Implementation of multimodal infection control and hand hygiene strategies in acute-care hospitals in Greece: A cross-sectional benchmarking survey


      • Implementation of multimodal infection control strategies was assessed in Greece.
      • Systematic situation analysis of hand hygiene practices in 17 acute-care hospitals.
      • Greek hospitals are, on average, at an intermediate level in hand hygiene practice.
      • Training, feedback and safety climate for hand hygiene require improvements.
      • Infection control nurse staffing levels significantly affect implementation progress.


      In this first attempt to suggest achievable standards for improvement in hospital infection prevention and control (IPC) in Greece, we assessed main IPC structure and process indicators emphasizing hand hygiene.


      Acute-care hospitals across the country participated in a cross-sectional survey by completing the World Health Organization Hand Hygiene Self-assessment Framework (HHSAF) and by providing hospital-level IPC indicators.


      Seventeen hospitals completed the survey, comprising 14% of the country's public hospitals. Median IPC staffing levels were 0.8 nurses and 0.5 doctors per 250 beds. Few hospitals implemented full multimodal IPC programs. The HHSAF indicated that appropriate hand hygiene practices and promotion strategies were in place in most hospitals, but the mean HHSAF score of 289 was lower compared with studies in Italy (mean, 332; P = .040) and the United States (mean, 373; P < .001). Presence of 1 additional IPC nurse was independently associated with increases of 53% in the HHSAF median score for training-education (P = .035) and by 38% in the lower 30th percentile HHSAF score for safety climate (P = .049).


      Surveyed hospitals are, on average, at an intermediate level in hand hygiene practice but require improvements on training-education, evaluation-feedback, and safety climate. Ensuring adequate IPC nurse staffing levels and systematically implementing multimodal IPC programs may lead to substantial improvements.

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