title: Impact of implementation of the World Health Organization multimodal hand hygiene improvement strategy in a teaching hospital in Taiwan.
abstract: BACKGROUND
  Hand hygiene (HH) is considered to be the most simple, rapid, and economic way to prevent health care-associated infection (HAI). However, poor HH compliance has been repeatedly reported. Our objective was to evaluate the impact of implementing the updated World Health Organization (WHO) multimodal HH guidelines on HH compliance and HAI in a tertiary hospital in Taiwan.
  
  
  METHODS
  We conducted a before-and-after interventional study during 2010-2011. A multimodal HH promotion campaign was initiated. Key strategies included providing alcohol-based handrub dispensers at points of care, designing educational programs tailored to the needs of different health care workers, placement of general and individual reminders in the workplace, and establishment of evaluation and feedback for HH compliance and infection rates.
  
  
  RESULTS
  Overall HH compliance increased from 62.3% to 73.3% after 1 year of intervention (P < .001). The rate of overall HAI decreased from 3.7% to 3.1% (P < .05), urinary tract infection rate decreased from 1.5% to 1.2% (P < .05), and respiratory tract infection rate decreased from 0.53% to 0.35% (P < .05). This campaign saved an estimated $940,000 and 3,564 admission patient days per year.
  
  
  CONCLUSIONS
  The WHO multimodal HH guidelines are feasible and effective for the promotion of HH compliance and are associated with the reduction of HAIs.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Jui-Kuang
authors.initials: JK
authors.lastname: Chen
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Kuan-Sheng
authors.initials: KS
authors.lastname: Wu
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Susan Shin-Jung
authors.initials: SS
authors.lastname: Lee
authors.affiliation: School of Nursing, Fooyin University, Kaohsiung, Taiwan; Department of Health Services Policy and Management, University of South Carolina, Columbia, SC.
authors.forename: Huey-Shyan
authors.initials: HS
authors.lastname: Lin
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Graduate Institute of Environmental Education, National Kaohsiung Normal University, Kaohsiung, Taiwan.
authors.forename: Hung-Chin
authors.initials: HC
authors.lastname: Tsai
authors.affiliation: Infection Control Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Ching-Hsien
authors.initials: CH
authors.lastname: Li
authors.affiliation: Infection Control Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Hsueh-Lan
authors.initials: HL
authors.lastname: Chao
authors.affiliation: Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Hsueh-Chih
authors.initials: HC
authors.lastname: Chou
authors.affiliation: Infection Control Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yueh-Ju
authors.initials: YJ
authors.lastname: Chen
authors.affiliation: Infection Control Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Hsiu
authors.initials: YH
authors.lastname: Huang
authors.affiliation: Infection Control Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Chin-Mei
authors.initials: CM
authors.lastname: Ke
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Cheng Len
authors.initials: CL
authors.lastname: Sy
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Tseng
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. Electronic address: yschen@vghks.gov.tw.
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
mesh_terms: D017046:Cost Savings; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D019983:Guideline Adherence; D063373:Hand Hygiene / Q000191:economics / Q000379:methods*; D006282:Health Personnel; D006284:Health Plan Implementation; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*; D012141:Respiratory Tract Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers; D014552:Urinary Tract Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D014944:World Health Organization
keywords: Cost-savings; Health care–associated infection; Multimodal hand hygiene promotion