{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:48:20Z","timestamp":1791870500032,"version":"4.3.4"},"reference-count":26,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Infect. Control Hosp. Epidemiol."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0899823X26105637_as1\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Hand hygiene (HH) is the most effective way to prevent healthcare-associated infections (HAIs) and the spread of antimicrobial-resistant pathogens. HH compliance is particularly relevant in Greece, which has among the highest rates of HAIs and antimicrobial resistance in the European Union. The aim of our study was to assess current HH practices in Greece and to improve compliance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105637_as2\">\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Prospective observational quasi-experimental (before-after) study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105637_as3\">\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Eight public adult tertiary hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105637_as4\">\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>\u201cPhysicians, Nurses, and Ancillary Healthcare Workers.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105637_as5\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Three time periods were defined: the baseline period (December 2021\u2013June 2022), intervention period (July 2022\u2013January 2023), and postintervention period (February 2023\u2013May 2024). An improvement bundle was implemented. A minimum of 30 observations per department per month of HH opportunities were required. Trained observers conducted observations using a standardized data collection tool. Interrupted time-series analysis was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105637_as6\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      38,069 HH opportunities were observed. Overall compliance was 48.5%. Glove use without proper HH was observed in 72.9% of opportunities. Alcohol-based hand rub was used for HH by 57.8% of HCW who conducted HH. Compliance improved from 37.3% in the baseline period to 53.3% after the intervention (16% increase,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). Improved compliance was observed in 9\/13 (69%) intensive care units. Of 10 participating medical and surgical wards, improved compliance was observed in 9 (90%) units, and improvement ranged from 7.2% to 28.3%\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0899823X26105637_as7\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Overall, we found low compliance rates and gaps in HH practices in Greek hospitals. A quality improvement intervention improved overall HH compliance. This is the largest study of HH compliance in Greek hospitals to date.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ice.2026.10563","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:38:16Z","timestamp":1791869896000},"page":"1-7","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Improving hand hygiene compliance in Greek hospitals: results of a Nationwide Quality Improvement Program (GRIPP-SNF)"],"prefix":"10.1017","author":[{"given":"Ilektra","family":"Balatsou","sequence":"first","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3662-0140","authenticated-orcid":false,"given":"Grammatiki-Christina","family":"Tsopela","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2392-4481","authenticated-orcid":false,"given":"Archontoula","family":"Moutou","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paraskevi","family":"Varda","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3415-1067","authenticated-orcid":false,"given":"Parthenopi","family":"Pantelidou","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3589-7855","authenticated-orcid":false,"given":"Dimitra","family":"Kousi","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Kourkouni","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6167-7152","authenticated-orcid":false,"given":"Dimitrios","family":"Paraskevis","sequence":"additional","affiliation":[{"name":"Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6075-3002","authenticated-orcid":false,"given":"Vassiliki","family":"Papaevangelou","sequence":"additional","affiliation":[{"name":"Third Department of Pediatrics, National and Kapodistrian University of Athens"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aggeliki","family":"Karaiskou","sequence":"additional","affiliation":[{"name":"ODIPY, Agency for Quality Assurance in Health S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0128-2727","authenticated-orcid":false,"given":"Eleftherios","family":"Thireos","sequence":"additional","affiliation":[{"name":"ODIPY, Agency for Quality Assurance in Health S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4881-3567","authenticated-orcid":false,"given":"Dafni","family":"Kaitelidou","sequence":"additional","affiliation":[{"name":"ODIPY, Agency for Quality Assurance in Health S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6499-4807","authenticated-orcid":false,"given":"Ioannis","family":"Kopsidas","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1536-3205","authenticated-orcid":false,"given":"Antonia","family":"Koutsoukou","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Outcomes Research (CLEO)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2422-6772","authenticated-orcid":false,"given":"Theoklis","family":"Zaoutis","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/04gnjpq42","id-type":"ROR","asserted-by":"publisher"}],"name":"National and Kapodistrian University of Athens School of Health Sciences: Athens"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the GRIPP-SNF Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"S0899823X26105637_ref9","doi-asserted-by":"publisher","DOI":"10.1086\/501777"},{"key":"S0899823X26105637_ref20","doi-asserted-by":"crossref","unstructured":"20. 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Point prevalence survey of healthcare-associated infections and antimicrobial use in acute care hospitals \u2013 2022\u20132023. European Centre for Disease Prevention and Control. https:\/\/www.ecdc.europa.eu\/en\/publications-data\/PPS-HAI-AMR-acute-care-europe-2022-2023. 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Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}