Promoting hand hygiene in healthcare through national/subnational campaigns☆
Introduction
Healthcare-associated infections (HAIs) are major causes of death and increased morbidity among patients worldwide.1 In developed countries, about 5–10% of patients admitted to acute care hospitals acquire an infection that was not present or incubating on admission. There is a paucity of data from resource-constrained countries, but rates are likely to be severalfold higher.2, 3
Improving hand hygiene among healthcare workers is a simple and effective measure to reduce the burden of HAI, but commitment and action at national level is essential to ensure sustained improvement at the point of care.1, 4, 5 Accordingly, the World Health Organization (WHO) Guidelines on Hand Hygiene in Health Care provide specific recommendations applicable at national level.1, 6 Improving hand hygiene is already part of many national infection control programmes.7, 8, 9, 10, 11 Evidence from statewide implementation of hand hygiene improvement strategies showed the approach to be effective in significantly improving hand hygiene compliance and reducing rates of meticillin-resistant Staphylococcus aureus (MRSA) infection.12, 13 Success in reducing HAI rates also has been reported by other national infection control initiatives.10, 11
A survey conducted in 2007 by the WHO First Global Patient Safety Challenge found that 20 nations and subnations in different parts of the world already had ongoing coordinated activities aimed at promoting hand hygiene in healthcare, either as part of wider HAI prevention initiatives or specifically for hand hygiene promotion.14 With the global increase in awareness of the role of hand hygiene for HAI prevention, we hypothesised that the number of promotional activities may have increased in recent years.2, 6 We report here the results of a survey conducted to document the current status of these initiatives and to compare the information with data collected in 2007. The study also aimed to identify factors contributing to success that could be useful to those planning and implementing large-scale hand hygiene promotional activities.
Section snippets
Methods
A baseline survey of national/subnational-level initiatives was conducted during the first semester of 2007.14 In January 2009, nations/subnations (defined as a whole state or a region within a country) with coordinated hand hygiene promotion activities were identified through the six WHO regional offices and experts in infection control. Coordinators/leaders of such activities were invited to participate in an online survey (Survey Monkey: available online) in March–April 2009.
A structured
Results
A total of 20 and 38 campaigns/programmes were identified during the surveys conducted in 2007 and 2009, respectively (Figure 1). Eighteen of 20 and all 38 completed the surveys during 2007 and 2009, respectively.
Discussion
The surveys were carried out to understand the roles nations play in sustaining and spreading a global hand hygiene movement and the current status of such activities. The numbers of national/subnational-level initiatives have increased during the past two years and differ widely in their maturity and coverage with some reporting the involvement of more than 70% of facilities. A review of the national hand hygiene campaigns in Europe showed also that there is a plethora of initiatives with a
Acknowledgements
The authors thank the members of the WHO First Global Patient Safety Challenge ‘Clean Care is Safer Care’ core group (lead: D. Pittet; J. Boyce, B. Cookson, N. Damani, D. Goldmann, L. Grayson, G. Mehta, Z. Memish, H. Richet, M. Rotter, S. Sattar, H. Sax, A. Voss and A. Widmer), the First Global Patient Safety Challenge team, and WHO Patient Safety focal points in the different WHO regions for helping us to identify initiatives. Thanks also to all the national/subnational hand hygiene campaign
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Presented in part at the 20th European Congress of Clinical Microbiology and Infectious Diseases, Vienna, Austria, 10–13 April 2010.