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  • 1 National Center for Epidemiology Department of Hospital Epidemiology Budapest Hungary
  • 2 European Center for Disease Prevention and Control (ECDC) European Programme for Intervention Epidemiology Training (EPIET) Stockholm Sweden
  • 3 National Center for Epidemiology Division of Virology Budapest Hungary
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Transmission of pathogens via healthcare workers’ (HCWs) hands is one of the most frequent means of spreading multi-resistant organisms and occurring healthcare-associated infections (HAIs) in hospitals. The role of contaminated hands in pathogen transmission was recognized by Hungarian physician, Ignác Semmelweis. Hand hygiene prevents cross-infections in hospitals, but numerous epidemiological and microbiology-based studies have documented low compliance of HCWs with this simple procedure. Furthermore, hand hygiene perception of HCWs plays an important role in determining hand hygiene compliance. Our aim was to describe the opinion of HCWs about their perception regarding hand hygiene practice. Our further goal was to strengthen a laboratory basis for bacterial backup control of nosocomial pathogens. A cross-sectional descriptive study was conducted between December 2010 and February 2011 in 13 participating hospitals in Hungary. HCWs know that there is correlation between contaminated hands and HAIs (83%), but neither the frequency (62%) nor the implementation (73%) of their hand hygiene performance are satisfying.We recommend that multimodal interventions — highlighted active microbiological surveillance of HCWs’ hands — are the most suitable strategies to reduce the occurrence of HAIs and to determine their impact on cross-transmission of microorganisms and to overcome barriers of HCWs.

  • Foca, M. et al.: Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit. New England Journal of Medicine 343, 695–700 (2000).

    Foca M. , 'Endemic Pseudomonas aeruginosa infection in a neonatal intensive care unit ' (2000 ) 343 New England Journal of Medicine : 695 -700.

    • Search Google Scholar
  • Sartor, C. et al.: Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap. Infection Control and Hospital Epidemiology 21, 196–199 (2000).

    Sartor C. , 'Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap ' (2000 ) 21 Infection Control and Hospital Epidemiology : 196 -199.

    • Search Google Scholar
  • Boyce, J. M. et al.: A common source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery. Journal of Infectious Diseases 161, 493–499 (1990).

    Boyce J. M. , 'A common source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery ' (1990 ) 161 Journal of Infectious Diseases : 493 -499.

    • Search Google Scholar
  • Zawaczki, A. et al.: An outbreak of Pseudomonas aeruginosa pneumonia and bloodstream infection associated with intermittent otitis externa in a healthcare worker. Infection Control and Hospital Epdemiology 25, 1083–1089 (2004).

    Zawaczki A. , 'An outbreak of Pseudomonas aeruginosa pneumonia and bloodstream infection associated with intermittent otitis externa in a healthcare worker ' (2004 ) 25 Infection Control and Hospital Epdemiology : 1083 -1089.

    • Search Google Scholar
  • El Shafie, S. S., Alishaq, M., Leni Garcia, M.: Investigation of an outbreak of multidrug-resistant Acinetobacter baumannii in trauma intensive care unit. Journal of Hospital Infections 56, 101–105 (2004).

    Leni Garcia M. , 'Investigation of an outbreak of multidrug-resistant Acinetobacter baumannii in trauma intensive care unit ' (2004 ) 56 Journal of Hospital Infections : 101 -105.

    • Search Google Scholar
  • Larson, E. L. et al.: Differences in skin flora between inpatients and chronically ill patients. Heart and Lung 29. 298–305 (2000).

    Larson E. L. , 'Differences in skin flora between inpatients and chronically ill patients ' (2000 ) 29 Heart and Lung : 298 -305.

    • Search Google Scholar
  • Ehrenkranz, N. J., Alfonso, B. C.: Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters. Infection Control and Hospital Epidemiology 12, 654–662 (1992).

