Strategies to Improve Hand Hygiene Practices in Two University Hospitals
Somwang Danchaivijitr MD*, Wilawan Pichiensatian MSc**, Anucha Apisarnthanarak MD***, Kanchana Kachintorn RN****, Rachada Cherdrungsi MSc****
Affiliation : *Department of Medicine,Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, **Faculty of Nursing, Chiang Mai University, Chiang Mai, ***Department of Medicine, Thammasart University, Pathum Thani, ****Center for Nosocomial Infection Control, Siriraj Hospital, Mahidol University, Bangkok
Objective : To evaluate the strategies to improve hand hygiene practices among participants in two university
hospitals.
Materials and Methods : A quasi-experimental study was performed from January 1, 2001 to December 31, 2004
at Siriraj Hospital and from January 1, 2004 to July 31, 2004 at the neonatal intensive care unit (NICU),
Maharaj Nakorn Chiang Mai Hospital. The study was divided into three phases; 1) pre-intervention phase to
identify factors associated with non-adherence in hand hygiene practices among participants, 2) interven-
tion phase, 3) post-intervention phase to include observations to evaluate the effectiveness of interventions
on hand hygiene practices among participants. Interventions at Siriraj Hospital included distribution of
posters, leaflets, rewarding healthcare workers (HCWs) who suggest the most attractive name for alcohol gel
and a handwashing slogan, and a parade to boost hand hygiene practice. Interventions at Maharaj Nakorn
Chiang Mai Hospital included training, a reminder poster display, provision of alcohol-based handrubs and
performance feedback.
Results : Six hundred and forty-six HCWs were observed before and after the non-invasive procedures and 404
HCWs were observed before and after an invasive procedure at Siriraj Hospital. At Maharaj Nakorn Chiang
Mai Hospital, participants included 26 nursing personnel in the NICU. After intervention, significant im-
provement on handwashing was observed in both the invasive procedure (p<0.001) and non-invasive proce-
dures ( p<0.001) at Siriraj Hosptial. Significant improvement on handhygiene practice was also observed
among participants at Maharaj Nakorn Chiang Mai Hosptial (p=0.001).
Conclusion : Different strategies worked well in different institutions. The present study suggested the role of
multi-faceted approaches to help improve handhygiene practices among HCWs.
Keywords : Hand hygiene, Strategies, University hospitals
