scholarly journals Reducing C. difficile in children: An agent-based modeling approach to evaluate intervention effectiveness

2020 ◽  
Vol 41 (5) ◽  
pp. 522-530 ◽  
Author(s):  
Anna K. Barker ◽  
Elizabeth Scaria ◽  
Oguzhan Alagoz ◽  
Ajay K. Sethi ◽  
Nasia Safdar
Keyword(s):  
Hand Hygiene ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Substantial Reduction ◽  
Patient Transfers ◽  
Agent Based ◽  
Contact Precautions ◽  
Clostridioides Difficile ◽  
Effective Interventions ◽  
Environmental Disinfection

AbstractObjective:Clostridioides difficile infection (CDI) is rapidly increasing in children’s hospitals nationwide. Thus, we aimed to compare the effectiveness of 9 infection prevention interventions and 6 multiple-intervention bundles at reducing hospital-onset CDI and asymptomatic C. difficile colonization.Design:Agent-based simulation model of C. difficile transmission.Setting:Computer-simulated, 80-bed freestanding, tertiary-care pediatric hospital, including 8 identical wards with 10 single-bed patient rooms each.Participants:The model includes 5 distinct agent types: patients, visitors, caregivers, nurses, and physicians.Interventions:Daily and terminal environmental disinfection, screening at admission, reduced intrahospital patient transfers, healthcare worker (HCW), visitor, and patient hand hygiene, and HCW and visitor contact precautions.Results:The model predicted that daily environmental disinfection with sporicidal product, combined with screening for asymptomatic C. difficile at admission, was the most effective 2-pronged infection prevention bundle, reducing hospital-onset CDI by 62.0% and asymptomatic colonization by 88.4%. Single-intervention strategies, including daily disinfection, terminal disinfection, asymptomatic screening at admission, HCW hand hygiene, and patient hand hygiene, as well as decreasing intrahospital patient transfers, all also reduced both hospital-onset CDI and asymptomatic colonization in the model. Visitor hand hygiene and visitor and HCW contact precautions were not effective at reducing either measure.Conclusions:Hospitals can achieve substantial reduction in hospital-onset CDIs by implementing a small number of highly effective interventions.

scholarly journals Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System

2020 ◽  
Vol 41 (S1) ◽  
pp. s199-s200
Author(s):  
Matthew Linam ◽  
Dorian Hoskins ◽  
Preeti Jaggi ◽  
Mark Gonzalez ◽  
Renee Watson ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Central Line ◽  
Contact Precautions ◽  
Stewardship Program ◽  
Tract Infections ◽  
The Impact

Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.Funding: NoneDisclosures: None

scholarly journals 747. Association of Clostridiodes difficile Infection Incidence With Renewed Vigor in Infection Prevention Practices With the Onset of the COVID-19 Pandemic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S471-S471
Author(s):  
Ahmed A Khan ◽  
Sana Waqar
Keyword(s):  
Hand Hygiene ◽  
Risk Reduction ◽  
Infection Prevention ◽  
Compliance Rate ◽  
Tertiary Care ◽  
Substantial Reduction ◽  
Care Hospital ◽  
Care Providers ◽  
Testing Strategy ◽  
Prevention Strategies

Abstract Background Clostridioides difficile is the leading cause of hospital associated infections. In 2017 it lead to an estimated 223,900 cases, 12,800 deaths and &1 billion in attributable healthcare costs.[1] Judicious use of antibiotics and good hand hygiene practices form the cornerstone of prevention. During the COVID-19 pandemic there has been a focus on infection control practices such as hand hygiene, which would also lead to decreased incidence of other contagious infections such as C. difficile diarrhea. Methods We looked at the incidence of C. difficile infection in a tertiary care hospital, 1 year before and 1 year after the start of the COVID-19 pandemic. We looked at the absolute number of hospital associated C. difficile infections and the rate per 1000 patient days. The testing methodology changed during the time of the study. Initially it included NAAT for C. difficile, however in March of 2020 the testing strategy included testing for GDH antigen and toxin A/B to differentiate between infection and asymptomatic colonization. Results From January 1st and December 31st 2019 there were a total of 182 C. difficile infections with a rate of 1.29% per 1000 patient days. Between January 1st and December 31st 2020 there were a total of 51 C. difficile infections with a rate of 0.39% per 1000 patient days. There was an absolute risk reduction of 0.9% and relative risk reduction of 69.7%. Hand hygiene audits did not show a difference in adherence between the two periods, with a compliance rate of 98% for both. Conclusion Our data suggests that there was a substantial reduction in C. difficile infection rate after widespread knowledge of COVID-19 and implementation of enhanced infection prevention strategies. These included frequent reminders of hand washing, gowning and social distancing to name some. This information was conveyed in the form of widely disseminated signs in highly visible areas, frequent reminders electronically and in person between staff and providers. There are limitations in our study, which include difficulty in longitudinally assessing the extent to which patient care providers adhered to infection prevention strategies and a change in testing strategy for C. difficile diagnosis during this time. Disclosures All Authors: No reported disclosures

