Hand Hygiene Self-Assessment Framework Research Articles

Ten years of hand hygiene excellence: a summary of outcomes, and a comparison of indicators, from award-winning hospitals worldwide.

Hand hygiene is a crucial measure for the prevention of healthcare-associated infections (HAIs). The Hand Hygiene Excellence Award (HHEA) is an international programme acknowledging healthcare facilities for their leadership in implementing hand hygiene improvement programmes, including the World Health Organisation's Multimodal Improvement Strategy. This study aimed at summarising the results of the HHEA campaign between 2010 and 2021 and investigating the relationship between different hand hygiene parameters based on data from participating healthcare facilities. A retrospective analysis was performed on datasets from HHEA forms, including data on hand hygiene compliance, alcohol-based handrub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. Descriptive statistics were reported for each variable. The correlation between variables was inspected through Kendall's test, while possible non-linear relationships between hand hygiene compliance, ABHR consumption and HHSAF scores were sought through the Locally Estimated Scatterplot Smoothing or logistic regression models. A tree-structured partitioning model was developed to further confirm the obtained findings. Ninety-seven healthcare facilities from 28 countries in three world regions (Asia-Pacific, Europe, Latin America) were awarded the HHEA and thus included in the analysis. HHSAF scores indicated an advanced hand hygiene promotion level (median 445 points, IQR 395-480). System change (100 [95-100] points) and institutional safety climate (85 [70-95] points) showed the highest and lowest score, respectively. In most cases, hand hygiene compliance was above 70%, with heterogeneity between countries. ABHR consumption above 20 millilitres per patient-day (ml/PD) was widely reported, with overall increasing trends. HHSAF scores were positively correlated with hand hygiene compliance (τ = 0.211, p = 0.007). We observed a positive correlation between compliance rates and ABHR consumption (τ = 0.193, p < 0.001), although the average predicted consumption was stable around 55-60ml/PD for compliance rates above 80-85%. Logistic regression and partitioning tree analyses revealed that higher HHSAF scores were more likely in the high-ABHR consumption group at cut-offs around 57-59ml/PD. Ten years after its inception, the HHEA proves to be a valuable hand hygiene improvement programme in healthcare facilities worldwide. Consistent results were provided by the different hand hygiene indicators and the HHSAF score represents a valuable proxy measure of hand hygiene compliance.

Multimodal strategies to hand hygiene in Ghanaian hospitals: a cross-sectional study in the Eastern Region of Ghana

BackgroundHand hygiene (HH) is one of the core components of infection prevention and control and is critical for a high quality of care. Multimodal approaches are recommended to strengthen and...

Prevalence of methicillin sensitive and resistant Staphylococcus aureus carriage among German emergency medical providers.

Health care workers (HCW) in Emergency Medical Services (EMS) frequently come into contact with carriers of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) strains and may acquire and transmit them to patients. However, there is little data on MSSA and MRSA colonization of medical personnel in the emergency services. Additionally, few studies have analyzed the association between personal hygiene of staff and colonization. Therefore, we examined the prevalence of MSSA and MRSA in EMS staff of two German regions and evaluated their personal hygiene behavior. Throat and nasal swabs from 300 EMS workers were analyzed. Both direct and pre-enriched cultures of the swabs were cultivated on culture media to identify MSSA and MRSA. Results were analyzed together with questionnaires about sociodemographic data and a self-assessment of hygiene behavior. Statistical analysis was done using the R statistical software. Of the total 300 swabs, 55% were from paramedics, 39% were from emergency medical technicians (EMT) and 5% were from emergency physicians. With 1%, the MRSA prevalence was comparable to that of the German population, while the MSSA rate - 43.7% - was higher than expected. Colonization with MSSA was significantly associated with poor hand hygiene and male sex, and was inversely correlated to time on the job in EMS. The sample size of 300 and a MRSA prevalence of 1% made a meaningful analysis of potential influencing factors on the prevalence of MRSA infeasible. The comparatively high prevalence of MSSA and the association with decreasing frequency of hand antisepsis suggests an influence of personal hygiene on MSSA colonization. HCW in EMS should be encouraged to make use of their personal protective equipment and practice frequent hand hygiene. The implementation of diagnostic tools such as the Hand Hygiene Self-Assessment Framework of the WHO could be utilized to reveal problems in organizations, followed by an individual program to promote hand hygiene.

