title: Effectiveness of a multimodal hand hygiene improvement strategy in the emergency department.
abstract: Hand hygiene (HH) is essential in preventing nosocomial infection. The emergency department (ED) is an open portal of entry for pathogens into the hospital system, hence the important sentinel function of the ED personnel. The main objective of this study was to assess the effect of a multimodal improvement strategy on hand hygiene compliance in the ED.
  
  
  
  Our study was a prospective before-and-after study to determine the effect of a multimodal improvement strategy on the compliance of HH in the ED according to the My 5 Moments of Hand Hygiene defined by the World Health Organization. Interventions such as education, reminders, and regular feedback on HH performance and role models were planned during the 3 intervention weeks.
  
  
  
  In total, 57 ED nurses and ED physicians were observed in this study, and approximately 1,000 opportunities for handrubs were evaluated during the 3 intervention periods. HH compliance increased significantly from baseline from 18% (74/407) to 41% (77/190) after the first intervention and stabilized to 50% (99/200) and 46% (96/210) after the second and third interventions, respectively.
  
  
  
  Implementing a multimodal HH improvement program significantly improved the HH compliance of ED personnel.
authors.affiliation: Emergency Department, Radboudumc, Nijmegen, The Netherlands.
authors.forename: P R H
authors.initials: PR
authors.lastname: Arntz
authors.affiliation: Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands. Electronic address: Joost.Hopman@radboudumc.nl.
authors.forename: J
authors.initials: J
authors.lastname: Hopman
authors.affiliation: Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Nillesen
authors.affiliation: Emergency Department, Radboudumc, Nijmegen, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Yalcin
authors.affiliation: Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands.
authors.forename: C P
authors.initials: CP
authors.lastname: Bleeker-Rovers
authors.affiliation: Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Voss
authors.affiliation: Emergency Department, Radboudumc, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Edwards
authors.affiliation: Emergency Department, Radboudumc, Nijmegen, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Wei
mesh_terms: D065187:Controlled Before-After Studies; D003428:Cross Infection / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D011446:Prospective Studies
keywords: Emergency department; alcohol-based handrub; hand hygiene; multimodal