***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To determine the frequency and predictors of compliance with h and hygiene ( HH ) practice in pediatric intensive care . Design Observational , prospect i ve cohort study performed from February to April 2000 . Setting Three intensive care units at a tertiary care children ’s hospital . Participants Nurses , physicians , respiratory therapists , and other healthcare workers . Methods During 156 30-min daytime observation periods , an unidentified observer monitored 2811 opportunities for HH during patient care and recorded HH compliance . Measurements and Main Results Average HH compliance was 34 % ( 946/2811 ) . It was higher ( p < 0.001 ) among respiratory therapists ( 68 % ; 171/251 ) than physicians ( 37 % ; 157/426 ) or nurses ( 29 % ; 587/2031 ) . Contact with body fluid secretions was associated with the highest compliance ( 77 % ; 46/60 ) , and contact with wounds ( 71 % ; 10/14 ) or indwelling devices ( 66 % ; 110/167 ) were associated with somewhat lesser compliance . The following were important predictors of compliance ( all p < 0.01 ) : being a respiratory therapist ( odds ratio [ OR ] , 5.1 ) ; working in the neonatal intensive care unit ( OR , 1.6 ) ; and contact with invasive devices ( OR , 2.5 ) , wounds ( OR , 6.9 ) , or body fluids ( OR , 11.5 ) . Compliance was lowest after interrupted patient-care activities ( 9 % ; OR , 0.15 ) . Surprisingly , decreased patient-to-nurse ratio ( mean , 1.3 ± 0.3 ) or opportunities per hr of care ( mean , 37 ± 7 ) were not independent predictors of compliance . Conclusions Average HH compliance was low , but it increased during high-risk patient-care activities . Intensified efforts are necessary to increase caretakers ’ compliance and the awareness of the risk of bacterial contamination after interrupted patient-care activities Context : The role of h and hygiene in preventing health care associated infections ( HCAIs ) has been clearly established . However , compliance rates remain poor among health care personnel . Aims : a ) To investigate the health care workers ’  h and hygiene compliance rates in the intensive care unit ( ICU ) , b ) to assess reasons for non-compliance and c ) to study the efficacy of a multimodal intervention strategy at improving compliance . Setting s : A mixed medical – surgical ICU of a tertiary level hospital . Design : A before – after prospect i ve , observational , intervention study . Material s and Methods : All health care personnel who came in contact with patients in the ICU were observed for their h and hygiene compliance before and after a multimodal intervention strategy ( education , posters , verbal reminders and easy availability of products ) . A self-report question naire was also circulated to assess perceptions regarding compliance . Statistical analysis was done using χ2 test or Fisher exact test ( Epi info software ) . Results : H and hygiene compliance among medical personnel working in the ICU was 26 % and the most common reason cited for non-compliance was lack of time ( 37 % ) . The overall compliance improved significantly following the intervention to 57.36 % ( P<0.000 ) . All health care worker groups showed significant improvements : staff nurses ( 21.48–61.59 % , P<0.0000 ) , nursing students ( 9.86–33.33 % , P<0.0000 ) , resident trainees ( 21.62–60.71 % , P<0.0000 ) , visiting consultants ( 22–57.14 % , P=0.0001 ) , physiotherapists ( 70–75.95 % , P=0.413 ) and paramedical staff ( 10.71–55.45 % , P < 0.0000 ) . Conclusions : H and hygiene compliance among health care workers in the ICU is poor ; however , intervention strategies , such as the one used , can be useful in improving the compliance rates significantly Background Frequent h and washing can prevent infections , but non-compliance to h and hygiene is pervasive . Few theory- and evidence -based interventions to improve regular h and washing are available . Therefore , two intervention modules , a motivational and a self-regulatory one , were design ed and evaluated . Methods In a longitudinal study , 205 young adults , aged 18 to 26 years , were r and omized into two intervention groups . The Mot-SelfR group received first a motivational intervention ( Mot ; risk perception and outcome expectancies ) followed by a self-regulatory intervention ( SelfR ; perceived self-efficacy and planning ) 17 days later . The SelfR-Mot group received the same two intervention modules in the opposite order . Follow-up data were assessed 17 and 34 days after the baseline . Results Both intervention sequences led to an increase in h and washing frequency , intention , self-efficacy , and planning . Also , overall gains were found for the self-regulatory module ( increased planning and self-efficacy levels ) and the motivational module ( intention ) . Within groups , the self-regulatory module appeared to be more effective than the motivational module , independent of sequence . Conclusions Self-regulatory interventions can help individuals to exhibit more h and washing . Sequencing may be important as a motivation module ( Mot ) first helps to set the goal and a self-regulatory module ( SelfR ) then helps to translate this goal into actual behavior , but further research is needed to evaluate mechanisms BACKGROUND H and hygiene compliance among health care providers is considered to be the single most effective factor to reduce  hospital acquired infections . Despite continuous education and awareness , compliance with h and hygiene guidelines has remained low , particularly during evening shifts . OBJECTIVE Our objective was to determine the compliance with h and hygiene guidelines among doctors , nurses , and paramedical staff during day and night duties in a multidisciplinary intensive care unit ( ICU ) . METHODS We used a prospect i ve , observational , 6-month study conducted in a 34-bed ICU within a tertiary care teaching hospital . All doctors , nurses , and paramedical staff in the ICU were included . An investigator , placed within the ICU setting , observed the h and hygiene practice s during day and night . Day and night shift change times were 08:00 and 20:00 hours , respectively . RESULTS Of the 5639 opportunities for h and hygiene , 3383 ( 59.9 % ) were properly performed . Overall rates of compliance were 66.1 % for doctors , 60.7 % for nurses , and 38.6 % for paramedical staff . H and hygiene compliance dropped during the night for doctors ( 81 % vs 46 % , respectively , P < .001 ) , for nurses ( 64 % vs 55 % , respectively , P = .02 ) , and for paramedical staff ( 44 % vs 31 % , respectively , P = .01 ) . Characterization