Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-12-01T02:40:37.319Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review

Published online by Cambridge University Press:  10 February 2016

Jackson S. Musuuza ,
Anna Barker ,
Caitlyn Ngam ,
Lia Vellardita  and
Nasia Safdar
Jackson S. Musuuza
Affiliation:
Institute of Clinical and Translational Research, University of Wisconsin, Madison, Wisconsin
Anna Barker
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Caitlyn Ngam
Affiliation:
University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Lia Vellardita
Affiliation:
Health Sciences Library, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Nasia Safdar*
Affiliation:
Department of Medicine, University of Wisconsin School of Medicine and Public Health; Department of Infectious Disease, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
*
Address correspondence to Nasia Safdar, MD, PhD, UWMF Centennial Building, 1685 Highland Avenue, Madison, WI 53705 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation.

DESIGN

Systematic review

METHODS

A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed.

RESULTS

A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure.

CONCLUSIONS

Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene.

Infect Control Hosp Epidemiol 2016;37:567–575

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 5 , May 2016 , pp. 567 - 575
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.Google Scholar
2. Roberts, RR, Scott, RD, Hota, B, et al. Costs attributable to healthcare-acquired infection in hospitalized adults and a comparison of economic methods. Med Care 2010;48:1026–1035.CrossRefGoogle Scholar
3. Zimlichman, E, Henderson, D, Tamir, O, et al. Health care–associated infections: a meta-analysis of costs and financial impact on the us health care system. JAMA Internal Medicine 2013;173:2039–2046.Google Scholar
4. Steed, C, Kelly, JW, Blackhurst, D, et al. Hospital hand hygiene opportunities: where and when (HOW2)? The HOW2 Benchmark Study. Am J Infect Control 2011;39:19–26.Google Scholar
5. Yokoe, DS, Classen, D. Improving patient safety through infection control: a new healthcare imperative. Infect Control Hosp Epidemiol 2008;29(Suppl 1):S3–11.CrossRefGoogle ScholarPubMed
6. Boyce, JM, Pittet, D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002;30:S1–S46.Google Scholar
7. Dumas, JE, Lynch, AM, Laughlin, JE, Phillips Smith, E, Prinz, RJ. Promoting intervention fidelity. Conceptual issues, methods, and preliminary results from the EARLY ALLIANCE prevention trial. Am J Prev Med 2001;20:38–47.Google Scholar
8. Henggeler, SW, Melton, GB, Brondino, MJ, Scherer, DG, Hanley, JH. Multisystemic therapy with violent and chronic juvenile offenders and their families: the role of treatment fidelity in successful dissemination. J Consult Clin Psychol 1997;65:821–833.Google Scholar
9. Dane, AV, Schneider, BH. Program integrity in primary and early secondary prevention: are implementation effects out of control? Clin Psychol Rev 1998;18:23–45.Google Scholar
10. Dusenbury, L, Brannigan, R, Falco, M, Hansen, WB. A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Educ Res 2003;18:237–256.Google Scholar
11. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, Group, P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8:336–341.CrossRefGoogle ScholarPubMed
12. Nelson, MC, Cordray, DS, Hulleman, CS, Darrow, CL, Sommer, EC. A procedure for assessing intervention fidelity in experiments testing educational and behavioral interventions. J Behav Health Serv Res 2012;39:374–396.Google Scholar
13. McGrew, JH, Bond, GR, Dietzen, L, Salyers, M. Measuring the fidelity of implementation of a mental health program model. J Consult Clin Psychol 1994;62:670–678.CrossRefGoogle ScholarPubMed
