Interventions to improve hand hygiene (HH) compliance are a key element in the practice infection prevention and control. It was our objective to assess the effect of a multimodal intervention on HH compliance at a tertiary care university hospital. As a secondary objective, we investigated the effect of the intervention on the occurrence of device-associated bloodstream infections. We performed a single centre cluster randomised controlled trial at a university hospital in Germany. Twenty peripheral wards were invited to participate and randomly assigned to either the intervention (n = 10) or control group (n = 10). Quarterly, specifically trained student employees conducted direct compliance observations in all twenty wards. The intervention entailed dissemination of teaching materials on aseptic procedures, equipment with flexibly mountable alcoholic hand rub dispensers, and quarterly feedback on HH compliance. In total, 21,424 HH opportunities were observed. Overall, compliance did not change significantly in either group (intervention group: 59% vs. 61% (1482 HH actions for 2494 HH opportunities vs. 5033 HH actions for 8215 HH opportunities), odds ratio (OR) 1.08 (95% confidence interval (CI95) 0.88, 1.33)); control group: 59% vs. 60% (1457 HH actions for 2484 HH opportunities vs. 4948 HH actions for 8231 HH opportunities), OR 1.06 (CI95 0.84, 1.35)). Compliance prior to aseptic procedures improved significantly in the intervention group from 44% (168 HH actions for 380 HH opportunities) to 53% (764 HH actions for 1452 HH opportunities) (OR 1.40 (CI95 1.04, 1.89), p = 0.03), while no significant increase was noted in the control group. In the intervention group, significantly fewer device-associated bloodstream infections per 1000 patient-days occurred than in the control group (84 vs. 123, incidence rate ratio 0.61 (CI95 0.46, 0.81), p < 0.01). The lack of a significant overall improvement of HH compliance demonstrated that comprehensive implementation of HH interventions in multiple wards simultaneously is difficult. However, through targeted intervention measures, we were able to significantly increase HH compliance before aseptic procedures.

中文翻译：

---

一种提高三级护理大学中心外围病房手卫生依从性的多模式干预措施：一项整群随机对照试验。

改善手部卫生（HH）顺从性的干预措施是实践中预防和控制感染的关键因素。我们的目标是评估三级大学医院多模式干预对HH依从性的影响。作为次要目标，我们调查了干预对与设备相关的血液感染发生的影响。我们在德国的一家大学医院进行了单中心集群随机对照试验。邀请20个外围病房参加，并随机分配至干预组（n = 10）或对照组（n = 10）。每季度，经过专门培训的学生员工在所有20个病区进行了直接合规性观察。干预需要传播有关无菌程序的教材，带有可灵活安装的酒精洗手液分配器的设备，以及有关HH合规性的季度反馈。总共发现了21424个HH机会。总体而言，两组的依从性均无显着变化（干预组：59％vs. 61％（2494个HH机会的1482个HH行动与8215个HH机会的5033个HH行动），优势比（OR）1.08（95％置信区间（CI95）0.88、1.33））；对照组：59％vs. 60％（2484个HH机会的1457个HH行动与8231个HH机会的4948个HH行动），或1.06（CI95 0.84，1.35）。干预组中，无菌操作前的依从性从44％（对于380个HH机会采取168个HH行动）显着提高到53％（对于1452个HH机会采取764个HH行动）（OR 1.40（CI95 1.04，1.89），p = 0.03），对照组没有明显增加。在干预组中，每千个患者日发生的与设备相关的血液感染明显少于对照组（84比123，发生率比0.61（CI95 0.46，0.81），p <0.01）。缺乏对HH依从性的全面改善，这表明很难同时在多个病房中全面实施HH干预措施。但是，通过有针对性的干预措施，我们能够在无菌操作之前显着提高HH依从性。缺乏对HH依从性的全面改善，这表明很难同时在多个病房中全面实施HH干预措施。但是，通过有针对性的干预措施，我们能够在无菌操作之前显着提高HH依从性。缺乏对HH依从性的全面改善，这表明很难同时在多个病房中全面实施HH干预措施。但是，通过有针对性的干预措施，我们能够在无菌操作之前显着提高HH依从性。