The effect of a 5-year hand hygiene initiative based on the WHO multimodal hand hygiene improvement strategy: an interrupted time-series study

Yumi Suzuki,Shigenori Yamamoto,Ichizo Morita,Motoko Morino

doi:10.1186/s13756-020-00732-7

Abstract

BackgroundA World Health Organization (WHO) guideline-based multimodal hand hygiene (HH) initiative was introduced hospital-wide to a nonteaching Japanese hospital for 5 years. The objective of this study was to assess the effect of this initiative in terms of changes in alcohol-based hand rub (ABHR) consumption and the Hand Hygiene Self-Assessment Framework (HHSAF) score.MethodsThe consumption of monthly hospital-wide ABHR was calculated in L per 1000 patient days (PDs). The change in ABHR consumption was analysed by an interrupted time series analysis with a pre-implementation period of 36 months and an implementation period of 60 months. The correlation between annual ABHR consumption and the HHSAF score was estimated using Pearson’s correlation coefficients.ResultsThe annual ABHR consumption was 4.0 (L/1000 PDs) to 4.4 in the pre-implementation period and 10.4 to 34.4 in the implementation period. The HHSAF score was 117.5 (out of 500) in the pre-implementation period and 267.5 to 445 in the implementation period. A statistically significant increase in the monthly ABHR consumption (change in slope: + 0.479 L/1000 PDs, p < 0.01) was observed with the implementation of the initiative. Annual ABHR consumption was strongly correlated with the annual HHSAF score (r = 0.971, p < 0.01).ConclusionsA 5-year WHO-based HH initiative significantly increased ABHR consumption. Our study suggested that the HHSAF assessment can be a good process measure to improve HH in a single facility, as ABHR consumption increased with the HHSAF score.

Highlights

A World Health Organization (WHO) guideline-based multimodal hand hygiene (HH) initiative was introduced hospital-wide to a nonteaching Japanese hospital for 5 years
The World Health Organization (WHO) published a multimodal strategy to improve hand hygiene compliance in 2009 [4], and improved HH has been reported from several areas following national and subnational HH campaigns based on the WHO guidelines [3, 5,6,7]
We examined the correlation between the Hand Hygiene Self-Assessment Framework (HHSAF) score and alcohol-based hand rub (ABHR) consumption as an exploratory analysis

Summary

Introduction

A World Health Organization (WHO) guideline-based multimodal hand hygiene (HH) initiative was introduced hospital-wide to a nonteaching Japanese hospital for 5 years. The WHO multimodal HH strategy includes 3 main concepts: the “My 5 Moments for Hand Hygiene” approach, the “five strategy components”, and the “step-wise approach” [12]. The “five strategy components” refer to the implementation of multiple actions to tackle different obstacles and behavioural barriers to improving HH These include Component 1: System Change, Component 2: Training and Education, Component 3: Evaluation and Feedback, Component 4: Reminders in the Workplace, Component 5: Institutional Safety Climate for Hand Hygiene. The “step-wise approach” helps to develop and plan the hand hygiene improvement programme over time based on a rational sequence of activities This approach includes the following five steps: Step 1: Facility preparedness, Step 2: Baseline evaluation, Step 3: Implementation, Step 4: Follow-up evaluation, and Step 5: Ongoing planning and review cycle. In spite of the original recommendations in the guidelines, to date no studies have implemented both the “five strategy components” and the “step-wise approach” for 5 consecutive years

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