Effectiveness of a hospital-wide programme to improve compliance with handhygiene

Background Hand hygiene prevents cross infection in hospitals, but complian ce with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphas is on bedside, alcohol-based hand disinfection. We measured nosocomial infe ctions in parallel. Methods We monitored the overall compliance with hand hygiene during routin e patient care in a teaching hospital in Geneva, Switzerland, before and du ring implementation of a hand-hygiene campaign. Seven hospital-wide observa tional surveys were done twice yearly from December, 1994, to December, 199 7. Secondary outcome measures were nosocomial infection rates, attack rates of meticillin-resistant Staphylococcus aureus (MRSA), and consumption of h andrub disinfectant. Findings We observed more than 20 000 opportunities for hand hygiene. Compl iance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Al though recourse to handwashing with soap and water remained stable, frequen cy of hand disinfection substantially increased during the study period (p< 0.001). This result was unchanged after adjustment for known risk factors o f poor adherence. Hand hygiene improved significantly among nurses and nurs ing assistants, but remained poor among doctors. During the same period, ov erall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% i n 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes p er 10 000 patient-days; p<0.001), and the consumption of alcohol-based hand rub solution increased from 3.5 to 15.4 L per 1000 patient-days between 199 3 and 1998 (p<0.001). Interpretation The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely c ontributed to the increase in compliance.