    Alfonso B. C. , 'Failure of bland soap handwash to prevent hand transfer of patient bacteria to urethral catheters ' (1992 ) 12 Infection Control and Hospital Epidemiology : 654 -662.

    • Search Google Scholar
  • Sanderson, J. P., Weissler, S.: Recovery of coliforms from the hands of nurses and patients: Activities leading to contamination. Journal of Hospital Infections 21, 85–93 (1992).

    Weissler S. , 'Recovery of coliforms from the hands of nurses and patients: Activities leading to contamination ' (1992 ) 21 Journal of Hospital Infections : 85 -93.

    • Search Google Scholar
  • Bertone, S. A., Fisher, M. C., Mortensen, J. E.: Quantitative skin cultures at potential catheter sites in neonates. Infection Control and Hospital Epidemiology 15, 315–318 (1994).

    Mortensen J. E. , 'Quantitative skin cultures at potential catheter sites in neonates ' (1994 ) 15 Infection Control and Hospital Epidemiology : 315 -318.

    • Search Google Scholar
  • Bonten, M. J. M. et al.: Epidemiology of colonisation of patient and environment with vancomycin-resistant Enterococci. Lancet 348, 1615–1619 (1996).

    Bonten M. J. M. , 'Epidemiology of colonisation of patient and environment with vancomycin-resistant Enterococci ' (1996 ) 348 Lancet : 1615 -1619.

    • Search Google Scholar
  • Vernon, M. O. et al.: Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant Enterococci. Archives of Internal Medicine 166, 306–312 (2006).

    Vernon M. O. , 'Chlorhexidine gluconate to cleanse patients in a medical intensive care unit: the effectiveness of source control to reduce the bioburden of vancomycin-resistant Enterococci ' (2006 ) 166 Archives of Internal Medicine : 306 -312.

    • Search Google Scholar
  • Riggs, M. M. et al.: Asymptomatic carriers are a potential source of transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clinical Infectious Diseases 45, 992–998 (2007).

    Riggs M. M. , 'Asymptomatic carriers are a potential source of transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents ' (2007 ) 45 Clinical Infectious Diseases : 992 -998.

    • Search Google Scholar
  • Bhalla, A., Aron, D. C., Donskey, C. J.: Staphylococcus aureus intestinal colonisation is associated with increased frequency of S. aureus on skin of hospitalized patient. BMC Infectious Diseases 7, 105–109 (2007).

    Donskey C. J. , 'Staphylococcus aureus intestinal colonisation is associated with increased frequency of S. aureus on skin of hospitalized patient ' (2007 ) 7 BMC Infectious Diseases : 105 -109.

    • Search Google Scholar
  • Boyce, J. M. et al.: Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance. Journal of Clinical Microbiology 32, 1148–1153 (1994).

    Boyce J. M. , 'Outbreak of multidrug-resistant Enterococcus faecium with transferable vanB class vancomycin resistance ' (1994 ) 32 Journal of Clinical Microbiology : 1148 -1153.

    • Search Google Scholar
  • McFarland, L. V. et al.: Nosocomial acquisition of Clostridium difficile infection. New England Journal of Medicine 320, 204–210 (1989).

    McFarland L. V. , 'Nosocomial acquisition of Clostridium difficile infection ' (1989 ) 320 New England Journal of Medicine : 204 -210.

    • Search Google Scholar
  • Samore, M. H. et al.: Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. American Journal of Medicine 100, 32–40 (1996).

    Samore M. H. , 'Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea ' (1996 ) 100 American Journal of Medicine : 32 -40.

    • Search Google Scholar
  • Boyce, J. M. et al.: Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infection Control and Hospital Epidemiology 18, 622–627 (1997).

    Boyce J. M. , 'Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications ' (1997 ) 18 Infection Control and Hospital Epidemiology : 622 -627.

    • Search Google Scholar
  • Hayden, M. K. et al.: Risk of hand or glove contamination after contact with patient colonized with vancomycin-resistant Enterococcus or the colonized patients’ environment. Infection Control and Hospital Epidemiology 29, 149–154 (2008).

