title: Use of hand hygiene agents as a surrogate marker of compliance in Hungarian long-term care facilities: first nationwide survey.
abstract: BACKGROUND
  Hand hygiene practice is an important measure for preventing infections in long-term care facilities (LTCFs). However, low compliance with hand hygiene has been reported in a number of studies. The purpose of this study was to provide an overview of the first reference data collected on alcohol-based handrub (ABHR) and antiseptic soap consumption, as surrogate markers for hand hygiene compliance by healthcare workers (HCWs) in Hungarian LTCFs. The objective was to inform stakeholders on the need of hand hygiene improvement in these settings.
  
  
  METHODS
  Between 5 May and 30 September 2014, we conducted a nationwide, cross-sectional survey using a standardized self-administered questionnaire; all Hungarian LTCFs were eligible. The Statistical Package for Social Sciences (SPSS) version 20.0 was used for data analysis.
  
  
  RESULTS
  The questionnaire was completed by 354 LTCFs, representing 24 % of all Hungarian LTCFs. In total, the median consumption of ABHR and antimicrobial soap was 15.5 L (IQR, 0-800 L) and 60 L (IQR, 0-1,680 L) per LTCFs, and 2.2 mL (IQR, 0.4-9.1 mL) and 12.1 mL (IQR, 0.7-32.8 mL) per HCWs in 2013, respectively. The estimated number of hand hygiene actions was 0.6 hygienic handrub/HCW per day (IQR, 0-12.8/HCWs) and 2.4 hygienic handwashing/HCW per day (IQR, 0-21.9/HCWs; P = .001), respectively.
  
  
  CONCLUSIONS
  This study suggests that non-compliance with hand hygiene is a significant problem in Hungarian LTCFs. Based on our results, there is an urgent need for a nationwide multimodal hand hygiene promotion strategy including education and performance monitoring and feedback in all LTCFs. Furthermore, monitoring of ABHR consumption constitute an additional component of the existing National Nosocomial Surveillance system.
authors.affiliation: National Center for Epidemiology, Department of Hospital Epidemiology and Hygiene, Albert Flórián út 2-6, Budapest, 1097 Hungary.
authors.forename: Rita
authors.initials: R
authors.lastname: Szabó
authors.affiliation: Semmelweis University, School of PH.D. Studies, Vas utca 17, Budapest, 1088 Hungary.
authors.forename: Júlia
authors.initials: J
authors.lastname: Morvai
authors.affiliation: Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, World Health Organization (WHO) Collaborating Centre on Patient Safety, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205 Switzerland.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bellissimo-Rodrigues
authors.affiliation: Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, World Health Organization (WHO) Collaborating Centre on Patient Safety, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205 Switzerland.
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
keywords: Alcohol-based handrub; Compliance; Hand hygiene; Hungary; Long-term care facilities