Table 12.1. Fourteen studies of practices to improve handwashing compliance*

Study Setting; PracticeStudy Design, OutcomesHandwashing Compliance (unless otherwise noted)**
All medical staff in a neurologic ICU and a surgical ICU in a 350-bed tertiary care teaching hospital in Washington, DC, 1983-84; multifaceted intervention (education, automatic sinks, feedback) 16 Level 2, Level 269% vs. 59% (p=0.005)
Medical staff in 2 ICUs in a university teach hospital in Philadelphia; increase number of available sinks 17 Level 2, Level 276% vs. 51% (p<0.01)
Medical staff in a 6-bed post-anesthesia recovery room and a 15-bed neonatal ICU in a tertiary care hospital in Baltimore, 1990; automatic sink compared with standard sink 14 Level 2, Level 2Mean handwashes per hour: 1.69 vs. 1.21 on unit 1;á 2.11 vs. 0.85 on unit 2; (p<0.001)
All staff at a large acute-care teaching hospital in France, 1994-97; hand hygiene campaign including posters, feedback, and introduction of alcohol-based solution 18 Level 3, Level 1Noscomial infections: 16.9% vs. 9.9% Handwashing: 66.2% vs. 47.6% (p<0.001)
Medical staff in a 6-bed pediatric ICU in a large academic medical center in Virginia, 1982-83; mandatory gowning 19 Level 3, Level 229.6% vs. 30.7%
Medical staff in 2 ICUs in a community teaching hospital in Tennessee, 1983-84; sequential interventions of lectures, buttons, observation, and feedback 24 Level 3, Level 229.9% vs. 22% (p=0.071)
Medical staff in an 18-bed ICU in a tertiary care hospital in Australia; introduction of chlorhexidine-based antiseptic handrub lotion 9 Level 3, Level 245% vs. 32% (p<0.001)
12 nurses in a 12-bed ICU in Mississippi, 1990; education/feedback intervention 31 Level 3, Level 292% vs. 81%
Medical staff in an 18-bed pediatric ICU in a children's teaching hospital in Melbourne, 1994; 5-step behavioral modification program 25 Level 3, Level 2Handwashing rates after patient contact: 64.8% vs. 10.6%
Medical staff in a 3000-bed tertiary care center in France, 1994-95; 13-step handwashing protocol 13 Level 3, Level 218.6% vs. 4.2% (p<0.0001)
Medical staff in two ICUs at a teaching hospital in Virginia, 1997; 6 education/feedback sessions followed by introduction of alcohol antiseptic agent 22 Level 3, Level 2Baseline 22%; Education/feedback 25%; Alcohol antiseptic 48%; (p<0.05)
Medical staff in a 14-bed ICU in a tertiary careá hospital in France, 1998; introduction of alcohol-based solution 21 Level 3, Level 260.9% vs. 42.4% (p=0.0001)
All staff in a medical ICU and step-down unit in a large teaching hospital in Virginia; installation of alcohol-based solution 23 Level 3, Level 252% vs. 60% (p=0.26)
Medical staff on 2 general inpatient floor at each of 4 community hospitals in New Jersey; patient education intervention 20 Level 3, Level 3Soap usage (as an indicator of handwashing) increased by 34% (p=0.021)

*ICU indicates intensive care unit.

**Results are reported as intervention group vs. control group.

From: 11, Automated Medication Dispensing Devices

Cover of Making Health Care Safer
Making Health Care Safer: A Critical Analysis of Patient Safety Practices.
Evidence Reports/Technology Assessments, No. 43.
Shojania KG, Duncan BW, McDonald KM, et al., editors.

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