Hand Hygiene Practices and Promotion in Public Hospitals in Western Sierra Leone: Changes Following Operational Research in 2021.

Hand hygiene is the most important intervention for preventing healthcare-associated infections and can reduce preventable morbidity and mortality. We described the changes in hand hygiene practices and promotion in 13 public hospitals (six secondary and seven tertiary) in the Western Area of Sierra Leone following the implementation of recommendations from an operational research study. This was a "before and after" observational study involving two routine cross-sectional assessments using the WHO hand hygiene self-assessment framework (HHSAF) tool. The overall mean HHSAF score changed from 273 in May 2021 to 278 in April 2023; it decreased from 278 to 250 for secondary hospitals but increased from 263 to 303 for tertiary hospitals. The overall mean HHSAF score and that of the tertiary hospitals remained at the "intermediate" level, while secondary hospitals declined from "intermediate" to "basic" level. The mean score increased for the "system change" and "institutional safety climate" domains, decreased for "training and education" and "reminders in the workplace" domains, and remained the same for the "evaluation and feedback" domain. Limited resources for hand hygiene promotion, lack of budgetary support, and formalized patient engagement programs are the persistent gaps that should be addressed to improve hand hygiene practices and promotion.

Compliance Analysis Of Hand Hygiene Regulation Implementation At Dr. M. Goenawan Partowidigdo Pulmonary Hospital Based On Who Multimodal Hand Hygiene Improvement Strategy

The Hospital Infection Prevention and Control Program (HIPCP) is an effort to reduce the risk of Healthcare-Associated Infections (HAIs), including hand hygiene compliance. WHO issued the Multimodal Hand Hygiene Improvement Strategy as one of the strategies to tackle low hand hygiene compliance. Dr. M. Goenawan Partowidigdo Pulmonary Hospital (RSPG) has implemented hand hygiene regulations referring to the current policies, but it has not met the target over the last three years. This study aims to analyze the implementation of the regulation of hand hygiene compliance at RSPG according to the WHO Multimodal Hand Hygiene Improvement Strategy, using an analytical descriptive qualitative approach with a case study method. The analysis uses the combination of the theory of George Edward III, Weaver, and the WHO Multimodal Hand Hygiene Improvement Strategy. WHO Multimodal Hand Hygiene Improvement Strategy assessment was conducted by scoring the Hand Hygiene Self-Assessment Framework (HHSAF). The results showed the lowest percentage of HHSAF scores on the bureaucratic structure variable, but the most important variable was the resource variable, namely human resources, related to activeness and behavior issues. These issues were obtained from in-depth interviews developed from structured questions on HHSAF. Hand Hygiene of RSPG is at an intermediate level. Researchers recommend behavioral enforcement with appreciative inquiry in addition to reward and punishment as an effort to improve compliance with the implementation of hand hygiene regulations at RSPG.

Train-the-Trainers in hand hygiene facilitate the implementation of the WHO hand hygiene multimodal improvement strategy in Japan: evidence for the role of local trainers, adaptation, and sustainability

