from Kirkland et al. 2012
published in BMJ Qual Saf 21(12):1019-26
DOI 10.1136/bmjqs-2012-000800

Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series

Multimodal interventions increase compliance rates and reduce the incidence of nosocomial infections

In this hospital-wide hand hygiene initiative on healthcare-associated infections five areas of intervention were introduced, which where the involvement of the management level and emphasis of responsibility, audits and feedback, accessibility to hand disinfectants, education and training including certification and marketing and communciation (campaigns). To determine the compliance rates by occupational group and ward, monthly covert, direct observations were conducted in all hospital wards until one year beyond the last intervention had been introduced. Additionally, the incidence of nosocomial infections per patient-day was recorded on a monthly basis and comprised several categories to identify infections, as for example infections that occurred in wards and infections attributable to surgeries. Furthermore, data on conducted hygiene audits, consumption of hand disinfectant and the number of campaign activities (posters, articles, etc.) were collected. HHC increased from 41% to 87% in 2 years and even increased to 91% after the year after the intervention. The number of NI decreased from 528 cases to 394 cases one year after the intervention. In addition the infection rates dropped from 4.8 to 3.3 per 1000 patient-days within a year. In conclusion multimodal interventions may increase compliance rates significantly and sustainably and may reduce the incidence of nosocomial infection.