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

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
implementation, but without clear recommendations. 1154 Details
provided in various documents were analysed.
Regular training was considered important in 15
guidelines, 58,1146,1148,1150,1151,1153,1154,1157-1162,1164,1165 and some
information on areas to be covered was provided in
five. 58,1153,1157,1160 ,1161 Reminders in the workplace were
recommended by eight. 58,1153,1158,1160-1164 Wall-mounted dispensers
for hand rub were recommended in 11 58,1147,1151-1153,1155,1158,1160,1162-1164
and pocket dispensers in 3. 58,1151,1164 Aspects of skin care were
dealt with in 19 documents. 58,1146-1148,1150-1156,1158-1165
Nine documents recommended monitoring of
performance by an audit of hand hygiene, with direct
observation being the method suggested in most
documents. 58,1148,1150,1151,1153,1158,1160,1162,1164 Audit of product
consumption was mentioned in three 58,1150,1153 and tools for
audit were provided in three. 58,1153,1160 Feedback to HCWs
was mentioned only in six guidelines. 58,1148,1150,1151,1158,1160
Two documents suggested the possibility of administrative
actions in the case of non-compliance with hand hygiene
recommendations. 1153,1160
Outlines on how to choose a hand hygiene product were
available in eight documents. 58,1151-1153,1158,1160-1162 Roles and
responsibilities of stakeholders were considered at least in a
very basic manner in eight documents. 1146,1150,1151,1153,1158,1160,1162,1164
Ten guidelines stressed the need for active HCW involvement for
successful implementation, 58,1146,1148,1150,1153,1157 ,1158 ,1160 ,1161 ,1162 and
four had recommendations for patient participation. 58,1160,1161,1164
Outlines for the location of handwashing facilities were provided
in 13. 1146-1149,1152,1153,1156,1158,1160-1164 Reference to wider safety issues
were made in four documents. 58,1153,1158,1160
Detailed information on costing or cost–effectiveness was not
provided in any guideline. Two documents included very basic
information on this aspect. 1147,1150
In summary, although the overall aim of all the documents
included in the comparison was to give recommendations for
optimal hand hygiene practices, there were wide variations in
the scope, goals, content, breadth, and depth of topics covered.
Lack of uniformity in terminology further compounded analytical
differences. Many documents did not adequately cover several
aspects, especially those essential for proper implementation
and sustainability. Some of the recommendations were such
that the HCW had to make decisions as to when and how to
perform hand hygiene.
Both documents reviewed evidence extensively and used a
similar grading system. The layout and the issues discussed
are also broadly similar and include a wide variety of topics
related to hand hygiene While the CDC guidelines are primarily
intended for use in the USA and other Western countries, the
<strong>WHO</strong> guidelines were conceived in a more global perspective
and, therefore, are not targeted at only developing or developed
countries, but all countries regardless of the resources available.
Another general, but essential, difference of approach is that the
present <strong>WHO</strong> <strong>Guidelines</strong> have been validated and finalized after
a pilot test phase using a specific implementation strategy in
different health-care settings worldwide.
Furthermore, in the present guidelines, evidence has been
derived from more recent studies, details of how the evidence
was collected are provided, and the recommendations are
based on extensive international consultations. Although
the CDC guidelines were constantly considered as a very
valuable framework, many innovative aspects of hand hygiene
are dealt with in the present <strong>WHO</strong> guidelines. For example,
there are sections on mathematical modelling to understand
the transmission of pathogens in health-care settings, local
production of alcohol-based handrubs, religious and cultural
aspects of hand hygiene, promotion of hand hygiene on a
national scale, and social marketing, and including the detailed
analyses of guidelines presented here. More details are also
provided on behavioural aspects, infrastructure required for
hand hygiene, and safety issues. The <strong>WHO</strong> guidelines are
therefore more extensive. Details of hand hygiene procedures
including pictorial representations are made available in the
<strong>WHO</strong> guidelines, and more detailed strategies for promotion for
use in a wider range of settings are also discussed.
Both documents present recommendations and indicate the
grading of recommendations. Most are similar, but the <strong>WHO</strong>
document (see Part II) has a few that are not considered in the
CDC document and vice versa. Recommendations for handling
medicines and food, and a set of recommendations for national
governments provided in the <strong>WHO</strong> guidelines are examples.
The respective strength for some recommendations also
differs between the two documents. Outcome measurements
are considered at great length in the <strong>WHO</strong> document. Other
aspects such as the promotion of hand hygiene on a large
scale and providing information to the public are also given due
importance in these guidelines. CDC guidelines provide links to
other web sites for further reference.
The <strong>WHO</strong> <strong>Guidelines</strong> on Hand Hygiene in Health Care were
developed in 2005 as an advanced draft and have been finalized
as the present document in 2008. This document has taken on
board the above-mentioned concerns and bridged most of the
gaps. This is the most extensively referenced and comprehensive
guidelines for hand hygiene available to date. These guidelines
are for use by policy-makers, managers, and HCWs in different
settings and geographical areas. In many countries, guidelineand
policy-developers are already using these guidelines as a
resource for adaptation to local needs and logistics.
<strong>Guidelines</strong> developed by the CDC in 2002 58 are also used as
a reference internationally. Both <strong>WHO</strong> and CDC guidelines are
documents prepared specifically to promote hand hygiene.
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