title: A multicenter study using positive deviance for improving hand hygiene compliance.
abstract: BACKGROUND
  Positive deviance (PD) can be a strategy for the improvement of hand hygiene (HH) compliance.
  
  
  METHODS
  This study was conducted in 8 intensive care units and 1 ward at 7 tertiary care, private, and public hospitals. Phase 1 was a 3-month baseline period (from August to October 2011) in which HH counts were performed by observers using iPods (iScrub program). From November 2011 to July 2012, phase 2, a PD intervention was performed in all the participating centers. We evaluated the consumption of HH products (alcohol gel and chlorhexidine) and the incidence density of health care-associated infections.
  
  
  RESULTS
  There was a total of 5,791 HH observations in the preintervention phase and 11,724 HH observations in the intervention phase (PD). A statistically significant difference was found in overall HH compliance with 46.5% in the preintervention phase and 62.0% in the PD phase (P < .001). There was a statistically significant reduction in the incidence of density of device-associated infections per 1,000 patient-days and also in the median of length of stay between the preintervention phase and the PD phase (13.2 vs 7.5 per 1,000 patient-days, respectively, P = .039; and 11.0 vs 6.8 days, respectively, P < .001, respectively).
  
  
  CONCLUSIONS
  PD demonstrated great promise for improving HH in multiple inpatient settings and was associated with a decrease in the median length of stay and the incidence of device-associated HAIs.
authors: Hospital Israelita Albert Einstein, São Paulo, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil. Electronic address: alexandre.marra@einstein.br.
authors: Alexandre R
authors: AR
authors: Marra
authors: Danilo Teixeira
authors: DT
authors: Noritomi
authors: Adilson J
authors: AJ
authors: Westheimer Cavalcante
authors: Thiago Zinsly
authors: TZ
authors: Sampaio Camargo
authors: Renata Puzzo
authors: RP
authors: Bortoleto
authors: Marcelino Souza
authors: MS
authors: Durao Junior
authors: Anucha
authors: A
authors: Apisarnthanarak
authors: Claudia
authors: C
authors: Laselva
authors: Walace
authors: W
authors: de Souza Pimentel
authors: Leonardo Jose
authors: LJ
authors: Rolim Ferraz
authors: Maria
authors: M
authors: Fátima dos Santos Cardoso
authors: Elivane
authors: E
authors: da Silva Victor
authors: Oscar Fernando
authors: OF
authors: Pavão dos Santos
authors: Miguel Cendoroglo
authors: MC
authors: Neto
authors: Michael B
authors: MB
authors: Edmond
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D019983:Guideline Adherence; D063373:Hand Hygiene; D006761:Hospitals; D006801:Humans
keywords: Health care-associated infection; Safety patient