title: Behavior-based interventions to improve hand hygiene adherence among intensive care unit healthcare workers in Thailand.
abstract: OBJECTIVE
  To evaluate behavioral-based interventions to improve hand hygiene (HH) among healthcare workers (HCWs) at a Thai tertiary care center.
  
  
  METHODS
  A quasi-experimental study was performed in 6 intensive care units with computer-generated allocation. Baseline demographic characteristics, self-reported stage of HH behavioral commitment, and observed HH adherence were examined from January 1, 2012, through December 31, 2012 (preintervention), and from January 1, 2013, through December 31, 2013 (postintervention). Self-reported HH was categorized by the stages construct from the Transtheoretical Model of Health Behavior Change. The intensive care unit group randomization was to either standard-of-care HH education every 3 months (S1), intensified HH interventions (S2), or intensified HH interventions plus increased availability of alcohol-based handrub throughout the unit (S3).
  
  
  RESULTS
  Among 125 HCWs from 6 intensive care units (42 in S1, 41 in S2, 42 in S3) there were 1,936 total HH observations; most HCWs (100 [ 80%]) were nurses or nurse assistants. Compared with preintervention, overall postintervention HH adherence improved in HCWs assigned to S2 (65% vs 85%; P=.02) and S3 (66% vs 95%; P=.005) but not S1 (68% vs 71%; P=.84). Improvement in HH adherence was demonstrated among HCWs who reported lower stages of HH commitment in S2 (21% vs 84%; P<.001) and S3 (24% vs 89%; P<.001) and in HCWs who self-reported higher stages of commitment in S3 (78% vs 96%; P<.001).
  
  
  CONCLUSIONS
  HCW HH programs may benefit from stage-based tailored strategies to promote sustained HH adherence.
authors: 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand.
authors: Anucha
authors: A
authors: Apisarnthanarak
authors: 1Division of Infectious Diseases, Faculty of Medicine,Thammasat University,Pathumthani,Thailand.
authors: Thanee
authors: T
authors: Eiamsitrakoon
authors: 2GlaxoSmithKline,Collegeville,Pennsylvania.
authors: Linda M
authors: LM
authors: Mundy
mesh_terms: D000328:Adult; D005260:Female; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000379:methods* / Q000592:standards; D064548:Hand Sanitizers / Q000600:supply & distribution / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D010564:Personnel, Hospital / Q000193:education / Q000523:psychology / Q000592:standards; D013785:Thailand; D000078329:Workforce; D055815:Young Adult
chemical_list: D064548:Hand Sanitizers