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Poor Handwashing Practices Among Health Care Workers

Inadequate handwashing among health care workers is recognized as an important cause of nosocomial and iatrogenic infection, but educational interventions have been relatively unsuccessful in changing behavior. Virginia researchers evaluated 2 approaches to promoting handwashing: (1) intensive educational and feedback programs and (2) increasing the availability of a waterless, alcohol-based, gel-like antiseptic cleanser.

The investigators observed 1575 opportunities for handwashing. The education and feedback intervention was assessed in a medical intensive care unit (ICU) and a cardiac surgery ICU; after this initial intervention, dispensers of the waterless cleanser were introduced into the medical ICU. Handwashing compliance during the educational intervention improved from 10 percent to 16 percent before patient contact and 22 percent to 25 percent after patient contact in the medical ICU; in the cardiac surgery ICU, compliance improved from 4 percent to 7 percent before patient contact and from 13 percent to 14 percent after patient contact. None of these increases were significant. Availability of the waterless cleanser increased compliance significantly, to 19 percent before patient contact and 41 percent after patient contact at a 1:4 dispenser-bed ratio and to 23 percent (before contact) and 48 percent (after contact) at a 1:1 ratio.

Comment: These results suggest that professional norms, social pressure, and education are not as effective in improving handwashing compliance as is sheer convenience -- in this case, the availability of a waterless cleanser dispenser at bedside. However, compliance still was relatively poor in this study.

— TL Schwenk

Published in Journal Watch General Medicine April 14, 2000

Citation(s):

Bischoff WE et al. Handwashing compliance by health care workers: The impact of introducing an accessible, alcohol-based hand antiseptic. Arch Intern Med 2000 Apr 10 160 1017-1021.

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