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Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance

Grady, Lynne
Zawacki, Anne
Potter-Bynoe, Gail
Samore, M. H.
Goldmann, D. A.
Published in Pediatric Infectious Disease Journal. 2002, vol. 21, no. 6, p. 489-495
Abstract OBJECTIVE: To evaluate the effects of the introduction of an alcohol-based hand gel and multifaceted quality improvement (QI) interventions on hand hygiene (HH) compliance. DESIGN: Interventional, randomized cohort study with four study phases (baseline; limited intervention in two units; full intervention in three units; washout phase), performed in three intensive care units at a pediatric referral hospital. METHODS: During 724 thirty-minute daytime monitoring sessions, a nonidentified observer witnessed 12,216 opportunities for HH and recorded compliance. INTERVENTIONS: Introduction of an alcohol-based hand gel; multifaceted QI interventions (educational program, opinion leaders, performance feedback). RESULTS: Baseline compliance decreased after the first 2 weeks of observation from 42.5% to 28.2% (presumably because of waning of a Hawthorne effect), further decreased to 23.3% in the limited intervention phase and increased to 35.1% after the introduction of a hand gel with QI support in all three units (P < 0.001). The rise in compliance persisted in the last phase (compliance, 37.2%); however, a gradual decline was observed during the final weeks. Except for the limited intervention phase, compliance achieved through standard handwashing and glove use remained stable around 20 and 10%, respectively, whereas compliance achieved through gel use increased to 8% (P < 0.001). After adjusting for confounding, implementation of the hand gel with QI support remained significantly associated with compliance (odds ratio, 1.6; 95% confidence interval, 1.4 to 1.8). In a final survey completed by 62 staff members, satisfaction with the hand gel was modest (45%). CONCLUSIONS: We noted a statistically significant, modest improvement in compliance after introduction of an alcohol-based hand gel with multifaceted QI support. When appropriately implemented, alcohol-based HH may be effective in improving compliance.
Keywords Alcohols/ administration & dosage/chemistryChildCohort StudiesCross Infection/epidemiology/prevention & controlGelsGuideline Adherence/statistics & numerical dataHandwashing/ standardsHealth Personnel/classificationHumansInfection Control/trendsIntensive Care UnitsIntervention StudiesQuestionnairesRisk FactorsSkin Care/ standardsTime Factors
PMID: 12182370
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Research groups Groupe Harbarth Stephan (Staphylocoques dorés résistants à la méthicilline) (866)
Staphylocoques dorés résistants à la méthicilline et hygiène hospitalière (330)
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HARBARTH, Stéphan Juergen et al. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. In: Pediatric Infectious Disease Journal, 2002, vol. 21, n° 6, p. 489-495. https://archive-ouverte.unige.ch/unige:7302

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Deposited on : 2010-06-21

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