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

PART IV. TOWARDS A GENERAL MODEL OF CAMPAIGNING FOR BETTER HAND HYGIENE – A NATIONAL APPROACH TO HAND HYGIENE IMPROVEMENT
4.
Public campaigning, <strong>WHO</strong>, and the mass media
Public campaigning is central to a number of <strong>WHO</strong> programmes. In The World Health Report 2002, 1065 <strong>WHO</strong>
reported on a series of comprehensive approaches that have been implemented at the national level to reduce
specific risks in health care, taking into account a variety of interventions including the dissemination of
information to the public, mainly through media outreach. The use of mass media within public health campaigns
forms one component of broader health promotion programmes and can be useful in wide-scale behaviour
change. 1061,1066,1067
As many international and national health campaigns have
demonstrated, the media play a key role in mobilizing public
support, influencing behavioural change, and setting the local
political agenda. A 2001 Cochrane review 1068 showed that the
use of the mass media was a way of presenting information
about important health issues, targeted by those who aim to
influence the behaviour of health professionals and patients. The
review concluded that the mass media should be considered
as one of the tools that may influence the use of healthcare
interventions. Their usefulness in changing knowledge,
awareness and attitudes makes mass media campaigning
a potentially significant component of attempts to impact on
hand hygiene behaviour change strategies, since hand hygiene
compliance is predicated upon knowledge, attitudes, and
beliefs of HCWs. Mass media campaigns are usually designed
to generate a specific outcome in a relatively large number
of individuals within a specific period of time and through an
organized set of communication activities. 1066 With the growth in
telecommunications, television and the Internet are increasingly
used as channels for promoting behaviour change 1069 and could
play a role in hand hygiene-related mass media campaigns,
particularly if they target national and local opinion leaders.
4.1 National campaigns within health care
National health improvement programmes are designed
to mobilize action at local levels to implement accepted
methods to change behaviour and improve health care. Such
programmes rely on carefully constructed improvement and
spread methodologies, with the prominent model of the PDSA
cycle 1070 incorporating quality improvement principles as a
central component.
As one approach to health improvement, there is a considerable
body of evidence to support the positive impact of campaigning
on health-related behaviours, 1071,1072 although campaigns are
not without their critics. 1066,1073 The Institute for Healthcare
Improvement (IHI) in the USA turned to the campaign approach
at a national, regional, and facility level to achieve a goal of
transformational improvements in health care, using learning
from electoral politics to reach a large number of health-care
facilities across the country. 1074 In describing the subsequent
IHI 100 000 Lives Campaign (Table IV.9.1), Berwick and
colleagues 1075 outline a need to create a sense of urgency and
pace. This campaign, one of the largest attempts to mobilize
health care to focus on issues of quality and safety, holds much
relevance when considering hand hygiene improvement in
health care.
A feature of conventional campaigns, reflected in the IHI
approach, is their association with a focused and time-bound
effort. 1063 The IHI campaign was constructed around specific
targets and deadlines; it also won support from national
professional organizations, creating what they describe as a
powerful national infrastructure to drive change and transform
health-care quality. IHI identified the target (described as
conceptually simple interventions) and the deadline and
provided tools and resources for implementation. Berwick and
colleagues 1075 emphasize, however, that the ultimate results
rest with the participating hospitals to reliably introduce the
interventions and engage boards, executives, frontline clinicians,
patients, and families.
National-level campaigns to improve antibiotic use in Europe
and the USA have been reported in the literature. 1076 Such
campaigns have targeted the population level and employed
techniques of mass media distribution. Similar to hand hygiene
improvement campaigns in health care, antibiotic campaigns
are multifaceted and are concerned with cost–effectiveness.
According to Goossens and colleagues, only two countries
in Europe have undertaken and evaluated national antibioticuse
campaigns and reported demonstrable success. 1076 The
USA has seen a dramatic reduction in the use of antibiotics by
paediatricians. 1077 In conclusion, these authors call for a wider
use of the campaign approach and the incorporation of social
marketing, together with cultural adaptation and population
targeting.
Campaigns are likely to be more successful when they are
accompanied by concomitant structural changes that provide
the opportunity structure for the target audience to act on
the recommended message. 1063 These authors also suggest
that accompanying campaigns with reinforcing “legislation
and regulation” can influence the campaign impact and
sustainability. An illustration of the impact of legislation and
regulation can be seen in England and Wales where the national
cleanyourhands campaign (Table IV.9.1) received considerable
leverage with a parallel national target to reduce MRSA rates by
50%. 1078
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