14. Ellingson, K, Haas, JP, Aiello, AE, et al. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol 2014;35(Suppl 2):S155–S178.CrossRefGoogle ScholarPubMed
15. Schweizer, ML, Reisinger, HS, Ohl, M, et al. Searching for an optimal hand hygiene bundle: a meta-analysis. Clin Infect Dis 2014;58:248–259.CrossRefGoogle ScholarPubMed
16. Rosenthal, VD, Pawar, M, Leblebicioglu, H, et al. Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach over 13 years in 51 cities of 19 limited-resource countries from Latin America, Asia, the Middle East, and Europe. Infect Control Hosp Epidemiol 2013;34:415–423.Google Scholar
17. Miranda-Novales, MG, Sobreyra-Oropeza, M, Rosenthal, VD, et al. Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach during 3 years in 6 hospitals in 3 Mexican cities. J Patient Saf 2015; Epub ahead of print.Google Scholar
18. WHO Guidelines on Hand Hygiene in Health Care: a Summary. World Health Organization website. http://www.who.int/gpsc/5may/tools/9789241597906/en/. Published 2009. Accessed July 10, 2015.Google Scholar
19. Downs, SH, Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 1998;52:377–384.Google Scholar
20. Aboumatar, H, Ristaino, P, Davis, RO, et al. Infection prevention promotion program based on the PRECEDE model: improving hand hygiene behaviors among healthcare personnel. Infect Control Hosp Epidemiol 2012;33:144–151.CrossRefGoogle ScholarPubMed
21. Bloomfield, J, Roberts, J, While, A. The effect of computer-assisted learning versus conventional teaching methods on the acquisition and retention of handwashing theory and skills in pre-qualification nursing students: a randomised controlled trial. Int J Nurs Stud 2009;47:287–294.Google Scholar
22. Moongtui, W, Gauthier, D, Turner, J. Using peer feedback to improve handwashing and glove usage among Thai health care workers. Am J Infect Control 2000;28:365–369.CrossRefGoogle ScholarPubMed
23. Nevo, I, Fitzpatrick, M, Thomas, R, et al. The efficacy of visual cues to improve hand hygiene compliance. Simulation Healthcare 2010;5:325–331.Google Scholar
24. Eldridge, NE, Woods, SS, Bonello, RS, et al. Using the six sigma process to implement the Centers for Disease Control and Prevention Guideline for Hand Hygiene in 4 intensive care units. J Gen Intern Med 2006;21(Suppl 2):S35–S42.Google Scholar
25. Seto, WH, Cowling, BJ, Cheung, CW, et al. Impact of the first hand sanitizing relay world record on compliance with hand hygiene in a hospital. Am J Infect Control 2015;43:295–297.CrossRefGoogle ScholarPubMed
26. Barahona-Guzmán, N, Rodríguez-Calderón, ME, Rosenthal, VD, et al. Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in three cities of Colombia. Int J Infect Dis 2014;19:67–73.Google Scholar
27. Chakravarthy, M, Myatra, SN, Rosenthal, VD, et al. The impact of the International Nosocomial Infection Control Consortium (INICC) multicenter, multidimensional hand hygiene approach in two cities of India. J Infect Public Health 2015;8:177–186.Google Scholar
28. Medeiros, EA, Grinberg, G, Rosenthal, VD, et al. Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional hand hygiene approach in 3 cities in Brazil. Am J Infect Control 2015;43:10–15.CrossRefGoogle ScholarPubMed
29. Sax, H, Allegranzi, B, Chraiti, MN, Boyce, J, Larson, E, Pittet, D. The World Health Organization hand hygiene observation method. Am J Infect Control 2009;37:827–834.Google Scholar
30. Sax, H, Allegranzi, B, Uckay, I, Larson, E, Boyce, J, Pittet, D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect 2007;67:9–21.Google Scholar
31. Pittet, D, Allegranzi, B, Boyce, J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009;30:611–622.Google Scholar
