title: Strategies to improve hand hygiene practices in two university hospitals.
abstract: OBJECTIVE
  To evaluate the strategies to improve hand hygiene practices among participants in two university hospitals.
  
  
  METHODS
  A quasi-experimental study was performed from January 1, 2001 to December 31, 2004 at Siriraj Hospital and from January 1, 2004 to July 31, 2004 at the neonatal intensive care unit (NICU), Maharaj Nakorn Chiang Mai Hospital. The study was divided into three phases; 1) pre-intervention phase to identify factors associated with non-adherence in hand hygiene practices among participants, 2) intervention phase, 3) post-intervention phase to include observations to evaluate the effectiveness of interventions on hand hygiene practices among participants. Interventions at Siriraj Hospital included distribution of posters, leaflets, rewarding healthcare workers (HCWs) who suggest the most attractive name for alcohol gel and a handwashing slogan, and a parade to boost hand hygiene practice. Interventions at Maharaj Nakorn Chiang Mai Hospital included training, a reminder poster display, provision of alcohol-based handrubs and performance feedback.
  
  
  RESULTS
  Six hundred and forty-six HCWs were observed before and after the non-invasive procedures and 404 HCWs were observed before and after an invasive procedure at Siriraj Hospital. At Maharaj Nakorn Chiang Mai Hospital, participants included 26 nursing personnel in the NICU. After intervention, significant improvement on handwashing was observed in both the invasive procedure (p<0.001) and non-invasive procedures (p<0.001) at Siriraj Hosptial. Significant improvement on handhygiene practice was also observed among participants at Maharaj Nakorn Chiang Mai Hosptial (p=0.001).
  
  
  CONCLUSIONS
  Different strategies worked well in different institutions. The present study suggested the role of multi-faceted approaches to help improve handhygiene practices among HCWs.
authors.affiliation: Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok. sisdc@mahidol.ac.th
authors.forename: Somwang
authors.initials: S
authors.lastname: Danchaivijitr
authors.forename: Wilawan
authors.initials: W
authors.lastname: Pichiensatian
authors.forename: Anucha
authors.initials: A
authors.lastname: Apisarnthanarak
authors.forename: Kanchana
authors.initials: K
authors.lastname: Kachintorn
authors.forename: Rachada
authors.initials: R
authors.lastname: Cherdrungsi
mesh_terms: D000328:Adult; D004649:Employee Incentive Plans; D019983:Guideline Adherence; D006225:Hand / Q000382:microbiology*; D006235:Hand Disinfection / Q000592:standards*; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D006920:Hygiene; D017053:Infection Control / Q000458:organization & administration* / Q000592:standards; D007318:Inservice Training; D007363:Intensive Care Units, Neonatal; D008875:Middle Aged; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*