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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

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hand hygiene program

Hand Hygiene Program

<<insert your hospital>>

about this presentation
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
what is hand hygiene
What is Hand Hygiene?
  • Hand hygiene practices include:
    • Washing with soap and water
    • Application of an alcohol-based hand rub
why the need to improve
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
why do we need to improve
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
why do we need to improve6
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
why do we need to improve7
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
what is our track record


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 ___ %
why is compliance poor
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
behavioural aspects of hand hygiene
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
hand hygiene behaviour
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’
  • 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
clean hands are life savers
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
the program
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
alcohol based rubs save time
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

cost effectiveness of hand hygiene
Cost-effectiveness of 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.
the program17
The Program
  • 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.
the program18
The Program
  • 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
the program19
The Program
  • Implement mechanisms for measuring and reporting compliance
    • Mandatory Performance Measure
      • Percentage compliance with hand hygiene recommendations as recorded by observers
roles responsibilities
Roles & Responsibilities
  • 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