Handwashing compliance by health care workers - The impact of introducing an accessible, alcohol-based hand antiseptic

Citation
We. Bischoff et al., Handwashing compliance by health care workers - The impact of introducing an accessible, alcohol-based hand antiseptic, ARCH IN MED, 160(7), 2000, pp. 1017-1021
Citations number
37
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Journal title
ARCHIVES OF INTERNAL MEDICINE
ISSN journal
0003-9926 → ACNP
Volume
160
Issue
7
Year of publication
2000
Pages
1017 - 1021
Database
ISI
SICI code
0003-9926(20000410)160:7<1017:HCBHCW>2.0.ZU;2-J
Abstract
Context: Under routine hospital conditions handwashing compliance of health care workers including nurses, physicians, and others (eg, physical therap ists and radiologic technicians) is unacceptably low. Objectives: To investigate the efficacy of an education/feedback interventi on and patient awareness program (cognitive approach) on handwashing compli ance of health care workers; and to compare the acceptance of a new and inc reasingly accessible alcohol-based waterless hand disinfectant (technical a pproach) with the standard sink/soap combination. Design: A 6-month, prospective, observational study. Setting: One medical intensive care unit (ICU), 1 cardiac surgery ICU, and 1 general medical ward located in a 728-bed, tertiary care, teaching facili ty. Participants: Medical caregivers in each of the above settings. Interventions: Implementation of an education/feedback intervention program (6 in-service sessions per each ICU) and patient awareness program, follow ed by a new, increasingly accessible, alcohol-based, waterless hand antisep tic agent, initially available at a ratio of 1 dispenser for every 4 patien ts and subsequently 1 for each patient. Main Outcome Measure: Direct observation of handwashing for 1575 potential opportunities monitored over 120 hours randomized for both time of day and bed locations. Results: Baseline handwashing compliance before and after defined events wa s 9% and 22% for health care workers in the medical ICU and 3% and 13% for health care workers in the cardiac surgery ICU, respectively. After the edu cation/feedback intervention program, handwashing compliance changed little (medical ICU, 14% [before] and 25% [after]; cardiac surgery ICU, 6% [befor e] and 13% [after]). Observations after introduction of the new, increasing ly accessible, alcohol-based, waterless hand antiseptic revealed significan tly higher handwashing rates (P<.05), and handwashing compliance improved a s accessibility was enhanced-before 19% and after 41% with 1 dispenser per 4 beds; and before 23% and after 48% with 1 dispenser for each bed. Conclusions: Education/feedback intervention and patient awareness programs failed to improve hand washing compliance. However, introduction of easily accessible dispensers with an alcohol-based waterless handwashing antisept ic led to significantly higher handwashing rates among health care workers.