ReviewThe CleanYourHandsCampaign: critiquing policy and evidence base
Introduction
Healthcare-associated infection (HAI) is a concern to health workers and the public. The most troublesome infections and those most difficult to treat are caused by antibiotic-resistant (including multiply-resistant) bacterial strains such as meticillin-resistant Staphylococcus aureus (MRSA), gentamicin-resistant Gram-negative bacilli, and glycopeptide-resistant Enterococcus. Mortality from MRSA has increased 15-fold over the last 10 years in the UK where the incidence of HAI is higher than in other European countries.1 Elsewhere more aggressive approaches are employed to tackle HAI, apparently with greater success. In the Netherlands a ‘search and destroy’ policy at national level has reduced the incidence of MRSA.2 Increased compliance with handwashing protocols and reduction in HAI in the University Hospitals Geneva has been achieved through a multifaceted approach employing a raft of interventions intended to ensure that health workers do not forget about hand hygiene.3 Continuing high levels of compliance are being achieved by combining use of alcohol products with intensive feedback on performance to health workers, resulting in a ‘continuous Hawthorne effect’.4 Over a period of six years HAI was reduced by 44%. MRSA colonization rates fell by 50%. The effect of reduced HAI rates on the community served by the hospital has not been reported.
The high incidence of HAI in British hospitals and media reports of ‘superbugs’ have captured public interest. In response the government has funded research to document the extent of the problem and explore methods of control. Patients with HAI are three times more expensive to treat than uninfected patients, stay in hospital three times longer, and more often require medical and domiciliary nursing care afterwards than patients who have not developed infection.5 A survey to explore how effectively acute NHS trusts manage HAI estimated that at least 100 000 cases were documented annually, causing 5000 deaths and costing £1 billion. Infection control guidance was being poorly implemented. The National Audit Office6 concluded that it would be possible to reduce HAI by 15%, saving £150 million through better application of existing polices and procedures.
This work has been followed by a flurry of legislation and action to improve the control of HAI. Evidence-based guidelines for infection control have been commissioned and kept updated.7, 8 Improved surveillance has been introduced to control the spread of specific infectious diseases, as well as HAI, after the publication of ‘Getting ahead of the curve’, including mandatory reporting of MRSA bacteraemias.9, 10 ‘Winning ways: working together to reduce healthcare-associated infection’ has increased the profile of infection control throughout the National Health Service (NHS) and has raised the authority of infection control teams.11 Numerous other measures have been introduced to improve standards of hospital cleanliness. One of the key functions of senior nurses (‘modern matrons’) is to support ward sisters and infection control nurses.12
Section snippets
The CleanYourHandsCampaign (CYHC)
The CYHC was launched by the National Patient Safety Agency in April 2005. All acute NHS Trusts in England and Wales have been supplied with a toolkit derived from the work of Pittet et al. in Geneva.3 The toolkit comprises selected interventions drawn from the literature, which are considered by policy makers to have the potential to promote handwashing and which might feasibly be introduced in all clinical settings where acute care is delivered.13 Alcohol-based products should now be placed
Conclusion
Lip service to infection control persisted throughout the NHS until clinical governance ushered in emphasis on clinical standards with systems to monitor risk.87 HAI and its prevention, especially hand hygiene, have since become hot political topics in the UK. With such a major problem it has been necessary to take swift action, and handwashing has been singled out for particular emphasis. Although published studies seeking to increase compliance with hand hygiene and reduce rates of HAI have
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2019, Safety ScienceCitation Excerpt :These might be under-reported in general, as they might have no visible consequences, are not followed consequently by sanctions, or might have been perceived as not worthwhile reporting during interviews as they might be viewed as less noteworthy and therefore less well remembered than more severe, but rare, accidents. These smaller violations might be comparable to the thoroughly analysed hand hygiene violations in the health care sector that have been identified to be correlated negatively with provision of alcohol hand rubs, visual reminders, feedback, and management commitment, with the latter two having the greatest influence (Clack et al., 2014; Gould et al., 2007; Maskerine and Loeb, 2006; Neo et al., 2016). Nevertheless, a systematic analysis of these violations is not possible here due to the lack of observational data and the fact that facilities differed strongly in their rules regarding animal transfer procedures and the routines for glove disinfection during cage change.
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