RESUMO
BACKGROUND: Hand hygiene is the cornerstone of prevention of nosocomial infections and a challenge for infection-control teams. METHODS: Bed-rail dispensers of alcohol-based hand rub antiseptic (AHRA) were first initiated only in department A (period I), followed by department B (period II). Opportunities for hand hygiene (OHH) were recorded during periods I, II, and III (post-trial follow-up). Only application of AHRA before and after contacting each patient was considered as appropriate. Comparative evaluation between periods I and II, as well as II and III, was performed. Predictors of AHRA compliance were also assessed by regression analysis. RESULTS: HCWs' compliance was improved after the initiation of the bed-rail approach in department B (51.5%, vs 36.4% P = .005). In department A, where this system already existed, no changes were observed. The bed-rail AHRA system (P = .007 [OR 1.8(1.2-3.0)]) and nurses (P < .0001[OR 5.6 (3.1-9.9)]) were predictors of hand hygiene in department B. HCWs' compliance declined in department B (26.5% vs 51.5%, P < .0001) and department A (27.5% vs 35.9%, P = .1) during period III. CONCLUSIONS: The bed-rail approach initially improved HCWs' compliance with AHRA but did not radically influence behavior in internal medicine settings. Multidisciplinary strategies are required to establish hand hygiene recommendations.
