Major article
The short-term and long-term effectiveness of a multidisciplinary hand hygiene improvement program

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Background

Although hand hygiene (HH) compliance has been an important issue for years, the compliance rate is still a problem in health care today.

Methods

This was an observational, prospective, before-and-after study. We measured HH knowledge and HH compliance before (baseline), directly after (poststrategy), and 6 months after the performance of HH team strategies (follow-up). The study was composed of employed nurses and physicians working in the department of internal medicine of a university hospital. We performed a multifaceted improvement program including HH education, feedback, reminders, social influence activities including the use of role models, and improvement of HH facilities.

Results

Ninety-two nurses and physicians were included. Compared with baseline, there was a significant improvement in the overall mean HH knowledge score at poststrategy (from 7.4 to 8.4) and follow-up (from 7.4 to 8.3). The overall HH compliance was 27% at baseline, 83% at poststrategy, and 75% at follow-up. At baseline, the compliance rate was 17% in nurses and 43% in physicians and significantly improved to 63% in nurses and 91% in physicians at follow-up.

Conclusion

Our multifaceted HH improvement program resulted in a sustained improvement of HH knowledge and compliance in nurses as well as physicians.

Section snippets

Study design

To improve HH knowledge and HH compliance among nurses and physicians, we performed an observational pilot study in the Department of Internal Medicine of a 953-bed university hospital in The Netherlands. Our study consisted of 4 study phases (Table 1), including the performance of a multifaceted HH improvement program (phase II). HH knowledge tests and HH compliance tests were performed at baseline (phase I), poststrategy (phase III), and follow-up (phase IV). In view of the observational and

Hand hygiene knowledge

At baseline, as well as poststrategy and follow-up, 68 HH knowledge questionnaires were distributed. Forty-four participants (65%) returned the questionnaire at baseline, 41 (60%) at poststrategy, and 39 (57%) at follow-up (Table 3). Compared with baseline, there was a significant improvement in the overall mean HH knowledge score at poststrategy (from 7.4 to 8.4) and follow-up (from 7.4 to 8.3). Overall, the questionnaire score was significantly better in nurses than in staff physicians (0.5

Discussion

Our study showed that overall as well as in the subgroups of nurses and physicians, a considerable increase in the HH knowledge (about 1 point increase at poststrategy and at follow-up) and in HH compliance (about 50% increase at poststrategy and at follow-up) was achieved.

In line with Naikoba and Hayward’s conclusion,8 we developed a multifaceted strategy. It is impossible to conclude which components were—to what degree—responsible for our achieved improvement. However, there was only a

Acknowledgment

The research team thanks the nurses and physicians of the Department of Internal Medicine for completing and returning the questionnaires and for giving us the opportunity to carry out the observations and, in particular, Dr C. Delsing (MD), M. Heijnen (PA), and the students from the faculty of health and social studies for the performance of the observations.

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Conflicts of interest: None to report.

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