WHO Guidelines on Hand Hygiene in Health Care - Safe Care ...

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
Some examples of the local adaptation of the strategy are the
local production of posters, brochures, training films, badges
and gadgets, organization of focus groups on glove use, use
of the fingerprint method for educational purposes, and the
involvement of patients and visitors in hand hygiene promotion.
21.5.2.2 Comments on specific elements of the <strong>WHO</strong> Strategy
System change. System change was considered a very
important component of the <strong>WHO</strong> Strategy (median score 7,
range 4-7). As far as handwashing was concerned, in some
cases where major infrastructure deficiencies were present (e.g.
lack of sinks and paper towels), these could not be completely
overcome, mainly due to lack of resources.
Forty-six CTS adopted locally-produced <strong>WHO</strong>-recommended
handrub formulations produced either at the hospital pharmacy
or in a centralized facility. In the sites where handrub was
already in use, the system was strengthened through the
increase in the number of dispensers and the use of different
types of dispensers.
Reported long-term obstacles to system change included
staff subconsciously resistant to using handrub (mainly for
self-protection reasons), leakage problem with liquid solutions,
rumours about handrubs causing skin cancer, and allergic
reactions.
Education. This component was considered of major
importance for the success of the campaign and the <strong>WHO</strong> tools
were widely used with the addition of local data in most cases.
HCWs who had previously received less education expressed
the most interest. In many cases, traditional educational
sessions with slide-shows were used, but other methods such
as interactive sessions and practical sessions on hand hygiene
technique were also adopted. The “My five moments for hand
hygiene” concept was perceived as the key winning message of
the Strategy and the visual impact of the educational tools and
the training film were highly appreciated.
Feedback was noted as being very important to raise
awareness and to acknowledge the results achieved. The
method used most frequently was a slide presentation during
educational sessions; in some cases, immediate compliance
feedback and a written report were given to staff and the
hospital directorate. In some facilities, the reaction of HCWs to
reported low rates of compliance was not positive; in others,
when data were disseminated to other units, they generated
much interest to take part in the implementation.
The other <strong>WHO</strong> tools for evaluation (structure, perception and
knowledge surveys) were used in some sites. Although their
usefulness to gather a more comprehensive understanding of
hand hygiene practices was acknowledged, it was also pointed
out that it was too time-consuming to perform the surveys,
some questionnaires are too long, and some questions are
difficult to understand. In some sites, a combined knowledge/
perception questionnaire was developed locally.
Reminders in the workplace. <strong>WHO</strong> posters were used in
all sites and adapted locally in some cases. They were also
useful for patients and visitors and led to spontaneous patient
participation. Perishability was one concern and, in some sites,
posters were plasticized to overcome this problem. The median
score attributed to the importance of reminders was 6 (range
3-7;) median scores attributed to the <strong>WHO</strong> posters were as
follows: “5 Moments”, 7 (range 6-7); “How to Handrub”, 6 (range
5-7); and “How to Handwash”, 6 (range 5-7).
Patient safety climate. Some coordinators pointed out that
the implementation of the hand hygiene campaign acted as a
trigger to introduce other patient safety topics. Support from
top managers and the directorate varied from strong practical
support to more moral and verbal support among the different
sites. No active patient participation was reported. The median
score attributed to the importance of the promotion of a safety
culture was 6 (range 2-7); scores attributed to the usefulness
of the tools to secure managerial support were: information
sheets, 5 (range 3-7); advocacy sheet, 4 (range 2-6); and senior
managers’ letter template, 5 (range 2-7).
Major obstacles were the limited time availability of HCWs
beyond the work shifts and the reluctance of doctors to attend
training sessions.
The median score attributed to the importance of education
was 7 (range 5-7). Scores given to the usefulness of the
different <strong>WHO</strong> educational tools were as follows: training film,
7 (range 5-7); slide presentation, 6 (range 5-7); hand hygiene
brochure, 7 (range 5-7); pocket leaflet, 7 (range 5-7); and the 9
recommendations leaflet, 7 (range 5-7).
Observation and feedback. All sites adopted the <strong>WHO</strong>
observation method and found it relatively easy to apply due to
the precise instructions included in the Manual for Observers.
The median score attributed to both the importance of
observation and feedback and the usefulness of the Manual for
Observers was 7 (ranges 4-7 and 1-7, respectively). Observers
were mainly infection control nurses. Nevertheless, difficulties
were experienced for their validation and the time availability for
this task, particularly when limited manpower was available.
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