Infection prevention promotion program based on the PRECEDE model: improving hand hygiene behaviors among healthcare personnel

Infect Control Hosp Epidemiol. 2012 Feb;33(2):144-51. doi: 10.1086/663707. Epub 2011 Dec 19.


Background: Healthcare-associated infections (HAIs) result in significant morbidity and mortality. Hand hygiene remains a cornerstone intervention for preventing HAIs. Unfortunately, adherence to hand hygiene guidelines among healthcare personnel is poor.

Objective: To assess short- and long-term effects of an infection prevention promotion program on healthcare personnel hand hygiene behaviors.

Design: Time series design.

Setting: Our study was conducted at a tertiary care academic center.

Participants: Hospital healthcare personnel.

Methods: We developed a multimodal program that included a multimedia communications campaign, education, leadership engagement, environment modification, team performance measurement, and feedback. Healthcare personnel hand hygiene practices were measured via direct observations over a 3-year period by "undercover" observers.

Results: Overall hand hygiene compliance increased by 2-fold after full program implementation (P < .001), and this increase was sustained over a 20-month follow-up period (P < .001). The odds for compliance with hand hygiene increased by 3.8-fold in the 6 months after full program implementation (95% confidence interval, 3.53-4.23; P < .001), and this increase was sustained. There was even a modest increase at 20 months of follow up. Hand hygiene compliance increased among all disciplines and hospital units. Hand hygiene compliance increased from 35% in the first 6 months after program initiation to 77% in the last 6 months of the study period among nursing providers (P < .001), from 38% to 62% among medical providers (P < .001), and from 27% to 75% among environmental services staff (P < .001).

Conclusions: Implementation of the infection prevention promotion program was associated with a significant and sustained increase in hand hygiene practices among healthcare personnel of various disciplines.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Baltimore
  • Cross Infection / prevention & control*
  • Guideline Adherence / statistics & numerical data*
  • Hand Disinfection / standards*
  • Hospitals, University
  • Humans
  • Infection Control / methods*
  • Infection Control / standards
  • Medical Staff, Hospital / standards*
  • Models, Theoretical
  • Nursing Staff, Hospital / standards*
  • Practice Guidelines as Topic
  • Program Evaluation
  • Retrospective Studies