32. McGuckin, M, Shubin, A, McBride, P, et al. The effect of random voice hand hygiene messages delivered by medical, nursing, and infection control staff on hand hygiene compliance in intensive care. Am J Infect Control 2006;34:673–675.Google Scholar
33. Abela, N, Borg, MA. Impact on hand hygiene compliance following migration to a new hospital with improved resources and the sequential introduction of World Health Organization recommendations. Am J Infect Control 2012;40:737–741.Google Scholar
34. Allegranzi, B, Sax, H, Bengaly, L, et al. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa. Infect Control Hosp Epidemiol 2009;31:133–141.Google Scholar
35. Allegranzi, B, Gayet-Ageron, A, Damani, N, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013;13:843–851.CrossRefGoogle ScholarPubMed
36. Amine, AE, Helal, MO, Bakr, WM. Evaluation of an intervention program to prevent hospital-acquired catheter-associated urinary tract infections in an ICU in a rural Egypt hospital. GMS Hyg Infect Control 2014;9:Doc15.Google Scholar
37. Ancona, RJ, Boehler, R, Chapman, LA. Sustained hand hygiene initiative reduces MRSA transmission. J Clinical Outcomes Management 2009;16:167–170.Google Scholar
38. Aragon, D, Sole, ML, Brown, S. Outcomes of an infection prevention project focusing on hand hygiene and isolation practices. AACN Clin Issues 2005;16:121–132.Google Scholar
39. Armellino, D, Hussain, E, Schilling, ME, et al. Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare. Clinical Infectious Diseases 2012;54:1–7.Google Scholar
40. Bedat, B, Mauler, F, Allegranzi, B, et al. Successful hand hygiene improvement strategy in a referral children’s hospital in Armenia. J Hosp Infect, Vol 76. England2010 362–363.CrossRefGoogle Scholar
41. Benton, C. Hand hygiene-meeting the JCAHO safety goal: can compliance with CDC hand hygiene guidelines be improved by a surveillance and educational program? Plast Surg Nurs 2007;27:40–44.Google Scholar
42. Bischoff, WE, Reynolds, TM, Sessler, CN, Edmond, MB, Wenzel, RP. Handwashing compliance by health care workers—the impact of introducing an accessible, alcohol-based hand antiseptic. Arch Internal Med 2000;160:1017–1021.CrossRefGoogle ScholarPubMed
43. Bissett, L. Marketing methods to improve hand hygiene compliance. Nursing Times 2007;103:28–29.Google Scholar
44. Bonuel, N, Byers, P, Gray-Becknell, T. Methicillin-resistant Staphylococcus aureus (MRSA) prevention through facility-wide culture change. Crit Care Nurs Q 2009;32:144–148.CrossRefGoogle ScholarPubMed
45. Borges, LF, Rocha, LA, Nunes, MJ, Gontijo Filho, PP. Low compliance to handwashing program and high nosocomial infection in a brazilian hospital. Interdiscip Perspect Infect Dis 2012;2012:579681.CrossRefGoogle Scholar
46. Brown, SM, Lubimova, AV, Khrustalyeva, NM, et al. Use of alcohol-based hand rub and quality improvement interventions to improve hand hygiene in a Russian neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:172–179.Google Scholar
47. Buffet-Bataillon, S, Leray, E, Poisson, M, Michelet, C, Bonnaure-Mallet, M, Cormier, M. Influence of job seniority, hand hygiene education, and patient-to-nurse ratio on hand disinfection compliance. J Hosp Infect 2010;76:32–35.Google Scholar
48. Caniza, MA, Duenas, L, Lopez, B, et al. A practical guide to alcohol-based hand hygiene infrastructure in a resource-poor pediatric hospital. Am J Infect Control 2009;37:851–854.Google Scholar
49. Colombo, C, Giger, H, Grote, J, et al. Impact of teaching interventions on nurse compliance with hand disinfection. J Hosp Infect 2002;51:69–72.Google Scholar
50. Conrad, A, Kaier, K, Frank, U, Dettenkofer, M. Are short training sessions on hand hygiene effective in preventing hospital-acquired MRSA? A time-series analysis. Am J Infect Control 2010;38:559–561.Google Scholar
