1. AUDITING STAFF COMPLIANCE TO HAND HYGEINE GUIDELINES THALASSMEIA CENTER Dr.Maisam L. Bakir SN. Suhair Hussain SEPTEMBER 2008

2. Background o The hands of staff are the most common vehicle by which micro-organisms are transmitted between patients and staffs. o Hand hygiene is the Single most important measure in preventing the transmission of infection. o Despite advances in infection control this simple message is not consistently translated into clinical practice.

3. Background Targeted educational programs proved to be useful. Audit is one of the effective approaches identified by the WHO in ensuring compliance with hand hygiene in health care settings.

4. Why Audit and re-audit this Subject ?what is the Criteria ? Are health care providers at Thalassemia Centre adherent to hand hygiene guidelines before and after touching the patient? Is the improvement of nursing staff compliance to hand hygiene guidelines achieved in the earlier audit (23rd Sep- 14th Oct) maintained?

5. Purpose of the Audit o To monitor hand hygiene compliance of health care providers at Thalassemia Centre. o To improve patient health outcome. o To improve delivery of care.

6. STANDARD o Health care providers at Thalassemia Centre should demonstrate >85% adherence to Hand Hygiene Guidelines before and after touching the patients. o As per RAG status that described by ICNA (Infection Control Nurses Association) in NHS services,the grading of compliance is as Following: - Green= compliant >85% -Amber=Partially compliant- 75%-84% -Red= minimally compliant -<75%

7. Audit-1(nursing) methodology A prospective audit carried out by our infection control link nurse. Date: 24th April to 16th May 2007. Sample: only nursing staff ( 16 nurses selected randomly). observed for adherent to hand hygiene guidelines before and after touching the patient. Total number of Episodes reported : 56 (each observed randomly 3 times). The reasons for being considered non adherent were recorded. The Data was entered manually into data collection tool. Data was analyzed and collated.

8. Staff Compliance to Hand Hygiene Guidelines Audit-1(nursing) Results were unsatisfactory; compliance was : -19% before touching the patient - 56% after touching the patient. Barriers to Hand Hygiene were identified The two major barriers amenable for improvement were selected: -Skin irritation -Ignorance of the guidelines An action plan was developed and implemented 1)Education of nursing staff about the importance of adherence to Hand Hygiene Guidelines and 2)Installment of a new alcohol based hand rub –Purell (that contains moisturizer and vitamin E,has Pleasant smell, Prevents drying of hands and easy to use).

9. Re-audit /audit-2(nursing) Conducted on 23rd Sep- 14th Oct 2007. To evaluate the staff performance following education and installment of new hand rub. Results showed significant improvement in nursing staff compliance: - 81% before touching the patient. - 87% after touching the patient.

11. Audit-3(health care providers ) Method Conducted on 2/7/2008, ended on 22/7/2008 Total number of Episodes reported was 60 Sample size was 20 health care providers ▫ 15 nursing staff ▫ 3 doctors ▫ 2 phlebotomists

12. Results Before Touching patientAfter Touching patient

13. Results Before Touching patientAfter Touching patient

14. Results HCW type vs reasons considered non compliant (BEFORE touching the patient

15. Results HCW type vs reasons considered non compliant (AFTER touching the patient)

16. Key findings Mean of compliance for all HCW Mean of compliance for Nurses Mean of compliance for Doctors NHS 1st Audit Feb 200768%75%50% NHS 2nd Audit Sep 200779%84%62% NHS 3rd Audit May 200888%92%75% Thal. 1st Audit May 200737.5% Thal. 2nd Audit Sep 200784% Thal. 3rd Audit July 200863%65.50%66.50%

17. Key findings Benchmarking with South Birmingham audit 2003

18. Key findings o Compliance of health care providers at Thalassemia centre falls in R (minimally compliant) o Obviously compliance with hand hygiene at Thalassemia center is below the standard and requires attention and follow up. o Clear decline in compliance of nursing staff compared to the significant improvement demonstrated in 2 nd Audit. o Poor compliance before touching the patient predominately seen among doctors and phlebotomists. o Not using proper technique of hand washing was more seen among phlebotomists. o Although doctors showed poor compliance before touching the patient, they showed the best compliance after touching the patient.

19. o Its easy to meet the standards once but its difficult to maintain it. o If you want to meet the standards In hand hygiene you will have to constantly audit and re-audit.

20. Recommendations  The infection control team at Thalassemia centre Shall provide the followings: 1.Regular 3 monthly training and education of all health care providers at Thalassemia Centre about hand hygiene guidelines. 2.One-by-one Bedside education to be provided for all health care workers at least once.  Continue Reaudit of Hand Hygiene 4 monthly.  Next Reaudit will include all Thalassemia Centre staff.

21. Action Plan Training and education (3 monthly) +bedside education Inf. Cont, Team 19/8/2008 Hand Hygiene Reaudit (6 monthly) Infection Cont Team + other nursing staff ?? !! (will not be announced) (will be conduct away form education month)

22. THANK YOU