WHO Multimodal Hand Hygiene Research Articles

Effectiveness of WHO's multimodal hand hygiene strategy on compliance and knowledge in a University Hospital in Morocco

Effectiveness of WHO's multimodal hand hygiene strategy on compliance and knowledge in a University Hospital in Morocco

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.

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.

Effectiveness and sustainability of the WHO multimodal hand hygiene improvement strategy in the University Hospital Bouak\xe9, Republic of C\xf4te d'Ivoire in the context of the COVID-19 pandemic

IntroductionThe most frequent adverse events in healthcare are healthcare-associated infections, whose burden is highest in resource-limited settings. In addition, low resource settings often lack Hand Hygiene (HH) knowledge and reliable supply to disinfectant, a necessity emphasized by the past West African Ebola Epidemic and the ongoing COVID-19 pandemic. PASQUALE aims to increase patient safety by introducing the WHO multimodal HH strategy in the University Hospital Bouaké, Côte d’Ivoire.MethodsAssessment of HH knowledge, perception and compliance was performed 12 months before, right after the intervention and at a ten months interval using questionnaires for knowledge and perception and direct observation for compliance. The intervention consisted of a HH training and the introduction of local production of alcohol-based hand-rub. In the absence of a control group, the effectiveness of the intervention was assessed by a before-and-after study.ResultsBaseline knowledge score was 14/25, increased significantly to 17/25 (p < 0.001) upon first and decreased to 13/25 in second follow-up. Compliance showed a significant increase from 12.7% to 36.8% (p < 0.001) in first and remained at 36.4% in second follow-up. Alcohol-based hand-rub production and consumption almost doubled after first confirmed COVID-19 case in Côte d’Ivoire.ConclusionThe WHO HH improvement strategy is an effective and pandemic-adaptable method to increase long-term HH compliance. This study emphasizes that the implementation of the strategy to build a robust system is of utmost importance.

Mixed methods study evaluating the implementation of the WHO hand hygiene strategy focusing on alcohol based handrub and training among health care workers in Faranah, Guinea.

The most frequent adverse health events in healthcare worldwide are healthcare-associated infection. Despite ongoing implementation of the WHO multimodal Hand Hygiene (HH) Improvement Strategy, healthcare-associated infection rate continues to be twofold higher in low- than in high-income countries. This study focused on continued evaluation of HH compliance and knowledge. The mixed method approach, with inclusion of patients and care-givers, provided insight into challenges and facilitators of the WHO HH Improvement Strategy, and highlighted improvement points. An uncontrolled, before-and-after intervention, mixed methods study in Faranah Regional Hospital was conducted from December 2017 to August 2019. The intervention implemented the WHO HH Strategy including HH training for healthcare workers (HCWs), and the relaunch of the local production of alcohol-based handrub (ABHR). A baseline assessment of HH knowledge, perception and compliance of HCWs was done prior to the intervention and compared to two follow-up assessments. The second follow-up assessment was complemented by a qualitative component. Overall compliance six months post-intervention was 45.1% and significantly higher than baseline but significantly lower than in first follow-up. Knowledge showed similar patterns of improvement and waning. The perception survey demonstrated high appreciation of the intervention, such as local production of ABHR. HCW's were concerned about overconsuming of ABHR, however simultaneous quantitative measurements showed that consumption in fact was 36% of the estimated amount needed for sufficient HH compliance. Potential fields for improvement identified by HCWs to enhance sustainability were permanent ABHR availability, having a dedicated person with ownership over continuous simulation HH trainings including simulations to improve technique. The study shows that the WHO multimodal HH strategy has a positive effect on HCW compliance and knowledge. Improvement points identified by local staff like sensitization on appropriate ABHR amount per HH action should be considered for sustainable HH improvement.

Effectiveness of Hand Hygiene Promotional Program based on the WHO Multimodal Hand Hygiene Improvement Strategy, in Terms of Compliance and Decontamination Efficacy in an Indian Tertiary Level Neonatal Surgical Intensive Care Unit

