Effectiveness of multifaceted hand hygiene interventions in long-term care facilities in Hong Kong: a cluster-randomized controlled trial

Infect Control Hosp Epidemiol. 2012 Aug;33(8):761-7. doi: 10.1086/666740. Epub 2012 Jun 20.


Objective: To determine the effectiveness of World Health Organization (WHO) multimodal strategy in promoting hand hygiene (HH) among healthcare workers (HCWs) in long-term care facilities (LTCFs).

Design: Cluster-randomized controlled trial.

Setting: Eighteen homes for the elderly in Hong Kong were randomly allocated to 2 intervention arms and a control arm. Direct observation of HH practice was conducted by trained nurses. Either handrubbing with alcohol-based handrub (ABHR) or handwashing with liquid soap and water was counted as a compliant action. Disease notification data during 2007-2010 were used to calculate incidence rate ratio (IRR).

Participants: Managers and HCWs of the participating homes.

Interventions: The WHO multimodal strategy was employed. All intervention homes were supplied with ABHR (WHO formulation I), ABHR racks, pull reels, HH posters and reminders, a health talk, video clips, training materials, and performance feedback. The only difference was that intervention arms 1 and 2 were provided with slightly powdered and powderless gloves, respectively.

Results: A total of 11,669 HH opportunities were observed. HH compliance increased from 27.0% to 60.6% and from 22.2% to 48.6% in intervention arms 1 and 2, respectively. Both intervention arms showed increased HH compliance after intervention compared to controls, at 21.6% compliance (both [Formula: see text]). Provision of slightly powdered versus powderless gloves did not have any significant impact on ABHR usage. Respiratory outbreaks (IRR, 0.12; 95% confidence interval [CI], 0.01-0.93; [Formula: see text]) and methicillin-resistant Staphylococcus aureus infections requiring hospital admission (IRR, 0.61; 95% CI, 0.38-0.97; [Formula: see text]) were reduced after intervention.

Conclusions: A promotion program applying the WHO multimodal strategy was effective in improving HH among HCWs in LTCFs.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Infective Agents, Local
  • Attitude of Health Personnel
  • Chi-Square Distribution
  • Cross Infection / prevention & control
  • Female
  • Guideline Adherence / statistics & numerical data
  • Hand Disinfection / methods*
  • Hand Disinfection / standards*
  • Health Education
  • Health Knowledge, Attitudes, Practice
  • Homes for the Aged / standards*
  • Hong Kong
  • Hospitalization / statistics & numerical data
  • Humans
  • Hygiene / standards
  • Long-Term Care
  • Male
  • Methicillin-Resistant Staphylococcus aureus
  • Middle Aged
  • Program Evaluation
  • Respiratory Tract Infections / prevention & control
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / prevention & control
  • Statistics, Nonparametric
  • World Health Organization
  • Young Adult


  • Anti-Infective Agents, Local