Assessing the sustainability of hand hygiene adherence prior to patient contact in the emergency department: A 1-year postintervention evaluation

Background: Health care-associated infection is one of the most important patient safety problems in the world. While many methods exist to prevent health care-associated infection, most experts believe that improving hand hygiene is paramount. We previously published the results of a successful before-and-after hand hygiene interventional study performed in the pediatric emergency department of the Meyer Hospital in Florence, Italy. The goal of the current study is to assess the longer term sustainability of the previously described intervention.

Methods: Direct observation was used to assess hand hygiene compliance for both doctors and nurses in the emergency department using the same methods and observers as previously employed.

Results: In addition to the 420 preintervention and 463 immediately postintervention observations previously reported, we observed another 456 clinician-patient interactions approximately 1 year after the intervention. Among all health care workers, there was no significant difference between hand hygiene compliance immediately postintervention (44.9%) compared with 1 year after the intervention (45.2%). Adherence among nurses, however, increased from 40.7% to 49.8% (P = .03), whereas adherence among doctors decreased from 50.5% to 36.5% (P = .008).

Conclusion: The overall effects of the intervention were sustained over a 1-year period, although a marked difference was observed between nurses and doctors.