title: Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance.
abstract: OBJECTIVE
  To determine whether a multimodal intervention could improve adherence to hand hygiene and glove use recommendations and decrease the incidence of antimicrobial resistance in different types of healthcare facilities.
  
  
  METHODS
  Prospective, observational study performed from October 1, 1999, through December 31, 2002. We monitored adherence to hand hygiene and glove use recommendations and the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures. We evaluated trends in and predictors for adherence and preferential use of alcohol-based hand rubs, using multivariable analyses.
  
  
  METHODS
  Three intervention hospitals (a 660-bed acute and long-term care hospital, a 120-bed community hospital, and a 600-bed public teaching hospital) and a control hospital (a 700-bed university teaching hospital).Intervention. At the intervention hospitals, we introduced or increased the availability of alcohol-based hand rub, initiated an interactive education program, and developed a poster campaign; at the control hospital, we only increased the availability of alcohol-based hand rub.
  
  
  RESULTS
  We observed 6,948 hand hygiene opportunities. The frequency of hand hygiene performance or glove use significantly increased during the study period at the intervention hospitals but not at the control hospital; the maximum quarterly frequency of hand hygiene performance or glove use at intervention hospitals (74%, 80%, and 77%) was higher than that at the control hospital (59%). By multivariable analysis, preferential use of alcohol-based hand rubs rather than soap and water for hand hygiene was more likely among workers at intervention hospitals compared with nonintervention hospitals (adjusted odds ratio, 4.6 [95% confidence interval, 3.3-6.4]) and more likely among physicians (adjusted odds ratio, 1.4 [95% confidence interval, 1.2-1.8]) than among nurses at intervention hospitals. A significantly reduced incidence of antimicrobial-resistant bacteria among isolates from clinical culture was found at a single intervention hospital, which had the greatest increase in the frequency of hand hygiene performance.
  
  
  CONCLUSIONS
  During a 3-year period, a multimodal intervention program increased adherence to hand hygiene recommendations, especially to the use of alcohol-based hand rubs. In one hospital, a concomitant reduction was found in the incidence of antimicrobial-resistant bacteria among isolates from clinical cultures.
authors.affiliation: Collaborative Research Unit, Department of Medicine, Stroger Hospital of Cook County, Chicago, IL 60612, USA. wtrick@cchil.org
authors.forename: William E
authors.initials: WE
authors.lastname: Trick
authors.forename: Michael O
authors.initials: MO
authors.lastname: Vernon
authors.forename: Sharon F
authors.initials: SF
authors.lastname: Welbel
authors.forename: Patricia
authors.initials: P
authors.lastname: Demarais
authors.forename: Mary K
authors.initials: MK
authors.lastname: Hayden
authors.forename: Robert A
authors.initials: RA
authors.lastname: Weinstein
mesh_terms: D000438:Alcohols / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D017575:Gloves, Protective / Q000706:statistics & numerical data*; D006090:Gram-Negative Bacteria / Q000187:drug effects; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology; D006095:Gram-Positive Cocci / Q000187:drug effects; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards; D006739:Hospital Administration; D006801:Humans; D015994:Incidence; D010564:Personnel, Hospital / Q000193:education* / Q000592:standards; D015397:Program Evaluation; D012915:Soaps / Q000008:administration & dosage
chemical_list: D000438:Alcohols; D012915:Soaps