Does a bed rail system of alcohol-based handrub antiseptic improve compliance of health care workers with hand hygiene? Results from a pilot study

Background: Hand hygiene is the cornerstone of prevention of nosocomial infections and a challenge for infection-control teams. Methods: Bed-rail dispensers of alcohol-based hand rub antiseptic (AHRA) were first initiated only in department A (period I), followed by department B (period II). Opportunities for hand hygiene (OHH) were recorded during periods I, II, and III (post-trial follow-up). Only application of AHRA before and after contacting each patient was considered as appropriate. Comparative evaluation between periods I and II, as well as II and III. was performed. Predictors of AHRA compliance were also assessed by regression analysis. Results: HCWs' compliance was improved after the initiation of the bed-rail approach in department B (51.5%, vs 36.4% P = .005). In department A, where this system already existed, no changes were observed. The bed-rail AHRA system (P = .007 [OR 1.8(1.2-3.0)]) and nurses (P <.0001 [OR 5.6 (3.1-9.9)]) were predictors of hand hygiene in department B. HCWs' compliance declined in department B (26.5% vs 51.5%, P <.0001) and department A (27.5% vs 35.9%, P = .1) during period III. Conclusions: The bed-rail approach initially improved HCWs' compliance with AHRA but did not radically influence behavior in internal medicine settings. Multidisciplinary strategies are required to establish hand hygiene recommendations. Copyright (C) 2009 Association or Professionals in Infection Control and Epidemiology. Inc.