Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in five intensive care units in three cities of China.

OBJECTIVES

To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene (HH) Approach in three hospitals in three cities of China, and analyze predictors of poor hand hygiene compliance.

STUDY DESIGN

A prospective before-after study from May 2009 to December 2010 in five intensive care units members of the INICC in China.

METHODS

The study was divided into two periods: a 3-month baseline period and a follow-up period. A Multidimensional HH Approach was implemented, which included the following elements: 1- administrative support, 2- supplies availability, 3- education and training, 4- reminders in the workplace, 5- process surveillance and 6- performance feedback. Observations were done for HH compliance in each ICU, during randomly selected 30-min periods.

RESULTS

A total of 2079 opportunities for HH were recorded. Overall HH compliance increased from 51.5% to 80.1% (95% CI 73.2-87.8; P = 0.004). Multivariate analysis indicated that several variables were significantly associated with poor HH compliance: females vs males (64% vs 55%; 95% CI 0.81-0.94; P = 0.0005), nurses vs physicians (64% vs 57%, P = 0.004), among others.

CONCLUSIONS

Adherence to HH was increased significantly with the INICC multidimensional approach. Specific programs directed to improve HH in variables found to be predictors of poor HH compliance should be implemented.