RESULTS Study intensive care units and healthcare worker population Three of the seven study hospitals were university affiliated, two had >50,000 admissions per year, two between 30,000 and 50,000, and three <30,000 admissions per year. The median number of ICU beds per hospital was 17 (range, 10‐40). The median nurse‐to‐ patient ratio in the ICU during day shifts was 0.5 (range, 0.29–1.00; Additional file 1: Table S1) at baseline, i.e., one nurse for two patients. The median activity index in the ICUs was 9.0 (IQR, 6.0–15.0) HH opportunities per hour. According to the inclusion criteria, 280 study HCWs (58% nurses, 20% doctors, 18% auxiliary nurses, 4% other HCWs) contributed 17,748 HH opportunities during 2,677 observation sessions with a median number of sessions per HCW of 4 (interquartile range (IQR), 2‐6) during baseline and 10 (IQR, 5‐15) during intervention. During baseline 365 HCW and during intervention another 623 HCWs were excluded because they did not meet the inclusion criteria of at least two observation sessions per study period. Hand hygiene compliance The pooled mean HH compliance of study HCWs increased significantly from 43.1% during baseline to 58.7% during intervention (Table 1). Similarly, the compliance of the 365 excluded HCWs was 43.1% during baseline. Overall HH compliance of study HCWs and non‐study HCWs increased from 43.1% to 60.8% (Additional file 1: Table S2, 61.0% for the excluded 623 HCWs). For Improving HCWs, Worsening HCWs, and Non‐changing HCWs HH compliance changed from 35% to 57%, 50% to 41%, and 59% to 66%, respectively. Individual HH compliance per HCW for the entire study population is shown in Fig. 1 and for each study ICU in Additional file 1: Figs. S1 and S2. Model 1: The proportion of Improving Healthcare workers and associated factors per ICU The overall proportion of Improving HCWs was 62.1% with an inter‐ICU range of 32.7% to 95.2% (Table 1). Per ICU, the proportion of Improving HCWs was not significantly associated
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