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

More documents

Recommendations

Info

<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. 202
PART VI. COMPARISON OF NATIONAL AND SUB-NATIONAL GUIDELINES FOR HAND HYGIENE Table VI.1 Grading of evidence used in different guideline documents USA* England** France Canada Germany Sweden Ireland IA IB IC II N 1 2 3 4 1 2 3 1 2 3 IA IB II III IV I II III I II III Randomised controlled trials Well-designed studies Suggestive studies Case-control studies Non-analytical studies Theoretical rationale Most experts Mandated by government Unresolved Issue * CDC guidelines ** EPIC 2 guidelines 203
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 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
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 165 and 166: PART III. PROCESS AND OUTCOME MEASU
Page 183 and 184: PART IV. TOWARDS A GENERAL MODEL OF
Page 197 and 198: PART V. PATIENT INVOLVEMENT IN HAND
Page 207 and 208: PART VI. COMPARISON OF NATIONAL AND
Page 209: PART VI. COMPARISON OF NATIONAL AND
Page 213 and 214: PART VI. COMPARISON OF NATIONAL AND
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 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?