    Hayden M. K. , 'Risk of hand or glove contamination after contact with patient colonized with vancomycin-resistant Enterococcus or the colonized patients’ environment ' (2008 ) 29 Infection Control and Hospital Epidemiology : 149 -154.

    • Search Google Scholar
  • Hall, C. B., Douglas, G.: Modes of transmission of respiratory syncytial virus. Journal of Pediatrics 99, 100–102 (1981).

    Douglas G. , 'Modes of transmission of respiratory syncytial virus ' (1981 ) 99 Journal of Pediatrics : 100 -102.

    • Search Google Scholar
  • Ojajavri, J.: Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing. Journal of Hygiene 85, 193–203 (1980).

    Ojajavri J. , 'Effectiveness of hand washing and disinfection methods in removing transient bacteria after patient nursing ' (1980 ) 85 Journal of Hygiene : 193 -203.

    • Search Google Scholar
  • Sala, M. R. et al.: An outbreak of food poisoning due to genogroup I Norovirus. Epidemiology and Infection 133, 187–191 (2005).

    Sala M. R. , 'An outbreak of food poisoning due to genogroup I Norovirus ' (2005 ) 133 Epidemiology and Infection : 187 -191.

    • Search Google Scholar
  • Passaro, D. J. et al.: Postoperative Serratia marcescens wound infections traced to an out-of-hospital source. Journal of Infectious Diseases 175, 992–995 (1997).

    Passaro D. J. , 'Postoperative Serratia marcescens wound infections traced to an out-of-hospital source ' (1997 ) 175 Journal of Infectious Diseases : 992 -995.

    • Search Google Scholar
  • Chang, H. J. et al.: An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonisation of health care workers’ pet dogs. New England Journal of Medicine 338, 706–711 (1998).

    Chang H. J. , 'An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonisation of health care workers’ pet dogs ' (1998 ) 338 New England Journal of Medicine : 706 -711.

    • Search Google Scholar
  • Pittet, D., Hugonnet, S., Harbarth, S., Mourouga, P., Sauvan, V., Touveneau, S. et al.: Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme. Lancet 356, 1307–1312 (2000).

    Touveneau S. , 'Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme ' (2000 ) 356 Lancet : 1307 -1312.

    • Search Google Scholar
  • Boyce, J. M., Pittet, D.: Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recommendation Report 51, 1–45 (2002).

    Pittet D. , 'Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America ' (2002 ) 51 MMWR Recommendation Report : 1 -45.

    • Search Google Scholar
  • Larson, E., Killien, M.: Factors influencing handwashing behaviour of patient care personnel. American Journal of Infection Control 10, 93–99 (1982).

    Killien M. , 'Factors influencing handwashing behaviour of patient care personnel ' (1982 ) 10 American Journal of Infection Control : 93 -99.

    • Search Google Scholar
  • Pittet, D., Mourouga, P., Perneger, T. V.: Compliance with handwashing in a teaching hospital. Infection Control Programme. Annals of Internal Medicine 130, 126–130 (1999).

    Perneger T. V. , 'Compliance with handwashing in a teaching hospital. Infection Control Programme ' (1999 ) 130 Annals of Internal Medicine : 126 -130.

    • Search Google Scholar
  • Maki, D. G.: The use of antiseptics for handwashing by medical personnel. Journal of Chemotherapy 1(Suppl), 3–11 (1989).

    Maki D. G. , 'The use of antiseptics for handwashing by medical personnel ' (1989 ) 1 Journal of Chemotherapy : 3 -11.

    • Search Google Scholar
  • MacDonald, A. et al.: Performance feedback of hand hygiene, using alcohol gel as the skin decontaminant, reduces the number of inpatients newly affected by MRSA and antibiotic costs. Journal of Hospital Infection 56, 56–63 (2004).

