Hygiene Initiative Research Articles

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.

EHPnet: WHO/AFRO Division of Healthy Environments and Sustainable Development

The people of Africa are besieged by a wide range of diseases that are hard to eradicate because of widespread lack of sanitation and medical facilities. A number of factors—including poverty, lack of technology, undeveloped infrastructure, and political conflict—mean that the vast mineral, water, and forest resources of the continent for the most part are not sustainably managed, leaving ecosystems degraded, biodiversity severely affected, and human health at risk. The World Health Organization Regional Office for Africa (WHO/AFRO) has implemented a Division of Healthy Environments and Sustainable Development to identify, control, and prevent environmental conditions that adversely impact human health in the context of sustainable development. The division has set up a website at http://www.afro.who.int/des/index.html to educate the public about its activities. The homepage features overviews of the division’s 12 focus areas: coordination of macroeconomics and health; environmental health policy; environment and promotion of health; environmental risk assessment; food safety; health action in times of crisis; health in sustainable development; long-term health; occupational health; poverty and ill health; protection of the human environment; and water, sanitation, and health. Each area has its own subpage with links to relevant publications and other related resources. Work in the environmental health policy arena concentrates on assisting countries in developing and implementing environmental health policies, and in building and strengthening nations’ capacity to offer sound environmental health services. Falling under the umbrella of environmental risk assessment are initiatives to improve and promote drinking water quality, chemical safety, environmental health impact assessments and mapping, sustainable management of biomedical wastes, and radiation safety. One of the more in-depth sections of the website covers food safety. Contained here are fact sheets for health care workers on topics such as genetically modified foods, mycotoxins, informal food trading, groups at high risk for foodborne illness, and hand-washing to prevent disease, among others. This section also includes profiles of 28 African countries with statistics on population, food production and consumption, food-related legislation, and other related topics. Other links go to the WHO’s main food safety pages and a photo gallery depicting the many problems encountered by Africans in obtaining safe food. The occupational health section provides a link to the WHO/International Labour Organization Joint Effort on Occupational Health and Safety in Africa site, available in English, French, Portuguese, and Arabic. This effort aims to bring occupational safety and health professionals from throughout Africa together in a collaborative network. Also available is contact information for the two occupational health training centers on the continent and links to WHO publications on the subject. The protection of human environment section has profiles for the 46 African countries under the jurisdiction of the WHO/AFRO. The profiles list details about the environmental health laws in each country, and in some instances about plans for developing and implementing new policies. The water, sanitation, and health section has information on the Africa 2000 Initiative. Launched in 1994 by the health ministries of the 46 WHO/AFRO nations, this initiative seeks to expand water and sanitation services throughout Africa. This section also has information on the Participatory Hygiene and Sanitation Transformation Initiative, a program developed by the WHO and other partners to promote community management of water and sanitation resources.

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.

Die gesellschaftliche und religiöse Entwicklung in Ungarn seit 1945 im Spiegel der seelischen Gesundheit der Bevölkerung

Six authors survey the processes that have contributed to deteriorating or enhancing the mental health of Hungarian society since World War II, reviewing a period from the emergence of the mental hygiene movement until the present time. In the early years of these socio-historical processes, post-war changes took place, which were soon followed by a Communist regime that was characterised mostly by negative influences – aspiration to absoluteness and aggressive expansion of communistic ideology. All of these changes affected mental health. People who were willing to retain their faith and conviction, and to preserve their independent and personal identity, were confronted with great difficulties. The 1960s were characterised by a milder political climate, and the nation was kept on a longer leash. In terms of social care, the state provided more effective services to the citizens (at the cost of a constantly increasing national indebtedness), while individualism was spreading across the country. Both psychology and religion were given somewhat greater elbow-room, and, in especially lucky cases, mental hygiene initiatives were allowed to emerge here and there. In the last phase of the regime’s existence, constantly increasing social problems could neither be prevented nor concealed by the state. Even in that era, the solution and prevention of problems were facilitated by several church and other non-governmental initiatives. The collapse of the dictatorship offered great opportunities. At the same time, challenges have been greater than the readiness of the society to solve them. The professions (such as psychotherapists, pastoral counsellors, and social workers) had been pushed into the background until now, and are still searching for their positions on a road that may lead to more efficient help and to the establishment of an infrastructure of assistance.

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.