scholarly journals 2418. Determining the Impact of Visitor Contact Precautions on Hospital-Onset Clostridioides difficile Infection Rates: An Agent-Based Simulation Modeling Approach

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S835-S835
Author(s):  
Oguzhan Alagoz ◽  
Elizabeth Scaria ◽  
Anna K Barker ◽  
Nasia Safdar
Keyword(s):  
Hand Hygiene ◽  
Simulation Model ◽  
Healthcare Worker ◽  
Healthcare Workers ◽  
Agent Based Simulation ◽  
Environmental Cleaning ◽  
Agent Based ◽  
Contact Precautions ◽  
Clostridioides Difficile ◽  
The Impact

Abstract Background Visitor contact precautions (VCP) have been suggested to reduce the transmission of Clostridiodes difficile at healthcare institutions. However, there are no data describing the impact of VCP on hospital-acquired C. difficile infection (HO-CDI) rates. Enforcing VCP for CDI control is also controversial, as VCP are poorly implemented and highly variable. Methods We developed an agent-based simulation model of C. difficile transmission at a model 200-bed acute-care adult hospital. Our agent-based simulation model represented interactions among the physicians, nurses, patients, visitors, and physical environment. We used the agent-based simulation model to evaluate the impact of VCP on reducing HO-CDI considering many different hospital settings and various assumptions on patient susceptibility, adherence rates to other infection control practices, interactions between healthcare workers and patients. Results VCP did not reduce the CDC-defined HO-CDI rates by more than 1% in any of the tested scenarios and hospital settings. Increasing the adherence of hand hygiene of healthcare workers to 56% from a baseline estimate of 55%, or compliance to room cleaning to 50% from a baseline estimate of 47% have led to higher rates of reduction in CDI compared with VCP. Conclusion This is the first mathematical model to quantify the reduction in HO-CDI with VCP. The agent-based simulation model suggests that the impact of VCP on hospital-onset CDI is minimal and hospitals can achieve a higher rate of reduction for HO-CDI by implementing other interventions such as healthcare worker hand hygiene, environmental cleaning and healthcare worker contact precautions. Further studies are needed to evaluate the impact of VCP on C. difficile colonization in community. Disclosures All authors: No reported disclosures.

The impact of a multimodel approach to designing a new orthopedic department

2020 ◽  
pp. 1-6
Author(s):  
Elad Keren ◽  
Abraham Borer ◽  
Lior Nesher ◽  
Tali Shafat ◽  
Rivka Yosipovich ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Prevention Measures ◽  
Orthopedic Department ◽  
Before And After ◽  
The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

scholarly journals Detecting carbapenemase-producing Enterobacterales (CPE): an evaluation of an enhanced CPE infection control and screening programme in acute care

2020 ◽  
Vol 75 (9) ◽  
pp. 2670-2676
Author(s):  
Jonathan A Otter ◽  
Siddharth Mookerjee ◽  
Frances Davies ◽  
Frances Bolt ◽  
Eleonora Dyakova ◽  
...  
Keyword(s):  
Infection Prevention ◽  
Screening Programme ◽  
Contact Tracing ◽  
Prevention Measures ◽  
National Guidelines ◽  
Carriage Rate ◽  
Contact Precautions ◽  
Admission Screening ◽  
Carrier Identification ◽  
Environmental Disinfection

