Teaching hospital medical staff to handwash

Objective: To increase the frequency of handwashing by medical staff. Design: A prospective study of handwashing before and after patient contact. Setting: A paediatric intensive care unit in a tertiary hospital. Participants: 61 intensive care unit medical staff and visiting medical staff. Interventions: A five-phase behaviour modification program: (i) unobtrusive observation for four weeks to obtain a baseline handwashing rate; (ii) overt observation for five weeks (preceded by written advice); (iii) overt observation continued for four weeks with performance feedback; (iv) all observation and feedback discontinued for seven weeks; and (v) unobtrusive observation for five weeks to obtain a residual rate. Results: 939 patient contacts were observed. The baseline handwashing rates before and after patient contact were 12.4% and 10.6%, respectively. During overt observation, the respective rates increased and plateaued at 32.7% and 33.3%, but increased further (to 68.3% and 64.8%) during the period of performance feedback. The residual handwashing rates, observed unobtrusively seven weeks after the cessation of performance feedback, were 54.6% before and 54.9% after patient contact. Conclusions: Performance feedback is moderately effective in training hospital medical staff to handwash.