American Journal of Infection Control
Vol 41 | No. 5 | May 2013 | Pages 389-480
http://www.ajicjournal.org/current

Compliance with hygiene guidelines: The effect of a multimodal hygiene intervention and validation of direct observations
Sara Mernelius, MS, Per-Olof Svensson, RN, BSc; Gunhild Rensfeldt, RN, BSc; Ewa Davidsson, RN, BSc; Barbro Isaksson, MD, PhD; Sture Löfgren, MD, PhD; Andreas Matussek, MD, PhD

Abstract
Background
Good compliance with hygiene guidelines is essential to prevent bacterial transmission and health care-associated infections. However, the compliance is usually <50%.

Methods
A multimodal and multidisciplinary hygiene intervention was launched once the baseline compliance was determined through direct observations in 4 departments of obstetrics and gynecology. Detailed evaluations of the compliance rates were performed at point of stability (at 80%) and follow-up (3 years after hygiene intervention). Validation of direct observations was performed using blinded double appraisal and multiappraisal.

Results
At baseline, the compliance with barrier precautions and the dress code at the 4 departments were 39% to 47% and 79% to 98%, respectively. Point of stability was reached approximately 1 year after the hygiene intervention was launched. The compliance with barrier precautions was significantly higher at follow-up compared with baseline in 3 departments. In the validation by double appraisal, 471 of 483 components were judged identical between observers. In the multiappraisal, 95% to 100% of the observers correctly judged the 7 components.

Conclusion
It is possible to improve compliance with hygiene guidelines, but, to ensure a long-lasting effect, a continuous focus on barrier precautions is required. Observation is a valid method to monitor compliance.
http://www.ajicjournal.org/article/S0196-6553%2812%2901249-7/abstract