AbstractBACKGROUND:Health-care-associated infections are a major threat to patient safety worldwide. Transmission is mainly via the hands of health-care workers, but compliance with recommendations is usually low and effective improvement strategies are needed. We assessed the effect of WHO'sstrategy for improvement of hand hygiene in five countries.
METHODS:We did a quasi-experimental study between December, 2006, and December, 2008, at six pilot sites (55 departments in 43 hospitals) in Costa Rica, Italy, Mali, Pakistan, and Saudi Arabia. A step-wise approach in four 3-6 month phases was used to implement WHO's strategy and we assessed the hand-hygiene compliance of health-care workers and their knowledge, by questionnaire, of microbial transmission and hand-hygieneprinciples. We expressed compliance as the proportion of predefined opportunities met by hand-hygiene actions (ie, handwashing or hand rubbing). We assessed long-term sustainability of core strategy activities in April, 2010.
实验的设计是类实验（前后对照，或自身对照），时间在于2006年12月~2008年12月。在6个点，43个医院。囊括了意大利、马里、巴基斯坦、萨特阿拉伯等国家（
为神马没有中国？？？！！！）。
We noted 21 884 hand-hygiene opportunities during 1423 sessions before the intervention and 23 746 opportunities during 1784 sessions after. Overall compliance increased from 51·0% before the intervention (95% CI 45·1-56·9) to 67·2% after (61·8-72·2). Compliance was independently associated with gross national income per head, with a greater effect of the intervention in low-income and middle-income countries (odds ratio [OR] 4·67, 95% CI 3·16-6·89; p<0·0001) than in high-income countries (2·19, 2·03-2·37; p<0·0001). Implementation had a major effect on compliance of health-care workers across all sites after adjustment for main confounders (OR 2·15, 1·99-2·32). Health-care-workers' knowledge improved at all sites with an increase in the average score from 18·7 (95% CI 17·8-19·7) to 24·7 (23·7-25·6) after educational sessions. 2 years after the intervention, all sites reported ongoing hand-hygiene activities with sustained or further improvement, including national scale-up.
手卫生依从性从51.0提高到67.2，（大家自问，敢问我国咋样呢？？这些似乎都是中低收入国家）在中低收入国家手卫生提高效果优于高收入国家，在所有的地方，“手卫生评分”均有显著提高。
手卫生评分是个什么玩意？欢迎大家去看一个翻译贴——手卫生促进策略指南。以前我发过的。这个内容主要由紫陌红尘会员翻译，在此在此表示感谢。
发现使用了一个非常有趣的度量——国家毛收入每人头。这点在当今的手卫生文章中少见。
INTERPRETATION:Implementation of WHO's hand-hygiene strategy is feasible and sustainable across a range of settings in different countries and leads to significant compliance and knowledge improvement in health-care workers, supporting recommendation for use worldwide.
FUNDING:WHO, University of Geneva Hospitals, the Swiss National Science Foundation, Swiss Society of Public Health Administration and Hospital Pharmacists.
Copyright © 2013 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd. All rights reserved.
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