The cleanyourhands campaign Julie Storr Safer Practice Lead NPSA

Understanding the problem Local, national and international issue: 300,000 patients per year UK 2 million US 5000 deaths UK 90,000 US £1bn UK $17-29 bn US Hand hygiene can probably reduce 9-50%

World Health Organisation (2004) Clean hands Clean environment Clean procedures Clean equipment Clean products

Sum – greater than parts Near to patient hand rubs Posters which change every month Posters featuring staff (champions) Patient involvement (posters, stickers, leaflets - promoting patient involvement) – ‘it’s okay to ask’ General promotional and marketing materials Observation and feedback Methods to involve every level of staff in a hospital

Why Pilot? Reality check of prototype solutions Check fitness for purpose Assess usability Identify issues for implementation Evaluation test perceptions of staff. establish the patient perspective

How we evaluated Staff surveys: before and after Visual impact of campaign Perceptions of alcohol rubs Patient involvement Patient interview/ survey: one off Staff interview: beginning & end Staff diary: continuous Staff observations: over time Usage of hand rubs: before & after

Top line pilot results 84% staff stated posters influenced hand hygiene 39% staff asked at least once ‘have you cleaned your hands? 97% staff comfortable being asked 71% patients thought they should be involved Observed compliance increased throughout pilot (2.5 times) Product usage increased 2.5 times

Clean hands help to save lives Call to action All acute hospitals to install near patient rubs Joint work with national purchasing body (NHS PASA) All acute hospitals invited to join the cleanyourhands campaign 99% uptake 3 month preparation

Impact so far: alcohol hand rub - Increase in usage and Price Reductions

Benefits Estimator: Case study of early adopters Approx. Bed size % Saving % Increase Hospital A 1100 12.4% 428% Hospital C 800 49.1% 460% Hospital D 900 42.8% 183%

The implementer wards will receive a starter pack made up of: Posters for monthly change Posters with a gap on which to stick staff photos Posters targeting patients “its okay to ask” Enamel badges Sticky badges (it’s okay ot ask). Patient leaflets Don’t cite numbers at this stage – this is likely to change.

Here are some of the poster drafts. Some of the posters have been toned down in order to be cleared for the national campaign (eg Weapon of mass destruction did not get through clearance). The posters have been developed considerably in terms of their appearance (colour/ brightness) as a direct result of feedback from the pilot. The glove abuse poster came into being as a result of feedback from patients who when asked: have you seen staff clean their hands in the last 24 hours stated that whilst they had not seen this – they had noticed many staff wearing gloves and were confused as to whether gloves indeed negated the need o clean hands.

Best evaluated part of the campaign – one of. Choose a staff champion to appear in the posters and this personalises the campaign. Has to be someone the staff and patients will recognise. Can be a team.

Patient materials: leaflet, poster Patient materials: leaflet, poster. There will also be sticker badges stating: “cleanyourhands – its okay to ask”. The phrase “its okay to ask” came from patients. Four simple words getting across a powerful message that patients should feel comfortable asking staff about hand hygiene if they want to. No compulsion. Many won’t like the idea – some will and some will ask. This is one part of the campaign and says a lot about the culture of the trusts which embrace this. Of course, not all patients can ask – not all will – but the point is you are creating an expectation in the trust that it is okay to do so and that staff will be expecting it. Staff do not know who will or won’t ask – but they know they might be asked and this is the driver for behaviour change.

The sticker badges look like this

Four year research evaluation NOSEC – nosocomial study of the effectiveness of the cleanyourhands campaign. Studying the impact on a range of outcomes. Cluster randomised controlled trial from year 2.

www.npsa.nhs.uk/cleanyourhands