title: Cross-sectional survey of hand-hygiene compliance and attitudes of health care workers and visitors in the intensive care units at King Chulalongkorn Memorial Hospital.
abstract: BACKGROUND
  Hand hygiene is the most important and effective measure to prevent cross-infection in hospitals. Hand-hygiene campaign must be implemented as a part of infection control program at King Chulalongkorn Memorial Hospital (KCMH). The behavior attitudes, and beliefs of health care workers (HCWs) and visitors regarding hand-hygiene practices have never been studied in KCMH.
  
  
  OBJECTIVE
  To determine the baseline compliance and assess the attitudes and beliefs regarding hand hygiene of HCWs and visitors in intensive care units (ICUs) at KCMH.
  
  
  METHODS
  We observed hand-hygiene compliance of HCWs and visitors in ICUs before patient contact for eight hours. A self-administered questionnaire was employed to measure attitudes and beliefs about hand hygiene for two-week period.
  
  
  RESULTS
  Overall hand-hygiene compliance obtained from this observational study was less than 50% and differed markedly among various professional categories of HCWs and visitors. In questionnaire-based study, patient needs perceived as a priority (51.2%) was the most common reason for non-compliance, followed by forgetfulness (35.7%), and skin irritation by hand-hygiene agents (15.5%). Subjects believed to improve their compliance by multiple strategies including available low irritating hand-hygiene agents (53.4%), information of current nosocomial infection rate (49.1%), and easily accessed hand-hygiene supplies (46.3%). Almost all subjects (99.7%) claimed to know correct hand-hygiene techniques. Handwashing with medicated soap was perceived to be the best mean of hand decontamination (37.8%).
  
  
  CONCLUSIONS
  Hand-hygiene compliance of HCWs and visitors is unacceptably low. Their knowledge, behavior attitudes, and beliefs toward hand hygiene need to be improved by the multimodal and multidisciplinary approach.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Kanitha
authors.initials: K
authors.lastname: Patarakul
authors.forename: Auchana
authors.initials: A
authors.lastname: Tan-Khum
authors.forename: Suthada
authors.initials: S
authors.lastname: Kanha
authors.forename: Darunee
authors.initials: D
authors.lastname: Padungpean
authors.forename: Ong-Orn
authors.initials: OO
authors.lastname: Jaichaiyapum
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D019983:Guideline Adherence; D006235:Hand Disinfection; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006920:Hygiene; D017053:Infection Control / Q000379:methods*; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control; D007362:Intensive Care Units / Q000592:standards*; D010564:Personnel, Hospital / Q000523:psychology*; D011795:Surveys and Questionnaires; D013785:Thailand; D014789:Visitors to Patients / Q000523:psychology*