A multifaceted approach to changing handwashing behavior

Am J Infect Control. 1997 Feb;25(1):3-10. doi: 10.1016/s0196-6553(97)90046-8.


Background: Few interventions to influence handwashing have had measurable effects. This prospective quasi-experimental study was designed to address predisposing, enabling, and reinforcing factors to improve frequency of handwashing.

Methods: Over a 12-month time period, a multifaceted intervention including focus group sessions, installation of automated sinks, and feedback to staff on handwashing frequency was implemented in one intensive care unit; a second unit served as a control. Dependent variables observed were handwashing frequency and self-reported practices and opinions about handwashing. Study phases included baseline, three phases of about 2 months each in duration in which sink automation was incrementally increased, and follow-up 2 months after intervention.

Results: During 301 hours of observation, 2624 handwashings were recorded. Proportion of times hands were washed varied by indication, ranging from 38% before invasive procedures to 86% for dirty-to-clean procedures (p < 0.00001). Although there were some significant differences between experimental and control units in handwashing during the study, these differences had returned to baseline by the 2-month follow-up. There were no significant differences in self-reported practices and opinions from before to after intervention nor between units.

Conclusions: Intensive intervention, including feedback, education, and increased sink automation, had minimal long-term effect on handwashing frequency.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analysis of Variance
  • Automation
  • Chi-Square Distribution
  • Focus Groups
  • Hand Disinfection*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Infection Control / methods*
  • Intensive Care Units
  • Nursing Staff, Hospital / education*
  • Prospective Studies
  • Statistics, Nonparametric