Isolation status and voice prompts improve hand hygiene

Background: Barrier precautions (gowns and gloves) prevent horizontal transmission of pathogens. Nosocomial infections have been linked to poor hand hygiene. Isolation rooms for infection control improve hand hygiene and decrease nosocomial infections. We hypothesized that both patient isolation and electronic hand hygiene prompts incrementally improve hand hygiene of health care workers compared with nonisolation rooms. Methods: A prospective, 14.5-month, 3-phase electronic surveillance study of hand hygiene behavior on an intermediate care unit with 9 patient rooms (3 isolation rooms, 6 nonisolation rooms) was conducted. (phase I: electronic observation, phase II: electronic observation with automated voice messages urging hand hygiene, phase III: electronic observation). Electronic sensors monitored room entries and exits and use of all sinks and all soap dispensers. Phases compared by 2 × 3 Tables, and odds ratios (OR) and 95% confidence intervals (CI) are reported. Results: Phase I (1616 patient-days) health care workers were 49% more likely to wash their hands in isolation rooms versus nonisolation rooms (OR, 1.49; 95% CI: 1.17-1.88). Phase II (1390 patient-days) and phase III (543 patient-days) health care workers were 59% more likely to wash their hands in isolation versus nonisolation rooms (OR, 1.59; 95% CI: 1.17-2.14), P = .001. Conclusion: Health care workers improve hand hygiene when constrained by isolation rooms. Electronic voice prompts further improve hand hygiene behavior. Both physical and auditory reminders improve hand hygiene.