to 1.16+/-0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r = -0.35 for the MICU, r = -0.46 for the SICU).
  
  
  CONCLUSIONS
  Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.
authors.affiliation: Section of Infectious Diseases, Veterans Affairs Medical Center, Omaha, Nebraska 68105-1873, USA.
authors.forename: Marvin J
authors.initials: MJ
authors.lastname: Bittner
authors.forename: Eugene C
authors.initials: EC
authors.lastname: Rich
authors.forename: Paul D
authors.initials: PD
authors.lastname: Turner
authors.forename: William H
authors.initials: WH
authors.lastname: Arnold
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000517:prevention & control*; D005246:Feedback; D006235:Hand Disinfection; D006787:Hospitals, Veterans / Q000458:organization & administration; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D009329:Nebraska; D010564:Personnel, Hospital / Q000193:education* / Q000706:statistics & numerical data; D012915:Soaps; D000078329:Workforce
chemical_list: D012915:Soaps