AbstractBackground: The WHO Multimodal Hand Hygiene Improvement Strategy (MHHIS) has been proposed to improve the Hand Hygiene (HH) compliance of the WHO recommendations on HH.Therefore, the current study was planned in our neonatal unit with the objective of evaluating the effectiveness of a Hand Hygiene Promotional Program (HHPP) based on the WHO MHHIS, in terms of compliance and decontamination efficacy among the health-care workers (HCWs) in the unit. Objective: The objective of the study was to evaluate the effectiveness of the WHO MHHIS on HH compliance and decontamination efficacy. Methods: The HHPP was carried out in our neonatal surgical intensive care unit from July to August 2013. A pre-intervention phase consisted of assessment of ward infrastructure, HH knowledge and perception, determination of HH compliance and collection of hand rinse samples from the HCWs before and after handwashing. Intervention phase consisted of changing traditional to elbow-operated taps, display of posters and reminders, placement of soaps in water draining trays, autoclaved single-use paper towels for hand drying, availability of hand rubs and training sessions for health-care providers. In the post-intervention phase, all the assessments and observations of pre-intervention phase were repeated. Results: HHPP resulted in a significant increase in overall HH compliance from 26.6% (95% confidence interval [CI] 23.9–29.3) to 65.3% (95% CI 62.4–68.2) (P < 0.001) and reduction in load of microorganisms (P = 0.013). There was a significant improvement in HH knowledge (P < 0.001), and perception surveys revealed high appreciation of each strategy component by the participants. Conclusion: To the best of our knowledge, this is the first study about the effect of implementation of the WHO MHHIS from an Indian hospital. HHPP was found to be effective in terms of HH compliance and decontamination efficacy. Its implementation is highly recommended to promote HH in a developing country like India.

WHO Multimodal Hand Hygiene Strategy and Alcohol Hand Rub Use is Effective in Reducing Hais and Antimicrobes in Developing Countries

WHO Multimodal Hand Hygiene Strategy and Alcohol Hand Rub Use is Effective in Reducing Hais and Antimicrobes in Developing Countries

Reducing Methicillin-Resistant Staphylococcus Aureus (MRSA) Cross-Infection through Hand Hygiene Improvement in Indonesian Intensive Tertiary Care Hospital

Background: Hand hygiene is a noncomplex and a cost-effective way to prevent hospital-acquired infection (HAI). The incidence of hospital acquired MRSA (HA-MRSA) cross-infection is an indicator directly measure the hand hygiene practice at the point of care. Objective: Our study aimed to evaluate the impact of hand hygiene compliance on HA-MRSA cross transmission in the intensive tertiary care of Dr. Sardjito General Hospital, Gadjah Mada University teaching hospital, Yogyakarta, Indonesia.Methods: A quasi-experimental before-after design was conducted to evaluate the implementation of the WHO multimodal hand hygiene improvement strategy which was adjusted to the local needs, based on the qualitative study result from the intensive care from June 2014to April 2016. All workers who have frequent contact with patients were observed for their hand hygiene compliance by trained observers. The incidence of HA-MRSA was recorded through active surveillance accompanied by microbiology data.Results: There were 92 healthcare workers (18 medical doctors, 45 nurses, 29 other staffs) and 5,280 patients involved throughout the study period. There were 16,313 hand hygiene opportunity observations which resulted in a signifcantly improved practical accuracy-consistency-sustainability, after intervention in the initial and end-evaluations. There was asignifcant decrease in the HA-MRSA rate from 12.6% before intervention to 1.2% and 0.3% at the initial and end-evaluations, respectively.Conclusion: Increasing hand hygiene compliance in intensive care reduced HA-MRSA signifcantly. It suggested cross-infection can be used as an indicator of hand hygiene compliance.

Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy in a Tertiary Academic Hospital in Rwanda