Background“Train-the-Trainers in hand hygiene” (TTT) is a standardized training to train infection prevention and control (IPC) practitioners with the aim to promote hand hygiene in health care according to the World Health Organization (WHO) multimodal improvement strategy. Little is known in the literature about the sustained impact of hand hygiene and IPC trainings adapted locally. The aim of this study is to describe the impact of three TTT courses conducted annually in Japan on the adoption of the WHO multimodal improvement strategy by local IPC practitioners who became a “trainer” after their first TTT participation as a “trainee”.MethodsThree TTT courses were conducted annually from 2020 to 2022 in Japan. A team “TTT-Japan” composed of more than 20 IPC practitioners who completed their first TTT participation adapted the original TTT program to reflect the local healthcare context in Japan, and subsequently convened the 2nd and 3rd TTTs. Pre- and post-course evaluations and post-course satisfaction surveys of the course participants were conducted to assess improvement in knowledge on hand hygiene and perception towards the course, respectively. Attitude and practice surveys of the TTT-Japan trainers were conducted to assess their perception and experience in hand hygiene promotion. The Hand Hygiene Self-Assessment Framework (HHSAF), a validated tool created by WHO to monitor the capacity of hand hygiene promotion at facility level, was applied at TTT-Japan trainers’ facilities to compare results before and after trainers’ engagement. We applied inductive thematic analysis for qualitative analyses of open-ended survey questions of the trainers’ attitude and practice surveys, and the Wilcoxon Sign Rank test for quantitive comparisons of pre- and post-data for the surveys and HHSAF.Results158 Japanese healthcare workers participated in three TTT courses, the majority of whom (131, 82.9%) were nurses. Twenty-seven local trainers were involved in 2nd and 3rd TTTs. The scores of pre- and post-course evaluations significantly improved after the course (P < 0.001) and the improvement was consistent across all three TTTs. Post-course satisfaction survey showed that over 90% of the participants reported that the course met their expectations and that what they learned in the courses would be useful for their practice. Trainers’ attitude and practice survey showed that more than three quarters (76.9%) of the trainers reported that their experience as a trainer had a positive impact on their practice at their own facilities. Qualitative analysis of the trainers’ attitude and practice survey revealed that trainers appreciated continuous learning as a trainer, and group effort to promote hand hygiene as the TTT-Japan team. The HHSAF institutional climate change element at the trainers’ facilities significantly improved after their engagement as a trainer (P = 0.012).ConclusionsTTTs were successfully adapted and implemented in Japan, leading to sustained hand hygiene promotion activities by local trainers over three years. Further research is warranted to assess the long-term impact on local hand hygiene promotion in different settings.

SafeHANDS: A Multimodal Hand Hygiene Intervention in a Resource-Limited Neonatal Unit.

Hand hygiene (HH) is a cornerstone of programmes to prevent healthcare associated infections (HAI) globally, but HH interventions are seldom reported from African neonatal units. We conducted a quasi-experimental study evaluating the impact of a multi-modal intervention (SafeHANDS) on HH compliance rates, alcohol-based handrub (ABHR) usage, the Hand Hygiene Self-Assessment Framework (HHSAF) score, and healthcare-associated bloodstream infection (HA-BSI) rates at a 132-bed South African neonatal unit (4 wards and 1 neonatal intensive care unit [NICU]). The intervention included a campaign logo, HH training, maternal education leaflets, ABHR bottles for staff, and the setting of HH performance targets with feedback. Three 5-month study phases were completed in July 2020 (baseline), December 2020 (early) and May 2021 (intensive). A total of 2430 HH opportunities were observed: 1002 (41.3%) at baseline, 630 (25.9%) at early and 798 (32.8%) at intensive study phases. At baseline, the overall neonatal unit HH compliance rate was 61.6%, ABHR use was 70 mL/patient day, and the baseline HHSAF score was 'basic' (165). The overall neonatal unit HH compliance rate was unchanged from baseline to intensive phases (617/1002 [61.6%] vs. 497/798 [62.3%]; p = 0.797). The ABHR use remained similar between phases (70 versus 73 mL/patient day). The HHSAF score improved to 'intermediate' level (262). There was no change in the neonatal unit HA-BSI rate. Despite improvement in the HHSAF score, no improvement in overall HH compliance rates, ABHR usage, or HA-BSI rates was observed. Future HH interventions in resource-limited neonatal units should incorporate implementation science and behaviour modification strategies to better understand the barriers and facilitators of HH best practice.

A WHO Guided Journey of Hand Hygiene (HH) from Basic to Advance Level in Lower Middle-Income Country (LMIC)

<h3>Background</h3> According to WHO; Hand hygiene is a primary measure to reduce hospital acquired infections. It is a simple act but the lack of compliances among health care workers. World Health Organization (WHO) offers a Hand hygiene Self-assessment framework to identify area of improvements and develop action plan and strategies accordingly. Being a low/middle income country initial scoring came to be 195 points i.e., Basic level thus we aim to achieve advance level i. e. > 375. <h3>Methods</h3> To work on project, Plan, Do, Study, Act (PDSA) quality improvement cycle was initiated, process and outcome indicators were measured to analyze the cause and effects/fish bone diagram was used. WHO's hand hygiene self-assessment framework/tool was utilized which has five components system change, training/ education, evaluation/ feedback, reminders in workplace & institution's safety climate for Hand Hygiene. Reassessments were done periodically to document the progress over time in each component and overall to track their progress in hand hygiene resources, promotion activities, plan their actions. <h3>Results</h3> After implementation of multiple strategies in each section of WHO's self-assessment framework we were able to achieve our set goal and our overall score increased from basic i.e., 195 to advance i.e., 395. In addition to that our category wise score also increased i.e., in system change from 60 to 85, in training/ education from 35 to 100, in evaluation/ feedback from 52.5 to 100, reminders in workplace from 17.5 to 45 & Institution's Safety Climate from 30 to 65. <h3>Conclusions</h3> WHO's hand hygiene self-assessment framework should be utilized by all the hospitals in lower- and middle-income country as a guide to improve their hand hygiene levels. It provides an opportunity to reflect on existing resources and helps to focus on future and challenges. It acts as a diagnostic tool, identifying key issues requiring attention and improvement.

