title: Positive deviance: a program for sustained improvement in hand hygiene compliance.
abstract: BACKGROUND
  There is a paucity of data evaluating whether positive deviance (PD) can sustain improvement in hand hygiene compliance.
  
  
  METHODS
  An observational study comparing the effect of PD on compliance with hand hygiene was conducted in two 20-bed step-down units (SDUs) at a private tertiary care hospital. In a 3-month baseline period (April-June 2008), hand hygiene counts were performed by electronic handwashing counters. Between July 1, 2008, and November 30, 2009, (East SDU) and between September 30, 2008, and December 2009 (West SDU), PD was applied in both units.
  
  
  RESULTS
  There was more than a 2-fold difference in the number of alcohol gel aliquots dispensed per month from April 2008 (before PD) to November 2009 (last month in PD) in the East SDU. There was also a 2-fold difference in the number of alcohol gel aliquots dispensed per month from September 2008 (before PD) to December 2009 (last month in PD) in the West SDU. The difference in the rate of health care‒associated infections (HAIs) between the baseline period and 2009 was statistically significant in the East SDU (5.8 vs 2.8 per 1,000 device-days; P = .008) and in the West SDU (3.7 vs 1.7 per 1,000 device-days; P = .023).
  
  
  CONCLUSIONS
  PD was responsible for a sustained improvement in hand hygiene in the inpatient setting and was associated with a decrease in the incidence of device-associated HAIs.
authors.affiliation: Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein 627/701, 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: Miguel Almeida O
authors.initials: MA
authors.lastname: Filho
authors.forename: Claudia Vallone
authors.initials: CV
authors.lastname: Silva
authors.forename: Julia Yaeko
authors.initials: JY
authors.lastname: Kawagoe
authors.forename: Miguel Cendoroglo
authors.initials: MC
authors.lastname: Neto
authors.forename: Oscar Fernando Pavão
authors.initials: OF
authors.lastname: dos Santos
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006235:Hand Disinfection / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*