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Updated: Jun 8, 2026

A Method to Test the Efficacy of Handwashing for the Removal of Emerging Infectious Pathogens
Published on: June 7, 2017
Effect of a multifaceted intervention on adherence to hand hygiene among healthcare workers: a cluster-randomized
Dominik Mertz1, Nancy Dafoe, Stephen D Walter
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Objectives:
Adherence to hand hygiene among healthcare workers (HCWs) is widely believed to be a key factor in reducing the spread of healthcare-associated infection. The objective of this study was to evaluate the impact of a multifaceted intervention to increase rates of adherence to hand hygiene among HCWs and to assess the effect on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) colonization.
Design:
Cluster-randomized controlled trial.
Setting:
Thirty hospital units in 3 tertiary care hospitals in Hamilton, Ontario, Canada.
Intervention:
After a 3-month baseline period of data collection, 15 units were randomly assigned to the intervention arm (with performance feedback, small-group teaching seminars, and posters) and 15 units to usual practice. Hand hygiene was observed during randomly selected 15-minute periods on each unit, and the incidence of MRSA colonization was measured using weekly surveillance specimens from June 2007 through May 2008.
Results:
We found that 3,812 (48.2%) of 7,901 opportunities for hand hygiene in the intervention group resulted in adherence, compared with 3,205 (42.6%) of 7,526 opportunities in the control group (P < .001; independent t test). There was no reduction in the incidence of hospital-acquired MRSA colonization in the intervention group.
Conclusion:
Among HCWs in Ontario tertiary care hospitals, the rate of adherence to hand hygiene had a statistically significant increase of 6% with a multifaceted intervention, but the incidence of MRSA colonization was not reduced.
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