title: The impact of the International Nosocomial Infection Control Consortium (INICC) multicenter, multidimensional hand hygiene approach in two cities of India.
abstract: The fundamental tool for preventing and controlling healthcare-acquired infections is hand hygiene (HH). Nonetheless, adherence to HH guidelines is often low. Our goal was to assess the effect of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach (IMHHA) in three intensive care units of three INICC member hospitals in two cities of India and to analyze the predictors of compliance with HH. From August 2004 to July 2011, we carried out an observational, prospective, interventional study to evaluate the implementation of the IMHHA, which included the following elements: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance and (6) performance feedback. The practices of health care workers were monitored during randomly selected 30-min periods. We observed 3612 opportunities for HH. Overall adherence to HH increased from 36.9% to 82% (95% CI 79.3-84.5; P=0.0001). Multivariate analysis indicated that certain variables were significantly associated with poor HH adherence: nurses vs. physicians (70.5% vs. 74%; 95% CI 0.62-0.96; P=0.018), ancillary staff vs. physicians (43.6% vs. 74.0%; 95% CI 0.48-0.72; P<0.001), ancillary staff vs. nurses (43.6% vs. 70.5%; 95% CI 0.51-0.75; P<0.001) and private vs. academic hospitals (74.2% vs. 66.3%; 95% CI 0.83-0.97; P<0.001). It is worth noticing that in India, the HH compliance of physicians is higher than in nurses. Adherence to HH was significantly increased by implementing the IMHHA. Programs targeted at improving HH are warranted to identify predictors of poor compliance.
authors.affiliation: Fortis Hospitals, Bangalore, India.
authors.forename: Murali
authors.initials: M
authors.lastname: Chakravarthy
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Sheila Nainan
authors.initials: SN
authors.lastname: Myatra
authors.affiliation: International Nosocomial Infection Control Consortium (INICC), Buenos Aires, Argentina(1). Electronic address: victor_rosenthal@inicc.org.
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
authors.affiliation: Breach Candy Hospital Trust, Mumbai, India.
authors.forename: F E
authors.initials: FE
authors.lastname: Udwadia
authors.affiliation: Fortis Hospitals, Bangalore, India.
authors.forename: B N
authors.initials: BN
authors.lastname: Gokul
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: J V
authors.initials: JV
authors.lastname: Divatia
authors.affiliation: Breach Candy Hospital Trust, Mumbai, India.
authors.forename: Aruna
authors.initials: A
authors.lastname: Poojary
authors.affiliation: Fortis Hospitals, Bangalore, India.
authors.forename: R
authors.initials: R
authors.lastname: Sukanya
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Rohini
authors.initials: R
authors.lastname: Kelkar
authors.affiliation: Breach Candy Hospital Trust, Mumbai, India.
authors.forename: Geeta
authors.initials: G
authors.lastname: Koppikar
authors.affiliation: Fortis Hospitals, Bangalore, India.
authors.forename: Leema
authors.initials: L
authors.lastname: Pushparaj
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Biswas
authors.affiliation: Breach Candy Hospital Trust, Mumbai, India.
authors.forename: Lata
authors.initials: L
authors.lastname: Bhandarkar
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Sandhya
authors.initials: S
authors.lastname: Raut
authors.affiliation: Breach Candy Hospital Trust, Mumbai, India.
authors.forename: Shital
authors.initials: S
authors.lastname: Jadhav
authors.affiliation: Tata Memorial Hospital, Mumbai, India.
authors.forename: Sulochana
authors.initials: S
authors.lastname: Sampat
authors.affiliation: Breach Candy Hospital Trust, Mumbai, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chavan
authors.affiliation: Breach Candy Hospital Trust, Mumbai, India.
authors.forename: Shweta
authors.initials: S
authors.lastname: Bahirune
authors.affiliation: Breach Candy Hospital Trust, Mumbai, India.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Durgad
mesh_terms: D001521:Behavior Therapy / Q000379:methods; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D003906:Developing Countries; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene; D006282:Health Personnel; D006801:Humans; D007194:India; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies
keywords: Care; Developing countries; Hand hygiene; Hand washing; Healthcare workers; India; Infection control; Intensive care units; International Nosocomial Infection Control Consortium; Multidimensional approach