51. Costers, M, Viseur, N, Catry, B, Simon, A. Four multifaceted countrywide campaigns to promote hand hygiene in Belgian hospitals between 2005 and 2011: impact on compliance to hand hygiene. Eurosurveillance 2012;17:12–17.Google Scholar
52. Creedon, SA. Health care workers’ hand decontamination practices: an Irish study. Clin Nurs Res 2006;15:6–26.Google Scholar
53. Danchaivijitr, S, Pichiensatian, W, Apisarnthanarak, A, Kachintorn, K, Cherdrungsi, R. Strategies to improve hand hygiene practices in two university hospitals. J Med Assoc Thai 2005;88(Suppl 10):S155–S160.Google Scholar
54. Davis, CR. Infection-free surgery: how to improve hand-hygiene compliance and eradicate methicillin-resistant Staphylococcus aureus from surgical wards. Ann Royal Coll Surgeon Engl 2010;92:316–319.Google Scholar
55. Dierssen-Sotos, T, Brugos-Llamazares, V, Robles-Garcia, M, et al. Evaluating the impact of a hand hygiene campaign on improving adherence. Am J Infect Control 2009;38:240–243.Google Scholar
56. Donnellan, RA, Ludher, J, Brydon, M. A novel approach to auditing the compliance of hand hygiene and staff behaviour change. Healthcare Infect 2011;16:55–60.Google Scholar
57. Doron, SI, Kifuji, K, Hynes, BT, et al. A multifaceted approach to education, observation, and feedback in a successful hand hygiene campaign. Jt Comm J Qual Patient Saf 2011;37:3–10.Google Scholar
58. Dubbert, PM, Dolce, J, Richter, W, Miller, M, Chapman, SW. Increasing ICU staff handwashing: effects of education and group feedback. Infect Control Hosp Epidemiol 1990;11:191–193.CrossRefGoogle ScholarPubMed
59. Duerink, D, Farida, H, Nagelkerke, N, et al. Preventing nosocomial infections: improving compliance with standard precautions in an Indonesian teaching hospital. J Hosp Infect 2006;64(1):36–43.Google Scholar
60. Earl, ML, Jackson, MM, Rickman, LS. Improved rates of compliance with hand antisepsis guidelines: a three-phase observational study. Am J Nursing 2001;101:26–33.Google Scholar
61. Eveillard, M, Raymond, F, Guilloteau, V, et al. Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units. J Clin Nurs 2011;20:2744–2751.Google Scholar
62. Girard, R, Amazian, K, Fabry, J. Better compliance and better tolerance in relation to a well-conducted introduction to rub-in hand disinfection. J Hosp Infect 2001;47:131–137.Google Scholar
63. Graf, K, Ott, E, Wolny, M, et al. Hand hygiene compliance in transplant and other special patient groups: an observational study. Am J Infect Control 2013;41:503–508.Google Scholar
64. Grant, AM, Hofmann, DA. It’s not all about me: motivating hand hygiene among health care professionals by focusing on patients. Psychol Sci 2011;22:1494–1499.Google Scholar
65. Grayson, ML, Jarvie, LJ, Martin, R, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust 2008;188:633–640.Google Scholar
66. Harbarth, S, Pittet, D, Grady, L, et al. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J 2002;21:489–495.Google Scholar
67. Harne-Britner, S, Allen, M, Fowler, K. Improving hand hygiene adherence among nursing staff. J Nurs Care Qual. 2011;26:39–48.CrossRefGoogle ScholarPubMed
68. Helder, OK, Brug, J, Looman, CWN, van Goudoever, JB, Kornelisse, RF. The impact of an education program on hand hygiene compliance and nosocomial infection incidence in an urban Neonatal Intensive Care Unit: an intervention study with before and after comparison. Int J Nurs Stud 2010;47:1245–1252.Google Scholar
69. Helms, B, Dorval, S, Laurent, PS, Winter, M. Improving hand hygiene compliance: a multidisciplinary approach. Am J Infect Control 2010;38:572–574.CrossRefGoogle ScholarPubMed
