title: Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina.
abstract: BACKGROUND
  Hand hygiene is a fundamental measure for the control of nosocomial infection. However, sustained compliance with hand hygiene in health care workers is poor. We attempted to enhance compliance with hand hygiene by implementing education, training, and performance feedback. We measured nosocomial infections in parallel.
  
  
  METHODS
  We monitored the overall compliance with hand hygiene during routine patient care in intensive care units (ICUs); 1 medical surgical ICU and 1 coronary ICU, of 1 hospital in Buenos Aires, Argentina, before and during implementation of a hand hygiene education, training, and performance feedback program. Observational surveys were done twice a week from September 2000 to May 2002. Nosocomial infections in the ICUs were identified using the National Nosocomial Infections Surveillance (NNIS) criteria, with prospective surveillance.
  
  
  RESULTS
  We observed 4347 opportunities for hand hygiene in both ICUs. Compliance improved progressively (handwashing adherence, 23.1% (268/1160) to 64.5% (2056/3187) (RR, 2.79; 95% CI: 2.46-3.17; P < .0001). During the same period, overall nosocomial infection in both ICUs decreased from 47.55 per 1000 patient-days (104/2187) to 27.93 per 1000 patient days (207/7409) RR, 0.59; 95% CI: 0.46-0.74, P < .0001).
  
  
  CONCLUSIONS
  A program consisting of focused education and frequent performance feedback produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction in nosocomial infection rates in the ICUs.
authors.affiliation: Section of Infectious Diseases and Hospital Epidemiology, Colegiales Hospital, Buenos Aires, Argentina. victor_rosenthal@fibertel.com.ar
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
authors.forename: Sandra
authors.initials: S
authors.lastname: Guzman
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
mesh_terms: D001118:Argentina / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards; D006282:Health Personnel; D006761:Hospitals; D006801:Humans; D006920:Hygiene; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male