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Improving Compliance With Hand Hygiene in Hospitals

Published online by Cambridge University Press:  02 January 2015

Didier Pittet
Didier Pittet*
Affiliation:
Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
*
Infection Control Program, Department of Internal Medicine, 24, rue Micheli-du-Crest, University of Geneva Hospitals, 1211 Geneva 14, Switzerland
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Abstract

Hand hygiene prevents cross-infection in hospitals, but compliance with recommended instructions often is poor among healthcare workers. Although some previous interventions to improve compliance have been successful, none has achieved lasting improvement. This article reviews reported barriers to appropriate hand hygiene and factors associated with poor compliance.

Easy access to hand hygiene in a timely fashion and the availability of skin-care lotion both appear to be necessary pre-requisites for appropriate hand-hygiene behavior. In particular, in high-demand situations, hand rub with an alcohol-based solution appears to be the only alternative that allows a decent compliance. The hand-hygiene compliance level does not rely on individual factors alone, and the same can be said for its promotion. Because of the complexity of the process of change, it is not surprising that solo interventions often fail, and multimodal, multidisciplinary strategies are necessary. A framework that includes parameters to be considered for hand-hygiene promotion is proposed, based on epidemiologically driven evidence and review of the current knowledge. Strategies for promotion in hospitals should include reasons for noncompliance with recommendations at individual, group, and institutional levels. Potential tools for change should address each of these elements and consider their interactivity.

Type
Reviews
Information
Infection Control & Hospital Epidemiology , Volume 21 , Issue 6 , June 2000 , pp. 381 - 386
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000 