How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals.

Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs.

Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019

SummaryBackgroundHand hygiene is at the core of effective infection prevention and control (IPC) programmes. 10 years after the development of the WHO Multimodal Hand Hygiene Improvement Strategy, we aimed to ascertain the level of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey.MethodsFrom Jan 16 to Dec 31, 2019, IPC professionals were invited through email and campaigns to complete the online Hand Hygiene Self-Assessment Framework (HHSAF). A geospatial clustering algorithm selected unique health-care facilities responses and post-stratification weighting was applied to improve representativeness. Weighted median HHSAF scores and IQR were reported. Drivers of the HHSAF score were determined through a generalised estimation equation.Findings3206 unique responses from 90 countries (46% WHO Member States) were included. The HHSAF score indicated an intermediate hand hygiene implementation level (350 points, IQR 248–430), which was positively associated with country income level and health-care facility funding structure. System Change had the highest score (85 points, IQR 55–100), whereby alcohol-based hand rub at the point of care has become standard practice in many health-care facilities, especially in high-income countries. Institutional Safety Climate had the lowest score (55 points, IQR 35–75). From 2015 to 2019, the median HHSAF score in health-care facilities participating in both HHSAF surveys (n=190) stagnated.InterpretationMost health-care facilities had an intermediate level of hand hygiene implementation or higher, for which health-care facility funding and country income level were important drivers. Availability of resources, leadership, and organisational support are key elements to further improve quality of care and provide access to safe care for all.FundingWHO, Geneva University Hospitals and Faculty of Medicine, and WHO Collaborating Center on Patient Safety, Geneva, Switzerland.

An Intra-COVID-19 Assessment of Hand Hygiene Facility, Policy and Staff Compliance in Two Hospitals in Sierra Leone: Is There a Difference between Regional and Capital City Hospitals?

Although hand hygiene (HH) is the most effective intervention to reduce the spread of infections, there are limited data on HH facilities, policy, and compliance in sub-Saharan Africa. This cross-sectional study is aimed at assessing HH using the WHO HH self-assessment framework, HH technical reference manual, and a modified infection control self-assessment tool in two hospitals in Sierra Leone. Only 10% and 9% of regional and capital city hospitals had running tap water, respectively. Veronica buckets were the resources for HH in 89% of units in the regional hospital and 92% of units in capital city hospital. Constant supply of soap and alcohol-based hand rub was available in 82% and 68%; and 74% and 79% of units in the capital city and regional hospitals, respectively. Only 10% of the units in both hospitals had hand-drying facilities and functional sinks. Overall HH compliance for the two hospitals was 18.6% and was higher in the regional (20.8%) than the capital city (17.0%) hospitals. The HH levels for the capital city and regional hospitals were 277.5 and 262.5 respectively. Despite the COVID-19 pandemic, there are still challenges with HH compliance in Sierra Leone. It is, therefore, necessary to strengthen the HH multi-modal strategy.

