title: Positive deviance: a new strategy for improving hand hygiene compliance.
abstract: OBJECTIVE
  To evaluate the effectiveness of a positive deviance strategy for the improvement of hand hygiene compliance in 2 adult step-down units.
  
  
  METHODS
  A 9-month, controlled trial comparing the effect of positive deviance on compliance with hand hygiene.
  
  
  METHODS
  Two 20-bed step-down units at a tertiary care private hospital.
  
  
  METHODS
  The first phase of our study was a 3-month baseline period (from April to June 2008) in which hand hygiene episodes were counted by use of electronic handwashing counters. From July to September 2008 (ie, the second phase), a positive deviance strategy was implemented in the east unit; the west unit was the control unit. During the period from October to December 2008 (ie, the third phase), positive deviance was applied in both units.
  
  
  RESULTS
  During the first phase, there was no statistically significant difference between the 2 step-down units in the number of episodes of hand hygiene per 1,000 patient-days or in the incidence density of healthcare-associated infections (HAIs) per 1,000 patient-days. During the second phase, there were 62,000 hand hygiene episodes per 1,000 patient-days in the east unit and 33,570 hand hygiene episodes per 1,000 patient-days in the west unit (P < .01 ). The incidence density of HAIs per 1,000 patient-days was 6.5 in the east unit and 12.7 in the west unit (p = .04). During the third phase, there was no statistically significant difference in hand hygiene episodes per 1,000 patient-days (P = .16) or in incidence density of HAIs per 1,000 patient-days.
  
  
  CONCLUSIONS
  A positive deviance strategy yielded a significant improvement in hand hygiene, which was associated with a decrease in the overall incidence of HAIs.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil. alexmarra@einstein.br
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Marra
authors.forename: Luciana Reis
authors.initials: LR
authors.lastname: Guastelli
authors.forename: Carla Manuela Pereira
authors.initials: CM
authors.lastname: de Araújo
authors.forename: Jorge L Saraiva
authors.initials: JL
authors.lastname: dos Santos
authors.forename: Luiz Carlos R
authors.initials: LC
authors.lastname: Lamblet
authors.forename: Moacyr
authors.initials: M
authors.lastname: Silva
authors.forename: Gisele
authors.initials: G
authors.lastname: de Lima
authors.forename: Ruy Guilherme Rodrigues
authors.initials: RG
authors.lastname: Cal
authors.forename: Angela Tavares
authors.initials: AT
authors.lastname: Paes
authors.forename: Miguel
authors.initials: M
authors.lastname: Cendoroglo Neto
authors.forename: Luciana
authors.initials: L
authors.lastname: Barbosa
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
mesh_terms: D000328:Adult; D000438:Alcohols / Q000627:therapeutic use; D002710:Chlorhexidine / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000379:methods*; D006757:Hospital Units; D006801:Humans; D006920:Hygiene; D015994:Incidence; D007902:Length of Stay; D009726:Nurses; D010564:Personnel, Hospital / Q000523:psychology; D011364:Professional Practice
chemical_list: D000438:Alcohols; D002710:Chlorhexidine