70. Ho, ML, Seto, WH, Wong, LC, Wong, TY. Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial. Infect Control Hosp Epidemiol 2012;33:761–767.CrossRefGoogle Scholar
71. Hugonnet, S, Perneger, TV, Pittet, D. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Intern Med 2002;162:1037–1043.Google Scholar
72. Huis, A, Schoonhoven, L, Grol, R, Donders, R, Hulscher, M, Achterberg, T. Impact of a team and leaders-directed strategy to improve nurses’ adherence to hand hygiene guidelines: a cluster randomised trial. Int J Nursing Stud 2013;50:464–474.Google Scholar
73. Hussein, R, Khak, R, Hobbs, G. Hand hygiene practices in adult versus pediatric intensive care units at a university hospital before and after intervention. Scand J Infect Dis 2007;39:566–570.Google Scholar
74. Jericho, BG, Kalin, AM, Schwartz, DE. Improving hand hygiene compliance by incorporating it into the verification process in the operating room. Internet J Anesthesiol 2013;32:2–2.Google Scholar
75. Khalifa, RA, Hamdy, MS, Heweidy, EI, Magdy, R, Al Rooby, MA. A multidisciplinary program using World Health Organization observation forms to measure the improvement in hand hygiene compliance in burn unit. Life Sci J Acta Zhengzhou Univ Overseas Ed 2011;8:763–790.Google Scholar
76. Kilbride, HW, Wirtschafter, DD, Powers, RJ, Sheehan, MB. Implementation of evidence-based potentially better practices to decrease nosocomial infections. Pediatrics 2003;111:e519–e533.Google Scholar
77. Koff, MD, Corwin, HL, Beach, ML, Surgenor, SD, Loftus, RW. Reduction in ventilator associated pneumonia in a mixed intensive care unit after initiation of a novel hand hygiene program. J Crit Care 2011;26:489–495.Google Scholar
78. Lederer, JW Jr., Best, D, Hendrix, V. A comprehensive hand hygiene approach to reducing MRSA health care-associated infections. Jt Comm J Qual Patient Saf 2009;35:180–185.Google Scholar
79. Linam, WM, Margolis, PA, Atherton, H, Connelly, BL. Quality-improvement initiative sustains improvement in pediatric health care worker hand hygiene. Pediatrics 2011;128:e689–e698.Google Scholar
80. Ling, ML, How, KB. Impact of a hospital-wide hand hygiene promotion strategy on healthcare-associated infections. Antimicrob Resist Infect Control 2012;1:13.Google Scholar
81. Marra, A, D’Arco, C, Bravim, BA, et al. Controlled trial measuring the effect of a feedback intervention on hand hygiene compliance in a step-down unit. Infect Control Hosp Epidemiol 2008;29:730–735.Google Scholar
82. Marra, A, Noritomi, D, Westheimer, CA, et al. A multicenter study using positive deviance for improving hand hygiene compliance. Am J Infect Control 2013;41:984–988.Google Scholar
83. Marra, AR, Sampaio Camargo, TZ, Magnus, TP, et al. The use of real-time feedback via wireless technology to improve hand hygiene compliance. Am J Infect Control 2014;42:608–611.Google Scholar
84. Martín-Madrazo, C, Soto-Díaz, S, Cañada-Dorado, A, et al. Cluster randomized trial to evaluate the effect of a multimodal hand hygiene improvement strategy in primary care. Infect Control Hosp Epidemiol 2012;33:681–688.Google Scholar
85. Mathai, AS, George, SE, Abraham, J. Efficacy of a multimodal intervention strategy in improving hand hygiene compliance in a tertiary level intensive care unit. Indian J Crit Care Med 2011;15:6–15.Google Scholar
86. Mayer, JA, Dubbert, PM, Miller, M, Burkett, PA, Chapman, SW. Increasing handwashing in an intensive care unit. Infect Control 1986;7:259–262.Google Scholar
87. McGuckin, M, Taylor, A, Martin, V, Porten, L, Salcido, R. Evaluation of a patient education model for increasing hand hygiene compliance in an inpatient rehabilitation unit. Am J Infect Control 2004;32:235–238.Google Scholar
