Changing culture on the front line

These issues were some of the key challenges explored by speakers at a recent conference, hosted by the Infection Prevention Society. LOUISE FRAMPTON reports.

Identifying effective strategies to deliver a sustainable “safety culture” remains a key challenge for infection prevention teams. Speakers at the Infection Prevention Society’s conference, held in Harrogate, recently shared their insights into the way forward – giving advice on influencing ingrained patterns of behaviour, overcoming resistance and engaging others with global initiatives to improve the way they work. Claire Kilpatrick, programme manager and technical officer, WHO World Alliance for Patient Safety, and Julie Storr, project manager, National Patient Safety Agency (NPSA), examined the issue of “how to make an impact on patient safety every single moment” and staged a game show, “Who wants to save a million lives?” (based on Chris Tarrant’s TV quiz), in a bid to engage delegates with the issue of hand hygiene. They acknowledged that one of the most over-used sound bites of the modern age is that “hand hygiene is the single most important practice for the prevention of cross infection”, and therefore sought a more memorable approach to promoting their hygiene message – a strategy that they hoped would inspire other delegates when returning to their own organisations and attempting to change practice. Highlighting the risks of cross contamination, they pointed out that in a single patient zone there are approximately 14,000 billion of a patient’s own microbes and gave an insight into the World Health Organization’s international guidelines on hand hygiene in healthcare which were launched earlier this year.1 Project director for the “Clean your Hands” campaign, Julie Storr is a contributing author of the WHO guidelines. Claire Kilpatrick, who joined WHO’s First Global Patient safety Challenge as programme manager in October 2008, also has an active role in leading and supporting the promotion of the guidelines and the “implementation tool kit”.2 They stressed the importance of embedding the recommendations into practice and raising awareness of the international guidelines, to promote a global movement around hand hygiene and infection prevention. A key feature of the guidelines is the “My Five Moments for Hand Hygiene” approach, which is aimed at protecting the patient, the healthcare worker and the healthcare environment against harmful germs. This approach recommends that healthcare workers perform hand hygiene at five key moments: • Before touching a patient. • Before clean/aseptic procedures. • After body fluid exposure/risk. • After touching a patient. • After touching patient surroundings. At present, compliance with hand hygiene at these critical moments averages at around 40%, which means that healthcare workers are failing to clean their hands 60% of the time that they should. The WHO guidance highlights the evidence supporting hand hygiene recommendations and aims to influence sustainable change in the behaviour of healthcare workers on an international scale. To deliver this, the WHO “Multimodel Hand Hygiene Improvement Strategy” includes five critical components that all healthcare facilities must address. These are:

System change: ensuring that the necessary infrastructure is in place to allow healthcare workers to practice hand hygiene – such as hand rubs at the point of care; access to safe, continuous water supply, soap and towels.
Training and education: providing regular training on the importance of hand hygiene, based on the “My Five Moments for Hand Hygiene” approach, and the correct procedures for hand rubbing and hand washing, to all healthcare workers.
Observation and feedback: monitoring hand hygiene practices and infrastructure, along with perceptions and knowledge, while providing performance and results feedback to staff.
Reminders in the workplace: prompting and reminding healthcare workers about the importance of hand hygiene, as well as the appropriate indications and procedures for performing it. This may include the use of “social marketing tools” and posters, for example.
Institutional safety climate: guaranteeing consideration of hand hygiene improvement is a high priority at all levels, including ensuring active participation at both institutional and individual levels.