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References

1. Larson, E. Skin hygiene and infection prevention: more of the same or different approaches? Clin Infect Dis 1999;29:1287–1294.Google Scholar
2. Simmons, B, Bryant, J, Neiman, K, Spencer, L, Arheart, K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589–594.Google Scholar
3. Webster, J, Faoagali, JL, Cartwright, D. Elimination of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit after hand washing with triclosan. J Paediatr Child Health 1994;30:59–64.Google Scholar
4. Zafar, AB, Butler, RC, Reese, DJ, Gaydos, LA, Mennonna, PA Use of 0.3% triclosan (Bacti-Stat*) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. Am J Infect Control 1995;23:200–208.Google Scholar
5. Casewell, M, Phillips, I. Hands as route of transmission for Klebsiella species. BMJ 1977;2:1315–1317.Google Scholar
6. Maki, DG. The use of antiseptics for handwashing by medical personnel. J Chemother 1989;1:3–11.Google Scholar
7. Massanari, RM, Hierholzer, WJJ. A crossover comparison of antiseptic soaps on nosocomial infection rates in intensive care units. Am J Infect Control 1984;12:247–248.Google Scholar
8. Doebbeling, BN, Stanley, GL, Sheetz, CT, Pfaller, MA, Houston, AK, Annis, L, et al. Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:88–93.Google Scholar
9. Butz, AM, Larson, E, Fosarelli, P, Yolken, R. Occurrence of infectious symptoms in children in day care homes. Am J Infect Control 1990;6:347–353.Google Scholar
10. Early, E, Battle, K, Cantwell, E, English, J, Lavin, JE, Larson, E. Effect of several interventions on the frequency of handwashing among elementary public school children. Am J Infect Control 1998;26:263–269.Google Scholar
11. Kimel, LS. Handwashing education can decrease illness absenteeism. J Sch Nurs 1996;12:14–16.Google Scholar
12. Master, D, Hess Longe, SH, Dickson, H. Scheduled hand washing in an elementary school population. Fam Med 1997;29:336–339.Google Scholar
13. Khan, MU. Interruption of shigellosis by handwashing. Trans R Soc Trop Med Hyg 1982;76:164–168.Google Scholar
14. Shahid, NS, Greenough, WB, Samadi, AR, Huq, MI, Rahman, N. Hand washing with soap reduces diarrhoea and spread of bacterial pathogens in a Bangladesh village. J Diarrhoeal Dis Res 1996;14:85–89.Google Scholar
15. Stanton, BF, Clemens, JD. An educational intervention for altering water-sanitation behaviors to reduce childhood diarrhea in urban Bangladesh. Am J Epidemiol 1987;125:292–301.Google Scholar
16. Jarvis, WR. Handwashing—the Semmelweis lesson forgotten? Lancet 1994;344:1311–1312.Google Scholar
17. Albert, RK, Condie, F. Hand-washing patterns in medical intensive-care units. N Engl J Med 1981;304:1465–1465.Google Scholar
18. Graham, M. Frequency and duration of handwashing in an intensive care unit. Am J Infect Control 1990;18:77–81.Google Scholar
19. Thompson, BL, Dwyer, DM, Ussery, XT, Denman, S, Vacek, P, Schwartz, B. Handwashing and glove use in a long-term care facility. Infect Control Hosp Epidemiol 1997;18:97–103.Google Scholar
20. Pittet, D, Mourouga, P, Perneger, TV, and the members of the Infection Control Program. Compliance with handwashing in a teaching hospital. Ann Intern Med 1999;130:126–130.Google Scholar
21. Larson, EL. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.Google Scholar
22. Rotter, ML. Hand washing and hand disinfection. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins, 1999:1339–1355.Google Scholar
23. Larson, E, Killien, M. Factors influencing handwashing behavior of patient care personnel. Am J Infect Control 1982;10:93–99.Google Scholar
24. Dubbert, PM, Dolce, J, Richter, W, Miller, M, Chapman, S. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191–193.Google Scholar
25. Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, T. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330–339.Google Scholar
26. Sproat, LJ, Inglis, TJ. A multicentre survey of hand hygiene practice in intensive care units. J Hosp Infect 1994;26:137–148.Google Scholar
27. Larson, E, Kretzer, EK. Compliance with handwashing and barrier precautions. J Hosp Infect 1995;30:88–106.Google Scholar
28. Kretzer, EK, Larson, EL. Behavioral interventions to improve infection control practices. Am J Infect Control 1998;26:245–253.Google Scholar
29. Boyce, JM. It is time for action: improving hand hygiene in hospitals. Ann Intern Med 1999;130:153–155.Google Scholar
30. Larson, E. Handwashing and skin: physiologic and bacteriologie aspects. Infect Control 1985;6:14–23.Google Scholar
31. Larson, E, McGeer, A, Quraishi, ZA, Krenzischek, D, Parsons, BJ, Holdford, J, et al. Effects of an automated sink on handwashing practices and attitudes in high-risk units. Infect Control Hosp Epidemiol 1991;12:422–428.Google Scholar
32. Marcil, WM. Handwashing practices among occupational therapy personnel. Am J Occupational Therapy 1993;47:523–528.Google Scholar
33. Khatib, M, Jamaleddine, G, Abdallah, A, Ibrahim, Y. Hand washing and use of gloves while managing patients receiving mechanical ventilation in the ICU. Chest 1999;116:172–175.Google Scholar
34. Doebbeling, BN, Pfaller, MA, Houston, AK, Wenzel, RP. Removal of nosocomial pathogens from the contaminated glove. Ann Intern Med 1988;109:394–398.Google Scholar
35. Voss, A, Widmer, AF. No time for handwashing!? Handwashing versus alcoholic rub: can we afford 100% compliance? Infect Control Hosp Epidemiol 1997;18:205–208.Google Scholar
36. Donowitz, L. Handwashing technique in a pediatric intensive care unit. Am J Dis Child 1987;141:683–685.Google Scholar
37. Tibballs, J. Teaching hospital medical staff to handwash. Med J Aust 1996;164:395–398.Google Scholar
38. Teare, EL, Cookson, B, French, G, Gould, D, Jenner, E, McCulloch, J, et al. Hand washing—a modest measure with big effects. BMJ 1999;318:686–686.Google Scholar
39. Teare, EL, Cookson, B, French, GL, Jenner, EA, Scott, G, Pallett, A, et al. UK handwashing initiative. J Hosp Infect 1999;43:1–3.Google Scholar
40. Larson, EL, Bryan, JL, Adler, LM, Blane, CB. A multifaceted approach to changing handwashing behavior. Am J Infect Control 1997;25:3–10.Google Scholar
41. Weeks, A. Why I don't wash my hands between each patient contact. BMJ 1999;319:518.Google Scholar
42. Harbarth, S, Sudre, P, Dharan, S, Cadenas, M, Pittet, D. Outbreak of Enterobacter cloacae related to understaffing, overcrowding, and poor hygiene practices. Infect Control Hosp Epidemiol 1999;20:598–603.Google Scholar
43. Preston, GA, Larson, EL, Stamm, W. The effect of private isolation rooms on patient care practices, colonization and infection in an intensive care unit. Am J Med 1981;70:641–645.Google Scholar
44. Larson, E. Compliance with isolation technique. Am J Infect Control 1983;11:221–225.Google Scholar
45. Pettinger, A, Nettleman, M. Epidemiology of isolation precautions. Infect Control Hosp Epidemiol 1991;12:303–307.Google Scholar
46. Larson, EL, McGinley, KJ, Foglia, A, Leyden, JJ, Boland, N, Larson, J, et al. Handwashing practices and resistance and density of bacterial hand flora on two pediatric units in Lima, Peru. Am J Infect Control 1992;20:65–72.Google Scholar
47. Zimakoff, JD, Pontoppidan, B, Larsen, SO, Poulsen, KB, Stickler, DJ. The management of urinary catheters: compliance of practice in Danish hospitals, nursing homes and home care to national guidelines. Scand J Urol Nephrol 1995;29:299–309.Google Scholar