OBJECTIVE:

To increase the frequency of handwashing by medical staff.

DESIGN:

a prospective study of handwashing before and after patient contact.

SETTING:

A paediatric intensive care unit in a tertiary hospital.

PARTICIPANTS:

61 intensive care unit medical staff and visiting medical staff.

INTERVENTIONS:

A five-phase behaviour modification program:(i) unobtrusive observation for four weeks to obtain a baseline handwashing rate (ii) overt observation for five weeks (preceded by written advice); (iii) overt observation continued for four weeks with performance feedback; (iv) all observation and feedback discontinued for seven weeks; and (v) unobtrusive observation for five weeks to obtain a residual rate.

RESULTS:

939 patient contacts were observed. The baseline handwashing rates before and after patient contact were 12.4% and 10.6%, respectively. During overt observation, the respective rates increased and plateaued at 32.7% and 33.3%, but increased further (to 68.3% and 64.8%) during the period of performance feedback. The residual handwashing rates, observed unobtrusively seven weeks after the cessation of performance feedback, were 54.6% before and 54.9% after patient contact.