1. Unwillingness to change (Compliance) presented by: Dalal zawahreh Dawlat Abu-Mahmoud. Supervised by : Dr. Hania Al-Jouzy

2. Introduction Compliance means :the degree to which one adhere to rules. Compliance with a good infection prevention and control (IC) policy is vital for preventing the spread of infection.

3. Compliance *Compliance is important with four very basic and effective infection control interventions: 1. Hand hygiene 2. Respiratory secretions 3. Personal habits 4. Personal protective equipments

4. Compliance Hand hygiene: > No single intervention has constantly improved compliance with hand hygiene practices. > Most studies on hand washing intervention programs demonstrated that improvement was usually short-term.

5. Compliance Hand hygiene: > Hand washing is considered as the simplest way for prevention of nosocomial infection

6. Compliance Respiratory secretions: Every effort must be made to educate staff, visitors and families about containing coughs and sneezes in tissues, particularly when working or visiting in hospitals.

7. Compliance Personal habits: - Make a conscious effort not to touch your eyes, nose or mouth. - Healthcare workers (HCWs) can contact patients' infections and patients can contact HCWs' infections. -HCWs must keep their immune systems healthy by keeping vaccinations up to date and leading healthy lifestyles.

8. Compliance Personal protective equipment (PPE). Know when to wear (masks, gowns, gloves, etc.) and when and where to remove and properly dispose of used equipment.

9. Compliance [ hand hygiene ] Do you know what is the impact of improvement in compliance of hand hygiene on incidence of nosocomial infection.!!!!!!!!!!!!!!!!!!!!!

10. Hand hygiene :_ Is there a problem?? Average rate of hand washing is only 40%_60%.  Compliance is usually estimates as <50%.  Health _care workers adherence to recommended hand hygiene practices is un acceptably low.

11. Is there a problem? Average compliance with hand hygiene recommendations varies:  Between hospital wards.  among professionals categories of health care workers.  According to working conditions.  As well as according to the definitions used in different studies.

12. Factors influencing reduced compliance,identified in observational studies of hand hygiene.  Being a physician rather than a nurse.  Being a nurse assistant rather than a nurse.  Being male rather than a female.  Working in an intensive care unit. (ICU).  Working during weekdays rather than the week end.  Wearing gown and gloves. **Ref. petit al.Annals intern Med 1999,130_126.

13. Compliance facts Raju et al : MD’s (medical doctors)37.5%,nurses 53.9%. De Carvalhoe et al: MD’s 44%, nurses 56%. Brown et al : MD’s 31.8%, 24.7% Larson et al :29% overall average

14. Why is compliance so difficult?? Lack of sinks. Lack of time. So in order to achieve 100% compliance with hand washing,it is estimated that two more nurses per shift would be needed to compensate for the additional time spent in hand washing.

15. Why is compliance so difficult?? Forgetfulness. Priorities to care of very sick patients. It takes at least a full minute to wash and dry hands. vigorous hand washing leads to dry,irritated hands.

16. Why is compliance so difficult?? The lowest compliance rate (36%)was found in ICU”S,where indications for hand washing were typically more frequent

17. Causes of failure of compliance… Lack of knowledge and or lack of motivation. staffing or low staff to patient ratio ( high work load). lack of sinks. hand washing products. the effect of hand washing on skin condition.

18. Other factors influencing compliance,at the group level: lack of encouragement or role models from key staff. lack of written guidelines. Lack of atmosphere of compliance. Lack of administrative leadership, sanctions,rewards, and support.

19. Compliance :_ Can we do better????

20. Compliance To sustain the improvement : > Continuous in service education. > Workshops,lectures,and performance, feedback on compliance rates. > (Transient improvement).

21. To sustain the improvement Regular evaluation of hand hygiene behavior and compliance with performance feedback to all staff. Positive feedback encouraging staff to improve their accountability.

22. Strategies for improvement: Improvement in infection control practices requires: > questioning basic beliefs,continuos assessment of the stage of behavioral change,interventions with an appropriate process of change,and supporting individuals and group creativity. > Because of the complexity of the process of change,single intervention often fail, and a multidisciplinary strategy is necessary.

23. Strategies for improvement: Lack of knowledge ………  Education with supportive literature, videotaped instructions.  Hand washing demonstrations.  Frequent refreshers,involvement of personnel in education, and feedback.

24. Strategies for improvement: Staffing or low staff to patient ratio:  Enhancement of minimal handling and clustering of nursing procedures reduced the total patient contact episodes,which could help to overcome the barriers of time constraint and thus improves hand hygiene.

25. Strategies for improvement: Lack of motivation:  Direct observation and feedback on regular basis, role models, involvement of staff in studies,application of new technologies.  programs on hand hygiene,and infection control for patients and families.

26. Strategies for improvement: Roles and responsibilities of individuals and departments:  It is the responsibility of ward or department manager to ensure,that adequate facility are provided,so that staff are encouraged to compliance regularly and appropriately.  The infection prevention and control team incorporates compliance training into all infection control sessions on induction and as apart of in- service training.

27. Strategies for improvement: Roles and responsibilities of individuals and departments:  Adequate provision of hand washing basins, liquids,soap and dispensable paper towels,alcohol hand rub and surgical scrub solutions,is the responsibility of the department manager.

28. References: Petit et al (2000)effectiveness of a hospital wide program to improve compliance with hand hygiene the lancet,vol.356 laboratory center for disease control health Canada PL0603e1 Ottawa,ontarrio K1a0l2. Baebara c.c.Lam,MBBS,FRCP(PEDIATRICS vol.114No.5 Nov,2004 petit al.Annals intern Med 1999,130_126. Dr Hania Al-Jouzy Lectures 2006-2007

29. Thank you for your listening