Involving consumers in peer‐facilitated home‐based food hygiene training

A community‐based food hygiene initiative was piloted in the Toxteth–Granby area of Liverpool between December 2001 and March 2002. The project aimed to increase awareness and behaviour, related to poor food purchase, storage and handling practices, by actively involving members of the local community in home‐based peer‐facilitated training.Facilitators (23) were actively recruited from within the Toxteth–Granby community, and undertook a 4‐day induction and training programme, which included successful completion of the CIEH Basic Food Hygiene course. Facilitators subsequently recruited and visited nearly 1000 households (992) within the Toxteth–Granby electoral ward, undertook an observation sheet, a detailed questionnaire, and spent approximately 1 hour delivering food hygiene training. Facilitators returned to all households within an 8‐week period, and completed further observation sheets and questionnaires, for use in a comparative analysis. Facilitators and householders received incentives for their involvement in the project.Analysis of the data collected showed that general awareness of a range of food hygiene issues was high (such as hand washing before handling food), and most participants (73.8%) were able to recognise the main symptoms of food borne disease. As a result of the home‐based hygiene training there were significant changes in knowledge, attitudes, and food handling practices, including the use of refrigerators, purchase of chilled and frozen foods, washing or peeling of fruits and vegetables, and the cooking of meat‐based products.The project demonstrates that it is possible for communities to improve their food hygiene awareness and food handling behaviours through home‐based peer‐facilitated training programmes, with minimal input from professionals.

Approaches and considerations for setting occupational exposure limits for sensory irritants: report of recent symposia.

Over the past 50 years significant strides have been made in reducing occupational exposure to airborne chemicals. To a large extent, the impetus behind the reductions has been the identification of presumably safe levels of exposure, or occupational exposure limits (OELs). Most of the reduction in exposure has been to chemicals such as hepatotoxins, neurotoxins, nephrotoxins, and carcinogens that cause frank toxic effects. Recently, however, a number of industrial hygiene and occupational medicine initiatives have sought to identify acceptable levels of exposure to sensory irritants and reduce exposure to this class of chemicals. This article presents an overview of the field with emphasis on the work presented at two symposia sponsored by the Chemical Manufacturers Association: "How Do We Set an Occupational Exposure Limit (OEL) for Irritation?" (1998) at the American Industrial Hygiene Conference and Exposition and "Respiratory Tract Irritation and Olfaction Conference" (1997). The two symposia reviewed clinical and experimental methods used to assess odor and sensory irritation, to increase understanding of the research needed to establish OELs for sensory irritants, and to discuss how to use this information to identify appropriate values. The symposia illustrated that research in this area is evolving quickly and that there is already sufficient understanding to permit scientists to identify chemicals likely to be sensory irritants. Further, there appears to be an ample number of research methods for identification of airborne concentrations that should protect most workers. This article summarizes some of the key points raised at these symposia and suggests areas deserving of future study.

The American Society of Tropical Medicine and Hygiene initiative to stimulate educational programs to enhance medical expertise in tropical diseases.

More than a decade ago, at a time when current and emerging tropical diseases posed growing threats to the United States, expert panels convened by the Institute of Medicine of the U.S. National Academy of Sciences concluded that medical expertise within the United States competent to address diseases of the tropics had declined. Recognizing a national need to encourage and enhance such, The American Society of Tropical Medicine and Hygiene developed a program to stimulate new postgraduate medical education in diseases of the tropics. The Society formally requested academic institutions within the United States and Canada to propose new postgraduate programs. To assure the quality of these new curricular offerings, the Society developed an outline of key areas of competency and agreed to offer an examination that would grant physicians a Certificate of Knowledge in Clinical Tropical Medicine and Travelers Health. The certifying examination was to be an integral component of a program to stimulate academic institutions to provide instructional programs in tropical diseases and to encourage physicians to become trained, evaluated, and recognized for their knowledge of clinical tropical diseases and travelers' health. The Society's initiative to stimulate educational programs in tropical medicine is reviewed.

Food hygiene initiative for schools

Food hygiene initiative for schools

Strategies and Approaches for Community-Based Initiatives A Source Book on Environmental Hygiene Promotion

Proceedings of the National Conference on « Environmental Hygiene and Promotional Initiatives », jointly organised by the Socio-Economic Units, Kerala, India (integrated rural water supply and environmental sanitation programme, supported by the Governments of the Netherlands and Denmark), and the International Union for Health Promotion and Education (IUHPE) under the South-East Asia Regional Bureau.