1. Hand Hygiene Survey: Preliminary Results A. McGeer, K. Green, J. Lourenco, and G. Youssef for the Hand Hygiene Research Steering Committee

2. Background The CPSI, CCHSA, PHAC and CHICA are working together to develop a national hand hygiene (HH) campaign Goal: To improve support to healthcare and public health organizations implementing HH initiatives across Canada

3. Background (cont.) HH Study Objective: to provide guidance to healthcare decision makers wishing to implement successful HH programs Help us to assess the following in Canadian healthcare facilities: –HH adherence –Current HH initiatives and which are considered effective –What type of support is needed

4. Study Description The HH survey includes 52 questions on: –Respondent demographics –Current HH environment and practices –HH initiatives and their perceived effectiveness –Needed resources –Future HH plans Survey was available on the CHICA website from April to May 2007 CHICA has 1327 members –Infection control professionals located across Canada –Come from different backgrounds including nursing, medicine, microbiology, medical technology, and epidemiology 171 CHICA members responded

5. Participants

6. Facility types of participants

7. Province in which participants are located All FacilitiesAcute Care Facilities

8. Participant’s role in their organization

9. Hand Hygiene Survey Findings for Acute Care Facilities

10. Number of facilities in which there is a written HH policy and if the policy is signed  Provide sample hand hygiene policies

11. Number of facilities that provide HH educational programs to staff  In most sites, HH education is not mandatory  Provide advice on how to ensure that most staff are educated

12. Types of HH products provided to staff by facilities  Very few are providing hand lotions and individual alcohol sanitizers

13. Location of HH products in the facility  We’re doing a good job of getting products into public areas but not to point of care  Need to help facilities determine optimal product placement

14. Types of skin care programs provided to staff by facilities 41% of responding acute-care facilities provide skin care programs to staff  Provide skin care program tools

15. Types of tools for monitoring HH adherence used by facilities 37% of respondents chose “None”  Need to explain why monitoring is important and how good each method is at determining adherence

16. Reasons why facilities have not audited HH adherence  Provide sites with auditing tools  Suggest strategies on how to make time for auditing and on how to obtain necessary resources

17. HH Initiatives 76% of organizations have implemented initiatives to improve hand hygiene in the last 2 years 31% of facilities receive financial support for HH initiatives Only 32% of these receive internal funding  Provide strategies for obtaining financial support

18. Individuals targeted by HH initiatives

19. Components of HH initiatives  Very few include staff in planning or have baseline or post-implementation audits  Provide staff education to ensure that it is adequate

20. Most effective component of campaign Increased access to alcohol hand rub Demonstration (Glo-germ, paint) Personal hand rub Feedback on performance  Identify positive strategies on how to inform staff of their performance

21. Least effective component of campaign Posters/ signs/ buttons/ fridge magnets (without other components or without ability to change; esp if negative) Education (esp. one-time, large group, not interactive) Alcohol hand rub at hospital entrance Negative messaging from/punitive sense to audits  Identify positive strategies on how to inform staff of their performance

22. Most useful added resources Audit tools Posters and supplies (lanyards, shoelaces, pencils, erasers, etc.) –Downloadable from internet Information from other projects (other countries, other hospitals) Videos  Provide pre-tested promotional tools that can be adapted to other facilities

23. Greatest organizational challenge Senior management commitment –Not considered important enough  Need strategies to get senior management on board with initiatives Time for staff to come to in-services Physician buy-in/participation Hand care programs

24. Additional Findings 8% have a dedicated budget for promotional material 46% reported hospital rules and regulations that limit their use of promotional material 17% of facilities include adherence in staff performance reviews –13% of those facilities take disciplinary actions for non-adherence  Provide ideas on how to include adherence in performance reviews and on what disciplinary actions should be taken

25. Additional Findings 16% of facilities include adherence to HH policies in their job descriptions 12% of facilities have monitored patient impressions of adherence in satisfaction surveys  Provide patient satisfaction surveys

26. Acute vs. Other Facility Types 1 Facilities that identified themselves as acute and those that did not were at equal risk of: –Having a written HH policy –Providing HH educational programs to staff –Providing staff with alcohol hand sanitizers, non-antibacterial soap, and individual alcohol hand sanitizers –Providing HH products on beds –Providing HH skin care programs to staff –Monitoring consumption of products, electronic monitoring, self- assessment, or using no tools for auditing HH adherence –Not auditing HH due to no time, no tools, and no resources –Implementing a HH initiative in the last 2 years and receiving financial support for their HH initiatives –Targeting their HH initiatives towards staff, patients, and visitors –Most components of their HH initiatives –Hospital rules limiting their use of promotional material –Including adherence in staff performance reviews and taking disciplinary measures for non-adherence –Monitoring patient impressions of adherence in satisfaction surveys

27. Acute vs. Other Facility Types 2 Facilities that identified themselves as acute were at greater risk of: –Providing staff with: hand lotion (RR=1.93, 95% CI=1.35-2.78) anti-bacterial soap (RR=2.59, CI=1.46-4.60) surgical scrub (RR=4.60, CI=2.98-7.10) –Providing HH products in the: Elevator bays (RR=1.32, CI=1.03-1.69) Waiting areas (RR=3.76, CI=2.13-6.63) Main lobby (RR=6.67, CI=1.17-6.11) Staff common areas (RR=2.60, CI=1.38-4.91) Bedside (RR=1.56, CI=1.26-1.93) Exam rooms (RR=4.40, CI=2.60-7.45) Door to room (RR=8.25, CI=4.21-16.17) –Among those that did provide skin care programs, providing programs for staff with skin problems (RR=2.13, CI=1.29-3.51) –Using adherence audits to monitor HH adherence (RR=1.37, CI=1.10- 1.71) –Collecting baseline indicators as part of their HH initiatives (RR=1.27, CI=1.05-1.52)

28. Acute vs. Other Facility Types 3 Facilities that DID NOT identify themselves as acute were at a greater risk of: –Having a dedicated budget for promotional material (RR=1.18, 95% CI=1.03-1.34) –Including adherence to HH policies in their job description (RR=1.15, 95% CI=1.04-1.28)

29. Future Actions 1636 surveys were mailed out to 1144 hospitals in July 2007 Thus far, 307 people have responded In October 2007 surveys will be sent out to long- term care, rehabilitation, and mental health facilities, public health units, and emergency medical services Focus groups starting in October 2007 will delve further into findings concerning HH initiatives

30. Summary of Recommendations 1 Only 23% of facilities are providing individual alcohol sanitizers Need tools that describe optimal product placement (especially at point of patient care) and how to determine this Since 37% of respondents indicated that they have no tools for monitoring HH adherence and 41% cite no tools as the reason for not auditing, provide auditing tools and information on how good the different methods of monitoring are at determining adherence Provide pre-tested promotional tools

31. Summary of Recommendations 2 Describe HH initiatives that have been effective in other facilities beyond (staff education) Provide sites with strategies on how to make time for auditing and on how to obtain the necessary resources Provide strategies to obtain financial support Since very few sites are providing hand lotion and only 41% are providing skin care programs for staff, we need to provide sites with skin care program tools Provide ideas on how to include HH in staff performance reviews Identify positive strategies on how to inform staff of their performance