Background: Hands of healthcare personnel are known to be the main route of cross transmission of pathogens in healthcare facilities and it is known that hand hygiene is the most effective preventive measure against healthcare-associated infections (HAIs). WHO Hand Hygiene Improvement Strategy is being implemented in a University Teaching Hospital of Butare (CHUB) since November 2011 to improve patients and staffs safety. Methods: This quasi-experimental study was conducted in Butare University Teaching Hospital, a tertiary academic hospital, between November 2011 and November 2015. We implemented the WHO's Multimodal Hand Hygiene Improvement Strategy and assessed the compliance of hand hygiene before and after the interventions. The entire project included five steps: (1) facility preparedness, (2) baseline evaluation, (3) implementation, (4) follow-up evaluation, and (5) on-going planning and review cycle. Baseline evaluation of multimodal hand hygiene self-assessment and hand hygiene compliance was performed, using the WHO Multimodal Hand Hygiene Self-Assessment Framework tool and the WHO's direct observation method. Data was analysed using Ms Excel. Results: The baseline hand hygiene compliance was measured at 6.25%. The Hand Hygiene Level of the hospital was 100 at the baseline, which means inadequate level. The intervention was conducted during 2012 and 2013 and it included provision of hand hygiene supplies, training of healthcare workers, and display of reminders in the workplace. The post intervention hand hygiene programme evaluation was conducted in 2015. Hand hygiene audit was conducted in 6 wards (Neonatology, Intensive Care Unit, Paediatrics, Surgical, Internal Medicine and Gynaeco-Obstetrics) and revealed an average score of 20.86%. There were 58 hand hygiene actions from 278 hand hygiene opportunities, with an average of 46 hand hygiene opportunity per ward. The compliance ranged from 1.9% (Internal Medicine) to 57.8% (ICU). An improvement of 14.61% of hand hygiene practice (6.25% in 2012 to 20.86% in 2015) was noted. Alcohol-based hand rub (ABHR) was the most used procedures and it was used in 89.66% (52/58) of performed indications. Hand hygiene practice among professional categories was 24.6% (33/134) actions for nurses’ opportunities, 22.7% (25/110) actions for medical doctors and there was no action among allied health professionals (0/8) or caretakers (0/26). Hand hygiene self-assessment tool was completed and the score was 355 which mean intermediate level. 60.46% (159/263) of hand washing basins were in good conditions (means working and not damaged) and availability of water was 40.30% (106/263). Conclusion: It is feasible and possible to implement WHO Hand Hygiene Improvement Strategy even in healthcare facilities with limited resources. The findings from the study showed the improvement from the basic level to intermediate level of hand hygiene and improvement in hand hygiene compliance of 14.61% (from 6.25% to 20.68%) in three year period. There is a need to continue with the implementation of the WHO Multimodal Hand Hygiene Improvement Strategy by sustaining what have been achieved and putting more effort in areas of improvement such developing SMART plans for staff training and education, patient involvement and infrastructure improvement plan.

Implementation of the WHO multimodal Hand Hygiene Improvement Strategy in a University Hospital in Central Ethiopia

BackgroundThe burden of health-care associated infections in low-income countries is high. Adequate hand hygiene is considered the most effective measure to reduce the transmission of nosocomial pathogens. We aimed to assess compliance with hand hygiene and perception and knowledge about hand hygiene before and after the implementation of a multimodal hand hygiene campaign designed by the World Health Organization.MethodsThe study was carried out at Asella Teaching Hospital, a university hospital and referral centre for a population of about 3.5 million in Arsi Zone, Central Ethiopia. Compliance with hand hygiene during routine patient care was measured by direct observation before and starting from six weeks after the intervention, which consisted of a four day workshop accompanied by training sessions and the provision of locally produced alcohol-based handrub and posters emphasizing the importance of hand hygiene. A second follow up was conducted three months after handing over project responsibility to the Ethiopian partners. Health-care workers’ perception and knowledge about hand hygiene were assessed before and after the intervention.ResultsAt baseline, first, and second follow up we observed a total of 2888, 2865, and 2244 hand hygiene opportunities, respectively. Compliance with hand hygiene was 1.4% at baseline and increased to 11.7% and 13.1% in the first and second follow up, respectively (p < 0.001). The increase in compliance with hand hygiene was consistent across professional categories and all participating wards and was independently associated with the intervention (adjusted odds ratio, 9.18; 95% confidence interval 6.61-12.76; p < 0.001). After the training, locally produced alcohol-based handrub was used in 98.4% of all hand hygiene actions. The median hand hygiene knowledge score overall was 13 (interquartile range 11–15) at baseline and increased to 17 (15–18) after training (p < 0.001). Health-care workers’ perception surveys revealed high appreciation of the different strategy components.ConclusionPromotion of hand hygiene is feasible and sustainable in a resource-constrained setting using a multimodal improvement strategy. However, absolute compliance remained low. Strong and long-term commitment by hospital management and health-care workers may be needed for further improvement.

WHO Multimodal Hand Hygiene Improvement Strategy and Its Effect on Hand Hygiene Adherence in the Asella Teaching Hospital, Central Ethiopia

WHO Multimodal Hand Hygiene Improvement Strategy and Its Effect on Hand Hygiene Adherence in the Asella Teaching Hospital, Central Ethiopia

WHO multimodal strategy for improving hand hygiene supported within the organization’s management system, Mater Dei Hospital, Belo Horizonte, Brazil

Hand hygiene (HH) has been singled out as a core element of patient safety for the prevention of healthcare-associated infections (HAIs) and the spread of antimicrobial resistance. Cleansing hands with alcohol-based hand rub is a simple and undemanding procedure that requires only a few seconds. Although we already had the five components of the WHO Multimodal Hand Hygiene Improvement Strategy implemented in our facility and a steady mandatory training program, compliance remains stable, with no further increase for many months.

