title: Observation-based evaluation of hand hygiene practices and the effects of an intervention at a public hospital cafeteria.
abstract: BACKGROUND
  Hand hygiene is important before meals, especially in a hospital cafeteria where patrons may have had recent contact with infectious agents. Few interventions to improve hand hygiene have had measureable success. This study was designed to use a poster intervention to encourage hand hygiene among health care workers (HCWs) and hospital visitors (HVs) upon entry to a hospital cafeteria.
  
  
  METHODS
  Over a 5-week period, a poster intervention with an accessible hand sanitizer unit was deployed to improve hand hygiene in a hospital cafeteria. The dependent variable observed was hand hygiene attempts. Study phases included a baseline, intervention, and follow-up phase, with each consisting of 3 randomized days of observation for 3 hours during lunch.
  
  
  RESULTS
  During the 27 hours of observation, 5,551 participants were observed, and overall hand hygiene frequency was 4.79%. Hygiene attempts occurred more frequently by HCWs than HVs (P = .0008) and females than males (P = .0281). Hygiene attempts occurred more frequently after poster introduction than baseline (P = .0050), and this improvement was because of an increase in frequency of HV hand hygiene rather than HCW hand hygiene.
  
  
  CONCLUSIONS
  The poster intervention tool with easily accessible hand sanitizer can improve overall hand hygiene performance in a US hospital cafeteria.
authors.affiliation: Department of Diagnostic Medicine/Pathobiology, Kansas State University, Manhattan, KS, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Filion
authors.forename: Kate S
authors.initials: KS
authors.lastname: Kukanich
authors.forename: Ben
authors.initials: B
authors.lastname: Chapman
authors.forename: Megan K
authors.initials: MK
authors.lastname: Hardigree
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Powell
mesh_terms: D004501:Education, Medical / Q000379:methods; D005260:Female; D006235:Hand Disinfection / Q000379:methods*; D006779:Hospitals, Public; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D012499:Sanitation / Q000379:methods*; D014481:United States