Results of 3 National hand hygiene campaigns in Belgian hospitals Eva Leens, Anne Simon et le groupe de travail « Vous êtes en de bonnes mains »
Methodology 1. Awareness campaign with standardised material to improve HH compliance 2. Measuring impact of the campaign - HH compliance (soap and/or alcool / HH opportunities) - Alcohol rub consumption (liter alcohol rub / patient days) - Respect of basic hygiene conditions (optional, only 3rd campaign)
Mea surement of HH indicators Planning Measurement of HH indicators National Feedback session Awareness Campaign During 1 month 1 month later and for 1 month 15/04-14/05 9 months later Post-campaign 1 month later and for 1 month First campaign: 2005 Second campaign: Third campaign: Invitation to participate + press conference
Awareness campaign: multi modal Reminders (posters) Education of HCW standardised powerpoint presentation Interactive quiz Distribution of gadgets for HCW or patients Promotion of hand rub (posters, black light) Implication of patients (leaflets, gadget) Feedback of measurement results before and after campaign
Campaign messages First campaign: Hand hygiene, just do it … and with alcohol rubs Second campaign: Hand hygiene, do it correctly Third campaign: Do not wear jewellery or artificial nails and keep your nails clean Use gloves correctly
Measurement of HH compliance Direct (overt or covert) observation By trained observers (IC practitioner or reference nurses for hospital hygiene) Standardised observation grid (WHO proofed) Observation period of 30 minutes, 24/24, 7/7 Minimum 150 opportunities for HH per unit At least intensive care units Same methodology before and after campaign
RESULTS
N observed opportunities Campaigns N institutions (with both data before and after campaign) N opportunities Before campaignAfter campaign TOTAL
1. HAND HYGIENE COMPLIANCE
n=148 n=127 n=178 n=158n=168n=145 N hop 48% 53% 69% 58% 69% 68% +20% +16% +11% Distribution of average HH compliance
HH compliance in psychiatric hospitals 43% 70% Base -line acute hosp: 50% 43% 70% 58% 67%
Hand hygiene compliance by profession
Overall HH compliance by profession (all) 20%
Evolution of HH compliance in nurses en physicians
HH compliance by HH indication (all) Before campaignAfter campaign 33% 50% 60% 75% 1.Before contact with patient 2.Before clean/invasive action 1.After contact with patient 2.After biological liquids exposure 3.After contact with patient environment
HH compliance by indication Before After 27% 50% 54% 75% +27% +25% 27% Before After
2. HAND RUB SOLUTION USE
Proportion Alcool / Alcool + soap 65 % 76 % 67 % 76 % 73 % 78 %
3 OBSERVATION OF JEWEL AND NAILS ( Basic requirements)
Participation N institutions (%) N observations Before campaign82 (52%)9.863 After campaign52 (38%)6.187 Optionnal participation (3rd campaign)
Impact of the campaign (all)
Impact by institution category Acute hospitals Long term care and psychiatric institutions
Impact on professionnal categories RingWatch
Nails
Conclusions for basic requirements Awareness campaign has a positif impact on jewels wearing and nails hygiene Ring and /or watches wearing are the most frequent problems Impact is variable depending on type of institutions and professionnal categories (chronic < acute) and (<< physicians) Nails hygiene is good in 50% of the institutions Students are the best !
General conclusions: Campaigns were succesfull - High participation rate - Increase of HH compliance at short and long term - Alcohol rub is widely used Key factors for succes: - Multi modal awareness campaign - Repetition of campaign - National implication - Political and financial support
Antibiotic use management teams 1st Camp d Camp d Camp MRSA new guidelines
Conclusions Results: - HH compliance nurses > medical doctors - HH compliance after contact > before contact - Pre-campaign compliance still increases after 3 camp - Post-campaign compliance remains stable after 3 camp - Impact of the campaign on HH compliance decreases Impact on content of 4th HH campaign
Thank you for your attention!