Comparison of hand hygiene compliance self-assessment and microbiological hand contamination among healthcare workers in Mwanza region, Tanzania

SummaryBackgroundCompliance with hand hygiene (HH) practices remains a major challenge in preventing healthcare-associated infections (HCAI). Little is known whether self-reported HH compliance reflects the level of hand contamination microbiologically as a guide for specific infection prevention and control (IPC) measures.MethodsA cross-sectional study was conducted between July and September 2019 involving 18 healthcare facilities (HCF) in Mwanza region, Tanzania. It assessed HH using astructured questionnaire and microbiological analysis of hand samples for culture (n=212), and the WHO Hand Hygiene Self-Assessment Framework (2010) (n=74).ResultsThe overall median HH score (interquartile range) was 212.5 (190–245) and designated at basic level in the WHO framework. The scores progressively increased from basic level in health centres to intermediate level in a tertiary hospital. Self-reported HH compliance using the WHO recommended cut-off value of ≥81.0% was 10.8% (8/74). A total of 56 (26.4%) healthcare workers (HCWs) hands had bacterial contamination; 17.9% (n=38) by Gram negative bacteria (including coliforms, Acinetobacter spp and Pseudomonas aeruginosa), 8.0% (n=17) by meticillin-resistant Staphylococcus aureus (MRSA) and 0.5% (n=1) by both. Hand contamination was significantly higher in district hospitals (P-value=0.0437), and among HCWs residing in the rural areas (P-value=0.017).ConclusionThe median HH score amongst HCF in Mwanza region was at basic level. A quarter of HCWs hands were contaminated by bacteria which mismatched self-reported HH. A need to incorporate HH microbiological paramaters to the WHO HH assessment tool is needed, and future IPC interventional measures should be tailored to the HCF tier and in rural areas.

Alcohol-Based Hand Rub Consumption and World Health Organization Hand Hygiene Self-Assessment Framework: A Comparison Between the 2 Surveillances in a 4-Year Region-Wide Experience.

Hand hygiene is essential for infection prevention. In Piedmont (Northwest Italy), hand hygiene is routinely monitored through 2 surveillance systems, the World Health Organization Hand Hygiene Self-Assessment Framework (HHSAF) and alcohol-based hand rub (ABHR) consumption. This study was aimed at (1) comparing the results of these surveillances, investigating the consistence of the 2 systems and (2) inquiring whether organizational differences among healthcare facilities significantly affected hand hygiene performances. A retrospective analysis was performed on data collected annually from 2015 to 2018 for both surveillances from 40 hospitals of the region: HHSAF score (500 points maximum) and ABHR consumption in milliliters per patient-day (mL/PD) were considered. Logistic regression models were built to evaluate possible correlations between these variables, and observations were clustered considering both variables to identify whether groups with significant differences could be discerned. A tree-structured partitioning model was used to confirm the obtained results. A positive correlation was observed between HHSAF score and odds of belonging to the high ABHR consumption group, particularly for cutoffs set to 19 to 23 mL/PD (P = 0.033 for 23 mL/PD). Two ABHR consumption peaks were identified at approximately 10 and 22 mL/PD, corresponding to median HHSAF scores of 353.75 and 375 points, respectively. The group with better performances was mainly composed of hub hospitals (with single-hospital management). The 2 surveillance systems are consistent, and the HHSAF score could work as a reasonable predictor of hand hygiene compliance in healthcare settings. Different management characteristics are crucial in creating a more/less favorable environment for hand hygiene compliance and infection prevention.

#44: Hand Hygiene during the COVID-19 Pandemic in Three Pediatric Oncology Units in Hispaniola Island

Abstract Background Hand hygiene (HH) is a basic measure to prevent the spread of infections in healthcare settings. We describe HH practices and resources in three pediatric oncology units (POUs) in Haiti and the Dominican Republic that comprise the Hispaniola Project (HP1: Santiago; HP2: Santo Domingo; HP3: Port-au-Prince). This project, started in January 2019, is a quality improvement initiative in infection care and prevention in pediatric oncology. The POUs are main referral centers for pediatric oncology on the island, HP1 (24 inpatient beds) and HP2 (18 beds) are housed within large public pediatric hospitals; HP3 (17 beds) is housed in a mother/child hospital. Methods Data related to HH resources and practices are intermittently collected as part of ongoing surveillance activities at Hispaniola Project sites; standardized data collection forms track infrastructure, supplies, compliance, and training. At regular intervals, the POUs conduct the World Health Organization (WHO) hand hygiene self-assessment framework (HHSAF) to assess the level (inadequate, basic, intermediate, advanced) of their units. Additionally, the POUs monitor HH compliance indirectly via alcohol gel (AG) consumption in liters, measured monthly. HP1 and HP3 also use direct observation to monitor HH compliance. Results From baseline to September 2020, the WHO HHSAF scores increased from 65 (Inadequate) to 210 (Intermediate) at HP1, 260 (Intermediate) to 363 (Intermediate) at HP2, and 260 (Intermediate) to 270 (Intermediate) at HP3. Despite constraints imposed by COVID-19, all 3 participating POUs remained at the intermediate level (scoring 260–375). HH infrastructure, including the sink:bed and AG:patient ratios remained stable from January 2020 to present. The AG:patient ratios were 1:3, 1:1 and 10:13 at HP1, HP2, and HP3 respectively. The sink:bed ratios were 1:6, 1:5 and 5:13 at HP1, HP2 and HP3 respectively. Indirect compliance (AG consumption) was first measured in January 2020 at HP1 and has remained relatively stable from June to present. At HP2, AG consumption increased from January to February but decreased throughout the year due to lack of AG which was replaced by soap and water. AG consumption at HP3 increased from January to March, with some variation throughout the year but generally at higher levels than in 2019. Direct HH observation data are limited; however, an increased number of observations at HP1 and increased compliance rates were noted for HP1 and HP3 between January and September 2020. As the pandemic emerged, all 3 POUs increased training of staff, patients, and caretakers. Between January and April, 8 training sessions were held for 349 attendees including 235 healthcare workers (HCWs) at HP1; 13 sessions were held for 443 attendees including 61 HCWs at HP2; 15 sessions were held for 288 attendees including 87 HCWs at HP3. Since these early efforts, a smaller number of sessions with fewer attendees have been held. Conclusion During the COVID-19 pandemic, the importance of HH practice was reinforced for HCWs, patients, and caretakers. As organizations and individuals, it is essential to ensure the continuation and sustainability of HH improvement as a strategy to ensure safe healthcare even after the threat of COVID-19 has subsided.

Infection Prevention and Control Measures at the Children Hospital Lahore: A My Child Matters Collaborative Project.

PURPOSEInfection prevention among children with cancer is a major challenge at Children Hospital Lahore (CHL), a public health care facility in Pakistan with 1,000 new pediatric cancer admissions annually. The objective has been to reduce infections through collaboration between CHL and the St Jude Children’s Hospital Global Infectious Disease program via a grant by the Sanofi Espoir foundation through the My Child Matters program. The aim of the current study was to describe the effect of the collaborative improvement strategy on existing infection prevention and control (IPC) standards at CHL.MATERIALS AND METHODSOur work was a prospective before-and-after study to improve IPC standards. We compared the WHO Hand Hygiene Self-Assessment Framework and four modules of the St Jude modified Infection Control Assessment Tool (ICAT) scores over a 3-year period. Our strategy included creating a multidisciplinary team of pediatric oncologists, infectious disease physicians, nurses, a microbiologist, and a data manager; engaging in monthly online IPC mentoring sessions with St Jude Children’s Hospital Global Infectious Disease program and My Child Matters mentors; performing daily inpatient health care–associated infection surveillance rounds; and performing regular hand hygiene training and compliance audits.RESULTSBaseline needs assessment showed health care–associated infections identified by positive blood cultures as 8.7 infections per 1,000 patient-days. Deficient hand hygiene supplies, health education measures, and bed sharing of neutropenic patients were identified as major challenges. Our hand hygiene facility level, per WHO scores, increased from Inadequate to Intermediate/Consolidation by the end of the 3-year implementation (122 v 352 WHO Hand Hygiene Self-Assessment Framework scores). The sink:bed and hand sanitizer:bed ratios improved to 1:6 and 1:1, respectively. The ICAT general infection control module increased by 40% (45 v 78 ICAT scores) and hygiene compliance improved by 20%.CONCLUSIONImplementing a collaborative improvement strategy improved IPC standards in our center, which can be easily replicated in other pediatric oncology centers in lower- and middle-income countries.

