title: Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals.
abstract: BACKGROUND
  Patients admitted to hospitals are at risk of acquiring nosocomial infections. Many peer-reviewed studies show that handwashing (HW) significantly reduces hospital infections and mortality. Our objective was to evaluate the effects of HW by health care workers (HCW) before contact with patients in 3 Argentinean hospitals. We performed an observational study of HCW to measure the effect of 2 interventions: education alone and education plus performance feedback.
  
  
  METHODS
  A total of 3 hospitals were studied for adherence to a HW protocol. The observed HCW included physicians, nursing personnel, and ancillary staff. After initial observations to establish baseline rates of HW (phase 1), we evaluated the effect of education alone (phase 2), followed by education plus performance feedback (phase 3). We also evaluated the relationship between the administrative support and HW adherence.
  
  
  RESULTS
  We observed 15,531 patient contacts in 3 hospitals. The baseline rate of HW before contact with patients was 17%. With education, HW before contact with the patients increased to 44% (relative risk 2.65; 95% confidence interval 2.33-3.02; P <.001). Using education and performance feedback HW further increased to 58% (relative risk 1.86; 95% confidence interval 1.38-2.51; P <.001). In the private hospitals where administrative support for the HW program was significantly greater, HW compliance was significantly higher (logistic regression analysis: odds ratio 5.57; 95% confidence interval 5.25-6.31; P <.001).
  
  
  CONCLUSIONS
  In this study, HW policies and education of HCW significantly improved HCW adherence to the HW protocol, however, when performance feedback was incorporated, the HW compliance increased to a greater degree. We identified that administrative support provides a positive influence in efforts to improve HW adherence.
authors.affiliation: Department of Infectious Diseases and Hospital Epidemiology, Bernal Medical Center, Buenos Aires, Argentina.
authors.forename: Victor Daniel
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Rita D
authors.initials: RD
authors.lastname: McCormick
authors.forename: Sandra
authors.initials: S
authors.lastname: Guzman
authors.forename: Claudia
authors.initials: C
authors.lastname: Villamayor
authors.forename: Pablo W
authors.initials: PW
authors.lastname: Orellano
mesh_terms: D000704:Analysis of Variance; D001118:Argentina; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D016001:Confidence Intervals; D003428:Cross Infection / Q000517:prevention & control*; D005246:Feedback; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000592:standards*; D006740:Hospital Administrators; D006786:Hospitals, Urban; D006801:Humans; D017053:Infection Control / Q000592:standards* / Q000639:trends; D007400:Interprofessional Relations; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D010564:Personnel, Hospital / Q000193:education; D017410:Practice Guidelines as Topic; D011336:Probability; D012308:Risk Management