Hand Hygiene Initiative Research Articles

Development of a standardised approach to observing hand hygiene compliance in Australia

Abstract Background Evidence indicates that improved hand hygiene compliance can lead to reductions in healthcare associated infection. However, there are few papers that clearly document the observation method used to collect the hand hygiene compliance data. This article describes the Hand Hygiene Australia 5 Moments for Hand Hygiene observation method in detail. Methods The Australian Commission for Safety and Quality in Health Care funded Hand Hygiene Australia (HHA) to implement the National Hand Hygiene Initiative (NHHI) to improve hand hygiene compliance (HHC) and establish a national validated system of HHC auditing. Based on the World Health Organisation (WHO) World Alliance for Patient Safety campaign ‘Clean Care is Safer Care', HHA adapted the WHO hand hygiene compliance data collection form to suit Australian healthcare facilities. Results Hand Hygiene Australia developed a standardised approach to direct observation of HHC of healthcare workers by developing a uniform suite of tools and a data management system for accurate data collection and report generation. Conclusion Implementation of the HHA 5 Moments HHC audit method has facilitated standardised, reliable and meaningful collection of hand hygiene compliance data that is driving HHC improvement across many different healthcare settings around Australia.

Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series

BackgroundEvidence that hand hygiene (HH) reduces healthcare-associated infections has been available for almost two centuries. Yet HH compliance among healthcare professionals continues to be low, and most efforts to improve...

Impact of a rapid cycle hand hygiene initiative in a pediatric emergency department

Impact of a rapid cycle hand hygiene initiative in a pediatric emergency department

Evaluating the economics of the Australian National Hand Hygiene Initiative

The National Hand Hygiene Initiative, implemented in Australia in 2009, is currently being evaluated for effectiveness and cost-effectiveness by a multidisciplinary team of researchers. Data from a wide range of sources are being harvested to address the research questions. The data are observational and appropriate statistical and economic modelling methods are being used. Decision makers will be provided with new knowledge about how hand hygiene interventions should be organised and what investment decisions are justified. This is novel research and the authors are unaware of any other evaluation of hand hygiene improvement initiatives. This paper describes the evaluation currently underway.

Low Compliance to Handwashing Program and High Nosocomial Infection in a Brazilian Hospital

Background. It is a fact that hand hygiene prevents nosocomial infection, but compliance with recommended instructions is commonly poor. The purpose of this study was to implement a hand hygiene program for increase compliance with hand hygiene and its relationship with nosocomial infection (NI) and MRSA infection/colonization rates. Methods. Compliance to hand hygiene was evaluated in a hospital by direct observation and measured of health care-associated infections, including methicillin resistant Staphylococcus aureus, before and after an educational intervention, using visual poster, colorful stamps, and feedback of the results. Results. Overall compliance did not increase during intervention, only handwashing before and after patient contact has improved from 40% to 76% (P = 0.01) for HCWs, but NI and MRSA rates remained high and stable. Conclusion. In a combination of high prevalence of NI and low compliance to hand hygiene, the programme of measure does not motivate the HCW hand hygiene. Future interventions should employ incremental evaluation to develop effective hand hygiene initiatives.

Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative

To report outcomes from the first 2 years of the National Hand Hygiene Initiative (NHHI), a hand hygiene (HH) culture-change program implemented in all Australian hospitals to improve health care workers' HH compliance, increase use of alcohol-based hand rub and reduce the risk of health care-associated infections. The HH program was based on the World Health Organization 5 Moments for Hand Hygiene program, and included standardised educational materials and a regular audit system of HH compliance. The NHHI was implemented in January 2009. HH compliance and Staphylococcus aureus bacteraemia (SAB) incidence rates 2 years after NHHI implementation. In late 2010, the overall national HH compliance rate in 521 hospitals was 68.3% (168,641/246,931 moments), but HH compliance before patient contact was 10%-15% lower than after patient contact. Among sites new to the 5 Moments audit tool, HH compliance improved from 43.6% (6431/14,740) at baseline to 67.8% (106,851/157,708) (P < 0.001). HH compliance was highest among nursing staff (73.6%; 116,851/158,732) and worst among medical staff (52.3%; 17,897/34,224) after 2 years. National incidence rates of methicillin-resistant SAB were stable for the 18 months before the NHHI (July 2007-2008; P = 0.366), but declined after implementation (2009-2010; P = 0.008). Annual national rates of hospital-onset SAB per 10,000 patient-days were 1.004 and 0.995 in 2009 and 2010, respectively, of which about 75% were due to methicillin-susceptible S. aureus. The NHHI was associated with widespread sustained improvements in HH compliance among Australian health care workers. Although specific linking of SAB rate changes to the NHHI was not possible, further declines in national SAB rates are expected.

Corrigendum: The challenges of implementing a national hand hygiene initiative in rural and remote areas: Is it time for a new approach to auditing?

The publisher wishes to apologize for errors that appeared in the above article. Page 64: participants were required to read Chapter 6 of the Hand Hygiene Australia Manual, not Chapter 5 as stated in the article. Page 68: Under “Conflict of Interest” Jenny Stackelroth wishes to declare that she is a member of the National Hand Hygiene Initiative Advisory Committee (as a representative of the Australian Commission on Safety and Quality in Healthcare's Healthcare Associated Infection Implementation Advisory Committee).

Changing behavior – ensuring hand hygiene is an institutional priority

In 2004 the Victorian Quality Council developed a state-wide model aiming to improve hand hygiene and reduce healthcare associated infections across Victoria. Many aspects of this culture change program have been incorporated into the National Hand Hygiene Initiative which commenced in 2008.

The development of an online database and mobile web application for the collection and analysis of hand hygiene compliance data

Hand Hygiene Australia (HHA) commenced implementation of a National Hand Hygiene Initiative (NHHI) in 2008 into all healthcare facilities. Based on the World Health Organization “5 Moments for Hand Hygiene” Program, one of the aims is to establish a uniform system of hand hygiene (HH) compliance auditing to allow local, national and international benchmarking. HH compliance (HHC) data was collected manually on a paper form, input to a local database and then emailed to HHA. This process was time consuming, resource intensive.

The challenges of implementing a national hand hygiene initiative in rural and remote areas: Is it time for a new approach to auditing?

Abstract Direct observation of health professionals is recognised as the ‘gold standard' for monitoring hand hygiene compliance. Trained and validated auditors directly observe health professionals' hand hygiene behaviours, and assess their compliance with standard guidelines. In June 2010, a hand hygiene program that coincided with the adoption of the National Hand Hygiene Initiative (NHHI), including the Five Moments for Hand Hygiene, was introduced into a rural health service district in Australia. Infection prevention and control representatives from each inpatient facility within the district attended hand hygiene auditor training during a 2-day face-to-face workshop using standard models and training materials. The district infection control practitioner and a representative from the jurisdiction's infection prevention and control unit conducted the workshop. The success of the program has been variable, particularly at the institutional level. In part, this has been due to a lack of administrative leadership and refusal by Directors of Nursing in some facilities to site the alcohol-based hand hygiene product at the point of care. At the individual level, not all representatives have achieved the benchmark set by the NHHI for validation of auditors, with some reporting difficulty grasping the definitions and methodology of auditing. The subsequent process of re-training auditors has been resource-intensive due to the significant physical distance between facilities and limited on-site resources. These challenges and difficulties have brought into question the sustainability of the NHHI model for a geographically vast health service district. This paper examines the implementation of a nationally sanctioned hand hygiene program in a rural and remote health service district, and proposes a novel model for monitoring hand hygiene compliance in such settings.

Infection Prevention Research in Europe: Recent Advances and Future Priorities

During the past 2 decades, Europe has made substantial progress in the prevention and control of hospital‐acquired infections and antimicrobial resistance (e.g., through multicenter trials, international surveillance networks, and hand hygiene initiatives). This short overview highlights recent advances and future priorities in infection prevention research, including methodological challenges to be addressed.

