WHO's strategy for improving hand hygiene is easy for health-care workers to practise, according to a new study published today in "Lancet Infectious Diseases". Health care-associated infections are a major threat to patient safety worldwide and transmission in these settings is mainly from the hands of health-care workers.
Strategy shown to increase hand hygiene compliance
In six sites in Costa Rica, Italy, Mali, Pakistan and the Kingdom of Saudi Arabia, the research team implemented WHO's strategy in 55 departments in 43 hospitals. During the two-year period between December 2006 and December 2008, compliance with best practices increased from 51% before the study to 67% and infrastructures and staff knowledge were also significantly improved in all sites. The study also demonstrated that this change in practices and safety culture was sustained up until at least two years since the conclusion of the testing phase.
"The WHO strategy was based on a multimodal approach previously proven to have a dramatic effect in reducing the number of health-care related infections at the WHO Collaborating Centre on Patient Safety at the University of Geneva Hospitals, but now for the first time we have evidence of its feasibility and successful effect to improve hand hygiene in a variety of different geographical and income settings, with even greater impact in low-income and middle-income countries than in high-income countries," said Dr Benedetta Allegranzi, Programme Manager, Clean Care is Safer Care, WHO Patient Safety Programme and lead author of the paper.
Hand contact the leading cause of infections
Health care-associated infections usually occur when germs are transferred by health-care providers' hands touching the patient. The most common infections are urinary tract and surgical site infections, pneumonia and infections of the bloodstream and are often caused by multi-drug resistant germs such as methicillin-resistant S. aureus (MRSA). Of every 100 hospitalized patients, at least seven in developed and 10 in developing countries will acquire a health care-associated infection. Among critically ill and vulnerable patients in intensive care units, that figure rises to around 30 per 100. Practising good hand hygiene during health care reduces the risk of these infections and the spread of antimicrobial resistance.
"As resistance to antibiotics and other key medicines becomes more common, it is more essential than ever to reduce the number of avoidable infections in hospital," said Edward Kelley, Coordinator of the Patient Safety Programme at WHO. "The best way of reducing the number of people contracting antimicrobial resistant infections is to protect them from cross-transmission of germs through health-care workers' hands in the first place."
Infection prevention and control is one of the key policy pillars identified by WHO to combat the growing problem of antimicrobial resistance. The other pillars include: appropriate national policies and plans, improving surveillance of these resistant pathogens; uninterrupted access to good quality essential medicines; proper use of medicine, and more research and development of new treatments.
The WHO hand-hygiene compliance strategy
WHO's hand-hygiene compliance strategy consists of five main components:
ensuring health-care workers have access to alcohol-based handrub at the point of patient care;
training and education of health-care workers on the most important times in patient care for hand hygiene;
monitoring and feedback on compliance;
visual reminders at the point of care in the workplace;
creation of a culture of attention to patient and health-care worker safety within the institution.
A simple, cost-effective intervention
"Sometimes the simplest and most cost-effective interventions can have the greatest impact," said Sir Liam Donaldson, WHO Envoy for Patient Safety. "We now have the effective methods to eliminate millions of avoidable sicknesses and death, and reduce the growing problem of antimicrobial resistant infections."
According to the WHO Clean Care is Safer Care Programme, when working with patients, hand hygiene should be performed at 5 key moments, preferably by using an alcohol-based rub or by handwashing with soap and water if hands are visibly dirty. The five moments for hand hygiene are:
before touching a patient;
before clean and aseptic procedures (e.g., inserting devices such as catheters);
after contact with body fluids;
after touching a patient;
after touching patient surroundings.
"WHO's hand-hygiene improvement strategy is recommended by both the US and European Centres for Disease Control, the Joint Commission International and accredited bodies, and almost all professional organizations worldwide," said Professor Didier Pittet, Director, WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, and senior author of the paper.
The strategy has been implemented so far in more than 15 700 health-care settings in 168 countries worldwide and more than 50 governments have based their national hand hygiene campaigns on it. The current study validates its use as a universal gold standard of patient care.