title: Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 3 cities in Brazil.
abstract: BACKGROUND
  Hand hygiene (HH) is the main tool for cross-infection prevention, but adherence to guidelines is low in limited-resource countries, and there are not available published data from Brazil.
  
  
  METHODS
  This is an observational, prospective, interventional, before-and-after study conducted in 4 intensive care units in 4 hospitals, which are members of the International Nosocomial Infection Control Consortium (INICC), from June 2006-April 2008. The study was divided into a 3-month baseline period and a follow-up period. A multidimensional HH approach was introduced, which included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. Health care workers were observed for HH practices in each intensive care unit during randomly selected 30-minute periods.
  
  
  RESULTS
  We recorded 4,837 opportunities for HH, with an overall HH compliance that increased from 27%-58% (P < .01). Multivariate analysis showed that some variables were associated with poor HH compliance: men versus women (49% vs 38%, P < .001), nurses versus doctors (55% vs 48%, P < .02), among others.
  
  
  CONCLUSIONS
  With the implementation of the INICC approach, adherence to HH was significantly increased. Programs should be aimed at improving HH in variables found to be predictors of poor HH compliance.
authors.affiliation: Hospital São Paulo, São Paulo, Brazil.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Medeiros
authors.affiliation: Hospital General Porto Alegre, Porto Alegre, Brazil; Hospital Sao Miguel, Joaçaba, Brazil; Hospital Universitario Santa Terezinha, Joaçaba, Brazil.
authors.forename: Gorki
authors.initials: G
authors.lastname: Grinberg
authors.affiliation: International Nosocomial Infection Control Consortium, Buenos Aires, Argentina. Electronic address: victor_rosenthal@inicc.org.
authors.forename: Victor D
authors.initials: VD
authors.lastname: Rosenthal
authors.affiliation: Hospital São Paulo, São Paulo, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Bicudo Angelieri
authors.affiliation: Hospital General Porto Alegre, Porto Alegre, Brazil.
authors.forename: Iselde
authors.initials: I
authors.lastname: Buchner Ferreira
authors.affiliation: Hospital General Porto Alegre, Porto Alegre, Brazil.
authors.forename: Raquel
authors.initials: R
authors.lastname: Bauer Cechinel
authors.affiliation: Hospital Sao Miguel, Joaçaba, Brazil.
authors.forename: Bruna Boaria
authors.initials: BB
authors.lastname: Zanandrea
authors.affiliation: Hospital Sao Miguel, Joaçaba, Brazil.
authors.forename: Carolina
authors.initials: C
authors.lastname: Rohnkohl
authors.affiliation: Hospital Sao Miguel, Joaçaba, Brazil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Regalin
authors.affiliation: Hospital Universitario Santa Terezinha, Joaçaba, Brazil.
authors.forename: Jamile Leda
authors.initials: JL
authors.lastname: Spessatto
authors.affiliation: Hospital Universitario Santa Terezinha, Joaçaba, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Scopel Pasini
authors.affiliation: Hospital Universitario Santa Terezinha, Joaçaba, Brazil.
authors.forename: Shaline
authors.initials: S
authors.lastname: Ferla
mesh_terms: D001521:Behavior Therapy; D001938:Brazil / Q000453:epidemiology; D002947:Cities; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000379:methods*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Developing countries; Hand hygiene; Hand washing; Intensive care unit; Multidimensional approach