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The relationship between hand hygiene and infection rates

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The relationship between hand hygiene and infection rates

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Compliance with the “Hand Hygiene” program August 2007 through June 2008.

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Compliance with the “Hand Hygiene” program August 2007 through June 2008.

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As hand hygiene compliance improved, it was noted that, during the same time, the infection rates decreased.

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According to the Centers for Disease Control and Prevention (CDC), pathogens in hospitals are commonly transmitted by hands. Adherence to hand hygiene is one of the most effective measures to prevent health care associated infections.

The Joint Commission recommendations regarding hand hygiene are as follows:

1. Wash with soap and water when:

Hands are visibly dirty or soiled with blood or other body fluids.

In case of contact with spore-forming pathogens such asClostridium difficile.

2. Use of alcohol-based hand rubs is preferred for all other clinical situations.

The WHO also provides an excellent comprehensive hand hygiene improvement program. The components of this program are as follows:

1. System changes; it is very important to make sure that hand rubs are available inside and outside all patient rooms. Surveying health care workers regarding their acceptance of the alcohol hand rub products is essential to compliance with using those products.

2. Training and education; Hospitals should invest in educating trainers, observers, and health care workers.

3. Evaluation and feedback; Hand hygiene compliance should be measured regularly and feedback must be given in a timely manner. Compliance can be measured by observation or by measuring soap and hand rub consumption. Some hospitals provide real-time feedback when hand hygiene is not performed. This can be a very effective tool to identify offenders and educate them quickly.

4. Reminders in the workplace; Posters should be used widely in the health care setting emphasising the indications for hand hygiene, such as the five moments, and the appropriate way to use hand rubs and soap.

5. Institutional safety climate; The medical board should make hand hygiene an institutional priority and provide the needed resources. Senior clinicians and administrators should provide visible support for hand hygiene as a role model. Policies and procedures should be implemented to hold health care workers accountable for hand hygiene compliance.

In conclusion, performing hand hygiene before and after patient contact is one of the most important measures to prevent transmission of pathogens. A multidisciplinary program is necessary to achieve and sustain hand hygiene compliance. Vocal and visible support of senior clinicians and high-level administrators is crucial for the success of hand hygiene program. Besides system change, accountability, education, and feedback are important to achieve and sustain hand hygiene compliance.

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Force Field Analysis to develop hand hygiene

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Force Field Analysis to develop hand hygiene

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http://www.journalofhospitalinfection.com/article/S0195-6701(07)00146-6/fulltext

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Two of the core concepts:

Possible to achieve continual improvement through small incremental changes

Continuous improvement is most effective when it becomes embedded in our everyday way of working

Levels of hand hygiene will take time to improve and should improve over time.

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WHO hand hygiene strategy feasible and sustainable for health-care settings around the world

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WHO hand hygiene strategy feasible and sustainable for health-care settings around the world

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WHO's strategy for improving hand hygiene is easy for health-care workers to practise, according to a new study published today in "Lancet Infectious Diseases". Health care-associated infections are a major threat to patient safety worldwide and transmission in these settings is mainly from the hands of health-care workers.

Strategy shown to increase hand hygiene compliance

In six sites in Costa Rica, Italy, Mali, Pakistan and the Kingdom of Saudi Arabia, the research team implemented WHO's strategy in 55 departments in 43 hospitals. During the two-year period between December 2006 and December 2008, compliance with best practices increased from 51% before the study to 67% and infrastructures and staff knowledge were also significantly improved in all sites. The study also demonstrated that this change in practices and safety culture was sustained up until at least two years since the conclusion of the testing phase.

"The WHO strategy was based on a multimodal approach previously proven to have a dramatic effect in reducing the number of health-care related infections at the WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals, but now for the first time we have evidence of its feasibility and successful effect to improve hand hygiene in a variety of different geographical and income settings, with even greater impact in low-income and middle-income countries than in high-income countries," said Dr Benedetta Allegranzi, Programme Manager, Clean Care is Safer Care, WHO Patient Safety Programme and lead author of the paper.

