hand hygiene
DESCRIPTION
stayhealthy and save our live by having clean hands and healthy bodyTRANSCRIPT
Hand Hygiene Innovations – overcoming barriers in compliance and
conducting campaign promotion
WH Seto Hong Kong, China
HH HH
HH HH HH
HH
HH HH
Results of HH Compliance
• 1st Baseline HH observation (n=575) – 52%
• 2nd HH observation (n=535): – 67.9% (p<0.05)
• 3rd HH observation (n=522): – 64% (p<0.05)
WHO Hand Hygiene Programmes along continnum of health care in Hong Kong
Visit of Professor Didier Pittet (Lead First GPSC) to Pilot Nursing Home in August 2008
8 pilot nursing homes
WHO Hand Hygiene Multimodal Strategy
� Hand hygiene compliance rate increases by 76% in 1 month and sustains over 80% at 4 months.
� Recourse to handrubbing in 4 months after intervention accounts for more than 70% of all hand hygiene actions, HH by alcohol-based hand rub increases substantially across the promotional period.
> 8000 HH opportunities observed in 3 phases Baseline Vs Post-1 mth (p<0.001) Baseline Vs Post-4 mth (p<0.001)
FIRST time with WHO HH Guidelines and Strategies adopted BEYOND conventional clinical settings
Overall Hand Hygiene Compliance in 8 Pilot Nursing Homes in Hong Kong
HH Promotion Further Extend in Long-term Care Facilities in 2009/2010 - over 140 Residential Care Homes providing skilled nursing care to over 10,000 elders -
Source: Surveillance & Research Team, Infection Control Branch, Centre for Health Protection, HKSAR Dept of Health Oral presentation to Members of Expert Group for WHO Finalization of Hand Hygiene Guidelines Meeting (29.9.08-1.10.08) Poster presentation at Health Protection Conference 2008 organised by UK Health Protection Agency (September 2008)
Dr Carole Tam Senior Medical and Health Officer
Centre for Health Protection Hong Kong SAR Department of Health
[Presentation Number 748]
“Nothing to Disclose”
Sustaining the campaign
1.Keep expanding the campaign
2. Effective linkage to other healthcare programs
Central Line Bundle Elements
� Hand hygiene � Maximal barrier precautions
� One Piece Drape: Preliminary Evaluation
� Chlorhexidine skin antisepsis � 2% solution
� Optimal catheter site selection, � with subclavian vein as the preferred site for
� Daily review of line necessity with prompt removal of unnecessary lines
25 25
Good hand hygiene is very important
Alcohol Hand Rub for clean hands
Hand washing for visibly dirty hand
100 mls 500 mls
Introduction � Pilot scheme: 5 hospitals in
HK including QMH � Accreditation body:
Australian Council on Health Standards ( ACHS)
� Satisfy the peer reviewed standards grouped under 3 functions mandated by ACHS
Sustaining the campaign
1.Keep expanding the campaign
2. Effective linkage to other healthcare programs
3. Regular reinforcement
7055
14486 17346 16850
13472
18427
26775
30934 31012
21151
38.29%
54.10% 56.07%
54.33%
63.69%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
0
5000
10000
15000
20000
25000
30000
35000
2007 2008 2009 2010 2011
Times hand hygiene performed
Observed hand hygiene indications
Hand hygiene compliance rate
Overall Hand Hygiene Compliance in HA
Year
38.29%
54.10% 56.07% 54.33%
63.69%
35.12%
51.51%
46.68% 47.96%
57.63%
47.92%
58.89%
73.52% 70.72%
77.15%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
2007 2008 2009 2010 2011
All hospitals
Group 1
Non-group 1
Overall Hand Hygiene Compliance Rate in HA Group 1 Hospitals vs Non-group 1 Hospitals
(2007-2011 Q2)
Group 1 - General acute hospitals with 24 hour & A&E services
Non-group 1 includes: Group 2 - Hospitals with a mix of acute and non-acute services Group 3 - Non-acute or infirmary hospitals Group 4 - Psychiatric hospitals
35.12%
51.51%
46.68% 47.96%
57.63%
0.098
0.087
0.076
0.068 0.064
0
0.02
0.04
0.06
0.08
0.1
0.12
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
