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

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<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE 7. The relevance of social marketing and social movement theories Part I, Section 20.3, provides a comprehensive account of the applicability of social marketing to hand hygiene improvement. In a systematic review of hand hygiene behavioural interventions, 872 Mah and colleagues found synergies in many modern-day approaches to hand hygiene improvement and the ethos of social marketing. Scott and colleagues 1089 extol consumer marketing as a new approach that might overcome some of the conventional limitations associated with hand hygiene behaviour change outside health care. Social marketing might add value to the global drive for better hand hygiene in health care, exactly because it has been applied in both developed and developing countries. 1090 Mah and colleagues 872 suggest that social and behavioural theories and models are underused in the design of current hand hygiene promotion interventions. They counter the commonly held belief that social marketing is cost-intensive and conclude that social marketing is not necessarily an expensive activity due to its scalability. One of the chief advantages of nationally coordinated campaigns with pooled financial input is that it ensures resource provision that maximizes economies of scale and utilizes the expertise of the marketing world in spreading hand hygiene improvement messages within health care. In contrast to the evidence relating to social marketing, the relevance of social movement theories to hand hygiene improvement, or health improvement generally, is an unresolved issue. Social movement theories concerned with largescale societal change have gained prominence within health improvement literature in recent years and embody much of what is aspired to by health policy-makers striving to improve practices in health care. However, Brown and colleagues 1091 urge caution in drawing conclusions regarding the usefulness of such a comparison and emphasize that social movements are defined by the emergence of informal networks based on shared beliefs and solidarity that mobilize around issues of conflict and usually involve some form of protest. These possibilities of applying social movement theories within general spread strategies offer a new angle to hand hygiene improvement in health care, and this might hold relevance in terms of pursuing a global hand hygiene improvement movement. Within the context of broader patient safety improvements and the need to mobilize HCWs in a different way of working, there may be benefits in the concept. Bate and colleagues 1092 argue that social and organizational change do have similarities with health-care improvement and conclude that those considering large-scale change in health care might benefit from consideration of change from a perspective of social movements. There is no literature specifically reviewing hand hygiene campaigns and social movement theories, and this gap in the literature may benefit from further study. Social movements tend to occur spontaneously, and this contrasts sharply with current examples of national hand hygiene improvements that rely on centrally constructed programmes of change implemented in a coordinated manner using accepted methodologies of health improvement spread. Whether it is possible to create a contagious hand hygiene improvement movement using the vehicle of national programmes is only recently being addressed, and emerging results of the impact of these approaches are expected in the coming years. 7.1 Hand hygiene improvement campaigns outside of health care While there is little available published literature on national hand hygiene improvement strategies in health care, the Global Public–Private Partnership for Handwashing with Soap (GPPHWS) illustrates a comprehensive strategy for improving hand hygiene in the community. The partnership was catalysed around a bold objective: to establish large-scale national programmes on handwashing, 1088 which involved putting into place a number of collaborative efforts for success at the national level including between government, academia, the private sector, and external support agencies. The partnership relied on the identification of a national coordinator at the governmental level. 1088 Within a developing country context, Scott and colleagues 1089 have used a social marketing approach to consider motivations, environmental factors, and habits that mitigate against the desired behaviour within their target audiences. This approach has been rolled out in Ghana and a number of other countries. In developing countries, this public–private partnership 1093 has attempted to tackle the problems across nations exacerbated by low compliance with hand hygiene in the community, rather than in the health-care setting. This campaign involves close working with the private sector with the aim of developing and executing far-reaching improvement strategies. Transferring such an approach to hand hygiene in health care will raise ethical issues relating to partnerships working with corporate bodies. This may not necessarily be a barrier, and <strong>WHO</strong> is ideally placed to act as a catalyst to this end. A list of critical factors that are necessary to drive forward this improvement has been drawn up: political will; policies and strategies that enable improvement; finance; coalition and partnerships; local governments and local action; and external support agencies. Fewtrell and colleagues 1094 emphasize the importance of selecting interventions for developing countries based on local desirability, feasibility, and cost–effectiveness. These factors will differ in a number of ways across developed and developing countries, not least in the absence of robust public health infrastructure in developing nations. Finally, they 180
PART IV. TOWARDS A GENERAL MODEL OF CAMPAIGNING FOR BETTER HAND HYGIENE – A NATIONAL APPROACH TO HAND HYGIENE IMPROVEMENT emphasize also the importance of making intelligent choices of interventions for specific settings. 1094 These non-health-care programmes to improve handwashing behaviour appear to be feasible and sustainable, especially when they incorporate traditional hygiene practices and beliefs 1095 and take into consideration locally appropriate channels of communication. 1096 Consumer and market studies were effectively employed to understand the nature of the market, consumer attitudes, behaviours, and most appropriate promotional strategies and communication channels. These programmes have achieved an effective partnership between private industry and the public sector to promote handwashing with non-branded soap; therefore, many of the strategies employed require further consideration by those involved in developing national campaigns on hand hygiene improvement in health care. 8. Nationally driven hand hygiene improvement in health care Lessons from the Global Public–Private Partnership for Handwashing with Soap suggest that mass behaviour change is achievable and that commercial marketing techniques can be applied to good effect, even on a large scale. 1096 Hand hygiene improvement in health care presents unique challenges: the target audience is not the public or patients with or at risk of a disease, but the HCW. Unlike other health improvement campaigns, the target behaviour (hand hygiene compliance) contributes to the prevention of numerous episodes of infection and not a single disease. The published literature illustrates few examples of national campaigns aimed at improving hand hygiene within a health-care context, thus reflecting the novelty of such approaches. However, <strong>WHO</strong> has monitored the development of national campaigning over the past five years and has recorded a rapidly increasing number of new initiatives (http://www.who.int/gpsc/national_campaigns/en/). The first documented campaign, cleanyourhands (Table IV.8.1), was launched in England and Wales in 2004. It is centrally coordinated and funded, has political backing, and involves the provision of campaign materials to support local implementation of a multimodal hand hygiene improvement strategy. The campaign is the subject of a fiveyear research evaluation project, 1028,1097 with early indications suggesting a change in hand hygiene behaviour. Although not without its critics, 787 the campaign has demonstrated the possibilities of running an integrated behaviour change programme on hand hygiene at a national level. Since 2004, a further 25 countries have been identified as running or preparing to embark on national programmes. A network of hand hygiene campaigning nations is in an embryonic stage, coordinated through the <strong>WHO</strong> World Alliance for Patient Safety. 857 This network will continue to centralize lessons learnt and share examples through its National Campaigns web platform. 181
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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
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