title: Efficacy of a multimodal intervention strategy in improving hand hygiene compliance in a tertiary level intensive care unit.
abstract: BACKGROUND
  The role of hand hygiene in preventing health care associated infections (HCAIs) has been clearly established. However, compliance rates remain poor among health care personnel.
  
  
  OBJECTIVE
  a) To investigate the health care workers' hand hygiene compliance rates in the intensive care unit (ICU), b) to assess reasons for non-compliance and c) to study the efficacy of a multimodal intervention strategy at improving compliance.
  
  
  METHODS
  A mixed medical-surgical ICU of a tertiary level hospital.
  
  
  METHODS
  A before-after prospective, observational, intervention study.
  
  
  METHODS
  All health care personnel who came in contact with patients in the ICU were observed for their hand hygiene compliance before and after a multimodal intervention strategy (education, posters, verbal reminders and easy availability of products). A self-report questionnaire was also circulated to assess perceptions regarding compliance. Statistical analysis was done using χ(2) test or Fisher exact test (Epi info software).
  
  
  RESULTS
  Hand hygiene compliance among medical personnel working in the ICU was 26% and the most common reason cited for non-compliance was lack of time (37%). The overall compliance improved significantly following the intervention to 57.36% (P<0.000). All health care worker groups showed significant improvements: staff nurses (21.48-61.59%, P<0.0000), nursing students (9.86-33.33%, P<0.0000), resident trainees (21.62-60.71%, P<0.0000), visiting consultants (22-57.14%, P=0.0001), physiotherapists (70-75.95%, P=0.413) and paramedical staff (10.71-55.45%, P< 0.0000).
  
  
  CONCLUSIONS
  Hand hygiene compliance among health care workers in the ICU is poor; however, intervention strategies, such as the one used, can be useful in improving the compliance rates significantly.
authors.affiliation: Department of Anaesthesiolgy and Critical Care, Christian Medical College, Ludhiana, Punjab, India.
authors.forename: Ashu S
authors.initials: AS
authors.lastname: Mathai
authors.forename: Smitha E
authors.initials: SE
authors.lastname: George
authors.forename: John
authors.initials: J
authors.lastname: Abraham