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National observational study to evaluate the Cleanyourhands campaign (NOSEC) in England and Wales 2004-8: a prospective ecological interrupted time series

Introduction / objectives

WHO SAVE LIVES initiative offers nations a multimodal hand-hygiene intervention. England & Wales rolled out similar intervention, the Cleanyourhands campaign (CYHC) (bedside alcohol hand-rub (AHR), posters, audit & patient empowerment) to all 187 acute hospitals. We report results of independent study evaluating its national effectiveness & sustainability.


6 questionnaires (5 voluntary, last mandatory) assessed CYHC implementation & sustainability every 6 months. Quarterly data on MRSAB, MSSAB & CDI, procurement soap & AHR, hospital type & bed occupancy collected for each hospital with data on other national infection control interventions Mixed effects Poisson regression model assessed associations between procurement & HCAI rates, testing for hospital heterogeneity.


Questionnaire response rates fell from 134 (71%) at 6 months to 82 (44%) at 30 months, rising to 167 (90%) for final mandatory one. No evidence attritional/ selection bias. Widespread early implementation bedside AHR & posters. At 36 months, 90% respondents reported CYHC a top hospital priority, with implementation of AHR, posters & audit reported by 96%, 97% and 91% respectively.

Combined soap & AHR procurement rose from 22 to 60mls/bed day. MRSAB rate fell from 1.88 to 0.91 cases/10000 beddays & CDI from 16.75 to 9.49. MSSAB did not fall.

Each extra ml/bed-day of AHR associated with 1.3% reduction MRSAB: IRR 0.987 (0.983, 0.991) p<.0001). Each extra ml soap associated with 0.33% reduction CDI (IRR 0.997 [0.995,0.998] p<0.0001). Associations remained after adjusting for other variables significantly associated with reductions MRSAB & CDI: publication of Health Act & Department of Health Improvement Team visits.


The CYHC appears to have been widely implemented & sustained. Strong associations found between procurement AHR/soap & reductions in MRSAB & CDI, that remained after adjustment for other variables & interventions. Campaign’s central funding & co-ordination and high profile political drive may affect its generalisability but may provide model for other countries to adopt to implement WHO SAVE LIVES initiative.

Disclosure of interest

S. Stone Grant/Research support from GOJO.

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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Stone, S., NOSEC group. National observational study to evaluate the Cleanyourhands campaign (NOSEC) in England and Wales 2004-8: a prospective ecological interrupted time series. BMC Proc 5 (Suppl 6), P117 (2011).

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