1. Results of 3 National hand hygiene campaigns in Belgian hospitals 2005-2009 Eva Leens, Anne Simon et le groupe de travail « Vous êtes en de bonnes mains »

2. 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 / 10000 patient days) - Respect of basic hygiene conditions (optional, only 3rd campaign)

3. 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: 2006-2007 Third campaign: 2008-2009 Invitation to participate + press conference

4. 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

5. 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

6. 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

7. RESULTS

8. N observed opportunities Campaigns N institutions (with both data before and after campaign) N opportunities Before campaignAfter campaign 200512973 66372 705 2006-200715888 48084 883 2008-2009142107 653109 826 TOTAL269 796267 414

9. 1. HAND HYGIENE COMPLIANCE

10. 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

11. HH compliance in psychiatric hospitals 43% 70% Base -line acute hosp: 50% 43% 70% 58% 67%

12. Hand hygiene compliance by profession

13. Overall HH compliance by profession (all) 20%

14. Evolution of HH compliance in nurses en physicians

15. 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

16. HH compliance by indication Before After 27% 50% 54% 75% +27% +25% 27% Before After

17. 2. HAND RUB SOLUTION USE

18. Proportion Alcool / Alcool + soap 65 % 76 % 67 % 76 % 73 % 78 %

19. 3 OBSERVATION OF JEWEL AND NAILS ( Basic requirements)

20. Participation N institutions (%) N observations Before campaign82 (52%)9.863 After campaign52 (38%)6.187 Optionnal participation (3rd campaign)

21. Impact of the campaign (all)

22. Impact by institution category Acute hospitals Long term care and psychiatric institutions

23. Impact on professionnal categories RingWatch

24. Nails

25. 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 !

26. 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

27. Antibiotic use management teams 1st Camp 2005 2d Camp 2006-2007 3d Camp 2008-2009 2008-2009 MRSA new guidelines

28. 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

29. Thank you for your attention!