We observed hygienic behavior as process outcome in a
pretest design and infection rates in an interrupted time
series. The study was performed in the level IIID NICU at
the Erasmus MC - Sophia Children’s Hospital in Rotterdam,
the Netherlands, from 1 January 2003 to 31 December
2006. The multifaceted intervention comprised an education
program, encouragement of key players to perform
correct hygienic behavior, and effecting a culture shift to
better hand hygiene. Hand hygiene compliance was
observed during two non-consecutive periods before
(pretests 1 and 2) and two non-consecutive periods after
the intervention (posttests 1 and 2). The intervals between
the observation periods ranged from 4 to 6 months.
Nosocomial bloodstream infections were continuously
documented during 30 months prior and 18 months after
the intervention. The Erasmus MC Institutional Review
Board approved the study