Improving hand hygiene compliance

At the recent Global Health Policy Summit, the Prime Minister, David Cameron, challenged the NHS to innovate through partnership. In his address he concluded: “That is my message today. Britain is open for business, open for partnership and open to ideas.” With this in mind and with the ever-increasing challenges of improving efficiency, improving patient safety and patient experience, can the NHS find partners to help address what is now an age old problem; hand hygiene compliance? How can healthcare providers be assured that their hand hygiene compliance is of an acceptable quality and be sure that their measurements are objective? One solution is for partnership, working with the aim of objective hand hygiene audit. This offers an unbiased evaluation of hand hygiene practices for assurance and as part of the clinical audit cycle. The importance of hand hygiene in reducing the risk of transmitting infections – in particular healthcareassociated infections (HCAI) is well established. As far back as 1847, Semmelweiss was able to provide conclusive clinical evidence to show that improved hand hygiene compliance led to significantly improved patient outcomes (Best and Neuhauser 2004). It is now accepted that hand hygiene is potentially the single most important intervention to reduce the risk of the transmission of infection and according to Stone (Stone 2001), ‘if hand hygiene were a new drug it would be used by all.’ The World Health Organization (WHO) undertook the task of reviewing the available literature regarding hand hygiene. This was considered to be the foundation of its Hand Hygiene Guidelines (WHO 2009). WHO concluded that there were five moments during health and social care when hand hygiene is critical:

1 Before patient contact.
2 Before aseptic task.
3 After body fluid exposure risk.
4 After patient contact.
 5 After contact with patient surroundings.

The evidence is clear that hand hygiene makes a real difference to the lives of healthcare staff, who are potentially themselves at risk of infection through exposure at work, as well as patients and service users. The National Patient Safety Agency (NPSA) ran a national campaign based on a two-prong strategy; increased awareness for staff as well as increased awareness for patients and service users (NPSA 2004). Good and timely hand hygiene was one of the key messages of the Department of Health’s pandemic influenza campaign, Catch It, Bin, It, Kill It (DH 2008). The continuing gap between theory and practice is an ongoing challenge for all health and social care providers. In the review papers evaluated by the WHO over the past 20 years, the range for hand hygiene compliance is cited at an average of 38.7% (baseline assessments) (WHO 2009). These same papers describe compliance improving to between 20% and 100% following a range of interventions such as education, poster campaigns or changes to hand hygiene products.