Effect of education and performance feedback on handwashing in Two Hospitals in Istanbul and Ankara

BACKGROUND: Patients admitted to hospitals are at risk of acquiring nosocomial infections. Many peer-reviewed studies show that handwashing (HW) significantly reduces hospital infections and mortality rates. Our objective was to evaluate the effects of education and performance feedback on handwashing compliance before contact with patients in intensive care units (ICUs) in two public hospitals in Turkey. We performed an observational study of healthcare workers (HCWs) to measure the effect of education alone plus performance feedback. METHODS: Two ICUs in two public hospitals were studied for adherence to a handwashing protocol. The HCWs observed included physicians, nursing personnel, and ancillary staff. Following initial observations to establish baseline rates of HW (phase one), we evaluated the effect of education plus performance feedback (phase two). RESULTS: At the hospital in Ankara, phase one occurred from August 2003 to November 2003, and phase two from December 2003 to August 2004. At the hospital in Istanbul, phase one was from October 2003 to March 2004, and phase two was from April 2004 to October 2004. We observed 1614 patient contacts during phase one, and 1816 during phase two. During phase one, the baseline rate of handwashing before contact with patients was 11.95% (193/1614). During phase two, with education and performance feedback, handwashing increased to 43.99% (799/1816) (RR 3.68; 95% CI 3.14 – 4.31; p = 0.0000). CONCLUSIONS: In this study, HW policies, education, and performance feedback for HCWs significantly improve worker adherence to handwashing protocol.