title: Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach over 13 years in 51 cities of 19 limited-resource countries from Latin America, Asia, the Middle East, and Europe.
abstract: OBJECTIVE
  To assess the feasibility and effectiveness of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 19 limited-resource countries and to analyze predictors of poor hand hygiene compliance.
  
  
  METHODS
  An observational, prospective, cohort, interventional, before-and-after study from April 1999 through December 2011. The study was divided into 2 periods: a 3-month baseline period and a 7-year follow-up period.
  
  
  METHODS
  Ninety-nine intensive care unit (ICU) members of the INICC in Argentina, Brazil, China, Colombia, Costa Rica, Cuba, El Salvador, Greece, India, Lebanon, Lithuania, Macedonia, Mexico, Pakistan, Panama, Peru, Philippines, Poland, and Turkey.
  
  
  METHODS
  Healthcare workers at 99 ICU members of the INICC.
  
  
  METHODS
  A multidimensional hand hygiene approach was used, including (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance, and (6) performance feedback. Observations were made for hand hygiene compliance in each ICU, during randomly selected 30-minute periods.
  
  
  RESULTS
  A total of 149,727 opportunities for hand hygiene were observed. Overall hand hygiene compliance increased from 48.3% to 71.4% ([Formula: see text]). Univariate analysis indicated that several variables were significantly associated with poor hand hygiene compliance, including males versus females (63% vs 70%; [Formula: see text]), physicians versus nurses (62% vs 72%; [Formula: see text]), and adult versus neonatal ICUs (67% vs 81%; [Formula: see text]), among others.
  
  
  CONCLUSIONS
  Adherence to hand hygiene increased by 48% with the INICC approach. Specific programs directed to improve hand hygiene for variables found to be predictors of poor hand hygiene compliance should be implemented.
authors: International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. victor_rosenthal@inicc.org
authors: Victor D
authors: VD
authors: Rosenthal
authors: Mandakini
authors: M
authors: Pawar
authors: Hakan
authors: H
authors: Leblebicioglu
authors: Josephine Anne
authors: JA
authors: Navoa-Ng
authors: Wilmer
authors: W
authors: Villamil-Gómez
authors: Alberto
authors: A
authors: Armas-Ruiz
authors: Luis E
authors: LE
authors: Cuéllar
authors: Eduardo A
authors: EA
authors: Medeiros
authors: Zan
authors: Z
authors: Mitrev
authors: Achilleas
authors: A
authors: Gikas
authors: Yun
authors: Y
authors: Yang
authors: Altaf
authors: A
authors: Ahmed
authors: Souha S
authors: SS
authors: Kanj
authors: Lourdes
authors: L
authors: Dueñas
authors: Vaidotas
authors: V
authors: Gurskis
authors: Trudell
authors: T
authors: Mapp
authors: Humberto
authors: H
authors: Guanche-Garcell
authors: Rosalía
authors: R
authors: Fernández-Hidalgo
authors: Andrzej
authors: A
authors: Kübler
mesh_terms: D000328:Adult; D001208:Asia; D002648:Child; D003428:Cross Infection / Q000517:prevention & control*; D003906:Developing Countries; D005060:Europe; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D017053:Infection Control / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D007843:Latin America; D016015:Logistic Models; D008297:Male; D008877:Middle East; D015999:Multivariate Analysis; D010564:Personnel, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies