Project Hand Hygiene implementing the WHO guidelines for improving hand hygiene in health care LATVIA -LITHUANIA-RUSSIA –SWEDEN Agita Melbārde-Kelmere.

ProjectHand Hygiene

implementing the WHO guidelines for improving hand hygiene in health care

LATVIA -LITHUANIA-RUSSIA –SWEDENAgita Melbārde-Kelmere Ruta Markevice Anna Lubimova Birgitta Lytsy

Olov Aspervall Anna Hambraeus

Relationship between ABR and HHYear Authors Hospital

settingMajor results

1994 Webster et al. NICU Elimination of MRSA

1995 Zafar et al. Newbornnursery

Control of a MRSA outbreak

2000 Larson et al. MICU/NICU Significant (85%) relative reduction of the VRE rate

2000 Pittet et al. Hospital-wide

Significant reduction MRSA cross-transmission rates (87%).

2004 MacDonald etal.

Hospital-wide

Significant reduction in hospital-acquired MRSA cases(from 1.9% to 0.9%)

2005 Johnson et al. Hospital-wide

Significant reduction (57%) in MRSA bacteremia

Aim

To implement WHO SAVE LIVES: Clean Your Hands to reduce HCAI and ABR.

• abbreviate • simplify • adapt

Multimodal interventions • System change: ABHR, soap, water at patient care

level • Education: standard presentation of feed-back of

results and adapted presentation according to results

• Measurements and feed-back: observation of compliance, measurement of ABHR consumption

• Reminders in workplace: posters • Patient safety climate: Knowledge and attitudes

questionnaire

Project design

• I. Preparation phase • II. Baseline phase • III. Intervention phase • IV. Evaluation • V. Reporting

Workshops• Vilnius in December 2011• During 2012

– Riga– St Petersburg – Upsala– Stockholm - 2

• During 2013– Riga– Final workshop - in Riga in May 2013

• During of the project– Teleconferences– Skype meetings

I. Preparation phase

• Development of the instruments– Wards infrastrustructure form– Hand rub consumption form– Hand hygiene observation form and instruction– Hand hygiene education level, knowledge and

attitudes assessment – Time line

Activities

• Ward infra structure survey– Measure Hand Rub Consumption and Compliance to HH policy – Perform Hand hygiene education level assessment

• Intervention I– Measure Hand Rub Consumption and Compliance to hand hygiene

policy

• Intervention II– Measure Hand Rub Consumption and Compliance to HH policy – Perform Hand hygiene education level, attitudes and knowledge

assessment

• Preparation of report

Interventions• Intervention I

– Discuss with all staff in the ward the baseline results of Hand Rub Consumption, Compliance to HH policy, HH education level assessment

– Educate all staff, those at night shifts included, at least one time

• Intervention II– Discuss with all staff in the ward the results of Hand Rub

Consumption, Compliance to HH policy after intervention I– Put up posters and change every 2 weeks– Find and educate link nurses

• Discuss with all staff in the ward the results of Hand Rub Consumption, Compliance to HH policy, HH education level assessment after intervention II

Education

PostersWHO posters BARN posters

Ward infra structure• 14 hospitals• 38 wards

– Medical - 6– Surgical – 11– ICU – 10– NICU – 5– Neonatal – 4– Pediatric - 2

• 998 patient-beds• Most rooms have sinks and alcoholic handrub available

(except children surgery – patients safety considerations)

Hand hygiene observation instruction

• During the observation days (max a week) 10 persons are observed. For each person the compliance during an entire patient care activity (from approaching to leaving the patient) is observed and the results are recorded in the form below.

• Definition of hand hygiene• Hand hygiene should be performed• Glows should be used and changed

Hand hygiene observation form adapted and simplified based on WHO guideline

Number of healthcare professionals surveyed for hand hygiene compliance:Before interventions – 456After interventions - 340

Percent of wards where hand hygiene compliance rate increased or remained 100% and decreased or remained 0%

after all interventions for various aspects of hand hygiene

Percent of wards where hand rub consumption increased

Hand hygiene education level assessment

What factors prevent you from performing alcoholic hand rub?

Country Q 10a (Lack of time) Q 10d (bad for my skin)

Q 10f (I use gloves)

Before interactio

nRange

(median)

After interactio

nRange

(median)

Before interactio

nRange

(median)

After interactio

nRange

(median)

Before interactio

nRange

(median)

After interactio

nRange

(median)Latvia nd 5-2 nd 6-0 nd 2-1Lithuania 16 28 22 31 24 24Russia 58-0 (30) 46-0 (19) 59-0 (17) 71-0 (29) 37-0 (14) 46-0 (4)Sweden 40-3 (21) 37-16 (17) 4-0 (3) 2-0 (0) 4-0 (3) 4-0 (4)

ConclusionLessons learnt

• Interventions led to improvement of the hand hygiene

• Education led to improvement of the knowledge of the medical personnel

ConclusionLessons learnt

Feedback of the leaders of the project allowed to understand what else

was needed to do for improvement of hand hygiene

Conclusion

Lessons learnt• Hand hygiene compliance

rates increased, especially among physicians, but compliance rate of hand hygiene is higher among nurses before and after intervention

Future suggestions• Doctor and nurse should

observe each other during performing manipulations

• Involvement of visitors/relatives to observation of hand hygiene

Conclusion

Lessons learnt

• Hand rub consumption reflects compliance to hand hygiene practice

• Lack of time for observation of HH

• Additional stress of the medical personnel under observation HH

Future suggestions

• Hand rub consumption can be used as indicator of hand hygiene compliance when time/trained personal for observation is lacking

Conclusion

Lessons learnt• Better results were received

in hospitals where hospital epidemiologists were leaders of the project, worse results – where nurses from the same ward were leaders of the project

Future suggestions• Infection control

professionals must head programs of improvement of hand hygiene

Conclusion

Lessons learnt• Easy for implementation• Possibility of

implementation of the experience obtained in other wards and hospitals

Future suggestions• Development of technical

guidelines on observation of hand hygiene and hand rub consumption

Future suggestions

• To pay more attention of these aspects in educational programs

Future suggestions

• Development of bundles of implementation of HH, including “5 moments of hand hygiene”

• Creation of the program of distance learningprograms of HH and prevention HAI

Forward to the Future!!!!