of noncompliance is as follows : " No h and washing after procedure " in 41 % , " improper duration of h and washing " in 32 % , and " no h and washing done at all " in 27 % of the events . " No h and washing done at all " occurred in 55 % of the time at night with doctors having the highest rate of noncompliance , making 163 ( 34 % ) contacts without h and washing . CONCLUSION Whereas compliance with h and hygiene guidelines was lower at night compared with day , irrespective of discipline in all 3 groups of health care providers , both periods of compliance would benefit from additional training focusing on the importance of h and hygiene around the clock BACKGROUND Although h and hygiene ( HH ) compliance has been an important issue for years , the compliance rate is still a problem in health care today . METHODS This was an observational , prospect i ve , before- and -after study . We measured HH knowledge and HH compliance  before ( baseline ) , directly after ( post strategy ) , and 6 months after the performance of HH team strategies ( follow-up ) . The study was composed of employed nurses and physicians working in the department of internal medicine of a university hospital . We performed a multifaceted improvement program including HH education , feedback , reminders , social influence activities including the use of role models , and improvement of HH facilities . RESULTS Ninety-two nurses and physicians were included . Compared with baseline , there was a significant improvement in the overall mean HH knowledge score at post strategy ( from 7.4 to 8.4 ) and follow-up ( from 7.4 to 8.3 ) . The overall HH compliance was 27 % at baseline , 83 % at post strategy , and 75 % at follow-up . At baseline , the compliance rate was 17 % in nurses and 43 % in physicians and significantly improved to 63 % in nurses and 91 % in physicians at follow-up . CONCLUSION Our multifaceted HH improvement program result ed in a sustained improvement of HH knowledge and compliance in nurses as well as physicians OBJECTIVES . H and hygiene promotion interventions rarely result in sustained improvement , and an assessment of their impact on individual infection risk has been lacking . We sought to measure the impact of h and hygiene promotion on health care worker compliance and health care – associated infection risk among neonates . METHODS . We conducted an intervention study with a 9-month follow-up among all of the health care workers at the neonatal unit of the Children 's Hospital , University of Geneva Hospitals , between March 2001 and February 2004 . A multifaceted h and hygiene education program was introduced with compliance assessed during successive observational surveys . Health care – associated infections were prospect ively monitored , and genotypic relatedness of bloodstream pathogens was assessed by pulsed-field gel electrophoresis . A comparison of observed h and hygiene compliance and infection rates before , during , and after the intervention was conducted . RESULTS . A total of 5325 opportunities for h and hygiene were observed . Overall compliance improved gradually from 42 % to 55 % across study phases . This trend remained significant after adjustment for possible confounders and paralleled the measured increase in h and -rub consumption ( from 66.6 to 89.2 L per 1000 patient-days ) . A 9-month follow-up survey showed sustained improvement in compliance ( 54 % ) , notably with direct patient contact ( 49 % at baseline vs 64 % at follow-up ) . Improved compliance was independently associated with infection risk reduction among very low birth weight neonates . Bacteremia caused by clonally related pathogens markedly decreased after the intervention . CONCLUSIONS . H and hygiene promotion , guided by health care workers ' perceptions , identification of the dynamics of bacterial contamination of health care workers ' h and s , and performance feedback , is effective in sustaining compliance improvement and is independently associated with infection risk reduction among high-risk neonates OBJECTIVES To assess h and washing frequency according to CDC recommendations ; and to test a simple intervention to increase h and  washing compliance , design ed for the unique setting of the ED . METHODS A prospect i ve , observational , before- and -after study design with a convenience sampling technique was used to assess h and washing  compliance in the ED of a 742-bed urban , university-affiliated medical center with 65,000 visits annually . Emergency physicians ( EPs ) , registered nurses ( RNs ) , and nurse practitioners ( NPs ) were informed that their patient encounters were being monitored , but the nature of the study was kept confidential . A single observer evaluated individual EPs , RNs , and NPs in one- , two- , or three-hour blocks , recording compliance with CDC h and washing recommendations . After two weeks , brightly colored signs with CDC recommendations for h and washing were posted at all sinks and a copy of a related publication on h and washing by medical personnel was distributed to all staff . H and washing behaviors were again observed . RESULTS A total of 252 situations requiring h and washing were observed , 132 pre-intervention and 120 post-intervention . Total h and washing , h and washing by each staff design ation , and h and washing in each CDC recommendation category -- except h and washing between contacts with different patients --all showed tendencies toward improvement , though none was significant ( p > 0.05 ) . Both the NPs and RNs demonstrated significantly higher adherence to recommended h and washing between patients after the intervention than did the EPs ( 85 % vs 71 % vs 31 % , p < 0.01 and p < 0.05 , respectively ) . CONCLUSION Despite a trend in improvement of compliance with CDC recommendations , h and washing among ED personnel remained unacceptably low BACKGROUND Improving h and hygiene compliance is still a major challenge for most hospitals . Innovative approaches are needed . OBJECTIVE We tested whether an innovative , theory based , team and leaders-directed strategy would be more effective in increasing h and hygiene compliance rates in nurses than a literature based state-of-the-art strategy . DESIGN AND SETTING A cluster r and omised controlled trial called HELPING H AND S was conducted in 67 nursing wards of three hospitals in the Netherl and s. PARTICIPANTS All affiliated nurses of the nursing wards . Wards were r and omly assigned to either the team and 
    Output:
    
Conclusions : Published research of h and hygiene compliance measured by direct observation lacks validity .