title: Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial.
abstract: OBJECTIVE
  To determine the effectiveness of World Health Organization (WHO) multimodal strategy in promoting hand hygiene (HH) among healthcare workers (HCWs) in long-term care facilities (LTCFs).
  
  
  METHODS
  Cluster-randomized controlled trial.
  
  
  METHODS
  Eighteen homes for the elderly in Hong Kong were randomly allocated to 2 intervention arms and a control arm. Direct observation of HH practice was conducted by trained nurses. Either handrubbing with alcohol-based handrub (ABHR) or handwashing with liquid soap and water was counted as a compliant action. Disease notification data during 2007-2010 were used to calculate incidence rate ratio (IRR).
  
  
  METHODS
  Managers and HCWs of the participating homes.
  
  
  METHODS
  The WHO multimodal strategy was employed. All intervention homes were supplied with ABHR (WHO formulation I), ABHR racks, pull reels, HH posters and reminders, a health talk, video clips, training materials, and performance feedback. The only difference was that intervention arms 1 and 2 were provided with slightly powdered and powderless gloves, respectively.
  
  
  RESULTS
  A total of 11,669 HH opportunities were observed. HH compliance increased from 27.0% to 60.6% and from 22.2% to 48.6% in intervention arms 1 and 2, respectively. Both intervention arms showed increased HH compliance after intervention compared to controls, at 21.6% compliance (both [Formula: see text]). Provision of slightly powdered versus powderless gloves did not have any significant impact on ABHR usage. Respiratory outbreaks (IRR, 0.12; 95% confidence interval [CI], 0.01-0.93; [Formula: see text]) and methicillin-resistant Staphylococcus aureus infections requiring hospital admission (IRR, 0.61; 95% CI, 0.38-0.97; [Formula: see text]) were reduced after intervention.
  
  
  CONCLUSIONS
  A promotion program applying the WHO multimodal strategy was effective in improving HH among HCWs in LTCFs.
authors: Infection Control Branch, Centre for Health Protection, Hong Kong Special Administrative Region (SAR), China. smo_icb3@dh.gov.hk
authors: Mei-lin
authors: ML
authors: Ho
authors: Wing-hong
authors: WH
authors: Seto
authors: Lai-chin
authors: LC
authors: Wong
authors: Tin-yau
authors: TY
authors: Wong
mesh_terms: D000328:Adult; D000891:Anti-Infective Agents, Local; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000517:prevention & control; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006235:Hand Disinfection / Q000379:methods* / Q000592:standards*; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006707:Homes for the Aged / Q000592:standards*; D006723:Hong Kong; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006920:Hygiene / Q000592:standards; D008134:Long-Term Care; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D015397:Program Evaluation; D012141:Respiratory Tract Infections / Q000517:prevention & control; D013203:Staphylococcal Infections / Q000382:microbiology / Q000517:prevention & control; D018709:Statistics, Nonparametric; D014944:World Health Organization; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local