Hand hygiene.pdf

6. PRINCIPLES OF COUNTRYWIDE HAND HYGIENE
IMPROVEMENT
Attempts to implement a national campaign along the lines of the United Kingdom
NPSA’s “cleanyourhands” requires careful consideration of context and community 708 ; for
this reason alone there can be no universal model or framework for spreading good practice
such as hand hygiene improvement. However, an overall programme can be developed
capable of dramatically enhancing success within nations. The chief benefits in favour of
national programmes relate to the avoidance of fragmentation, cost inefficiency and duplication
of effort.
The critical factors for success are hinged around:
• the presence of drivers for improvement;
• the adaptability of the programme;
• political commitment;
• policies and strategies that enable spread and sustainability;
• availability of finance;
• coalitions and partnerships;
• local ownership;
• presence of external support agencies;
• capacity for rapid dissemination and active learning;
• links to health-care regulation;
• economies of scale to be achieved through central production;
• capacity for public–private partnership working.
These factors will differ in a number of ways across developed and less developed countries,
not least in the absence of robust public health infrastructures in less developed
nations. Fewtrell and colleagues 714 emphasize the importance of making intelligent choices
of interventions for specific settings and that these should be underpinned by considerations
of feasibility, social issues, cost–effectiveness and sustainability. The learning from
the “cleanyourhands” campaign outlines the importance of risk assessment prior to the
introduction of a nationally driven improvement. To achieve such improvement inevitably
requires the combined expertise of many professional groups 714 .
The WHO World Alliance for Patient Safety, and in particular the Global Patient Safety
Challenge 2005–2006, have committed to developing a self-assessment toolkit to enable
countries to evaluate their state of progress in relation to patient safety, and the appropriateness
of a national or countrywide hand hygiene improvement programme could be
incorporated into this toolkit. Furthermore, The World Health Report 2004 711 emphasizes
the motivating effect of a time-bound target.
It is clear that while further research is required into the feasibility and long-term impact
of national interventions for hand hygiene improvement, such programmes do have the
potential to raise the stakes, focus minds and act as a catalyst for action. They can add value
to the daily efforts designed to ensure local implementation of currently existing policies
and guidelines. While the barriers and facilitators differ across developed and less developed
countries, the broad principles behind the need for carefully designed interventions to
ensure effectiveness, cost–effectiveness and sustainable improvement remain similar.