title: A multifaceted approach to education, observation, and feedback in a successful hand hygiene campaign.
abstract: BACKGROUND
  Prevention of health care-associated infections starts with scrupulous hand hygiene (HH). Improving HH compliance is a major target for the World Health Organization Patient Safety Challenge and is one of The Joint Commission's National Patient Safety Goals. Yet, adherence to HH protocols is generally poor for health care professionals, despite interventions designed to improve compliance. At Tufts Medical Center (Boston), HH compliance rates were consistently low despite the presence of a traditional HH campaign that used communication and education.
  
  
  METHODS
  A comprehensive program incorporated strong commitment by hospital leadership-who were actively involved in responsibilities previously only performed by infection preventionists and quality and patient safety staff-dedication of financial resources, including securing a grant; collaborating with a private advertising firm in a marketing campaign; and employing a multifaceted approach to education, observation, and feedback.
  
  
  RESULTS
  This campaign resulted in a rapid and sustained improvement in HH compliance: Compared with the mean HH compliance rate for the six months before the campaign (72%), postcampaign HH compliance (mean = 94%) was significantly greater (p < .0001). Factors contributing to the success of the campaign included the development of the marketing campaign to fit this academic medical center's particular culture, strong support from the medical center leadership, a multifaceted educational approach, and monthly feedback on HH compliance.
  
  
  CONCLUSIONS
  A comprehensive campaign resulted in rapid and sustained improvement in HH compliance at an academic medical center after traditional communication and education strategies failed to improve HH performance.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, USA.
authors.forename: Shira I
authors.initials: SI
authors.lastname: Doron
authors.forename: Kayoko
authors.initials: K
authors.lastname: Kifuji
authors.forename: Brooke Tyson
authors.initials: BT
authors.lastname: Hynes
authors.forename: Dan
authors.initials: D
authors.lastname: Dunlop
authors.forename: Tricia
authors.initials: T
authors.lastname: Lemon
authors.forename: Karen
authors.initials: K
authors.lastname: Hansjosten
authors.forename: Teresa
authors.initials: T
authors.lastname: Cheung
authors.forename: Barbara
authors.initials: B
authors.lastname: Curley
authors.forename: David R
authors.initials: DR
authors.lastname: Snydman
authors.forename: David G
authors.initials: DG
authors.lastname: Fairchild
mesh_terms: D000046:Academic Medical Centers; D019983:Guideline Adherence / Q000458:organization & administration*; D006235:Hand Disinfection / Q000379:methods*; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation