Hand Hygiene Program

1
Hand Hygiene Program

• ltltinsert your hospitalgtgt

2
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

3
What is Hand Hygiene?

• Hand hygiene practices include
• Washing with soap and water
• Application of an alcohol-based hand rub

4
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

5
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

6
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

7
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

8
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 ___

9
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 dont look
  dirty)
• Lack of knowledge of hand hygiene guidelines
• Insufficient time for hand hygiene
• Forgetfulness

10
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 patients
  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

11
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

12
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

13
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

14
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

15
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 (lt3 of the total work
  force)

Voss A, Widmer A. No time for handwashing!?
Handwashing versus Alcoholic Rub Can we afford
100 compliance? Infection Control and Hospital
Epidemiology 199718205-208
16
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.

17
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.

18
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

19
The Program

• Implement mechanisms for measuring and reporting
  compliance
• Mandatory Performance Measure
• Percentage compliance with hand hygiene
  recommendations as recorded by observers

20
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 staffs hand hygiene
  behaviour on more junior staff should not be
  underestimated

21
Questions?