Hand contact the leading cause of infections

Health care-associated infections usually occur when germs are transferred by health-care providers' hands touching the patient. The most common infections are urinary tract and surgical site infections, pneumonia and infections of the bloodstream and are often caused by multi-drug resistant germs such as methicillin-resistant S. aureus (MRSA). Of every 100 hospitalized patients, at least seven in developed and 10 in developing countries will acquire a health care-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100. Practising good hand hygiene during health care reduces the risk of these infections and the spread of antimicrobial resistance.

"As resistance to antibiotics and other key medicines becomes more common, it is more essential than ever to reduce the number of avoidable infections in hospital," said Edward Kelley, Coordinator of the Patient Safety Programme at WHO. "The best way of reducing the number of people contracting antimicrobial resistant infections is to protect them from cross-transmission of germs through health-care workers' hands in the first place."

Infection prevention and control is one of the key policy pillars identified by WHO to combat the growing problem of antimicrobial resistance. The other pillars include: appropriate national policies and plans, improving surveillance of these resistant pathogens; uninterrupted access to good quality essential medicines; proper use of medicine, and more research and development of new treatments.

The WHO hand-hygiene compliance strategy

WHO's hand-hygiene compliance strategy consists of five main components:

ensuring health-care workers have access to alcohol-based handrub at the point of patient care;

training and education of health-care workers on the most important times in patient care for hand hygiene;

monitoring and feedback on compliance;

visual reminders at the point of care in the workplace;

creation of a culture of attention to patient and health-care worker safety within the institution.

A simple, cost-effective intervention

"Sometimes the simplest and most cost-effective interventions can have the greatest impact," said Sir Liam Donaldson, WHO Envoy for Patient Safety. "We now have the effective methods to eliminate millions of avoidable sicknesses and death, and reduce the growing problem of antimicrobial resistant infections."

According to the WHO Clean Care is Safer Care Programme, when working with patients, hand hygiene should be performed at 5 key moments, preferably by using an alcohol-based rub or by handwashing with soap and water if hands are visibly dirty. The five moments for hand hygiene are:

before touching a patient;

before clean and aseptic procedures (e.g., inserting devices such as catheters);

after contact with body fluids;

after touching a patient;

after touching patient surroundings.

"WHO's hand-hygiene improvement strategy is recommended by both the US and European Centres for Disease Control, the Joint Commission International and accredited bodies, and almost all professional organizations worldwide," said Professor Didier Pittet, Director, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and senior author of the paper.

The strategy has been implemented so far in more than 15 700 health-care settings in 168 countries worldwide and more than 50 governments have based their national hand hygiene campaigns on it. The current study validates its use as a universal gold standard of patient care.

For more information please contact:

Tarik Jasarevic
WHO Communications Officer
Telephone: +41 22 791 5099
Mobile: +41 793 676 214
E-mail: jasarevict@who.int

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WHO hand hygiene strategy feasible and sustainable for health-care settings around the world

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WHO's strategy for improving hand hygiene is easy for health-care workers to practise, according to a new study published today in "Lancet Infectious Diseases". Health care-associated infections are a major threat to patient safety worldwide and transmission in these settings is mainly from the hands of health-care workers.

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Guide to Hand Hygiene Programs for Infection Prevention

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Guide to Hand Hygiene Programs for Infection Prevention

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Clinical Governance | Cumbria Partnership NHS Foundation Trust CPFT

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Cumbria Partnership NHS Foundation Trust (CPFT) provide over 60 expert health services across Cumbria, supporting people our communities to live happier, healthier and more hopeful lives.

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Suboptimal care of the acutely unwell ward patient: a concept analysis.

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Suboptimal care of the acutely unwell ward patient: a concept analysis.

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Quirke et al, 2011.

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Recognising that things have the potential to go wrong, and sometimes do.

Be aware of when things have gone wrong in your particular area.

Have back up plans in place in case things go awry.

Admit when you need to seek help from those more experienced/qualified than you.

Have the courage to challenge and question the knowledge or expertise of your colleagues, especially if you do not know them well.

Acknowledge that errors occur due to false assumptions.

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Medication Safety Thermometer & Omitted and Delayed Medicines Webinar Recording

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NHS Safety Thermometer - a way to measure 'Harm free' Care

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This video describes why we need to use the NHS Safety Thermometer.