2007 2008 2009 2010 2011
Hand hygiene compliance rate(%)
Hospital-apportioned MRSAbacteremia/ 1,000 patient days
Rate of Hospital-apportioned MRSA Bacteremia and
Year Hospital-apportioned cases refer to those detected or after 2 days of hospital admission
2009 2010 2011
� HH poster design competition with hospital- wide display of winner
� HH talks � HH promotions
related to 2009 swine flu pandemic
� Role models promotion with posters & election of top 10 personnel
� Election of best HH department
� Hospital-wide ceremony with presentation of the 10 role models with special lecture
� HH talks � Starts HH day
celebration
� Special HH workshop
� New hospital-wide posters
� Enhancement program for hand rub locations
� HH talks
2009 (95% CI) n = 347
2010 (95% CI) n =166
2011 (95% CI) n = 599
(2008- 2011)
p 53 (48−58) 55 (47−63) 50 (46−54) 0.3
Doctors 25 (9−49) 5 (0−24) 23 (12−37) 0.16
Nurses 57 (45−67) 63 (51−74) 59 (54−65) 0.72
Health care assistants
62 (49−73) 54 (39−69) 45 (37−53) 0.05
Advertisement fatigue: where a user tires of an advertisement as it is seen more often. Zo¨e Abrams and Erik Vee
Campaign fatigue is when there is evidence that promotional activities are
being ignored
Definition
• Received 2-days training course on infection control.
• Awarded a certificate and badge on passing the course assessment.
• ICLNs has the full routine of workload in the ward.
• Frontline staff to first encounter IC problems and representative to liaise with ICN
• Report all important events.
Link Nurse strategy – first published in HK Seto et al: Am. J of Infection Control 1991:19:86-91. Ching, Seto:Journal of Advanced Nursing.1990;15:1128-1131.
A Significant factors in hindering compliance to hand hygiene % Yes
1 Doctors’ noncompliance widespread and affects the entire ward/area 53.9*
2. Agree with hand hygiene, but not enough reminders in the ward area. 53.9*#
3. Concern for allergic and adverse reactions 38.5
4. Found incompatibility of ABHR with the use of hand creams 26.9
5. Still believe that hand hygiene must involve hand washing by the tap 26.9
6. Don’t understand that ABHR can enhance practice in a busy ward 23.1
7. ABHR rubs not generally available at point of care 19.2
8. Number of key strong resisters hindering the process 15.4
9. Turned off by the smell or content of ABHR 15.4
Table 2. Survey of infection control link nurses on enhancing hand hygiene strategy in Hong Kong Baptist Hospital, July 2012 (n=26 clinical areas with patient admissions)
B. Further educational or improvement activities in
your ward/area (Prioritize top 3 from list with scores†)
Priority
scores
1. Develop special program to remind doctors of hand
hygiene during rounds
49*#
2. A special program to remind staff other than nurses and
doctors of hand hygiene
30*
3. Review to ensure that ABHR is fully available at strategic
points of care
29*
4. Special 15-min talk by an expert in your ward 26
5. Put up more hospital-wide posters for good hand hygiene
practice
16
6. Special section for high resisters 9
2009 (95% CI) n = 347
2010 (95% CI) n =166
2011 (95% CI) n = 599 2012
53 (48−58) 55 (47−63) 50 (46−54) Doctors 25 (9−49) 5 (0−24) 23 (12−37) 72%
Nurses 57 (45−67) 63 (51−74) 59 (54−65) 89%
Health care assistants
62 (49−73) 54 (39−69) 45 (37−53) 84%
All participants must follow hand hygiene seven steps observed by official witness and signed by participants.
For 5th May Hand Hygiene Day 2014
We have break the Guinness World Records: ‘MOST PARTICIPANTS IN A HAND SANITISING RELAY’. Total participants 277 Time started -12:45 and completed at 14:05. Total time:1 hour 20mins.
The field of Change Management
Change management is a systematic approach to dealing with change, both from the perspective of an organization and on the individual level. CMC.com