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

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<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE Table I.21.5.2 Lessons learnt from testing in pilot sites (Cont.) Country Site Lessons learnt and suggestions for improving the <strong>WHO</strong> strategy Saudi Arabia Saudi Arabia Pakistan Hong Kong SAR King Saud Medical Complex King Abdul Aziz Medical City Pakistan Institute of Medical Sciences (PIMS) Four pilot hospitals • Strong infection control team and support from the hospital directorate were keys to the success • In general, the <strong>WHO</strong> strategy requires considerable investment, particularly in human resources. This is not very clear in the Guide to Implementation • <strong>WHO</strong> should offer training on using Epi Info for data entry and especially data analysis • When the <strong>WHO</strong> formulation (liquid) was introduced, some HCWs expressed their preference for gel products • The knowledge questionnaire is difficult to understand in many places, especially questions 23, 24, and 25 • Leadership is an important success factor. • Assessing shared beliefs and values regarding the issue of patient safety is highly important in order to create a safety culture • A patient-centred/customer-focused approach would be beneficial. • It is important to build on system thinking and not individual thinking • More training is needed for co-ordinators on: behavioural theories; change management; and project management principles • A post description is needed to facilitate co-ordinator selection. • Some questions regarding the perceptions and knowledge questionnaires are redundant and others are difficult to understand and need re-wording • A “facilitators guide” together with the PowerPoint presentation can be very helpful. The presentation should include slides that assess the feelings (emotions) of the HCWs, i.e. photos of infections, experiences of people who were infected, etc. • The “Let us do it Together” form to assess the “how to” perform hand hygiene (psychomotor) should be added to the other <strong>WHO</strong> tools • A standardized “sample” reporting format is needed where metrics are shown in a consistent manner • An Excel sheet could be helpful for the calculation of product consumption • Communication is the key component of success: to provide ideas on the topic in a very helpful and informative manner (communications management plans) • A small guide is needed on how to overcome resistance to change • Coordinators and project facilitators should be trained on how to address HCWs’ resistance, i.e. surprise, apprehension of the unknown, scepticism, cynicism, complacency, strong resistance, etc. • The success of this project was possible due to strong commitment of PIMS senior management. • The project is very demanding in terms of time to be dedicated to education, because of shortage of permament members of staff and high turnover of medical and nursing students • Language barriers exist (especially among non-medical staff), and there is a need for translation of the <strong>WHO</strong> material into the local language (currently been undertaken) • There are difficulties to identify some tasks as “aseptic”, e.g. dental/oral care; therefore, the wording of Moment 2 is not adequate • Availability and production of good quality 100 ml flip-top bottles to dispense alcohol-based hand rub was challenging • Providing a dedicated room with adequate temperature control and storage facilities for the production and storage of alcohol was a difficult task • The Guide to Implementation was complex and difficult to understand • Delay to obtain quality control information of locally produced <strong>WHO</strong> formulation from Geneva because of restriction of sending liquid sample by postal and couriers services • Staff were delighted at the introduction of the <strong>WHO</strong> formulation as the commercial product previously in use had a very high incidence of dermatitis • No religious issues were raised on the use of the alcohol-based handrub product • Barriers to implement system change: HCWs’ concerns about the use of alcohol-based handrubs (potential skin damage, fire safety, and pocket bottle contamination) and the perception that hands are clean only after handwashing. • Difficulties to allocate time to attend the education sessions • No hand hygiene compliance improvement was observed among doctors. The <strong>WHO</strong> strategy should include suggestions and ideas how to induce behavioural change in different professional categories 118
PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE Figure I.21.1 Visual representation of the 5-Step Implementation Strategy Step 5 Step 1 Step 5 Step 1 <strong>WHO</strong> Guide to Implementation Step 4 Step 2 <strong>WHO</strong> Guide to Implementation Step 4 Step 2 Step 3 Step 3 Year 1 Year 2 Repeat minimum 5 years Table I.21.2 Action plan step-by-step Step 1: Facility Preparedness Step 2: Baseline Evaluation Step 3: Implementation Step 4: Follow-up Evaluation Step 5: Developing Ongoing Action Plan and Review Cycle Activities Activities Activities Activities Activities • Identify coordinator • Baseline Assessments: undertake • Launch the strategy • Follow-up assessments: undertake • Study all results carefully • Identify key individuals/ groups • Senior managers perception survey • Feedback baseline data • Health-care worker knowledge survey • Feedback of follow-up data • Undertake Facility Situation Analysis • Health-care worker perception survey • Distribute posters • Senior executive managers perception survey • Develop a five year action plan • Complete alcohol-based handrub production, planning and costing tool • Ward structure survey • Distribute alcohol-based handrub • Health-care workers perception and campaign evaluation survey • Consider scale-up of the strategy • Train observers/trainers • Local production or market procurement of handrubs • Distribute other <strong>WHO</strong> materials from the Pilot Implementation Pack • Facility Situation Analysis • Procure raw materials for alcohol-based handrub (if necessary) • Data entry and analysis • Educate facility staff • Data entry and analysis • Collect data on costbenefit • Hand hygiene observations • Undertake practical training of facility staff • Hand hygiene observations • Evaluate computer equipment • Health-care worker knowledge survey • Undertake handrub tolerance tests • Monthly monitoring of use of products • Undertake training on data entry and analysis • Monitor use of soap and alcohol • Complete monthly monitoring of usage of products 119
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