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    1 Comment for this article
    Sad State
    Teri Newman, RN, BSN, MSN | Nurse Practitioner
    Hand washing is one of the the most basic tenets of the practice of medicine. 42 years ago in RN school they hammered it into us non-stop. We didn't use gloves then either. Staphylococcus infections are 100% preventable with hand washing and that you actually did a study about moving a sign to encourage medical professionals to wash their hands is a very sad comment on how totally incompetent a large percentage of "paycheck nurses" actually are. When I got my RN we made $5 an hour and no one went into nursing for the money. Now the starting pay is much better, and many people go into nursing for the money rather than the satisfaction of helping another human being recover from sickness or injury. Staphylococcus infections are rampant because filthy, contaminated gloves have been substituted for hand washing. Putting up a sign does nothing to increase compliance from lazy health care workers. I never let anyone touch me unless they wash their hands and I ask them to do so. About 80% of the time they tell me "Oh--I've got gloves on" which means little because every warm body that comes in the room sticks their filthy, unwashed hand into the contaminated glove box. I read a study where a hospital in Australia swabbed all the gloves in the room boxes and 94% of them had staphylococcus pathogens. Wash your hands!
    Original Investigation
    Infectious Diseases
    October 23, 2019

    Effect of Frequency of Changing Point-of-Use Reminder Signs on Health Care Worker Hand Hygiene Adherence: A Cluster Randomized Clinical Trial

    Author Affiliations
    • 1Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa
    • 2Department of Internal Medicine, University of Iowa, Iowa City
    • 3Department of Psychological and Brain Sciences, University of Iowa, Iowa City
    • 4Department of Epidemiology, University of Iowa, Iowa City
    • 5Department of Biostatistics, University of Iowa, Iowa City
    • 6Miami VA Healthcare System, Miami, Florida
    • 7VA Ann Arbor Healthcare System, Ann Arbor, Michigan
    • 8South Texas Veterans Health Care System, San Antonio
    • 9Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio
    • 10VA Portland Health Care System, Portland, Oregon
    • 11VA Boston Healthcare System, Boston, Massachusetts
    • 12VA Maryland Health Care System, Baltimore
    • 13VA Salt Lake City Health Care System, Salt Lake City, Utah
    • 14Minneapolis VA Medical Center, Minneapolis, Minnesota
    • 15Nebraska-Western Iowa Veterans Affairs Health Care System, Omaha, Nebraska
    JAMA Netw Open. 2019;2(10):e1913823. doi:10.1001/jamanetworkopen.2019.13823
    Key Points español 中文 (chinese)

    Question  Does changing reminder signs more frequently in a hospital setting improve health care workers’ hand hygiene adherence?

    Findings  In this cluster randomized clinical trial of 58 inpatient units in 9 acute care hospitals, overall hand hygiene adherence did not change significantly between before and during the intervention period at patient room entry or exit. In units assigned to change signs most frequently, hand hygiene decreased at patient room entry and exit.

    Meaning  Hand hygiene adherence in the hospital setting is not likely to be affected solely by more frequent changes of reminder signs.


    Importance  Although hand hygiene (HH) is considered the most effective strategy for preventing hospital-acquired infections, HH adherence rates remain poor.

    Objective  To examine whether the frequency of changing reminder signs affects HH adherence among health care workers.

    Design, Setting, and Participants  This cluster randomized clinical trial in 9 US Department of Veterans Affairs acute care hospitals randomly assigned 58 inpatient units to 1 of 3 schedules for changing signs designed to promote HH adherence among health care workers: (1) no change; (2) weekly; and (3) monthly. Hand hygiene rates among health care workers were documented at entry and exit to patient rooms during the baseline period from October 1, 2014, to March 31, 2015, of normal signage and throughout the intervention period of June 8, 2015, to December 28, 2015. Data analyses were conducted in April 2018.

    Interventions  Hospital units were randomly assigned into 3 groups: (1) no sign changes throughout the intervention period, (2) signs changed weekly, and (3) signs changed monthly.

    Main Outcomes and Measures  Hand hygiene adherence as measured by covert observation. Interrupted time series analysis was used to examine changes in HH adherence from baseline through the intervention period by group.

    Results  Among 58 inpatient units, 19 units were assigned to the no change group, 19 units were assigned to the weekly change group, and 20 units were assigned to the monthly change group. During the baseline period, 9755 HH opportunities were observed at room entry and 10 095 HH opportunities were observed at room exit. During the intervention period, a total of 15 855 HH opportunities were observed at room entry, and 16 360 HH opportunities were observed at room exit. Overall HH adherence did not change from baseline compared with the intervention period at either room entry (4770 HH events [48.9%] vs 3057 HH events [50.1%]; P = .14) or exit (6439 HH events [63.8%] vs 4087 HH events [65.2%]; P = .06). In units that changed signs weekly, HH adherence declined from baseline at room entry (−1.9% [95% CI, −2.7% to −0.8%] per week; P < .001) and exit (−0.8% [95% CI, −1.5% to 0.1%] per week; P = .02). No significant changes in HH adherence were observed in other groups.

    Conclusions and Relevance  The frequency of changing reminder signs had no effect on HH rates overall. Units assigned to change signs most frequently demonstrated worsening adherence. Considering the abundance of signs in the acute care environment, the frequency of changing signs did not appear to provide a strong enough cue by itself to promote behavioral change.

    Trial Registration  ClinicalTrials.gov Identifier: NCT02223455