88. Mertz, D, Dafoe, N, Walter, S, Brazil, K, Loeb, M. Effect of a multifaceted intervention on adherence to hand hygiene among healthcare workers: a cluster-randomized trial. Infect Control Hospital Epidemiol 2010;31:1170–1176.Google Scholar
89. Mestre, G, Berbel, C, Tortajada, P, et al. “The 3/3 strategy”: a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology. PLoS One 2012;7:e47200.Google Scholar
90. Monistrol, O, Calbo, E, Riera, M, et al. Impact of a hand hygiene educational programme on hospital-acquired infections in medical wards. Clin Microbiol Infect 2012;18:1212–1218.Google Scholar
91. Mukerji, A, Narciso, J, Moore, C, McGeer, A, Kelly, E, Shah, V. An observational study of the hand hygiene initiative: a comparison of preintervention and postintervention outcomes. BMJ Open 2013:3.Google Scholar
92. Muto, CA, Sistrom, MG, Farr, BM. Hand hygiene rates unaffected by installation of dispensers of a rapidly acting hand antiseptic. Am J Infect Control 2000;28:273–276.Google Scholar
93. Pessoa-Silva, CL, Hugonnet, S, Pfister, R, et al. Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics 2007;120:e382–e390.Google Scholar
94. Picheansathian, W, Pearson, A, Suchaxaya, P. The effectiveness of a promotion programme on hand hygiene compliance and nosocomial infections in a neonatal intensive care unit. Int J Nurs Pract 2008;14:315–321.Google Scholar
95. Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.Google Scholar
96. Randle, J, Arthur, A, Vaughan, N, Wharrad, H, Windle, R. An observational study of hand hygiene adherence following the introduction of an education intervention. J Infect Prevent 2014;15:142–147.Google Scholar
97. Raskind, CH, Worley, S, Vinski, J, Goldfarb, J. Hand hygiene compliance rates after an educational intervention in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2007;28:1096–1098.CrossRefGoogle Scholar
98. Rees, S, Houlahan, B, Safdar, N, Sanford-Ring, S, Shore, T, Schmitz, M. Success of a multimodal program to improve hand hygiene compliance. J Nurs Care Qual 2013;28:312–318.Google Scholar
99. Reisinger, HS, Perencevich, EN, Morgan, DJ, et al. Improving hand hygiene compliance with point-of-use reminder signs designed using theoretically grounded messages. Infect Control Hosp Epidemiol 2014;35:593–594.Google Scholar
100. Rosenthal, VD, Guzman, S, Pezzotto, SM, Crnich, CJ. Effect of an infection control program using education and performance feedback on rates of intravascular device-associated bloodstream infections in intensive care units in Argentina. Am J Infect Control 2003;31:405–409.Google Scholar
101. Rosenthal, VD, Guzman, S, Safdar, N. Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. Am J Infect Control 2005;33:392–397.Google Scholar
102. Salmon, S, Tran, HL, Bui, DP, Pittet, D, McLaws, ML. Beginning the journey of hand hygiene compliance monitoring at a 2,100-bed tertiary hospital in Vietnam. Am J Infect Control 2014;42:71–73.Google Scholar
103. Santana, SL, Furtado, GH, Coutinho, AP, Medeiros, EA. Assessment of healthcare professionals’ adherence to hand hygiene after alcohol-based hand rub introduction at an intensive care unit in Sao Paulo, Brazil. Infect Control Hosp Epidemiol 2007;28:365–367.Google Scholar
104. Scheithauer, S, Kamerseder, V, Petersen, P, et al. Improving hand hygiene compliance in the emergency department: getting to the point. BMC Infect Dis 2013;13:367.Google Scholar
105. Schmitz, K, Kempker, RR, Tenna, A, et al. Effectiveness of a multimodal hand hygiene campaign and obstacles to success in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control 2014;3:8.Google Scholar
