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Effect of a Multifaceted Intervention on Adherence to Hand Hygiene among Healthcare Workers: A Cluster-Randomized Trial

  • Dominik Mertz (a1) (a2), Nancy Dafoe (a3), Stephen D. Walter (a1), Kevin Brazil (a1) and Mark Loeb (a1) (a3) (a4) (a2)...



Adherence to hand hygiene among healthcare workers (HCWs) is widely believed to be a key factor in reducing the spread of healthcare-associated infection. The objective of this study was to evaluate the impact of a multifaceted intervention to increase rates of adherence to hand hygiene among HCWs and to assess the effect on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) colonization.


Cluster-randomized controlled trial.


Thirty hospital units in 3 tertiary care hospitals in Hamilton, Ontario, Canada.


After a 3-month baseline period of data collection, 15 units were randomly assigned to the intervention arm (with performance feedback, small-group teaching seminars, and posters) and 15 units to usual practice. Hand hygiene was observed during randomly selected 15-minute periods on each unit, and the incidence of MRSA colonization was measured using weekly surveillance specimens from June 2007 through May 2008.


We found that 3,812 (48.2%) of 7,901 opportunities for hand hygiene in the intervention group resulted in adherence, compared with 3,205 (42.6%) of 7,526 opportunities in the control group (P < .001; independent t test). There was no reduction in the incidence of hospital-acquired MRSA colonization in the intervention group.


Among HCWs in Ontario tertiary care hospitals, the rate of adherence to hand hygiene had a statistically significant increase of 6% with a multifaceted intervention, but the incidence of MRSA colonization was not reduced.


Corresponding author

Departments of Pathology and Molecular Medicine and Clinical Epidemiology and Biostatistics, McMaster University, MDCL 3203, 1200 Main Street W, Hamilton, ON, L8N 3Z5, Canada, (


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