You are not currently logged in.

Access JSTOR through your library or other institution:


Log in through your institution.

Journal Article

Dissemination and Sustainability of a Hospital‐Wide Hand Hygiene Program Emphasizing Positive Reinforcement

Jeanmarie Mayer , MD, Barbara Mooney , RN, CIC, Adi Gundlapalli , MD, PhD, Stephan Harbarth , MD, MS, Gregory J Stoddard , MPH, Michael A. Rubin , MD, PhD, Louise Eutropius , RN, CIC, Britt Brinton , MT, CIC and Matthew H. Samore , MD
Infection Control and Hospital Epidemiology
Vol. 32, No. 1 (January 2011), pp. 59-66
DOI: 10.1086/657666
Stable URL:
Page Count: 8
Were these topics helpful?
See something inaccurate? Let us know!

Select the topics that are inaccurate.

  • Subscribe ($19.50)
  • Add to My Lists
  • Cite this Item
Dissemination and Sustainability of a Hospital‐Wide Hand Hygiene Program Emphasizing Positive Reinforcement
Preview not available


Objective.  To increase and sustain hospital‐wide compliance with hand hygiene through a long‐term ongoing multidimensional improvement program emphasizing behavioral factors. Design.  Quasi‐experimental short study (August 2000–November 2001) and descriptive time series (April 2003–December 2006). Setting.  A 450‐bed teaching tertiary‐care hospital. Interventions.  An initial intervention bundle was introduced in pilot locations that addressed cognitive behavioral factors, which included access to alcohol sanitizer, education, and ongoing audit and feedback. The bundle was subsequently disseminated hospital‐wide, along with a novel approach focused on behavior modification through positive reinforcement and annually changing incentives. Results.  A total of 36,123 hand hygiene opportunities involving all categories of healthcare workers from 12 inpatient units were observed from October 2000 to October 2006. The rate of compliance with hand hygiene significantly improved after the intervention in 2 cohorts over the first year (from 40% to 64% of opportunities and from 34% to 49% of opportunities; \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P< .001$ \end{document} , compared with the control group). Mean compliance rates ranged from 19% to 41% of 4174 opportunities (at baseline), increased to the highest levels of 73%–84% of 6,420 opportunities 2 years after hospital‐wide dissemination, and remained improved at 59%–81% of 4,990 opportunities during year 6 of the program. Conclusion.  This interventional cohort study used a behavioral change approach and is one of the earliest and largest institution‐wide programs promoting alcohol sanitizer from the United States that has shown significant and sustained improvements in hand hygiene compliance. This creative campaign used ongoing frequent audit and feedback with novel use of immediate positive reinforcement at an acceptable cost to the institution.

Page Thumbnails

Part of Sustainability