Dr Anand S Kannapur, Dr Sudarshan Naik


RATIONALE: Hand hygiene is one of the most neglected practices amongst health care personnel. We devised a
positive habit reinforcement tool called “ring the bell” and hypothesized that it will not lead to better hand hygiene
OBJECTIVES: Hand hygiene events (hand washing and hand rub) of two Intensive Care Units (ICUs) of a large tertiary care hospital were
METHODS: For purpose of the study the control limb was designated ICU A and the test limb ICU B. All medical personnel in ICU B were
instructed to “ring the bell” hung next to the wash basin prior to washing hands.
MEASUREMENTS: The study was performed for one hour a day over a period of 90 days and numbers of hand hygiene events were recorded
by obscure observers.
MAIN RESULTS: Total hand hygiene events of ICU A were 909 out of 1584 (0.58%) medical personnel attending and in ICU B were 3870 out
of 2706 (1.43%) medical personnel attending, a signicant increase of more than 125% (2.5 times). The two sided Z test was applied and Z value
was calculated to be 12.34 (SE=0.068). Since p value (0.0001) was less than 0.05, we rejected the null hypothesis at 5% level of signicance.
CONCLUSION(S): “Ring the bell” campaign used for positive habit reinforcement effectively increased hand hygiene compliance and
such a low cost and high impact innovative tool is strongly recommended to improve safety and quality of medical care in order to prevent
nosocomial infections.

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