Continued direct observation and feedback of hand hygiene adherence can result in long-term improvement.
Hospital-wide multifaceted approaches can improve hand hygiene compliance in health care workers. However, the true effects of monitoring and feedback interventions are not clear.



Hand hygiene compliance was evaluated by applying direct observation techniques over 5 years (2005-2009) in a tertiary care general hospital in Japan. The observed results were periodically reported as feedback to the health care workers.



The overall hand hygiene compliance rate increased from 50.8% in 2005 to 61.0% in 2006 (P = .004) and was sustained at approximately 60% through the completion of the study. The compliance rate for the indication before entering the room increased from 2005 to 2009 (P = .005). The compliance rates for 4 before patient contact indications increased from 2005 to 2009 (P = .002). The combined compliance rate for the 6 indications with the lowest compliance rates in 2005 increased from 2005 to 2009 (P = .001).



Direct observation and feedback methods are effective strategies that resulted in a long-lasting improvement in hand hygiene compliance that was sustained over 5 years through the completion of the study. Focusing on the procedures with high baseline noncompliance rates can be an effective way to improve the overall compliance.
Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan.
Kazumi
K
Arise
Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan.
Sayaka
S
Nishizaki
Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Japan.
Tamae
T
Morita
Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of Pharmacy, Kochi Medical School Hospital, Nankoku, Japan.
Yusuke
Y
Yagi
Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of General Medicine, Kochi Medical School Hospital, Nankoku, Japan. Electronic address: takeuti@kochi-u.ac.jp.
Seisho
S
Takeuchi
D000328:Adult; D005246:Feedback; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000379:methods*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007564:Japan; D008297:Male; D019370:Observation / Q000379:methods*; D055815:Young Adult
Direct observation; Hand hygiene; Infection control; Standard precaution