[A multimodal strategy to improve adherence to hand hygiene in a university hospital].
OBJECTIVE
Within the framework of the PaSQ (Patient Safety and Quality care) Project, this hospital decided to implement a multifaceted hospital-wide Hand Hygiene (HH) intervention based on a multimodal WHO approach over one year, focusing on achieving a sustained change in HH cultural change in this hospital.


METHODS
Setting: University Hospital Marqués de Valdecilla, Santander (Spain), a tertiary hospital with 900 beds. Intervention period: 2014. An action plan was developed that included the implementation of activities in each component of the 5-step multimodal intervention. An observation/feedback methodology was used that included the provision of performance and results feedback to the staff. A 3/3 strategy (non-blinded direct observation audits performed during 3 randomised days every 3 weeks with pro-active corrective actions at the end of each observation period). HH compliance, alcohol-based hand-rub (ABHR) consumption, and rate of MRSA infection, were monitored during the intervention.


RESULTS
Hospital ABHR consumption increased during the study period: from 17.5 to 19.7mL/patient-days. In the intervention units, this consumption was 24.8mL pre-intervention, 42.5mL during the intervention, and 30.4mL two months post-intervention. There were 137 evaluation periods in 30 different days, in which a total of 737 health-care workers were observed and 1,870 HH opportunities. HH compliance was 54.5%, ranging between 44.8% and 69.9%. The incidence of MRSA infection decreased during the intervention in the selected units, from 13.2 infections per 10,000 patient-days pre-intervention to 5.7 three months post-intervention.


CONCLUSIONS
Our HH strategy, supported by a 3/3 strategy increased alcohol-based hand-rub consumption and compliance. A reduction in MRSA infections was observed.
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España. Electronic address: cfarinas@humv.es.
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Fariñas-Alvarez
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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Portal-María
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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Flor-Morales
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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Aja-Herrero
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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M
Fabo-Navarro
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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S
Lanza-Marín
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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R
Lobeira-Rubio
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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N
Polo-Hernández
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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M
Sixto-Montero
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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Moreta-Sánchez
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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MÁ
Ballesteros-Sanz
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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L
Yañez-San Segundo
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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MJ
Bartalome-Pacheco
Grupo de Mejora de la Higiene de Manos, Hospital Universitario Marqués de Valdecilla, Santander, España.
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Armiñanzas-Castillo
D057189:Checklist; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D004363:Drug Utilization; D000068156:Formative Feedback; D019983:Guideline Adherence; D006235:Hand Disinfection / Q000379:methods; D063373:Hand Hygiene / Q000592:standards; D064548:Hand Sanitizers; D006757:Hospital Units; D006785:Hospitals, University / Q000458:organization & administration*; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000458:organization & administration*; D055624:Methicillin-Resistant Staphylococcus aureus; D015279:Organizational Culture; D010564:Personnel, Hospital / Q000193:education / Q000523:psychology; D010865:Pilot Projects; D013030:Spain; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control
D064548:Hand Sanitizers
Adherencia a recomendaciones; Guideline adherence; Hand hygiene; Health personnel/education; Higiene de manos; Patient safety; Personal sanitario/educación; Seguridad del paciente