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
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.