title: The impact of gown-use requirement on hand hygiene compliance.
abstract: BACKGROUND
  Hand hygiene compliance remains low, despite its effectiveness in preventing infections. Gowns are routinely used to reduce dissemination of organisms within hospitals. Use of gowns is time consuming and costly, and their effectiveness, compared with that of hand hygiene alone, is debated. Among the arguments supporting a gown-use requirement is the potential to boost awareness of infection control, leading to improved hand hygiene compliance.
  
  
  METHODS
  Hand hygiene compliance was recorded in a 14-month crossover trial comparing compliance at 2 intensive care units during periods with and without a gown-use requirement.
  
  
  RESULTS
  During 170 h of observation, 1619 hand hygiene opportunities were recorded. Compliance was 10% before care was given and 36% after care was given. Compliance with glove and gown use was 62% and 63%, respectively. After-care hand hygiene compliance for nurses, physicians, and therapists was 40%, 38%, and 22%, respectively. Compliance after patient contact, body fluid contact, and other in-room activity was 42%, 48%, and 22%, respectively. For periods with and without a gown-use requirement, overall after-care compliance (37% vs. 34%) and rates by personnel and activity type were similar. In the subgroup of patients on contact precautions, hand hygiene compliance during the period with a gown-use requirement versus the period without a gown-use requirement was 11% versus 10% (P=.85) before care was given and 45% versus 39% (P=.09) after care was given. In this subgroup, after adjustment for type of in-room activity, medical personnel, intensive care unit, and observer, the predicted after-care hand hygiene compliance during periods with and without a gown-use requirement was 48% versus 41% (P=.02).
  
  
  CONCLUSIONS
  The hypothesis that a gown-use requirement might improve hand hygiene compliance in the intensive care unit could not be confirmed. In the subgroup of patients on contact precautions, improvement in hand hygiene compliance associated with the gown-use requirement was small and did not affect precare rates.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts-New England Medical Center, Boston, MA 02111, USA. ygolan@tufts-nemc.org
authors.forename: Yoav
authors.initials: Y
authors.lastname: Golan
authors.forename: Shira
authors.initials: S
authors.lastname: Doron
authors.forename: John
authors.initials: J
authors.lastname: Griffith
authors.forename: Hesham
authors.initials: H
authors.lastname: El Gamal
authors.forename: Maged
authors.initials: M
authors.lastname: Tanios
authors.forename: Keri
authors.initials: K
authors.lastname: Blunt
authors.forename: Laurie
authors.initials: L
authors.lastname: Barefoot
authors.forename: Judy
authors.initials: J
authors.lastname: Bloom
authors.forename: Katelyn
authors.initials: K
authors.lastname: Gamson
authors.forename: Laura K
authors.initials: LK
authors.lastname: Snydman
authors.forename: Karen
authors.initials: K
authors.lastname: Hansjosten
authors.forename: Eldad
authors.initials: E
authors.lastname: Elnekave
authors.forename: Stanley A
authors.initials: SA
authors.lastname: Nasraway
authors.forename: David R
authors.initials: DR
authors.lastname: Snydman
mesh_terms: D019983:Guideline Adherence / Q000592:standards; D006235:Hand Disinfection / Q000592:standards*; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units / Q000592:standards; D015999:Multivariate Analysis; D016017:Odds Ratio; D011481:Protective Clothing / Q000592:standards*