Hand hygiene program
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Hand Hygiene Program <<insert your hospital>> About this presentation This presentation is designed to assist with seeking support from senior management and senior staff for the implementation of the Clean hands are life savers Program

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Hand hygiene program l.jpg

Hand Hygiene Program

<<insert your hospital>>


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About this presentation

  • This presentation is designed to assist with seeking support from senior management and senior staff for the implementation of the Clean hands are life savers Program

  • The presentation should be customised to include facility-specific data


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What is Hand Hygiene?

  • Hand hygiene practices include:

    • Washing with soap and water

    • Application of an alcohol-based hand rub


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Why the need to improve?

  • Health Quality and Complaints Commission (HQCC) Hand Hygiene Standard

    • Effective 1 July 2007

    • “Requires all health service providers to develop implement and monitor multimodal hand hygiene strategies to ensure a sustained reduction of healthcare associated infection rates.”

      • Process principles

      • Outcome principles

        • Mandatory data

      • Improvement principles


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Why do we need to improve?

  • The major route of transmission of microorganisms has been determined as the unwashed hands of healthcare workers (HCW) (direct contact transmission)

  • On average, infections complicate 7% to 10% of hospital admissions

    • Morbidity & mortality

    • Increased length of stay

    • Costs of treatment

  • 10% to 70% are preventable

    • However, additional measures are required to decrease healthcare associated infection (HAI) and multi-resistant organism (MRO) transmission e.g. isolation


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Why do we need to improve?

  • Numerous studies show that proper hand hygiene reduces the spread of bacteria in various healthcare settings.

  • For example: in the University of Geneva Hospitals, Switzerland, the introduction of a hospital-wide program to improve compliance with hand hygiene resulted in an overall decrease of healthcare associated infections, including decreased MRSA transmission rates


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Why do we need to improve?

  • Hand hygiene is the most effective and inexpensive measure to prevent cross transmission and healthcare associated infections

  • Compliance remains universally low

    • Overall average 40%

  • Duration of handwashing rarely meets a minimum standard of 10 to 15 seconds


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Average

What is our track record?

  • Although hand hygiene has been proven to reduce the spread of microorganisms in hospitals, healthcare workers often do not clean their hands when recommended.

  • In 34 published studies of handwashing, healthcare workers only washed their hands 40% of the time.

  • At our facility the compliance rate is ___ %


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Why is compliance poor?

  • A number of factors affecting HCW compliance with hand hygiene have been identified and include:

    • Professional category

    • Hospital ward

    • Time of day/week

    • Type and intensity of patient care

    • Interference with HCW-patient relationships

    • High workload and understaffing (too busy)

    • Inaccessible hand hygiene supplies e.g. sinks poorly located

    • Skin irritation caused by hand hygiene products

    • Lack of awareness of the risk of cross transmission of pathogens (“hands don’t look dirty’)

    • Lack of knowledge of hand hygiene guidelines

    • Insufficient time for hand hygiene

    • Forgetfulness


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Behavioural aspects of hand hygiene

  • Two types of hand hygiene practice

    • Inherent

      • Drives the majority of community and HCW hand hygiene behaviour

      • Occurs when hands are visibly soiled, sticky or gritty OR

      • After touching an ‘emotionally dirty’ area e.g. groin or genitals

      • Requires subsequent hand washing with soap and water

    • Elective

      • Hand hygiene opportunities not encompassed in the inherent category

      • Taking a pulse or blood pressure, or having contact with an inanimate object in the patient’s environment equates to common social interactions such as shaking hands

      • Does not trigger an intrinsic need to cleanse hands and therefore omitted by busy HCWs


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Hand hygiene behaviour

  • Modifying hand hygiene behaviour of HCWs is a complex task

  • Individual, institutional and community factors

  • Focus group data suggests that hand hygiene patterns are firmly established before the age of 9 or 10 years

    • Self-protective from infection

    • Drivers to practice hand hygiene are emotionally based on the concepts of ‘dirtiness’ and ‘cleanliness’


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Solutions?

  • Aim to change the culture of the organisation in relation to hand hygiene

    • Top-level management support

    • Role modelling by senior staff

    • Alcohol-based hand hygiene products located at the point-of-care

    • Education program

    • Visual cues such as posters

    • Performance monitoring and feedback


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Clean hands are life savers

  • This program is aimed at improving hand hygiene in the wards and departments which provide clinical care to patients

  • All recommendations must be implemented to ensure increased compliance with hand hygiene

  • The program is able to be adapted to reflect local circumstances


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The Program

  • Compliance with hand hygiene policy

    • The need for HCWs to comply with the hand hygiene policy on all occasions must be emphasised as a significant and major institutional priority

    • Embedded in the overall safety climate

    • Emphasis must come from Executive leaders

    • Must be promoted verbally, in writing, and in person, and reiterated time and time again

    • Provision of appropriate facilities including alcohol-based hand rub


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Voss & Widmer calculated that if HCWs were to wash their hands as frequently as recommended, additional staff positions would be required in the hospital because of the increased time requirements

100% compliance

Handwashing (included walking to sink etc; 40-80 seconds)=16 hours of nursing time per shift (17% of the total work force)

Alcohol-based hand rub (20 seconds)=3 hours of nursing time per shift (<3% of the total work force)

Alcohol-based rubs save time

Voss A, Widmer A. No time for handwashing!? Handwashing versus Alcoholic Rub: Can we afford 100% compliance? Infection Control and Hospital Epidemiology 1997;18:205-208


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Cost-effectiveness hands as frequently as recommended, additional staff positions would be required in the hospital because of the increased time requirementsof hand hygiene

  • The costs of hand hygiene promotion programs have been estimated at $2.50 per discharged patient.

  • Total cost of the program would be cost saving if less than 1% reduction in HAI was observed.


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The Program hands as frequently as recommended, additional staff positions would be required in the hospital because of the increased time requirements

  • Motivate appropriate hand hygiene practices through role modelling and peer pressure from senior medical, nursing and administrative staff

    • Social leaders amongst medical consultants

      • “Champions”

    • Overt and continuing support

    • Recognition as an institutional priority

    • Support must be provided in person, verbally and in writing, and reiterated again and again.


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The Program hands as frequently as recommended, additional staff positions would be required in the hospital because of the increased time requirements

  • Implement strategies to engage staff

    • Many of these interventions are commonly put in place, but will not be effective unless Tier 1 and Tier 2 interventions are implemented first, soundly established and promoted in an ongoing fashion

      • Education programs

      • Choice of hand hygiene products

      • Promotion of the program

        • Reminders in the workplace / visual cues

        • Ongoing and multiple modes


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The Program hands as frequently as recommended, additional staff positions would be required in the hospital because of the increased time requirements

  • Implement mechanisms for measuring and reporting compliance

    • Mandatory Performance Measure

      • Percentage compliance with hand hygiene recommendations as recorded by observers


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Roles & Responsibilities hands as frequently as recommended, additional staff positions would be required in the hospital because of the increased time requirements

  • Locate alcohol-based hand hygiene products

  • Act as good role models

  • Show support to staff

  • Appear (if requested to do so) on the staff posters which show your commitment to hand hygiene improvement

    • The influence of senior staff’s hand hygiene behaviour on more junior staff should not be underestimated


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Questions? hands as frequently as recommended, additional staff positions would be required in the hospital because of the increased time requirements


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