Impact of a bundle of hand hygiene-related interventions in nursing homes on the infectious risk.

INTERVENTION: Nursing homes are randomly assigned to the intervention or control arm. 1. Control arm: nursing home use standard infection control practices 2. Intervention arm: a multifaceted hand‐hygiene intervention is implemented. The key elements of the multifaceted intervention are the following: 2.1. Increased availability of alcohol‐based hand‐rub for the staff as well as for residents and visitors 2.2. An educational program for the staff based on e‐learning 2.3. The creation of a work group within each nursing home which will propose a list of local recommendations 2.4. A hand hygiene promotion campaign aimed at the staff, as well as at residents and visitors CONDITION: Epidemics of acute respiratory infections and acute gastro‐enteritis; hospitalizations; deaths ; Infections and Infestations PRIMARY OUTCOME: 1. Total number of cases of acute respiratory infections and acute gastro‐enteritis that are reported to regional health agencies (ARS) in the context of clustered cases episodes; 2. Episodes of clustered cases are defined as at least 5 cases over 4 days SECONDARY OUTCOME: 1. Number of antibiotic prescriptions for 1000 resident‐days (measured at 0, 6 and 12 months); 2. Mortality rate (measured at 0, 6 and 12 months); 3. Hospitalization rate (measured at 0, 6 and 12 months); 4. Hand hygiene compliance assessed by direct observation at 0, 6 and 12 months INCLUSION CRITERIA: 1. For the primary outcome: all residents in the participating nursing homes 2. For the secondary outcomes and the intervention: all residents and staff in the participating nursing homes