Implementation of WHO multimodal hand hygiene (HH) improvement strategy to reduce healthcare-associated infections (HAI) and VAP (ventilator-associated pneumonia) caused by multi-drug resistant acinetobacter baumanii (MDRAB) at Siloam Hospitals Surabaya (SHBS), Indonesia

SHSB is a 160 bed private hospital in Surabaya, Indonesia. The average length of stay (ALOS) is 9.52 d. In 2010, HAI rates at SHSB were high (3.12%) and HH compliance among healthcare workers (HCW) was low (73.34%). At the same time, SHSB had MDRAB outbreak among ICU patients with VAP rate of 10.99/device-days. Therefore, there was a need for quality improvement to reduce HAI and VAP caused by MDRAB.

Factors associated with hand hygiene compliance at a tertiary care teaching hospital in Argentina

Several interventions have been implemented by hospitals to improve hand hygiene compliance. In that sense, the WHO Multimodal Hand Hygiene Improvement Strategy based on administrative support, system change including availability of alcohol-based handrub, education, reminders in the workplace, monitoring, and performance feedback has been successfully implemented.

PDCA cycle reports: a quality tool to improve physician hand hygiene compliance

Physician hand hygiene (HH) compliance is often found to be lower than that of nurses in the literature. In our institution HH compliance among physicians was about 40% despite many ongoing activities supported by WHO Multimodal HH Strategy to improve it. In 2013, a HH improvement PDCA (Plan-Do-Check-Act) category was created and the best works awarded at annual institutional Quality Exhibits.

Implementation of the Australian national hand hygiene initiative

In 2008, the Australian Commission on Quality and Safety in Health Care (ACSQHC) engaged Hand Hygiene Australia (HHA) to implement the National Hand Hygiene Initiative (NHHI), a national approach to hand hygiene (HH) culture change adapted from the WHO Multimodal HH Improvement Strategy.

The Implementation of intervention program based on WHO multi-modal hand hygiene improvement strategy in a tertiary care university hospital

The Implementation of intervention program based on WHO multi-modal hand hygiene improvement strategy in a tertiary care university hospital

Hand hygiene compliance improvement using the WHO multimodal hand hygiene improvement strategy in Siloam Hospitals Surabaya Indonesia

Hand hygiene compliance improvement using the WHO multimodal hand hygiene improvement strategy in Siloam Hospitals Surabaya Indonesia

Hand Hygiene Promotion in a Hospital Setting through the WHO Multimodal Hand Hygiene Improvement Strategy

Background: This study evaluated the frequency and types of hand hygiene practices among healthcare workers directed by the WHO multimodal hand hygiene improvement strategy, and investigated the effect of hand hygiene practice on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) isolation and MRSA acquisition rate and colonization pressure. Methods: A quasi-experimental study was performed at a tertiary care university hospital with 850 beds from January to September 2012. We assessed the hospital hand hygiene program using the WHO hand hygiene self-assessment framework. The WHO multimodal strategy was used for healthcare workers with low indexes, and the subjects were reassessed. Results: Hand hygiene compliance increased significantly from a pre-intervention rate of 58.7% to 72.6% post-intervention. MRSA and VRE isolation rates decreased from 1.69 per 1000 patient days to 1.41 and from 0.17 to 0.11, respectively. In intensive care units (ICUs), hand hygiene compliance rate rose to 77.9%, with a total score of 4.16 points out of 5 being awarded for the hand hygiene method, which was higher than that for the other care units. The pre-intervention MRSA acquisition rate in the ICU decreased from 7.47% to 4.30% post-intervention. This was associated with a decrease in the MRSA colonization pressure over the intervention period (26.2% to 16.9%). Conclusion: The utilization of the WHO multimodal strategy for improvement of hand hygiene increased the hand hygiene compliance rate and was effective in predicting a decreased rate of cross-infection, MRSA acquisition, and colonization pressure. We conclude that the implementation of such improvement strategies is crucial to maintaining hygiene standards and reducing infection within healthcare facilities.

Indicators of long-term sustainability of hand hygiene improvement and barriers in healthcare settings worldwide

Implementation of the WHO multimodal hand hygiene (HH) improvement strategy was successfully tested in 8 pilot sites in 2006-2008 with a significant improvement in HH compliance and other indicators. Indicators of long-term sustainability and barriers were evaluated 2 years later.