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

More documents

Recommendations

Info

<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
PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE ahead of the meeting, including relevant comments from the reviewers. A specific session of the meeting was dedicated to the evaluation of data and lessons learnt from the testing sites and how to integrate these aspects into the text. Final discussion took place about the content of the final version of the document with a particular focus on the recommendations and the research agenda, and reviewers’ comments and queries; approval was obtained by consensus. Following the consultation, the final amendments and insertions were made and, at the latest stage, the document was submitted to a <strong>WHO</strong> reference editor. Table I.2.1 Task forces for discussion and expert consensus on critical issues related to hand hygiene in health care Task forces on hand hygiene in health care • Behavioural changes • Education/training/tools • <strong>WHO</strong>-recommended hand antisepsis formulations • Glove use and reuse • Water quality for handwashing • Patient involvement • Religious and cultural aspects of hand hygiene • Indicators for service implementation and monitoring • Regulation and accreditation • Advocacy/communication/campaigning • National guidelines on hand hygiene • “Frequently asked questions” development Table I.2.2 Modified CDC/HICPAC ranking system for evidence CATEGORY IA IB IC II CRITERIA Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiological studies. Strongly recommended for implementation and supported by some experimental, clinical, or epidemiological studies and a strong theoretical rationale. Required for implementation, as mandated by federal and/or state regulation or standard. Suggested for implementation and supported by suggestive clinical or epidemiological studies or a theoretical rationale or a consensus by a panel of experts. 5
Page 1 and 2: WHO Guidel
Page 3 and 4: WHO Guidel
Page 5 and 6: WHO GUIDELINES ON
Page 7 and 8: WHO GUIDELINES ON
Page 9 and 10: PART I. REVIEW OF SCIENTIFIC DATA R
Page 11: PART I. REVIEW OF SCIENTIFIC DATA R
Page 63 and 64:
PART I. REVIEW OF SCIENTIFIC DATA R
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
PART II. CONSENSUS RECOMMENDATIONS
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
PART III. PROCESS AND OUTCOME MEASU
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
PART IV. TOWARDS A GENERAL MODEL OF
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
PART V. PATIENT INVOLVEMENT IN HAND
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
PART VI. COMPARISON OF NATIONAL AND
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
REFERENCES 35. Jroundi I et al. Pre
Page 217 and 218:
REFERENCES 109. Boyce JM et al. Out
Page 219 and 220:
REFERENCES 177. McBryde ES, Pettitt
Page 221 and 222:
REFERENCES 250. Squier C, Yu VL, St
Page 223 and 224:
REFERENCES 327. Rotter ML, Koller W
Page 225 and 226:
REFERENCES 400. McMurry LM, McDermo
Page 227 and 228:
REFERENCES 468. Martin LS, McDougal
Page 229 and 230:
REFERENCES 542. Wheelock SM, Lookin
Page 231 and 232:
REFERENCES 615. Voss A, Widmer AF.
Page 233 and 234:
REFERENCES 690. Saba R et al. Hand
Page 235 and 236:
REFERENCES 765. Lee B, Newberg A. R
Page 237 and 238:
REFERENCES 841. Gillet P. Construir
Page 239 and 240:
REFERENCES 915. De Groot-Kosolcharo
Page 241 and 242:
REFERENCES 986. Kinsella G, Thomas
Page 243 and 244:
REFERENCES 1062. Runciman WB, Molle
Page 245 and 246:
REFERENCES 1138. Chen YC, Chiang LC
Page 247 and 248:
WHO GUIDELINES ON
Page 249 and 250:
WHO GUIDELINES ON
Page 251 and 252:
WHO GUIDELINES ON
Page 253 and 254:
WHO GUIDELINES ON
Page 255 and 256:
WHO GUIDELINES ON
Page 257 and 258:
WHO GUIDELINES ON
Page 259 and 260:
WHO GUIDELINES ON
Page 261 and 262:
WHO GUIDELINES ON
Page 263 and 264:
WHO GUIDELINES ON
Page 265 and 266:
WHO GUIDELINES ON
Page 267 and 268:
WHO GUIDELINES ON
Page 269 and 270:
WHO GUIDELINES ON
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?