Hand Hygiene Program

1. Hand Hygiene Program <<insert your hospital>>

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. Average 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 don’t 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 patient’s 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. 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 (<3% of the total work force) Alcohol-based rubs save time Voss A, Widmer A. No time for handwashing!? Handwashing versus Alcoholic Rub: Can we afford 100% compliance? Infection Control and Hospital Epidemiology 1997;18:205-208

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 staff’s hand hygiene behaviour on more junior staff should not be underestimated

21. Questions?