title: Positive deviance: using a nurse call system to evaluate hand hygiene practices.
abstract: BACKGROUND
  Many approaches have been taken to increase compliance with hand hygiene by health care professionals. We evaluated a nurse call system used as a tool in a positive deviance (PD) approach to improving compliance.
  
  
  METHODS
  We conducted a quasi-experimental study between September 2008 and December 2010 in 2 step-down units (SDUs). The consumption of alcohol-based sanitizers for hand hygiene was monitored by electronic handwash counters installed in each room as of January 2009. The number of nurse visits to patient rooms was measured by the nurse call system, which provides information on each instance of nursing care provided to the patients.
  
  
  RESULTS
  The use of alcohol hand rubs was increased in both units after implementation of the PD approach, with higher rates sustained for more than 2 years. The rate of device-related infections showed a decreasing trend, especially for catheter-associated urinary infection in the east SDU. In both units, the ratio of alcohol hand rub uses to nurse visits was >2.5, indicating increased use of alcohol rubs, especially in the east SDU, which had a ratio of 3 for 2010.
  
  
  CONCLUSIONS
  The PD approach to hand hygiene produced increased compliance, as measured by increased consumption of alcohol hand sanitizer, an improved ratio of alcohol hand rub uses to nurse visits, and a reduced rate of device-related infections, with results sustained over 2 years.
authors.affiliation: Intensive Care Unit, Albert Einstein Hospital, São Paulo, Brazil. cassia@einstein.br
authors.forename: Rita de Cássia Ribeiro de
authors.initials: Rde C
authors.lastname: Macedo
authors.forename: Eloísa Martins Oliveira
authors.initials: EM
authors.lastname: Jacob
authors.forename: Vanessa Pio da
authors.initials: VP
authors.lastname: Silva
authors.forename: Edson Américo
authors.initials: EA
authors.lastname: Santana
authors.forename: Antonio Ferreira de
authors.initials: AF
authors.lastname: Souza
authors.forename: Priscila
authors.initials: P
authors.lastname: Gonçalves
authors.forename: Alexandre Rodrigues
authors.initials: AR
authors.lastname: Marra
authors.forename: Oscar Fernando Pavão dos
authors.initials: OF
authors.lastname: Santos
authors.forename: Miguel
authors.initials: M
authors.lastname: Cendoroglo
authors.forename: Michael B
authors.initials: MB
authors.lastname: Edmond
mesh_terms: D000438:Alcohols / Q000008:administration & dosage; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D004202:Disinfectants / Q000008:administration & dosage; D004363:Drug Utilization / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000592:standards*; D063373:Hand Hygiene / Q000379:methods* / Q000592:standards*; D006801:Humans; D009726:Nurses
chemical_list: D000438:Alcohols; D004202:Disinfectants