Hand hygiene initiatives found to reduce HAIs
Alcohol hand rubs are recommended as most effective hand hygiene method
An evaluation of the UK-wide Cleanyourhands campaign shows that an effective hand-hygiene initiative can reduce some healthcare associated infections, according to a new study published in the British Medical Journal (BMJ).
But a second survey by the World Health Organisation (WHO) of more than 2,000 healthcare facilities in 69 countries found that 65% are at a good level of progress with regards to hand hygiene promotion, resources and activities, but at least 35% are still at an inadequate or basic level.
The Cleanyourhands campaign was rolled out to all 187 NHS Trusts in the UK from January 2005 with instructions to provide bed-side alcohol handrub (AHR), posters encouraging healthcare workers to clean their hands and a range of patient-empowering materials. It was one of a series of national initiatives intended to reduce levels of MRSA/MSSA bacteraemia and Clostridium difficile infection in hospitals in England and Wales.
Researchers at UCL’s Medical School and the Health Protection Agency (HPA) measured hospitals’ quarterly procurement of AHR and soap between July 2004 and 2008. After adjusting for a number of factors, including the effect of bed occupancy, hospital type and the timing of other national interventions, they found a significant link between procurement levels and infection rates.
They found that over the four-year period the combined procurement of soap and AHR almost tripled from 21.8ml per-patient-per-bed to 59.8ml. MRSA bacteraemia rates fell from 1.88 to 0.91 cases per 10,000 bed-days and C. difficile infection from 16.75 to 9.49. Levels of MSSA bacteraemia did not fall.
The research also showed that the increased procurement of soap was independently associated with reduced C. difficile infection throughout the study, and with reduced MRSA infection only in the last year of the study.
“What this study shows is that the Cleanyourhands campaign, a centrally co-ordinated and funded strategy, produced sustained increases in the amounts of alcohol hand-rub and soap bought by hospitals, and that this in turn helped to reduce infection and improve health outcomes,” said principal investigator Dr Sheldon Stone of the UCL Medical School.
Although the WHO survey recommends AHR as the most effective and easiest method for hand hygiene performance during routine healthcare delivery, Dr Benedetta Allegranzi, team lead in the WHO Patient Safety Clean Care is Safer Care programme, emphasised that handrubs are either unavailable or unaffordable in many countries.
To address these issues, the WHO Patient Safety Programme is launching Private Organisations for Patient Safety (POPS), a computer-based platform for knowledge-sharing to promote compliance with WHO recommendations, share information and enhance hand hygiene product availability and accessibility in all parts of the world.