Hand Hygiene Survey: Preliminary Results

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Hand Hygiene SurveyPreliminary Results

• A. McGeer, K. Green, J. Lourenco, and G. Youssef
  for the Hand Hygiene Research Steering Committee

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Background

• The CPSI, CCHSA, PHAC and CHICA are working
  together to develop a national hand hygiene (HH)
  campaign
• Goal To improve support to healthcare and public
  health organizations implementing HH initiatives
  across Canada

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Background (cont.)

• HH Study Objective to provide guidance to
  healthcare decision makers wishing to implement
  successful HH programs
• Help us to assess the following in Canadian
  healthcare facilities
• HH adherence
• Current HH initiatives and which are considered
  effective
• What type of support is needed

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Study Description

• The HH survey includes 52 questions on
• Respondent demographics
• Current HH environment and practices
• HH initiatives and their perceived effectiveness
• Needed resources
• Future HH plans
• Survey was available on the CHICA website from
  April to May 2007
• CHICA has 1327 members
• Infection control professionals located across
  Canada
• Come from different backgrounds including
  nursing, medicine, microbiology, medical
  technology, and epidemiology
• 171 CHICA members responded

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Participants
6
Facility types of participants
7
Province in which participants are located
All Facilities
Acute Care Facilities
8
Participants role in their organization
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Hand Hygiene Survey Findings for Acute Care
Facilities
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Number of facilities in which there is a written
HH policy and if the policy is signed

• Provide sample hand hygiene policies

11
Number of facilities that provide HH educational
programs to staff

• In most sites, HH education is not mandatory
• Provide advice on how to ensure that most staff
  are educated

12
Types of HH products provided to staff by
facilities

• Very few are providing hand lotions and
  individual alcohol sanitizers

13
Location of HH products in the facility

• Were doing a good job of getting products into
  public areas but not to point of care
• Need to help facilities determine optimal product
  placement

14
Types of skin care programs provided to staff by
facilities

• 41 of responding acute-care facilities provide
  skin care programs to staff
• Provide skin care program tools

15
Types of tools for monitoring HH adherence used
by facilities

• 37 of respondents chose None
• Need to explain why monitoring is important and
  how good each method is at determining adherence

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Reasons why facilities have not audited HH
adherence

• Provide sites with auditing tools
• Suggest strategies on how to make time for
  auditing and on how to obtain necessary resources

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HH Initiatives

• 76 of organizations have implemented initiatives
  to improve hand hygiene in the last 2 years
• 31 of facilities receive financial support for
  HH initiatives
• Only 32 of these receive internal funding
• Provide strategies for obtaining financial support

18
Individuals targeted by HH initiatives
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Components of HH initiatives

• Very few include staff in planning or have
  baseline or post-implementation audits
• Provide staff education to ensure that it is
  adequate

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Most effective component of campaign

• Increased access to alcohol hand rub
• Demonstration (Glo-germ, paint)
• Personal hand rub
• Feedback on performance
• Identify positive strategies on how to inform
  staff of their performance

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Least effective component of campaign

• Posters/ signs/ buttons/ fridge magnets (without
  other components or without ability to change
  esp if negative)
• Education (esp. one-time, large group, not
  interactive)
• Alcohol hand rub at hospital entrance
• Negative messaging from/punitive sense to audits
• Identify positive strategies on how to inform
  staff of their performance

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Most useful added resources

• Audit tools
• Posters and supplies (lanyards, shoelaces,
  pencils, erasers, etc.)
• Downloadable from internet
• Information from other projects (other countries,
  other hospitals)
• Videos
• Provide pre-tested promotional tools that can be
  adapted to other facilities

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Greatest organizational challenge

• Senior management commitment
• Not considered important enough
• Need strategies to get senior management on board
  with initiatives
• Time for staff to come to in-services
• Physician buy-in/participation
• Hand care programs

