Abstract
BACKGROUND: Patients admitted to hospitals are at risk of acquiring nosocomial infections. Many peer-reviewed studies show that handwashing (HW) significantly reduces hospital infections and mortality rates. Our objective was to evaluate the effects of education and performance feedback on handwashing compliance before contact with patients in intensive care units (ICUs) in a public hospital in Mexico City. We performed an observational study of healthcare workers (HCWs) to measure the effect of education alone plus performance feedback. METHODS: Two ICUs at one public hospital, one for newborns (NICU) and one for adults (MICU), were studied for adherence to a handwashing protocol. The observed HCWs included physicians, nursing personnel, and ancillary staff. Following initial observations to establish baseline rates of HW compliance (phase one), we evaluated the effect of education plus performance feedback (phase two). RESULTS: Phase one occurred from October 2003 to March 2004, and phase two from April 2004 to June 2004. We observed 1595 patient contacts in the N ICU, 1070 during phase one and 525 during phase two. We observed 1535 patient contacts in the MICU, 952 during phase one and 583 during phase two. During phase one, the baseline rate of handwashing before contact with patients was 46.35% (496/1070) in the NICU, and 38.76% (369/952) in the M ICU. During phase two, with education and performance feedback, handwashing in the NICU improved to 69.71% (366/525) (RR 1.50; 95% CI 1.31 – 1.72; p = 0.0000). And Handwashing in the MICU increased to 63.63% (371/583) (RR 1.64; 95% CI 1.42 – 1.90; p = 0.0000). Comparing HW after intervention, during phase two, we did not find significant differences among the NICU and MICU: 69.71% (366/525) versus 63.63% (371/583), respectively (RR:1.10, 95% CI:0.95 – 1.27, p = 0.2154). CONCLUSIONS: In this study, HW policies, education, and performance feedback for HCWs significantly improved adherence to the handwashing protocol.
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