Impact on National Policy on the Hand Hygiene Promotion Activities in Hospitals in Korea

Background: After the Middle East respiratory syndrome coronavirus outbreak in Korea in 2015, the government newly established the additional reimbursement for infection prevention to encourage infection control activities in the hospitals. The new policy was announced in December 2015 and was implemented in September 2016. We evaluated how infection control activities improved in hospitals after the change of government policy in Korea. Methods: Three cross-sectional surveys using the WHO Hand Hygiene Self-Assessment Framework (HHSAF) were conducted in 2013, 2015, and 2017. Using multivariable linear regression model including hospital characteristics, we analyzed the changes in total HHSAF scores according to the survey time. Results: In total, 32 hospitals participated in the survey in 2013, 52 in 2015, and 101 in 2017. The number of inpatient beds per infection control professionals decreased from 324 in 2013 to 303 in 2015 and 179 in 2017. Most hospitals were at intermediate or advanced levels of progress (90.6% in 2013, 86.6% in 2015, and 94.1% in 2017). In a multivariable linear regression model, the total HHSAF scores were significantly associated with hospital teaching status (β coefficient of major teaching hospital, 52.6; 95% CI, 8.9–96.4; P = .018), bed size (β coefficient of 100-bed increase, 5.1; 95% CI, 0.3–9.8; P = .038), and survey time (β coefficient of 2017 survey, 45.1; 95% CI, 19.3–70.9; P = .001). Conclusions: After the national policy implementation, the number of infection control professionals increased, and the promotion of hand hygiene activities was strengthened in Korean hospitals.Funding: NoneDisclosures: None

A Journey of Hand Hygiene (HH) from Basic to Advance Level at a Tertiary-Care Hospital in Karachi, Pakistan

Background: According to the WHO, hand hygiene is the primary measure to reduce infections. It is a simple act, but the lack of compliance among healthcare workers has been a great concern for all healthcare facilities. Healthcare facilities can perform a situation analysis of hand hygiene promotion and practices according to a set of indicators designed by the WHO in the form of a hand hygiene self-assessment framework. Results can be used to identify areas of improvement and to develop an action plan and strategies accordingly. Low- or middle-income country (LMIC) initial scoring within this framework was 195 points (ie basic level); thus, we aimed to achieve the advanced level, with a score of &gt; 375. Methods: The WHO hand hygiene self-assessment framework is a diagnostic tool to identify key issues requiring attention and improvement. Repeated assessments are done to document the progress over time, which allows a health-care facility to track their progress in hand hygiene resources, to conduct promotion activities, to plan their actions, and to achieve improvement and sustainability. We developed an action plan under each category of WHO framework that included: system change, training and education, evaluation and feedback, reminders in workplace, and institutional safety climate for hand hygiene. We implemented the following measures: point-of-care hand hygiene stations were made available at all bedsides; mandatory training was introduced for all healthcare workers, and consumption of hand rub or hand sanitizers and liquid soap was monitored as a consumption indicator. In addition, posters were placed in all wards and clinics, time was dedicated for HH promotion, and a May 5th plan was implemented. HH leaders, role models, and champions were identified from each discipline. Patients were involved in HH promotion; HH leaflets were given to patients, HH e-learning tools were implemented, and a system for personal accountability was initiated, as well as a buddy system for new employees. Results: After implementation of multiple strategies in each section of the WHO self-assessment framework, we our overall score increased from basic (ie, 195) to advanced (ie, 395). In addition, category score increased in system change from 60 to 85, in training and education from 35 to 100, in evaluation and feedback from 52.5 to 100, in reminders in workplace from 17.5 to 45, and in institutional safety climate from 30 to 65. Conclusions: The WHO hand hygiene self-assessment framework should be utilized by all the hospitals in LMICs as a guide to improve hand hygiene levels.Funding: NoneDisclosures: None

Hand Hygiene Compliance in a University Hospital in West Bank, Palestine: An Observational Study 2017–2019

