Center for Innovation in Quality Patient Care, Johns Hopkins Medicine, Baltimore, Maryland, USA.
Infect Control Hosp Epidemiol. 2012 Feb;33(2):144-51. doi: 10.1086/663707. Epub 2011 Dec 19.
Healthcare-associated infections (HAIs) result in significant morbidity and mortality. Hand hygiene remains a cornerstone intervention for preventing HAIs. Unfortunately, adherence to hand hygiene guidelines among healthcare personnel is poor.
To assess short- and long-term effects of an infection prevention promotion program on healthcare personnel hand hygiene behaviors.
Time series design.
Our study was conducted at a tertiary care academic center.
Hospital healthcare personnel.
We developed a multimodal program that included a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback. Healthcare personnel hand hygiene practices were measured via direct observations over a 3-year period by "undercover" observers.
Overall hand hygiene compliance increased by 2-fold after full program implementation (P < .001), and this increase was sustained over a 20-month follow-up period (P < .001). The odds for compliance with hand hygiene increased by 3.8-fold in the 6 months after full program implementation (95% confidence interval, 3.53-4.23; P < .001), and this increase was sustained. There was even a modest increase at 20 months of follow up. Hand hygiene compliance increased among all disciplines and hospital units. Hand hygiene compliance increased from 35% in the first 6 months after program initiation to 77% in the last 6 months of the study period among nursing providers (P < .001), from 38% to 62% among medical providers (P < .001), and from 27% to 75% among environmental services staff (P < .001).
Implementation of the infection prevention promotion program was associated with a significant and sustained increase in hand hygiene practices among healthcare personnel of various disciplines.
医疗保健相关感染（HAI）会导致严重的发病率和死亡率。手卫生仍然是预防 HAI 的基石干预措施。不幸的是，医护人员对手卫生指南的依从性很差。
评估感染预防促进计划对医护人员手卫生行为的短期和长期影响。
时间序列设计。
我们的研究在一家三级保健学术中心进行。
医院医护人员。
我们开发了一种多模式计划，包括多媒体传播活动、教育、领导力参与、环境修改、团队绩效衡量和反馈。通过“卧底”观察员在 3 年期间进行直接观察来测量医护人员的手卫生实践。
在全面实施计划后，整体手卫生合格率提高了 2 倍（P <.001），并且在 20 个月的随访期间保持了这种增加（P <.001）。在全面实施计划后的 6 个月内，合规的几率增加了 3.8 倍（95%置信区间，3.53-4.23；P <.001），并且这种增加持续存在。甚至在 20 个月的随访中也有适度增加。所有学科和医院科室的手卫生合格率都有所提高。护理提供者的手卫生合格率从计划启动后的前 6 个月的 35%增加到研究期间最后 6 个月的 77%（P <.001），从医疗提供者的 38%增加到 62%（P <.001），从环境服务人员的 27%增加到 75%（P <.001）。
感染预防促进计划的实施与各学科医护人员手卫生实践的显著和持续增加相关。