Hand Hygiene: Staff-Driven Approach Leads to Success

ISSUE: Since Ignaz Semmelweis first demonstrated the effectiveness of hand hygiene in reducing instances of puerperal sepsis, hand hygiene has been the key concept in reducing the transmission of organisms. Despite the availability of hand sanitizers in the hallways and reminders by Infection Control personnel, compliance with hand hygiene at our institution was similar to trends of low hand hygiene compliance as reported nationally. PROJECT: In 2004, the Infection Control Department, in conjunction with Quality Management, initiated a hospital wide hand hygiene campaign, whose goal was to improve staff compliance with hand hygiene. One nursing unit volunteered to be the initial "kick-off" unit. Staff determined how to implement the initiative on their unit. They were empowered to intercede with any health care worker who missed a hand hygiene opportunity. Education via lectures and glow-in-the-dark handwashing demonstrations started the campaign. A hospital-wide slogan contest for the campaign was held with a prize awarded for the winning slogan. Physician Champions of Hand Hygiene promoted hand hygiene during rounds and physician presentations. Other initiatives to increase awareness hand hygiene included letters to Chairman, publishing in facility newsletter pictures of Administrators "caught in the act" performing hand hygiene, and rewards to employees observed performing hand hygiene. Data from anonymous observations were compiled weekly and results provided to the unit in a trending graph. RESULTS: As a result of staff-driven unit-based hand hygiene initiatives, observations of physicians, nurses and patient care associates demonstrated improvement in compliance with hand hygiene. Overall mean compliance went from a baseline of 34% in March 2004 to an improved rate of 80% that was sustained and was the impetus for expansion of the campaign to additional units in September 2005. The initial unit's recommendation to place hand sanitizers in each patient room was implemented. LESSONS LEARNED: Personal "buy-in" and unit self-determination, in addition to education and feedback of compliance data, are key in implementing a successful hand hygiene campaign. Hand hygiene education and reminders to staff continue to maintain increased compliance and guarantee success.

Focus group data as a tool in assessing effectiveness of a hand hygiene campaign

Routine handwashing has been proven to decrease incidence of health care-associated infections, including methicillin-resistant Staphylococcus aureus (MRSA), spawning numerous attempts to "advertise" its importance. However, most control measures fail to evaluate systematically the efficacy of handwashing initiatives. The purpose of this study was to implement a hand hygiene program in an academic medical center, utilizing visual cues developed with periodic input from hospital personnel. After estimation of baseline compliance (20%), visual cues in the form of 11'' x 17'' posters were developed in a sequential fashion, based on suggestions from participants. The stepwise approach was supported by data collected via focus groups. These data were used to design target-specific messages and to understand better the benefits of utilizing participant input. Postexposure compliance rates indicated a modest improvement over baseline, increasing to 37% during the 12-month study. In addition, the stepwise design proved to be highly useful in guiding the intervention process. Analysis of qualitative data also elucidated numerous routes through which effective hand hygiene campaigns could be implemented. Through diligent observation and participant feedback, the research team was able to develop and market educational cues to meet service demands of health care professionals in a unified effort to control health care-associated infections. Future interventions should employ incremental evaluation designs supported by participant input to develop effective hand hygiene initiatives.

Kaiser Permanente National Hand Hygiene Program.

Hand hygiene has historically been identified as an important intervention for preventing infection acquired in health care settings. Recently, the advent of waterless, alcohol-based skin degermer and elimination of artificial nails have been recognized as other important interventions for preventing infection. Supplied with this information, the National Infection Control Peer Group convened a KP Hand Hygiene Work Group, which, in August 2001, launched a National Hand Hygiene Program initiative titled "Infection Control: It's In Our Hands" to increase compliance with hand hygiene throughout the Kaiser Permanente (KP) organization. The infection control initiative was designed to include employee and physician education as well as to implement standard hand hygiene products (eg, alcohol degermers), eliminate use of artificial nails, and monitor outcomes. From 2001 through September 2003, the National KP Hand Hygiene Work Group coordinated implementation of the Hand Hygiene initiative throughout the KP organization. To date, outcome monitoring has shown a 26% increase in compliance with hand hygiene as well as a decrease in the number of bloodstream infections and methycillin-resistant Staphylococcus aureus (MRSA) infections. As of May 2003, use of artificial nails had been reduced by 97% nationwide. Endorsement of this Hand Hygiene Program initiative by KP leadership has led to implementation of the initiative at all medical centers throughout the KP organization. Outcome indicators to date suggest that the initiative has been successful; final outcome monitoring will be completed in December 2003.