Assessing sustainability of hand hygiene adherence 5 years after a contest-based intervention in 3 Japanese hospitals

•Physician and nurse hand hygiene was studied in 3 Japanese hospitals over 5 years.•We conducted direct observation of hand hygiene before patient contact.•A multimodal hand hygiene intervention had been successfully implemented 5 years prior.•Hand hygiene improved from 18% before to 33% 6 months after the intervention.•Hand hygiene at 5 years after the intervention was unchanged at 32%. [Display omitted] Our goal was to evaluate the 5-year sustainability of a multimodal intervention that included a prize to the hospital with the highest overall hand hygiene adherence rates among health care workers. We conducted an observational study in 3 Japanese tertiary care hospitals using unobtrusive direct observation of physician and nurse hand hygiene adherence. Observations were performed by a trained observer on inpatient medical, surgical, intensive care, and emergency units. The primary outcome was hand hygiene adherence rates before patient contact. Secondary outcomes were health care worker survey responses to a World Health Organization (WHO) questionnaire on hand hygiene practices. Hand hygiene adherence rates had improved significantly after the introduction of a multimodal intervention (based on principles recommend by the WHO) in 2012 and 2013 (from 18.0% pre-intervention to 32.7% 6 months post-intervention; P < .001). No significant changes were found in hand hygiene adherence in these hospitals 5 years after the original intervention (31.9% 5 years after intervention; P = .53); however, substantial variability in hand hygiene adherence by unit and health care worker type was noted. A multimodal hand hygiene initiative achieved sustained improvement in hand hygiene adherence in 3 Japanese hospitals 5 years after the original intervention.