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

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
2.
<strong>Guidelines</strong>’ preparation process
The preparation process of the <strong>WHO</strong> <strong>Guidelines</strong> on Hand Hygiene in Health Care involved the steps that are
briefly described in this section.
2.1 Preparation of the Advanced Draft
The present guidelines were developed by the “Clean Care
is Safer Care” team (Patient Safety Department, Information,
Evidence and Research Cluster).
A Core Group of international experts in the field of infection
control, with specific expertise in hand hygiene, participated
in the writing and revision of the document. The group was
constituted at <strong>WHO</strong> Headquarters in Geneva in December
2004. During its first meeting, the experts discussed the
approach to be emphasized in these guidelines and their
content and drew up a plan for their preparation. The
objectives identified were to develop a document including
a comprehensive overview of essential aspects of hand
hygiene in health care and evidence- and consensus-based
recommendations for optimal hand hygiene practices and
successful hand hygiene promotion. Users were meant to be
policy-makers, managers and HCWs in different settings and
geographical areas. It was decided to adopt the CDC Guideline
for Hand Hygiene in Health-Care Settings issued in 2002 as
a basis for the present document but to introduce many new
topics. A distinctive feature of the present <strong>Guidelines</strong> is the fact
that they were conceived with a global perspective; therefore,
they are not targeted at only developing or developed countries,
but at all countries regardless of the resources available (see
also Part VI).
Various task forces were established (Table I.2.1) to examine
different controversial topics in depth and reach consensus
on the best approach to be included in the document for both
implementation and research purposes. According to their
expertise, authors were assigned various chapters, the content
of which had to be based on the scientific literature and their
experience. A systematic review of the literature was performed
through PubMed (United States National Library of Medicine),
Ovid, MEDLINE, EMBASE, and the Cochrane Library, and
secondary papers were identified from reference lists and
existing relevant guidelines. International and national infection
control guidelines and textbooks were also consulted. Authors
provided the list of keywords that they used for use in the next
update of the <strong>Guidelines</strong>.
In April 2005 and March 2006, the Core Group reconvened at
<strong>WHO</strong> Headquarters in Geneva for task force meetings, final
revision, and consensus on the first draft. Recommendations
were formulated on the basis of the evidence described in
the various sections; their terminology and consistency were
discussed in depth during the expert consultations. In addition
to expert consensus, the criteria developed by the Healthcare
Infection Control Practices Advisory Committee (HICPAC) of
the United States Centers for Disease Control and Prevention
(CDC), Atlanta, GA, were used to categorise the consensus
recommendations in the <strong>WHO</strong> <strong>Guidelines</strong> for Hand Hygiene
in Health Care (Table I.2.2). In the case of difficulty in reaching
consensus, the voting system was adopted. The final draft was
submitted to a list of external and internal reviewers whose
comments were considered during the March 2006 Core Group
consultation. The Advanced Draft of the <strong>WHO</strong> <strong>Guidelines</strong> on
Hand Hygiene in Health Care was published in April 2006.
2.2 Pilot testing the Advanced Draft
According to <strong>WHO</strong> recommendations for guideline preparation,
a testing phase of the guidelines was undertaken. In parallel
with the Advanced Draft, an implementation strategy
(<strong>WHO</strong> Multimodal Hand Hygiene Improvement Strategy)
was developed, together with a wide a range of tools (Pilot
Implementation Pack) to help health-care settings to translate
the guidelines into practice (see also Part I, Sections 21.1–4).
The aims of this testing were: to provide local data on the
resources required to carry out the recommendations; to
generate information on feasibility, validity, reliability, and cost–
effectiveness of the interventions; and to adapt and refine
proposed implementation strategies. Eight pilot sites from seven
countries representing the six <strong>WHO</strong> regions were selected for
pilot testing and received technical and, in some cases, financial
support from the First Global Patient Safety Challenge team
(see also Part I, Section 21.5). Other health-care settings around
the world volunteered to participate autonomously in the testing
phase, and these were named “complementary test sites”.
Analysis of data and evaluation of the lessons learnt from pilot
and complementary sites were undertaken and are reported in
Part I, Section 21.5.
2.3 Finalization of the <strong>WHO</strong> <strong>Guidelines</strong> on Hand
Hygiene in Health Care
In August 2007, the expert Core Group reconvened in Geneva
to start the process of guideline finalization. Authors were asked
to update their text according to relevant new publications up
to October 2007 and to return the work by December 2007;
some authors were asked to write new chapters by the same
deadline. The First Global Patient Safety Challenge team and
the <strong>Guidelines</strong>’ editor contributed with the content of several
chapters and took the responsibility to revise the updated and
new material, to perform technical editing, and to add any
further relevant reference published between October 2007 and
June 2008. Six new chapters, 11 additional paragraphs, and
three new appendices were added in the present final version
compared with the Advanced Draft. External and internal
reviewers were asked again to comment on the new parts of the
guidelines.
In September 2008, the last Core Group consultation took
place in Geneva. The final draft of the <strong>Guidelines</strong> was circulated
4