Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance.
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.


METHODS
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.


METHODS
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.
Infection Control Program, Children's Hospital, Boston, MA, USA.
Stephan
S
Harbarth
Didier
D
Pittet
Lynne
L
Grady
Anne
A
Zawacki
Gail
G
Potter-Bynoe
Matthew H
MH
Samore
Donald A
DA
Goldmann
D000438:Alcohols / Q000008:administration & dosage* / Q000737:chemistry; D002648:Child; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D005782:Gels; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006235:Hand Disinfection / Q000592:standards*; D006282:Health Personnel / Q000145:classification; D006801:Humans; D017053:Infection Control / Q000639:trends; D007362:Intensive Care Units; D012307:Risk Factors; D017592:Skin Care / Q000592:standards*; D011795:Surveys and Questionnaires; D013997:Time Factors
D000438:Alcohols; D005782:Gels