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

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
5.
Benefits and barriers in national programmes
National political commitment to a health issue increases awareness and helps leverage additional resources. 1072
Translation of national political commitment into action yields benefits, and these can be quantified in terms of
avoiding a fragmented and cost-inefficient duplication of effort. 1062,1079 The focus should be on producing practical
tools that can be implemented across entire health-care systems. Pragmatic adaptations to these national
programmes are described as necessary in order to achieve maximum local ownership, which is critical to
ensuring successful implementation.
Dawson and colleagues 1080 describe the ongoing oral polio
vaccine campaign in India as an example of a mass populationbased
intervention that illustrates both the benefits and
problems of mass campaigning. The authors highlight the
importance of establishing procedures for reviewing policy
formulation and implementation and emphasize monitoring
and evaluation, with explicit, clear lines of responsibility for
all aspects of the programme. Evaluation is central to mass
health-care improvement. 1027,1081 The necessary expertise and
resources are essential in ensuring robust evaluation. Tilson
Pietrow and colleagues 1082 describe a number of new challenges
for international health programmes of the 21st century and
conclude that health communication programmes will be under
increasing scrutiny in terms of evaluation and documentation
of their impact, cost–effectiveness, and sustainability. Data
to facilitate impact assessment, while crucial to determine
success, are not always available in many published studies 1083
and, where available, it is often difficult to prove a definite
correlation between the campaign and the desired outcome. 1084
The NHS for England and Wales, where a national patient safety
alert 1031 was issued instructing organizations to implement
alcohol-based handrub at the point of care, provides further
evidence of the role of regulation. Its action was supported
by built-in monitoring mechanisms via the national health
watchdog (Health Care Commission), which examines whether,
and to what extent, organizations have implemented both the
campaign and the near-patient handrubs.
When deciding on the suitability of a national approach to
improvement in relation to hand hygiene, politicians or leaders
need to consider a number of factors that can influence
success. Characteristics of national strategies will be influenced
by the key drivers for improvement 868 which, in the context of
infection control in the developed world, relate to the growing
need to reassure patients and the public that care provided is
clean and safe.
(CEOs) should be made aware of any recommendations/
requirements for hand hygiene promotion campaigns that are
issued by organizations that accredit or license health-care
facilities. Accreditation can be a powerful driver for health
improvement and is cited as a powerful driver for improvement
across many <strong>WHO</strong> regions (see, for example, AFRO Workshop
Report 2007 and SEARO Workshop Report 2007, available
at http://www.who.int/patientsafety/gpsc/en). The benefits
and barriers associated with national improvements will be
influenced by how health care is regulated and operated
nationally, regionally, and locally. 1085
Wachter and colleagues 1027 in their critique of the IHI “100 000
Lives Campaign” describe the modus operandi of the campaign
as being one of leveraging “unprecedented” social pressure
for participation, pressure that was constructed upon a set of
realistic goals for improvement. Risks to success associated
with national-level health improvements are further explored
within the context of the campaign, with the need for regular
communication, clear role definitions, and a clear national
agenda emerging as critical factors for success. 1074
If a decision is taken to integrate campaigning into a national
health improvement programme, cultural and contextual
alignment should be considered. Pillsbury and colleagues, 1086
in their reflection on a campaign to raise community awareness
about reproductive and sexual health, highlight a lack of
research into understanding local behaviours. They emphasize
the importance of evaluating the local understanding and
appropriateness of messages used; some of the African
examples cited by them illustrate the risks associated with
communication strategies where messages do not “talk” to the
audience.
Improvement is a dynamic process, and success will be
affected by internal as well as external factors. 1085 Improvement
must be preceded by an analysis and understanding of existing
patient safety and infection control structures, policies and
programmes – and this is emphasized by the <strong>WHO</strong> World
Alliance for Patient Safety toolkit for the implementation of hand
hygiene strategies. Political commitment and national ownership
of programmes are essential but, inevitably, those strategies
that are dependent on social and political dynamics are subject
to risk. The integration of all levels of a health improvement
programme is crucial; national and hospital programmes should
be harmonized. At the hospital level, chief executive officers
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