Background: Worldwide, medical staff adherence to hand hygiene (HH), the most cost-effective measure to decrease healthcare-associated infections (HAIs), is ~40%–60%. The infection control program (ICP) at An-Najah National University Hospital (NNUH), a tertiary-care referral teaching hospital located in Nablus, in northern Palestine, monitors HH compliance by direct observations using the WHO observation checklist. In this descriptive study, we investigated the prevalence of HH across the institution during 2017–2019. Methods: The WHO multimodal strategy to enhance HH in healthcare settings was implemented at NNUH, a tertiary-care referral hospital, in 2017. HH compliance has been measured during routine patient care by direct observation by ICP team and anonymously by other trained observers. Results are reported on monthly basis to the administration and medical team (nurses and doctors), and corrective plans to increase the compliance are discussed. Training is reinforced with ultraviolet light and fluorescent alcohol-based hand rub. Yearly, staff are engaged in HH Day activities (Figs. 1 and 2). Leadership support is constant by securing the annual budget for the HH program and the enforcement of HH policy across the setting. Results: NNUH, using the WHO Hand Hygiene Self-Assessment Framework, is currently in the advanced level (395 of 500) compared to 2017 (intermediate level, 292 of 500). Overall, HCW HH compliance increased from 44% (range, 31%–57%) in 2017 to 53% (range, 30%–72%) in 2018 and to 61% (range, 55%–66%) through October 2019. During the 3-year study period, Nursing compliance increased from 36% to 59% and to 64%, respectively, whereas the compliance for doctors increased from 42% to 56% and 58%, respectively. Regarding the missed opportunities, before patient was the most frequent cause for missed opportunity with a rate of 60% (Fig. 3). This missed opportunity was mainly related to the misuse of gloves (mainly among nurses), which requires an ad hoc intervention. Conclusions: Implementation of the WHO HH strategy is feasible and effective in low-income countries and leads to significant improvements in compliance. Periodic training, personnel engagement, and leadership are key factors of HH improvement in our setting.Funding: NoneDisclosures: None

The evaluation of a multimodal hand hygiene improvement strategy in Cambodian hospitals.

Hand hygiene is the most effective method of preventing healthcare-associated infections. Healthcare-associated infections are considered serious in developing countries, and there are few reports on the hand-hygiene status of these countries. Thus, we evaluated hand-hygiene status in eight hospitals in Cambodia to understand and identify factors hindering effective infection control. Eight infection-management instructors working in one of the eight Cambodian government hospitals in a large city were interviewed with the WHO Hand Hygiene Self-Assessment Framework. The mean Hand Hygiene Self-Assessment Framework score across the eight hospitals was 177.81 ± 56.73. The overall level of compliance with the multimodal hand hygiene improvement strategy across these eight hospitals was basic-two hospitals scored inadequate and six hospitals scored basic. The scores for the 5 factors of the Hand Hygiene Self-Assessment Framework were as follows: 45.63 ± 15.45 for system change, 33.13 ± 16.89 for education and training, 27.81 ± 21.65 for evaluation and feedback, 58.13 ± 5.30 for reminders in the workplace, and 13.13 ± 11.00 for institutional safety climate for hand hygiene CONCLUSIONS: The promotion of hand hygiene compliance requires the establishment of a basic infrastructure, reinforcement of the hand hygiene education system, and provision of diverse educational materials, as well as the fostering of a professional workforce for education. Hospitals should also bolster their management systems for hand hygiene compliance.

Impact of national policy on hand hygiene promotion activities in hospitals in Korea

BackgroundAfter the Middle East respiratory syndrome coronavirus outbreak in Korea in 2015, the Government established a strategy for infection prevention to encourage infection control activities in hospitals. The new policy was announced in December 2015 and implemented in September 2016. The aim of this study is to evaluate how infection control activities improved within Korean hospitals after the change in government policy.MethodsThree cross-sectional surveys using the WHO Hand Hygiene Self-Assessment Framework (HHSAF) were conducted in 2013, 2015, and 2017. Using a multivariable linear regression model, we analyzed the change in total HHSAF score according to survey year.ResultsA total of 32 hospitals participated in the survey in 2013, 52 in 2015, and 101 in 2017. The number of inpatient beds per infection control professionals decreased from 324 in 2013 to 303 in 2015 and 179 in 2017. Most hospitals were at intermediate or advanced levels of progress (90.6% in 2013, 86.6% in 2015, and 94.1% in 2017). In the multivariable linear regression model, total HHSAF score was significantly associated with hospital teaching status (β coefficient of major teaching hospital, 52.6; 95% confidence interval [CI], 8.9 to 96.4; P = 0.018), beds size (β coefficient of 100 beds increase, 5.1; 95% CI, 0.3 to 9.8; P = 0.038), and survey time (β coefficient of 2017 survey, 45.1; 95% CI, 19.3 to 70.9; P = 0.001).ConclusionsAfter the new national policy was implemented, the number of infection control professionals increased, and hand hygiene promotion activities were strengthened across Korean hospitals.