title: Improving healthcare worker hand hygiene adherence before patient contact: A multimodal intervention of hand hygiene practice in Three Japanese tertiary care centers.
abstract: BACKGROUND
  Though hand hygiene is an important method of preventing healthcare-associated infection, we found suboptimal hand hygiene adherence among healthcare workers in 4 diverse Japanese hospitals (adherence rates of 11%-25%).
  
  
  OBJECTIVE
  Our goal was to assess multimodal hand hygiene intervention coupled with a contest to improve hand hygiene adherence.
  
  
  METHODS
  A total of 3 to 4 inpatient wards in 3 Japanese hospitals.
  
  
  METHODS
  Pre-post intervention study.
  
  
  METHODS
  The intervention was a multimodal hand hygiene intervention recommended by the World Health Organization that was tailored to each facility. The hospital with the highest adherence after the intervention was given $5000 US dollars and a trophy, provided by an American coinvestigator unaffiliated with any of the Japanese hospitals.
  
  
  METHODS
  We tracked hand hygiene adherence rates before patient contact for each unit and hospital and compared these to pre-intervention adherence rates.
  
  
  RESULTS
  We observed 2982 postintervention provider-patient encounters in 10 units across 3 hospitals. Hand hygiene adherence rates were improved overall after the intervention (18% pre- to 33% postintervention; P < 0.001), but postintervention adherence rates varied considerably: hospital A + 29%, B + 5%, C + 8%. Hospital A won the contest with 40% adherence after the intervention.
  
  
  CONCLUSIONS
  Using a novel contest coupled with a multimodal intervention successfully improved hand hygiene rates among Japanese healthcare workers. Given the overall low rates, however, further improvement is necessary.
authors.affiliation: Department of Nursing, International University of Health and Welfare Graduate School, Minato-ku, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sakihama
authors.affiliation: Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Honda
authors.affiliation: VA Ann Arbor Healthcare System, Ann Arbor, Michigan.|University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Saint
authors.affiliation: VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Fowler
authors.affiliation: Division of General Internal Medicine & Infectious Diseases, Rakuwakai Otowa Hospital, Yamashina, Kyoto, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kamiya
authors.affiliation: Division of Infection Control, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Division of Infection Control, Rakuwakai Otowa Hospital, Yamashina, Kyoto, Japan.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Iuchi
authors.affiliation: Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Tokuda
mesh_terms: D003428:Cross Infection / Q000517:prevention & control; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007564:Japan; D010564:Personnel, Hospital / Q000592:standards*; D062606:Tertiary Care Centers