The purpose of this study is to identify the effects of improvement in environmental condition on hand washing compliance and the incidences of overall and site-specific nosocomial infection in neurosurgical patients in the intensive care unit (ICU) and to determine the risk factors of nosocomial infection.

The design of facilities in the ICU was changed. Then nurses' hand washing compliance and the incidence of nosocomial infection in all neurosurgical, patients hospitalized for more than 48 hours in ICU, were investigated from July 1, 2003 to June 30, 2004 (second survey). Hand washing compliance and overall and site-specific nosocomial infection rates during that period were compared with the results of the first survey, which was conducted from April 1, 2002 to March 31, 2003.

The rate of hand washing compliance increased from 25.65% to 47.90%. The overall nosocomial infection rates during the first and second survey were 42.51% and 28.80% (p=0.02) respectively. Risk factors associated with the incidence of nosocomial pneumonia were the length of hospital day, Glasgow Coma Scale (GCS) score, the use of ventilator and the presence of tracheostomy, and those associated with the incidence of nosocomial urinary tract infections were the duration of urinary catheter, the presence of diabetes mellitus and female gender.

These results showed that the improvement in environmental condition was an important factor in increasing hand washing compliance and in decreasing the incidence of nosocomial infection