Abstract Objectives The transmission of carbapenemase-producing Enterobacterales (CPE) poses an increasing healthcare challenge. A range of infection prevention activities, including screening and contact precautions, are recommended by international and national guidelines. We evaluated the introduction of an enhanced screening programme in a multisite London hospital group. Methods In June 2015, an enhanced CPE policy was launched in response to a local rise in CPE detection. This increased infection prevention measures beyond the national recommendations, with enhanced admission screening, contact tracing and environmental disinfection, improved laboratory protocols and staff/patient education. We report the CPE incidence and trends of CPE in screening and clinical cultures and the adoption of enhanced CPE screening. All non-duplicate CPE isolates identified between April 2014 and March 2018 were included. Results The number of CPE screens increased progressively, from 4530 in July 2015 to 10 589 in March 2018. CPE detection increased from 18 patients in July 2015 (1.0 per 1000 admissions) to 50 patients in March 2018 (2.7 per 1000 admissions). The proportion of CPE-positive screening cultures remained at approximately 0.4% throughout, suggesting that whilst the CPE carriage rate was unchanged, carrier identification increased. Also, 123 patients were identified through positive CPE clinical cultures over the study period; there was no significant change in the rate of CPE from clinical cultures per 1000 admissions (P = 0.07). Conclusions Our findings suggest that whilst the enhanced screening programme identified a previously undetected reservoir of CPE colonization in our patient population, the rate of detection of CPE in clinical cultures did not increase.

scholarly journals A multimodal intervention program to control a long-term Acinetobacter baumannii endemic in a tertiary care hospital

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
R. Valencia-Martín ◽  
◽  
V. Gonzalez-Galan ◽  
R. Alvarez-Marín ◽  
A. M. Cazalla-Foncueva ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acinetobacter Baumannii ◽  
Intervention Program ◽  
Tertiary Care ◽  
Incidence Density ◽  
Care Hospital ◽  
Interrupted Time Series Analysis ◽  
Tertiary Referral Centre ◽  
Contact Precautions ◽  
Multicomponent Intervention

Abstract Background Acinetobacter baumannii causes frequently nosocomial infections worldwide. Its ability to survive on dry surfaces facilitates its spread and the persistence of endemic situations, especially in the intensive care units (ICUs). The objective of this paper is to describe a multicomponent intervention program designed to control a hyperendemic persistence of multidrug-resistant A. baumannii (MDR-Ab) and to characterize its impact. Methods Design: Quasi-experimental intervention study based on open cohorts. Setting: Public tertiary referral centre. Period: January 2009–August 2017. Intervention: multifaceted program based on environmental decontamination, hand hygiene, antimicrobial stewardship, contact precautions, active surveillance, weekly reports and regular meetings. Analysis: joinpoint regression and interrupted time-series analysis. Results The intervention was successfully implemented. Through the study period, the compliance with contact precautions changed from 0 to 100% and with hand hygiene, from 41.8 to 82.3%. Between 2012 and 2016, the antibiotic consumption decreased from 165.35 in to 150.44 daily-defined doses/1000 patients-days in the ICU. The incidence density of MDR-Ab in the ICU was 10.9 cases/1000 patients-days at the beginning of the intervention. After this moment, the evolution of the incidence density of MDR-Ab was: between months 0 and 6°, it remained stable; between months 7° and 10°: there was an intense decrease, with an average monthly percentage change (AMPC) = − 30.05%; from 11° month until the end, the decrease was lighter but continuous (AMPC:-2.77%), achieving an incidence density of 0 cases/1000 patients-days on the 18° month, without any new case for 12 months. From the 30° month until the end of the study period, several little outbreaks of MDR-Ab were detected, all of them rapidly controlled. The strains of MDR-Ab isolated during these outbreaks were not clonally related with the previously endemic one, which supports its eradication from the environmental reservoirs. Conclusion The multicomponent intervention performed by a multidisciplinary team was effective to eradicate the endemic MDR-Ab.

