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

<strong>WHO</strong> GUIDELINES ON HAND HYGIENE IN HEALTH CARE
System change
Structural. As successful behavioural hand hygiene promotion
programmes induce increased compliance, the convenience
and time-saving effects of cosmetically acceptable alcoholbased
handrubs will prove of further benefit. However, inherent
hand hygiene behaviour will always persist and will continue
to require handwashing with water and soap; hence, the
accessibility of sinks must still be carefully considered.
Philosophical. Heightened institutional priority for hand
hygiene will require that a decision be made, at least at the
organizational level as for many social behaviours, as to whether
these other promotional facets of hand hygiene are then
supported by law or marketing. Rewards and/or sanctions for
acceptable or unacceptable behaviour may prove necessary
and effective in both the short and long term, given both the
duration of pre-existing hand hygiene behaviour inappropriate
to the health-care setting and its continued reinforcement in
the community. This approach has been successfully applied in
many countries to other public health issues such as smoking
and driving under the influence of alcohol, but further studies
are necessary to assess its application to hand hygiene
promotion. Alternatively, the philosophy of marketing may be
considered; such an approach takes particular consideration of
self-interest, which may be extremely pertinent given that selfprotection
continues to be the primary motivational force behind
all hand hygiene practice. The value of active participation at
the institutional level and its impact on HCWs’ compliance with
hand hygiene have been demonstrated in several studies. 60,651,713
18.2.3 Research implementation
Confirmation of behavioural determinants of hand hygiene in all
other health-care occupational groups and in varying ethnic and
professional groups is essential to ensure that these findings are
constant and the implications that flow from them are universally
relevant.
The impact in practice of each behavioural factor influencing
hand hygiene must be carefully measured and considered, so
as to design cost-effective motivational programmes suitable for
both high- and low-resource health-care settings.
Patterns of hand hygiene both in the community and in health
care represent a complex, socially entrenched and ritualistic
behaviour. It is thus not surprising that single interventions have
failed to induce a sustained improvement in HCW behaviour.
Multi-level, multimodal and multidisciplinary strategies,
responding to these behavioural determinants, would seem to
hold most promise. 59,60,684,789
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