106. Sharek, PJ, Benitz, WE, Abel, NJ, Freeburn, MJ, Mayer, ML, Bergman, DA. Effect of an evidence-based hand washing policy on hand washing rates and false-positive coagulase negative staphylococcus blood and cerebrospinal fluid culture rates in a level III NICU. J Perinatol 2002;22:137–143.Google Scholar
107. Stevenson, KB, Searle, K, Curry, G, et al. Infection control interventions in small rural hospitals with limited resources: results of a cluster-randomized feasibility trial. Antimicrob Resist Infect Control 2014;3:10.CrossRefGoogle ScholarPubMed
108. Stewardson, AJ, Iten, A, Camus, V, et al. Efficacy of a new educational tool to improve Handrubbing technique amongst healthcare workers: a controlled, before-after study. PLoS One 2014;9:e105866.CrossRefGoogle ScholarPubMed
109. Swoboda, SM, Earsing, K, Strauss, K, Lane, S, Lipsett, PA. Isolation status and voice prompts improve hand hygiene. Am J Infect Control 2007;35:470–476.Google Scholar
110. Szilagyi, L, Haidegger, T, Lehotsky, A, et al. A large-scale assessment of hand hygiene quality and the effectiveness of the “WHO 6-steps.” BMC Infect Dis 2013;13:249.Google Scholar
111. Trick, WE, Vernon, MO, Welbel, SF, Demarais, P, Hayden, MK, Weinstein, RA. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol 2007;28:42–49.Google Scholar
112. Tromp, M, Huis, A, de Guchteneire, I, et al. The short-term and long-term effectiveness of a multidisciplinary hand hygiene improvement program. Am J Infect Control 2012;40:732–736.Google Scholar
113. van de Mortel, T, Bourke, R, Fillipi, L, et al. Maximising handwashing rates in the critical care unit through yearly performance feedback. Australian Crit Care 2000;13:91–95.Google Scholar
114. van den Hoogen, A, Brouwer, AJ, Verboon-Maciolek, MA, Gerards, LJ, Fleer, A, Krediet, TG. Improvement of adherence to hand hygiene practice using a multimodal intervention program in a neonatal intensive care. J Nurs Care Qual 2011;26:22–29.Google Scholar
115. Venkatesh, AK, Lankford, MG, Rooney, DM, Blachford, T, Watts, CM, Noskin, GA. Use of electronic alerts to enhance hand hygiene compliance and decrease transmission of vancomycin-resistant Enterococcus in a hematology unit. Am J Infect Control 2008;36:199–205.Google Scholar
116. Whitby, M, McLaws, M-L, Slater, K, Tong, E, Johnson, B. Three successful interventions in health care workers that improve compliance with hand hygiene: is sustained replication possible? Am J Infect Control 2008;36:349–355.Google Scholar
117. Won, SP, Chou, HC, Hsieh, WS, et al. Handwashing program for the prevention of nosocomial infections in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2004;25:742–746.Google Scholar
118. Yeung, WK, Tam, WSW, Wong, TW. Clustered randomized controlled trial of a hand hygiene intervention involving pocket-sized containers of alcohol-based hand rub for the control of infections in long-term care facilities. Infect Control Hospital Epidemiol 2011;32:67–76.Google Scholar
119. Zerr, DM, Allpress, AL, Heath, J, Bornemann, R, Bennett, E. Decreasing hospital-associated rotavirus infection—A multidisciplinary hand hygiene campaign in a children’s hospital. Pediatr Infect Dis J 2005;24:397–403.CrossRefGoogle ScholarPubMed
120. Zingg, W, Imhof, A, Maggiorini, M, Stocker, R, Keller, E, Ruef, C. Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Crit Care Med 2009;37:2167–2173; quiz 2180.CrossRefGoogle ScholarPubMed
Supplementary material: File

Musuuza supplementary material S1

Supplementary Table

Download Musuuza supplementary material S1(File)
File 5.4 MB
Supplementary material: File

Musuuza supplementary material S2

Supplementary Table

Download Musuuza supplementary material S2(File)
File 409.1 KB
Supplementary material: File

Musuuza supplementary material S3

Supplementary Table

Download Musuuza supplementary material S3(File)
File 433.7 KB