Open Access Open Badges Study protocol

The ACCOMPLISH study. A cluster randomised trial on the cost-effectiveness of a multicomponent intervention to improve hand hygiene compliance and reduce healthcare associated infections

Vicki Erasmus1*, Anita Huis2, Anke Oenema3, Pepijn van Empelen4, Matthijs C Boog1, Elise HE van Beeck1, Suzanne Polinder1, Ewout W Steyerberg1, Jan Hendrik Richardus1, Margreet C Vos5 and Ed F van Beeck1

Author Affiliations

1 Erasmus Medical Centre, Department of Public Health, Rotterdam, the Netherlands

2 Radboud University Nijmegen Medical Centre, IQ healthcare, Nijmegen, the Netherlands

3 Research Group Life Style, TNO, Leiden, the Netherlands

4 Maastricht University, Department of Health Promotion, Maastricht, the Netherlands

5 Erasmus Medical Centre, Department of Medical Microbiology & Infectious Diseases, Rotterdam, the Netherlands

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BMC Public Health 2011, 11:721  doi:10.1186/1471-2458-11-721

Published: 24 September 2011



Public health authorities have recognized lack of hand hygiene in hospitals as one of the important causes of preventable mortality and morbidity at population level. The implementation strategy ACCOMPLISH (Actively Creating COMPLIance Saving Health) targets both individual and environmental determinants of hand hygiene. This study aims to evaluate the cost-effectiveness of a multicomponent implementation strategy aimed at the reduction of healthcare associated infections in Dutch hospital care, by promotion of hand hygiene.


The ACCOMPLISH package will be evaluated in a two-arm cluster randomised trial in 16 hospitals in the Netherlands, in one intensive care unit and one surgical ward per hospital.


A multicomponent package, including e-learning, team training, introduction of electronic alcohol based hand rub dispensers and performance feedback.


The primary outcome measure will be the observed hand hygiene compliance rate, measured at baseline and after 6, 12 and 18 months; as a secondary outcome measure the prevalence of healthcare associated infections will be measured at the same time points. Process indicators of the intervention will be collected pre and post intervention. An ex-post economic evaluation of the ACCOMPLISH package from a healthcare perspective will be performed.

Statistical analysis

Multilevel analysis, using mixed linear modelling techniques will be conducted to assess the effect of the intervention strategy on the overall compliance rate among healthcare workers and on prevalence of healthcare associated infections. Questionnaires on process indicators will be analysed with multivariable linear regression, and will include both behavioural determinants and determinants of innovation. Cost-effectiveness will be assessed by calculating the incremental cost-effectiveness ratio, defined here as the costs for the intervention divided by the difference in prevalence of healthcare associated infections between the intervention and control group.


This study is the first RCT to investigate the effects of a hand hygiene intervention programme on the number of healthcare associated infections, and the first to investigate the cost-effectiveness of such an intervention. In addition, if the ACCOMPLISH package proves successful in improving hand hygiene compliance and lowering the prevalence of healthcare associated infections, the package could be disseminated at (inter)national level.

Trial registration