title: Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections.
abstract: BACKGROUND
  Hand hygiene is the single most important intervention to combat infections in any health care setting. However, adherence to hand hygiene practice remains low among health care workers.
  
  
  OBJECTIVE
  Our objective was to assess compliance with hand hygiene over time utilizing a multifaceted approach to hand hygiene. In addition, we assessed the rate of device-associated infections.
  
  
  METHODS
  This is a descriptive time series study with a multitude of interventions from October 2006 to December 2011 set in a 350-bed community hospital in Saudi Arabia. We utilized a multimodal program to promote hand hygiene activities. We also calculated device-associated infection rates as outcome measures.
  
  
  RESULTS
  Over the study, the overall hand hygiene compliance rate increased from a baseline of 38% in second quarter 2006 to 65% in 2010 and then to 85% in 2011 (P < .001). The compliance rates increased among all professions and different hospital units. The compliance rates were 87% for physicians, 89% for nursing staff, and 93% for nutritionist. The rate of health care-associated methicillin-resistant Staphylococcus aureus per 1,000 patient-days decreased from 0.42 in 2006 to 0.08 in 2011. Ventilator-associated infection rates decreased from 6.12 to 0.78, central line-associated bloodstream infections rates decreased from 8.23 to 4.8, and catheter-associated urinary tract infection rates decreased from 7.08 to 3.5.
  
  
  CONCLUSIONS
  This intervention used a multitude of interventions and resulted in an institution-wide increase and sustained improvement in compliance rates.
authors.affiliation: Internal Medicine Unit, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia. jaffar.tawfiq@aramco.com
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Al-Tawfiq
authors.forename: Mahmoud S
authors.initials: MS
authors.lastname: Abed
authors.forename: Nashma
authors.initials: N
authors.lastname: Al-Yami
authors.forename: Richard B
authors.initials: RB
authors.lastname: Birrer
mesh_terms: D003428:Cross Infection / Q000517:prevention & control*; D004865:Equipment and Supplies, Hospital / Q000382:microbiology*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene; D006293:Health Promotion; D006801:Humans; D017053:Infection Control / Q000379:methods*; D055624:Methicillin-Resistant Staphylococcus aureus; D010564:Personnel, Hospital; D017410:Practice Guidelines as Topic; D012529:Saudi Arabia; D013203:Staphylococcal Infections / Q000517:prevention & control; D013996:Time and Motion Studies