Thea van de Mortel, Louise Heyman

Nosocomial infections affect up to 30% of ICU patients. Although infection rates decline with increasing handwashing frequency, handwashing rates in ICU's are poor. This study investigated the hypotheses that the subjects' profession would not influence, and performance feedback would not increase, the incidence of handwashing post-patient contact. The study involved an initial period of covert observation to record the baseline level of handwashing, followed by a period of overt observation with regular feedback on handwashing performance by means of letters to staff and histograms of the data displayed in the ICU. Handwashing incidence was reassessed 6 months after performance feedback had ceased. Handwashing differed significantly between professions (P = 0.0001). Initially, the incidence of handwashing was highest amongst wardsmen (90%) and lowest amongst Visiting Medical Officers (VMOs) (20%). Sixty-nine percent (69%) of Registered Nurses (RNs), 57% of physiotherapists, 41% of Resident Medical Officers (RMOs) and 35% of radiographers washed their hands after touching patients. With the exception of the wardsmen, there was a trend towards an increased frequency in handwashing in all groups after performance feedback, but the differences were only statistically significant in the VMO and physiotherapist groups (P < 0.001). The improvements were maintained for 6 months after the feedback phase ended in 4 of the 6 groups.