Discontinuing MRSA and VRE contact precautions: Defining hospital characteristics and infection prevention practices predicting safe de-escalation

2021 ◽  
pp. 1-8
Author(s):  
Elise M. Martin ◽  
Bonnie Colaianne ◽  
Christine Bridge ◽  
Andrew Bilderback ◽  
Colleen Tanner ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Poisson Regression ◽  
Infection Prevention ◽  
Interrupted Time Series ◽  
Healthcare Associated Infections ◽  
Contact Precautions ◽  
Before And After ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
Hospital Characteristics

Abstract Objective: To define conditions in which contact precautions can be safely discontinued for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE). Design: Interrupted time series. Setting: 15 acute-care hospitals. Participants: Inpatients. Intervention: Contact precautions for endemic MRSA and VRE were discontinued in 12 intervention hospitals and continued at 3 nonintervention hospitals. Rates of MRSA and VRE healthcare-associated infections (HAIs) were collected for 12 months before and after. Trends in HAI rates were analyzed using Poisson regression. To predict conditions when contact precautions may be safely discontinued, selected baseline hospital characteristics and infection prevention practices were correlated with HAI rate changes, stratified by hospital. Results: Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between intervention and non-intervention hospitals. All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. We observed no correlations between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, but the rate improved with higher proportion of semiprivate rooms (P = .04). Conclusions: Discontinuing contact precautions for MRSA/VRE did not result in increased HAI rates, suggesting that contact precautions can be safely removed from diverse hospitals, including community hospitals and those with lower proportions of private rooms. Good hand hygiene and low baseline HAI rates may be conditions permissive of safe removal of contact precautions.

scholarly journals 2423. Cost-effectiveness of core and emerging infection control interventions to reduce hospital-onset Clostridioides difficile infection: An agent-based simulation modeling approach

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S837-S837
Author(s):  
Oguzhan Alagoz ◽  
Anna K Barker ◽  
Elizabeth Scaria ◽  
Nasia Safdar
Keyword(s):  
Cost Effectiveness ◽  
Hand Hygiene ◽  
Infection Control ◽  
Hospital Setting ◽  
Multiple Infection ◽  
Agent Based ◽  
Emerging Infection ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
The Cost

Abstract Background Multiple infection control interventions have been recommended to reduce hospital-onset Clostridioides difficile infection (C. difficile; HO-CDI), including contact isolation, environmental disinfection, and hand hygiene. These interventions have differential effects on reducing HO-CDI that change for each hospital setting. In the context of today’s constrained resources, with trade-offs a necessary part of any prevention plan, infection control personnel need information regarding intervention cost-effectiveness that is tailored to their unique hospital setting. Methods We evaluated the cost-effectiveness of nine infection control interventions and eight multiple-intervention bundles using our group’s agent-based model of C. difficile transmission. This previously developed model represents a general 200-bed acute-care adult hospital. Effectiveness was measured from the hospital perspective in terms of both quality-adjusted life years (QALYs) and HO-CDIs. Results Six interventions reduced cost while increasing QALYs and averting HO-CDI, compared with baseline standard hospital practices: daily cleaning (saved an average of $407,854 and 36.8 QALYs annually in a 200-bed hospital), HCW hand hygiene ($181,767; 17.7 QALYs), patient hand hygiene ($25,700; 6.3 QALYs), terminal cleaning ($64,986; 12.8 QALYs), screening at admission ($9,083; 18.5 QALYs), and reducing patient transfers ($27,514; 3.1 QALYs). Adding patient hand hygiene to the HCW hand hygiene intervention was cost saving. When screening, HCW hand hygiene, and patient hand hygiene interventions were sequentially added to daily cleaning to form two, three, and four-pronged bundles, the incremental cost-effectiveness ratios for these additions were $26,588, $44,173, and $123,379 per QALY, respectively. Conclusion Using cost-effectiveness data, institutions may consider streamlining their infection control initiatives and prioritizing a smaller number of highly effective interventions. Our model could be used to evaluate the cost-effectiveness of existing core and emerging infection control interventions for specific hospital settings. Disclosures All authors: No reported disclosures.

