A multimodal intervention to improve hand hygiene in ICUs in Buenos Aires, Argentina: a stepped wedge trial.
OBJECTIVE
Hand hygiene is a cost-effective measure to reduce microbial transmission (Teare EL, Cookson B, French GL, et al. UK handwashing initiative. J Hosp Infect. 1999;43:1-3.) and is considered to be the most important measure to prevent healthcare-associated infections (Pittet D, Allegranzi B, Sax H, Evidence-based model for hand transmission during patient care and the role of improved practices. Lancet Infect Dis 2006;6:641-52). Unfortunately, the compliance rate of healthcare workers (HCWs) with recommended hand hygiene procedures is less than expected.


METHODS
In order to estimate the effect of a multimodal intervention on improving healthcare workers' compliance with hand hygiene in eleven intensive care units (ICUs) from 11 hospitals of Buenos Aires, a randomized cluster-stepped wedge trial was designed.
A multimodal intervention was designed based on practices characterized by being evidence-based, low cost and suggested by qualitative research: (i) leadership commitment, (ii) surveillance of materials needed to comply with hand hygiene and alcohol consumption, (iii) utilization of reminders, (iv) a storyboard of the project and (v) feedback (hand hygiene compliance rate).


RESULTS
The study enrolled 705 participants, comprising nurses (66.4%), physicians (25.8%) and other HCW (7.8%) along 9 months of observation. Compliance with hand hygiene in the control group was 66.0% (2354/3565) vs. 75.6% (5190/6864) in the intervention group. Univariate analysis showed an association between the intervention and hand hygiene compliance (odds ratio, OR 1.17; 95% confidence interval (CI), 1.13-1.22). The effect was still present after adjustment by calendar's time and providers' characteristics-age, gender and profession (OR 1.08; 95% CI, 1.03-1.14).


CONCLUSIONS
His study supports that a multimodal intervention was effective to improve compliance with hand hygiene in ICUs.
Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
Viviana
V
Rodriguez
Association of Nurses for Infection Control (ADECI), Buenos Aires, Argentina.
Carolina
C
Giuffre
Association of Nurses for Infection Control (ADECI), Buenos Aires, Argentina.
Silvia
S
Villa
Association of Nurses for Infection Control (ADECI), Buenos Aires, Argentina.
Griselda
G
Almada
Patient Safety Programme, World Health Organization, Geneva, Switzerland.
Nittita
N
Prasopa-Plaizier
Study Center for State and Society (CEDES), Buenos Aires, Argentina.
Monica
M
Gogna
Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
Luz
L
Gibbons
Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
Ezequiel
E
García Elorrio
D001118:Argentina; D003428:Cross Infection / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006235:Hand Disinfection / Q000592:standards; D063373:Hand Hygiene / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D017053:Infection Control / Q000458:organization & administration* / Q000592:standards; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D007857:Leadership; D008297:Male; D010564:Personnel, Hospital
Argentina; WHO; hand hygiene; infection control; intensive care unit; multimodal intervention