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Additional Findings

• 8 have a dedicated budget for promotional
  material
• 46 reported hospital rules and regulations that
  limit their use of promotional material
• 17 of facilities include adherence in staff
  performance reviews
• 13 of those facilities take disciplinary actions
  for non-adherence
• Provide ideas on how to include adherence in
  performance reviews and on what disciplinary
  actions should be taken

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Additional Findings

• 16 of facilities include adherence to HH
  policies in their job descriptions
• 12 of facilities have monitored patient
  impressions of adherence in satisfaction surveys
• Provide patient satisfaction surveys

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Acute vs. Other Facility Types 1

• Facilities that identified themselves as acute
  and those that did not were at equal risk of
• Having a written HH policy
• Providing HH educational programs to staff
• Providing staff with alcohol hand sanitizers,
  non-antibacterial soap, and individual alcohol
  hand sanitizers
• Providing HH products on beds
• Providing HH skin care programs to staff
• Monitoring consumption of products, electronic
  monitoring, self-assessment, or using no tools
  for auditing HH adherence
• Not auditing HH due to no time, no tools, and no
  resources
• Implementing a HH initiative in the last 2 years
  and receiving financial support for their HH
  initiatives
• Targeting their HH initiatives towards staff,
  patients, and visitors
• Most components of their HH initiatives
• Hospital rules limiting their use of promotional
  material
• Including adherence in staff performance reviews
  and taking disciplinary measures for
  non-adherence
• Monitoring patient impressions of adherence in
  satisfaction surveys

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Acute vs. Other Facility Types 2

• Facilities that identified themselves as acute
  were at greater risk of
• Providing staff with
• hand lotion (RR1.93, 95 CI1.35-2.78)
• anti-bacterial soap (RR2.59, CI1.46-4.60)
• surgical scrub (RR4.60, CI2.98-7.10)
• Providing HH products in the
• Elevator bays (RR1.32, CI1.03-1.69)
• Waiting areas (RR3.76, CI2.13-6.63)
• Main lobby (RR6.67, CI1.17-6.11)
• Staff common areas (RR2.60, CI1.38-4.91)
• Bedside (RR1.56, CI1.26-1.93)
• Exam rooms (RR4.40, CI2.60-7.45)
• Door to room (RR8.25, CI4.21-16.17)
• Among those that did provide skin care programs,
  providing programs for staff with skin problems
  (RR2.13, CI1.29-3.51)
• Using adherence audits to monitor HH adherence
  (RR1.37, CI1.10-1.71)
• Collecting baseline indicators as part of their
  HH initiatives (RR1.27, CI1.05-1.52)

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Acute vs. Other Facility Types 3

• Facilities that DID NOT identify themselves as
  acute were at a greater risk of
• Having a dedicated budget for promotional
  material (RR1.18, 95 CI1.03-1.34)
• Including adherence to HH policies in their job
  description (RR1.15, 95 CI1.04-1.28)

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Future Actions

• 1636 surveys were mailed out to 1144 hospitals in
  July 2007
• Thus far, 307 people have responded
• In October 2007 surveys will be sent out to
  long-term care, rehabilitation, and mental health
  facilities, public health units, and emergency
  medical services
• Focus groups starting in October 2007 will delve
  further into findings concerning HH initiatives

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Summary of Recommendations 1

• Only 23 of facilities are providing individual
  alcohol sanitizers
• Need tools that describe optimal product
  placement (especially at point of patient care)
  and how to determine this
• Since 37 of respondents indicated that they have
  no tools for monitoring HH adherence and 41 cite
  no tools as the reason for not auditing, provide
  auditing tools and information on how good the
  different methods of monitoring are at
  determining adherence
• Provide pre-tested promotional tools

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Summary of Recommendations 2

• Describe HH initiatives that have been effective
  in other facilities beyond (staff education)
• Provide sites with strategies on how to make time
  for auditing and on how to obtain the necessary
  resources
• Provide strategies to obtain financial support
• Since very few sites are providing hand lotion
  and only 41 are providing skin care programs for
  staff, we need to provide sites with skin care
  program tools
• Provide ideas on how to include HH in staff
  performance reviews
• Identify positive strategies on how to inform
  staff of their performance