Promoting and sustaining a hospital-wide, multifaceted hand hygiene program resulted in significant reduction in health care-associated infections

Am J Infect Control. 2013 Jun;41(6):482-6. doi: 10.1016/j.ajic.2012.08.009. Epub 2012 Dec 20.


Background: Hand hygiene is the single most important intervention to combat infections in any health care setting. However, adherence to hand hygiene practice remains low among health care workers.

Objectives: Our objective was to assess compliance with hand hygiene over time utilizing a multifaceted approach to hand hygiene. In addition, we assessed the rate of device-associated infections.

Methods: This is a descriptive time series study with a multitude of interventions from October 2006 to December 2011 set in a 350-bed community hospital in Saudi Arabia. We utilized a multimodal program to promote hand hygiene activities. We also calculated device-associated infection rates as outcome measures.

Results: Over the study, the overall hand hygiene compliance rate increased from a baseline of 38% in second quarter 2006 to 65% in 2010 and then to 85% in 2011 (P < .001). The compliance rates increased among all professions and different hospital units. The compliance rates were 87% for physicians, 89% for nursing staff, and 93% for nutritionist. The rate of health care-associated methicillin-resistant Staphylococcus aureus per 1,000 patient-days decreased from 0.42 in 2006 to 0.08 in 2011. Ventilator-associated infection rates decreased from 6.12 to 0.78, central line-associated bloodstream infections rates decreased from 8.23 to 4.8, and catheter-associated urinary tract infection rates decreased from 7.08 to 3.5.

Conclusion: This intervention used a multitude of interventions and resulted in an institution-wide increase and sustained improvement in compliance rates.

MeSH terms

  • Cross Infection / prevention & control*
  • Equipment and Supplies, Hospital / microbiology*
  • Guideline Adherence / statistics & numerical data*
  • Hand Hygiene*
  • Health Promotion
  • Humans
  • Infection Control / methods*
  • Methicillin-Resistant Staphylococcus aureus
  • Personnel, Hospital
  • Practice Guidelines as Topic
  • Saudi Arabia
  • Staphylococcal Infections / prevention & control
  • Time and Motion Studies