    MacDonald A. , 'Performance feedback of hand hygiene, using alcohol gel as the skin decontaminant, reduces the number of inpatients newly affected by MRSA and antibiotic costs ' (2004 ) 56 Journal of Hospital Infection : 56 -63.

    • Search Google Scholar
  • Hilburn, J. et al.: Use of alcohol hand sanitizer as an infection control strategy in an acute care facility. American Journal of Infection Control 31, 109–116 (2003).

    Hilburn J. , 'Use of alcohol hand sanitizer as an infection control strategy in an acute care facility ' (2003 ) 31 American Journal of Infection Control : 109 -116.

    • Search Google Scholar
  • Pessoa-Silva, C. L. et al.: Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics 120, 382–390 (2007).

    Pessoa-Silva C. L. , 'Reduction of health care associated infection risk in neonates by successful hand hygiene promotion ' (2007 ) 120 Pediatrics : 382 -390.

    • Search Google Scholar
  • Conly, J. M. et al.: Handwashing practices in an intensive care unit: The effect of an educational program and its relationship to infection rates. American Journal of Infection Control 17, 330–339 (1989).

    Conly J. M. , 'Handwashing practices in an intensive care unit: The effect of an educational program and its relationship to infection rates ' (1989 ) 17 American Journal of Infection Control : 330 -339.

    • Search Google Scholar
  • Dubbert, P. M. et al.: Increasing ICU staff handwashing: Effects of education and group feedback. Infection Control and Hospital Epidemiology 11, 191–193 (1990).

    Dubbert P. M. , 'Increasing ICU staff handwashing: Effects of education and group feedback ' (1990 ) 11 Infection Control and Hospital Epidemiology : 191 -193.

    • Search Google Scholar
  • Boyce, J. M.: It is time for action: Improving hand hygiene in hospitals. Annals of Internal Medicine 130, 153–155 (1999).

    Boyce J. M. , 'It is time for action: Improving hand hygiene in hospitals ' (1999 ) 130 Annals of Internal Medicine : 153 -155.

    • Search Google Scholar
  • Johnson, P. D. et al.: Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. Medical Journal of Australia 183, 509–514 (2005).

    Johnson P. D. , 'Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection ' (2005 ) 183 Medical Journal of Australia : 509 -514.

    • Search Google Scholar
  • Whitby, M., McLaws, M. L.: Handwashing in healthcare workers: Accessibility of sink location does not improve compliance. Journal of Hospital Infection 58, 247–253 (2004).

    McLaws M. L. , 'Handwashing in healthcare workers: Accessibility of sink location does not improve compliance ' (2004 ) 58 Journal of Hospital Infection : 247 -253.

    • Search Google Scholar
  • Kretzer, E. K., Larson, E. L.: Behavioural interventions to improve infection control practices. American Journal of Infection Control 26, 245–253 (1998).

    Larson E. L. , 'Behavioural interventions to improve infection control practices ' (1998 ) 26 American Journal of Infection Control : 245 -253.

    • Search Google Scholar
  • Whitby, M. et al.: Behavioural considerations for hand hygiene practices: The basic building blocks. Journal of Hospital Infection 65, 1–8 (2007).

    Whitby M. , 'Behavioural considerations for hand hygiene practices: The basic building blocks ' (2007 ) 65 Journal of Hospital Infection : 1 -8.

    • Search Google Scholar
  • Seto, W. H.: Staff compliance with infection control practices: Application of behavioural sciences. Journal of Hospital Infection 30(Suppl), 107–115 (1995).

    Seto W. H. , 'Staff compliance with infection control practices: Application of behavioural sciences ' (1995 ) 30 Journal of Hospital Infection : 107 -115.

    • Search Google Scholar
  • Pittet, D.: The Lowbury lecture: Behaviour in infection control. Journal of Hospital Infection 58, 1–13 (2004).

    Pittet D. , 'The Lowbury lecture: Behaviour in infection control ' (2004 ) 58 Journal of Hospital Infection : 1 -13.

    • Search Google Scholar