Global implementation of WHO's multimodal strategy for improvement of hand hygiene: a quasi-experimental study

• Published in: The Lancet infectious diseases 2013-10, Vol.13 (10), p.843-851
• Main Authors: Allegranzi, Benedetta, MD, Gayet-Ageron, Angèle, MD, Damani, Nizam, MD, Bengaly, Loséni, PhD, McLaws, Mary-Louise, Prof, Moro, Maria-Luisa, MD, Memish, Ziad, MD, Urroz, Orlando, MD, Richet, Hervé, Prof, Storr, Julie, MBA, Donaldson, Liam, MD, Pittet, Didier, Prof
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Epidemiology. Vaccinations; General aspects; Guideline Adherence - standards; Hand Disinfection - standards; Hand Hygiene - methods; Health care; Health Personnel - standards; Hospitals; Humans; Income; Infection Control - methods; Infectious Disease; Infectious diseases; Medical sciences; Personal hygiene; Public health; Socioeconomic Factors; World Health Organization - organization & administration
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(13)70163-4

Summary Background Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO's strategy for improvement of hand hygiene in five countries. Methods We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3–6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygiene principles. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010. Findings We noted 21 884 hand-hygiene opportunities during 1423 sessions before the intervention and 23 746 opportunities during 1784 sessions after. Overall compliance increased from 51·0% before the intervention (95% CI 45·1–56·9) to 67·2% after (61·8–72·2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio [OR] 4·67, 95% CI 3·16–6·89; p