Hand decontamination: what interventions improve compliance?

Haemodialysis units have traditionally been classified as high-risk areas in relation to infection control. Hand decontamination is the fundamental infection control practice, although this is not always performed optimally Deficiencies in the technique, frequency and appropriateness of this vital practice are frequently reported in health care journals. A literature search was carried out to determine what interventions improve compliance with hand decontamination practice.

A literature search was carried out of electronic databases from 1988-2000. Forty articles matched the key search words. When inclusion/exclusion criteria had been applied, seven primary research articles were found to be suitable. Appropriate tools were used to critically analyse the research. The findings were then synthesised into similar themes.

The interventions used in the seven articles utilised a combination of staff and patient education, feedback and motivational interventions to improve compliance. The evidence showed that these interventions met with different degrees of success. Multiple interventions were generally more successful than individual efforts. The improvement in hand decontamination practice often fell back to base line measurements after the intervention had ceased.

The findings can cautiously be used to improve practice. A combination of continuous, innovative education and motivation should improve and maintain this important skill.