BACKGROUND Given the lack of hospital-wide ownership and shortage of nurses, the ideal model for large-scale implementation of hand hygiene (HH) behaviour change in low- and middle-income countries is unknown. AIM The aim of the multi-modal strategy was to engender hospital accountability for HH compliance. METHODS The quasi-experimental study was conducted in 50 South African hospitals (November 2015 to July 2017) and involved five overlapping phases: executive governance and corporate behaviour change; group-wide systematic situational analysis; development of an electronic-assisted direct-observed data collection and analysis application; launch and implementation; and accountable governance. Measurement of intra- and inter-hospital variance to six HH opportunities was calculated and data compliance dashboards were e-mailed weekly to hospital leadership teams to provide feedback of recorded HH compliance and behaviour to frontline teams. Baseline comparison (July 2016) of compliance was compared versus post-implementation (July 2017). FINDINGS Baseline HH compliance of ≤60% was documented for 16% (8/50) of hospitals, whereas overall, 48% (24/50) of hospitals demonstrated a significant improvement (P < 0.01). Over the 13-month observation period, 523,422 observations were recorded with a mean rate of 277 ± 223 observations per 1000 patient-days. The group mean composite compliance improved by 7.8% (P < 0.01) from 77.4% ± 12.8 to 85.2% ± 8.8 between July 2016 and July 2017, respectively. CONCLUSION Implementation of a multi-faceted HH model in a large, diverse group of South African hospitals translated into changes in the organizational systems and accountability, standardized HH compliance management and feedback that led to HH proprietorship.

中文翻译：

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在南非医院网络中实施一套多方面的手卫生合规性框架：利用Ubuntu理念。

背景技术由于缺乏医院范围内的所有权和护士的短缺，在中低收入国家大规模实施手部卫生（HH）行为改变的理想模型尚不清楚。目的多模式策略的目的是使医院对HH合规性负责。方法在2015年11月至2017年7月在50所南非医院中进行了准实验研究，该研究涉及五个重叠阶段：执行管理和公司行为改变；以及对医院的控制。全集团的系统情况分析；开发电子辅助直接观测数据收集和分析应用程序；启动和实施；和负责任的治理。计算了六个HH机会的院内和院际差异的度量，并每周通过电子邮件将数据合规仪表板发送给医院领导团队，以向一线团队提供记录的HH依从性和行为反馈。比较了法规遵从性的基线比较（2016年7月）与实施后的基线比较（2017年7月）。研究结果表明，有16％（8/50）的医院的基线HH依从性≤60％，而总体而言，有48％（24/50）的医院表现出显着改善（P <0.01）。在13个月的观察期内，记录了523,422次观察，每1000个患者日的平均观察值为277±223次。在2016年7月至2017年7月之间，该组的平均复合依从性分别提高了7.8％（P <0.01）从77.4％±12.8至85.2％±8.8。