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The Impact of Introducing an Accessible, Alcohol-Based Hand Antiseptic

Werner E. Bischoff, MD; Tammy M. Reynolds, RN, BSN, CIC; Curtis N. Sessler, MD; Michael B. Edmond, MD, MPH; Richard P. Wenzel, MD, MSc

Arch Intern Med. 2000;160:1017-1021.

Context  Under routine hospital conditions handwashing compliance of health care workers including nurses, physicians, and others (eg, physical therapists and radiologic technicians) is unacceptably low.

Objectives  To investigate the efficacy of an education/feedback intervention and patient awareness program (cognitive approach) on handwashing compliance of health care workers; and to compare the acceptance of a new and increasingly accessible alcohol-based waterless hand disinfectant (technical approach) with the standard sink/soap combination.

Design  A 6-month, prospective, observational study.

Setting  One medical intensive care unit (ICU), 1 cardiac surgery ICU, and 1 general medical ward located in a 728-bed, tertiary care, teaching facility.

Participants  Medical caregivers in each of the above settings.

Interventions  Implementation of an education/feedback intervention program (6 in-service sessions per each ICU) and patient awareness program, followed by a new, increasingly accessible, alcohol-based, waterless hand antiseptic agent, initially available at a ratio of 1 dispenser for every 4 patients and subsequently 1 for each patient.

Main Outcome Measure  Direct observation of handwashing for 1575 potential opportunities monitored over 120 hours randomized for both time of day and bed locations.

Results  Baseline handwashing compliance before and after defined events was 9% and 22% for health care workers in the medical ICU and 3% and 13% for health care workers in the cardiac surgery ICU, respectively. After the education/feedback intervention program, handwashing compliance changed little (medical ICU, 14% [before] and 25% [after]; cardiac surgery ICU, 6% [before] and 13% [after]). Observations after introduction of the new, increasingly accessible, alcohol-based, waterless hand antiseptic revealed significantly higher handwashing rates (P<.05), and handwashing compliance improved as accessibility was enhanced—before 19% and after 41% with 1 dispenser per 4 beds; and before 23% and after 48% with 1 dispenser for each bed.

Conclusions  Education/feedback intervention and patient awareness programs failed to improve handwashing compliance. However, introduction of easily accessible dispensers with an alcohol-based waterless handwashing antiseptic led to significantly higher handwashing rates among health care workers.

From the Division of Quality Health Care, Department of Internal Medicine, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond. Dr Bischoff is now with the Institute for Medical Microbiology, Medical School Hanover, Hanover, Germany.

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