Pittet_EU_Infectious.qxp 24/1/08 9:05 am Page 10
Infection Control
Developing the World Health Organization Hand Hygiene Improvement Strategy
a report by
Didier Pittet,
1,2
Benedetta Allegranzi,
2
Sepideh Bagheri Nejad,
2
Gerald Dziekan,
2
Agnes Leotsakos
2
and Julie Storr
2
1. Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva;
2. World Health Organization (WHO) World Alliance for Patient Safety, First Global Patient Safety Challenge, Geneva
Healthcare-associated infection (HAI) affects hundreds of millions capacity to survive on skin for differing times. Defective hand hygiene
of people worldwide and is a major global issue for patient safety. contributes to germ proliferation and hand transmission during patient
During healthcare delivery, pathogens are transmitted by the hands care, whereas adequate and timely hand hygiene techniques are
of healthcare workers (HCWs) in most cases. Inspired by Semmelweis’ essential for effective removal of contamination and for preventing
innovative approach in the mid-1800s, researchers have investigated in persistent colonisation.
recent years the best method by which to change the behavioural
attitudes of HCWs towards hand hygiene and have demonstrated the Strategies to Promote Hand Hygiene
effectiveness of improved practices in decreasing HAI rates. Despite the accumulated scientific evidence on the importance of hand
transmission, optimal hand hygiene practices are seldom observed
Prevention of HAI is the target of the First Global Patient Safety and HCWs frequently seem to be almost reluctant to change their
Challenge, ‘Clean Care is Safer Care’, launched in October 2005 by the behaviour. According to the literature, compliance with hand hygiene is
World Health Organization (WHO) World Alliance for Patient Safety. unacceptably poor, with mean baseline rates ranging from 5 to 81%
Since then, a formal statement has been signed by 80 ministries of and an overall average of about 40%.
2
The major determinants of poor
health as a pledge of their support for actions to reduce HAI, leading practice are time constraints and intensive workload, lack of adequate
to coverage of more than three-quarters of the worldwide population. structures and equipment for hand hygiene close to the point of care,
The WHO ‘Guidelines on Hand Hygiene in Health Care’ have been knowledge gaps or forgetfulness. The behavioural attitudes of HCWs
developed and an implementation strategy based on simple and towards compliance with recommended practices are extremely
affordable solutions to improve hand hygiene at the bedside is being complex and multifactorial, and experts agree that a successful
tested on a large scale at several sites around the world. programme must be multidisciplinary and based on multiple
interventions tailored to target the most important reasons for poor
Hand Transmission of Micro-organisms in Healthcare compliance among HCWs.
3–7
A clear understanding of the process of hand transmission is critical
to successful education strategies, assessment of the hand hygiene Many studies showed a significant increase in hand hygiene
performance of healthcare workers and research. According to compliance after the introduction of multimodal strategies combining
existing scientific evidence, a five-step sequential model for hand several elements.
8–18
The availability of alcohol-based handrub
transmission has been identified.
1
As the starting point, both formulations in dispensers located at the point of care or in individual
the patient’s skin and the inanimate environment harbour pocket bottles is considered the key to achieving behavioural changes
large numbers of germs, including multiresistant bacteria, fungi and and improving adherence.
2,8,9,12,16–22
An assessment of the local
viruses. In addition to resident flora, HCWs contaminate their hands situation regarding the structures available for hand hygiene, the
with high loads of transient flora through exposure to colonised perception and knowledge on the part of HCWs on the importance of
objects, inanimate surfaces and patients. Hand colonisation was HAI and hand hygiene and the monitoring of compliance rates are
shown to increase progressively during patient care due to germ crucial in identifying obstacles and increasing awareness about the
need for improvement. In addition, effective hand hygiene promotion
Didier Pittet is a Professor of Medicine and Hospital
has been based on a reinforcement of staff education, appropriate
Epidemiology, an Attending Physician in Adult and Paediatric rewarding, visible administrative support and active involvement of a
Infectious Diseases and Director of the Infection Control
large number of organisational leaders, enhanced individual
Programme at the University of Geneva Hospitals,
Switzerland. He is also Honorary Professor in the Division of
participation and self-efficacy, patient involvement and, in some cases,
Investigative Sciences and School of Medicine, Imperial
administrative sanctions for non-compliance.
College London. Dr Pittet serves on the Editorial Boards of the
American Journal of Infection Control, the American Journal of
Respiratory and Critical Care Medicine, The Lancet Infectious
The First Global Patient Safety Challenge –
Diseases and Infection Control and Hospital Epidemiology. He is also an editorial consultant for
‘Clean Care Is Safer Care’
The Lancet. He currently leads the First Global Patient Safety Challenge ‘Clean Care is Safer
Care’ of the World Health Organization (WHO) World Alliance for Patient Safety. He was
Every two years, the WHO World Alliance for Patient Safety launches
awarded the CBE in 2007 by HM Queen Elizabeth II for services to the prevention of healthcare- a Challenge to galvanise global commitment and action on a
associated infection in the UK. His major research interests include the epidemiology and
relevant topic. The topic chosen for the first challenge in 2005 was the
prevention of nosocomial infections, methods for improving compliance with hand hygiene
practices and methods for improving the quality of patient care and patient safety.
prevention of HAI. Under the banner ‘Clean Care is Safer Care’,
E:
didier.pittet@hcuge.ch
the Challenge covers actions in five major areas: blood safety, clinical
procedure safety, injection safety, sanitation and waste management
10 © TOUCH BRIEFINGS 2007
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