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This article is part of the supplement: International Conference on Prevention & Infection Control (ICPIC 2011)

Open Access Poster presentation

Comparing short term and sustained effects of two strategies to improve nurses’ adherence with hand hygiene prescriptions: a cluster randomised trial

A Huis*, L Schoonhoven, R Grol, R Donders, M Hulscher and T van Achterberg

  • * Corresponding author: A Huis

Author Affiliations

IQ Healthcare, Radbound University Nijmegen Medical Centre, Nijmegen, Netherlands

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BMC Proceedings 2011, 5(Suppl 6):P119  doi:10.1186/1753-6561-5-S6-P119

The electronic version of this article is the complete one and can be found online at:

Published:29 June 2011

© 2011 Huis et al; licensee BioMed Central Ltd.

This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction / objectives

Improving hand hygiene (HH) compliance is still a major challenge. We compared a literature based 'state of the art' strategy with a 'team directed' strategy, based on social influence and leadership, on their effectiveness on HH compliance.


We undertook a cluster randomised trial with inpatient wards as the unit of randomisation. The 'state of the art' strategy (SAS) included education, reminders, feedback and targeting adequate products and facilities. The 'team directed' strategy (TD) also contained activities based on social influence and leadership, gaining active commitment and initiative of ward management, modelling by informal leaders, and setting norms and targets within the team. Strategies were delivered during a period of 6 months. Measurements took place directly before and after strategy delivery and 6 months later. The effects were evaluated on an intention-to-treat basis by comparing the post-strategy hand hygiene compliance rates with the baseline rates. Multilevel analysis was applied to compensate for the clustered nature of the data by using mixed linear modelling techniques.


The SAS showed a short-term improvement of 19,6% and a long term improvement of 23,7%. The improvement for the TD was 33,7% (short term) and 33.1% (long term). The difference between TD and SAS showed an Odds Ratio of 1.641 (p<0.001) in favour of the 'team directed' strategy.


Both the 'state of the art' strategy and the 'team directed' strategy successfully improved hand hygiene compliance, but the ‘team directed' strategy showed even better results. The methodology of this ‘team directed’ strategy can also be used to improve team performance on other patient safety issues.

Disclosure of interest

None declared.