Promoting hand hygiene in healthcare through national/subnational campaigns

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Summary

The World Health Organization (WHO) First Global Patient Safety Challenge conducted a baseline survey of coordinated large-scale activities in improving hand hygiene in healthcare in 2007. The survey was repeated in early 2009 to assess current status and generate information on factors contributing to success. Coordinated activities were identified through WHO regional offices and experts in the field. An online survey using a structured questionnaire was conducted during March–April 2009. Personnel involved in all 38 campaigns/programmes in 2009 completed the survey. Of these, 29 were active national/subnational-level initiatives and 22 (75.8%) were initiated after the Challenge launch in October 2005. Main targets were general, district, and university hospitals with increasing coverage of long-term care facilities and primary care. The scope varied from awareness-raising to formal scaled-up activities with ongoing evaluation. Most initiatives (20/29) obtained funding from multiple sources with governments among the main funders; governments also initiated 25/29 (86.2%) programmes. The facilitator role played by the Challenge in initiating and supporting activities with tools and recommendations was clearly identified. The perceived significance of specific barriers varied considerably across initiatives. Those related to commitment (priority and support) and resource availability were important across all regions. Hand hygiene is being promoted in healthcare in many nations/subnations with clear objectives, strategies, and governmental support through policies and resource allocation. While this is important for sustainability, further action is required to initiate coordinated activities across the world, including countries with limited resources.

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.

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