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Improving Compliance With Hand Hygiene in Hospitals

  • Didier Pittet (a1)

Hand hygiene prevents cross-infection in hospitals, but compliance with recommended instructions often is poor among healthcare workers. Although some previous interventions to improve compliance have been successful, none has achieved lasting improvement. This article reviews reported barriers to appropriate hand hygiene and factors associated with poor compliance.

Easy access to hand hygiene in a timely fashion and the availability of skin-care lotion both appear to be necessary pre-requisites for appropriate hand-hygiene behavior. In particular, in high-demand situations, hand rub with an alcohol-based solution appears to be the only alternative that allows a decent compliance. The hand-hygiene compliance level does not rely on individual factors alone, and the same can be said for its promotion. Because of the complexity of the process of change, it is not surprising that solo interventions often fail, and multimodal, multidisciplinary strategies are necessary. A framework that includes parameters to be considered for hand-hygiene promotion is proposed, based on epidemiologically driven evidence and review of the current knowledge. Strategies for promotion in hospitals should include reasons for noncompliance with recommendations at individual, group, and institutional levels. Potential tools for change should address each of these elements and consider their interactivity.

Corresponding author
Infection Control Program, Department of Internal Medicine, 24, rue Micheli-du-Crest, University of Geneva Hospitals, 1211 Geneva 14, Switzerland
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1. E Larson . Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:12871294.

2. B Simmons , J Bryant , K Neiman , L Spencer , K Arheart . The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589594.

3. J Webster , JL Faoagali , D Cartwright . Elimination of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan. J Paediatr Child Health 1994;30:5964.

4. AB Zafar , RC Butler , DJ Reese , LA Gaydos , PA Mennonna Use of 0.3% triclosan (Bacti-Stat*) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. Am J Infect Control 1995;23:200208.

5. M Casewell , I Phillips . Hands as route of transmission for Klebsiella species. BMJ 1977;2:13151317.

6. DG Maki . The use of antiseptics for handwashing by medical personnel. J Chemother 1989;1:311.

8. BN Doebbeling , GL Stanley , CT Sheetz , MA Pfaller , AK Houston , L Annis , et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:8893.

10. E Early , K Battle , E Cantwell , J English , JE Lavin , E Larson . Effect of several interventions on the frequency of handwashing among elementary public school children. Am J Infect Control 1998;26:263269.

11. LS Kimel . Handwashing education can decrease illness absenteeism. J Sch Nurs 1996;12:1416.

13. MU Khan . Interruption of shigellosis by handwashing. Trans R Soc Trop Med Hyg 1982;76:164168.

15. BF Stanton , JD Clemens . An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. Am J Epidemiol 1987;125:292301.

16. WR Jarvis . Handwashing—the Semmelweis lesson forgotten? Lancet 1994;344:13111312.

17. RK Albert , F Condie . Hand-washing patterns in medical intensive-care units. N Engl J Med 1981;304:14651465.

18. M Graham . Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:7781.

19. BL Thompson , DM Dwyer , XT Ussery , S Denman , P Vacek , B Schwartz . Handwashing and glove use in a long-term care facility. Infect Control Hosp Epidemiol 1997;18:97103.

20. D Pittet , P Mourouga , TV Perneger , and the members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126130.

21. EL Larson . APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251269.

23. E Larson , M Killien . Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:9399.

24. PM Dubbert , J Dolce , W Richter , M Miller , S Chapman . Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191193.

25. JM Conly , S Hill , J Ross , J Lertzman , T Louie . Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330339.

26. LJ Sproat , TJ Inglis . A multicentre survey of hand hygiene practice in intensive care units. J Hosp Infect 1994;26:137148.

27. E Larson , EK Kretzer . Compliance with handwashing and barrier precautions. J Hosp Infect 1995;30:88106.

28. EK Kretzer , EL Larson . Behavioral interventions to improve infection control practices. Am J Infect Control 1998;26:245253.

29. JM Boyce . It is time for action: improving hand hygiene in hospitals. Ann Intern Med 1999;130:153155.

30. E Larson . Handwashing and skin: physiologic and bacteriologie aspects. Infect Control 1985;6:1423.

31. E Larson , A McGeer , ZA Quraishi , D Krenzischek , BJ Parsons , J Holdford , et al. Effects of an automated sink on handwashing practices and attitudes in high-risk units. Infect Control Hosp Epidemiol 1991;12:422428.

32. WM Marcil . Handwashing practices among occupational therapy personnel. Am J Occupational Therapy 1993;47:523528.

33. M Khatib , G Jamaleddine , A Abdallah , Y Ibrahim . Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest 1999;116:172175.

34. BN Doebbeling , MA Pfaller , AK Houston , RP Wenzel . Removal of nosocomial pathogens from the contaminated glove. Ann Intern Med 1988;109:394398.

35. A Voss , AF Widmer . No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205208.

39. EL Teare , B Cookson , GL French , EA Jenner , G Scott , A Pallett , et al. UK handwashing initiative. J Hosp Infect 1999;43:13.

40. EL Larson , JL Bryan , LM Adler , CB Blane . A multifaceted approach to changing handwashing behavior. Am J Infect Control 1997;25:310.

41. A Weeks . Why I don't wash my hands between each patient contact. BMJ 1999;319:518.

42. S Harbarth , P Sudre , S Dharan , M Cadenas , D Pittet . Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 1999;20:598603.

43. GA Preston , EL Larson , W Stamm . The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641645.

44. E Larson . Compliance with isolation technique. Am J Infect Control 1983;11:221225.

45. A Pettinger , M Nettleman . Epidemiology of isolation precautions. Infect Control Hosp Epidemiol 1991;12:303307.

46. EL Larson , KJ McGinley , A Foglia , JJ Leyden , N Boland , J Larson , et al. Handwashing practices and resistance and density of bacterial hand flora on two pediatric units in Lima, Peru. Am J Infect Control 1992;20:6572.

47. JD Zimakoff , B Pontoppidan , SO Larsen , KB Poulsen , DJ Stickler . The management of urinary catheters: compliance of practice in Danish hospitals, nursing homes and home care to national guidelines. Scand J Urol Nephrol 1995;29:299309.

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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