Management of an Outbreak ofClostridium difficile–Associated Disease Among Geriatric Patients

2006 ◽  
Vol 27 (11) ◽  
pp. 1200-1205 ◽  
Author(s):  
S. Cherifi ◽  
M. Delmee ◽  
J. Van Broeck ◽  
I. Beyer ◽  
B. Byl ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Tertiary Care ◽  
Control Unit ◽  
Stool Culture ◽  
Surveillance Program ◽  
Ofclostridium Difficile ◽  
Contact Isolation ◽  
Early Implementation ◽  
Secondary Hospital ◽  
Environmental Disinfection

Objective.To describe a nosocomial outbreak ofClostridium difficile–associated disease (CDAD).Design.A traditional outbreak investigation.Setting.Geriatric department of a tertiary care teaching hospital from March through April 2003.Methods.The outbreak was detected by theC. difficilesurveillance program of the infection control unit. CDAD was diagnosed by stool culture and fecal toxin A detection with a qualitative rapid immunoassay. Isolates ofC difficilewere serotyped and genotyped using pulsed-field gel electrophoresis.Results.The incidence of CDAD increased from 27 cases per 100,000 patient-days in the 6-month period before the outbreak to 99 cases per 100,000 patient-days during the outbreak. This outbreak involved 21 of 92 patients in 4 geriatric wards, which were located at 2 geographically distinct sites and staffed by the same medical team. The mean age of patients was 83 years (range, 71-100 years). Five (24%) of the 21 patients had community-acquired diarrhea, and secondary hospital transmission resulted in 3 clusters involving 16 patients. Serotyping and genotyping were performed on isolates in stool specimens from 19 different patients; 16 of these isolates were serotype A1, whereas 3 displayed profiles different from the outbreak strain. Management of this outbreak consisted in reinforcement of contact isolation precautions for patients with diarrhea, cohorting of infected patients in the same ward, and promotion of hand hygiene. Relapses occurred in 6 (29%) of 21 patients.Conclusion.Control of this rapidly developing outbreak of CDAD was obtained with early implementation of cohorting and ward closure and reinforcement of environmental disinfection, hand hygiene, and enteric isolation precautions.

Factors Associated with Hand Hygiene Compliance at a Tertiary Care Teaching Hospital

2013 ◽  
Vol 34 (11) ◽  
pp. 1146-1152 ◽  
Author(s):  
Benjamin Kowitt ◽  
Julie Jefferson ◽  
Leonard A. Mermel
Keyword(s):  
Hand Hygiene ◽  
Teaching Hospital ◽  
Hand Hygiene Compliance ◽  
Tertiary Care ◽  
Support Staff ◽  
Tertiary Care Teaching Hospital ◽  
Care Teaching ◽  
Factors Associated ◽  
Contact Precautions ◽  
Hygiene Compliance

Objective.To identify factors associated with hand hygiene compliance during a multiyear period of intervention.Design.Observational study.Setting.A 719-bed tertiary care teaching hospital.Participants.Nursing, physician, technical, and support staff.Methods.Light-duty staff performed hand hygiene observations during the period July 2008-December 2012. Infection control implemented hospital-wide hand hygiene initiatives, including education modules; posters and table tents; feedback to units, medical directors and the executive board; and an increased number of automated alcohol hand hygiene product dispensers.Results.There were 161,526 unique observations; overall compliance was 83%. Significant differences in compliance were observed between physician staff (78%) and support staff (69%) compared with nursing staff (84%). Pediatric units (84%) and intensive care units (84%) had higher compliance than did medical (82%) and surgical units (81%). These findings persisted in the controlled multivariate model for noncompliance. Additional factors found to be significant in the model included greater compliance when healthcare workers were leaving patient rooms, when the patient was under contact precautions, and during the evening shift. The overall rate of compliance increased from 60% in the first year of observation to a peak of 96% in the fourth year, and it decreased to 89% in the final year, with significant improvements occurring in each of the 4 professional categories.Conclusions.A multipronged hand hygiene initiative is effective in increasing compliance rates among all categories of hospital workers. We identified a variety of factors associated with increased compliance. Additionally, we note the importance of continuous interventions in maintaining high compliance rates.

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