Alcohol-based handrub improves compliance with hand hygiene in intensive care units

Arch Intern Med. 2002 May 13;162(9):1037-43. doi: 10.1001/archinte.162.9.1037.


Background: Nosocomial infection is a leading complication in intensive care units. Although hand hygiene is the single most efficient preventive measure, compliance with this simple action remains low.

Objectives: To assess the effect of an intervention to promote hand hygiene and to investigate risk factors for noncompliance in intensive care units.

Methods: We performed 7 observational surveys and implemented a promotional campaign after baseline in medical, surgical, and pediatric intensive care units of a teaching hospital. Health care workers were observed during routine patient care. The intervention consisted of a hospitalwide promotional campaign, including observation and performance feedback, posters display, and distribution of individual bottles of alcohol-based handrub. The main outcome measure was compliance with hand hygiene through handwashing or handrubbing.

Results: We observed 2743 opportunities for hand hygiene distributed over 248 periods. Overall compliance increased from 38.4% to 54.5% during the study (P<.001). Although recourse to handwashing remained stable at around 30%, handrubbing increased from 5.4% at baseline to 21.7% at the last survey (P<.001). Compliance increased among nurses and nursing assistants, but remained stable among physicians. Handwashing compliance decreased, on average, by 4.7% for an increase of 10 opportunities for hand hygiene per hour of patient care (P<.001), whereas no such association existed for handrubbing.

Conclusions: Our intervention induced a marked and sustained increase in compliance with hand hygiene. In intensive care units, less time-consuming handrubbing might replace standard handwashing and overcome the barrier of time constraints.

MeSH terms

  • Critical Care
  • Cross Infection / prevention & control*
  • Data Collection
  • Female
  • Hand Disinfection*
  • Health Personnel*
  • Humans
  • Infection Control*
  • Intensive Care Units*
  • Male
  • Risk Factors