title: Compliance with hygiene guidelines: the effect of a multimodal hygiene intervention and validation of direct observations.
abstract: BACKGROUND
  Good compliance with hygiene guidelines is essential to prevent bacterial transmission and health care-associated infections. However, the compliance is usually <50%.
  
  
  METHODS
  A multimodal and multidisciplinary hygiene intervention was launched once the baseline compliance was determined through direct observations in 4 departments of obstetrics and gynecology. Detailed evaluations of the compliance rates were performed at point of stability (at 80%) and follow-up (3 years after hygiene intervention). Validation of direct observations was performed using blinded double appraisal and multiappraisal.
  
  
  RESULTS
  At baseline, the compliance with barrier precautions and the dress code at the 4 departments were 39% to 47% and 79% to 98%, respectively. Point of stability was reached approximately 1 year after the hygiene intervention was launched. The compliance with barrier precautions was significantly higher at follow-up compared with baseline in 3 departments. In the validation by double appraisal, 471 of 483 components were judged identical between observers. In the multiappraisal, 95% to 100% of the observers correctly judged the 7 components.
  
  
  CONCLUSIONS
  It is possible to improve compliance with hygiene guidelines, but, to ensure a long-lasting effect, a continuous focus on barrier precautions is required. Observation is a valid method to monitor compliance.
authors: Clinical Microbiology, Division of Medical Services, Jönköping, Sweden. sara.mernelius@lj.se
authors: Sara
authors: S
authors: Mernelius
authors: Per-Olof
authors: PO
authors: Svensson
authors: Gunhild
authors: G
authors: Rensfeldt
authors: Ewa
authors: E
authors: Davidsson
authors: Barbro
authors: B
authors: Isaksson
authors: Sture
authors: S
authors: Löfgren
authors: Andreas
authors: A
authors: Matussek
mesh_terms: D003428:Cross Infection / Q000517:prevention & control* / Q000635:transmission; D019983:Guideline Adherence; D006235:Hand Disinfection; D006801:Humans; D006920:Hygiene / Q000592:standards*; D017053:Infection Control / Q000379:methods* / Q000592:standards*; D009775:Obstetrics and Gynecology Department, Hospital / Q000592:standards; D010564:Personnel, Hospital / Q000592:standards; D017410:Practice Guidelines as Topic; D011481:Protective Clothing