Hand hygiene.pdf

follow the intent 588 . Studies have shown that where there is agreement for a patient-care
practice, a standard educational programme of lectures or posters will be effective 557 .
In the next category, non-established practices (no resources), the lack of resources is the
limiting factor. A list of such resources should be compiled for the new guideline, and the
infection control team must ensure that these materials are in place before launching the
implementation programme.
The successful implementation of the new guideline usually hinges on the last category,
non-established practices (HCW resistance). Disagreement from HCWs is anticipated, and
a programme of persuasion is needed to institute the required change. It will be worth while
for the infection control team to understand the reasons for resistance, and both quantitative
and qualitative studies may be required to elicit these factors. Special studies or surveys may
be carried out on the various barriers to hand hygiene that have been identified in the literature.
After understanding the reasons for resistance, a special behavioural change strategy
might also be adopted to implement these practices 551,589 (see Part I, Sections 16 and 18).
17.3 STEPS IN GUIDELINE IMPLEMENTATION
Using the scheme just described, there are seven basic steps in implementation:
1. Elaborate a final draft of the guideline for the health-care institution/centre. After
obtaining various international guidelines on hand hygiene from the literature, the
infection control team needs to customize the recommendations according to the
requirements of its health-care facility. It might highlight some of the recommendations
that are deemed to be critically important for success or, on the other hand,
choose to exclude recommendations that are not relevant for the institution. The
document should provide specific information, such as the actual person to contact
for queries and the precise location of the supply of hand antisepsis products. A final
draft of the guideline will often require endorsement for implementation from the
management of the institution or from the infection control committee. Importantly,
institutional experts need to be knowledgeable about evidence-based information
regarding hand hygiene.
2. Categorize all recommendations into the four types of practices as described above,
with the help of a panel of experienced HCWs in the institution.
3. Work with the institution to provide the necessary resources for the non-established
practice (no resources) recommendations. The infection control team must
ensure that these resources are actually available on the wards when the guideline
is introduced.
4. Conduct research on reasons for resistance for the non-established practices (HCW
resistance). The easiest method will be to convene a focus group consisting of HCWs
from the relevant wards. This can be followed, if necessary, by a simple survey of the
key issues identified by the focus group.
5. Measure baseline rates before the introduction of the new guideline. The infection
rate may be included, but by itself it may be difficult to document improvement
because large numbers are usually needed. Other structural, process or outcome
indicators may be measured and it is also pragmatic to obtain the compliance rate
or evidence of behavioural change. This involves assessing the level of several key
practices before introduction of the guideline, e.g. observations for hand hygiene
compliance rates before and after patient contact, or the amount of antisepsis product
usage in the institution.