Results of 3 National hand hygiene campaigns in Belgian hospitals

2005-2009

Eva Leens, Anne Simon et le groupe de travail

« Vous êtes en de bonnes mains »

Methodology

1. Awareness campaign with standardised material to improve HH compliance

2. Measuring impact of the campaign- HH compliance (soap and/or alcool / HH opportunities)- Alcohol rub consumption (liter alcohol rub / 10000

patient days)- Respect of basic hygiene conditions (optional, only 3rd

campaign)

Mea surement of HH indicators

Planning

Measurement of HH indicators

NationalFeedback session

Awareness Campaign

During 1 month

1 month later and for 1

month15/04-14/05

9 months later Post-campaign

1 month later and for 1

month

First campaign: 2005

Second campaign: 2006-2007

Third campaign: 2008-2009

Invitation to participate

+ press conference

Awareness campaign: multi modal

• Reminders (posters)• Education of HCW

• standardised powerpoint presentation• Interactive quiz

• Distribution of gadgets for HCW or patients• Promotion of hand rub (posters, black light)• Implication of patients (leaflets, gadget)• Feedback of measurement results before and

after campaign

Campaign messages

• First campaign: Hand hygiene, just do it … and with alcohol rubs

• Second campaign: Hand hygiene, do it correctly

• Third campaign: Do not wear jewellery or artificial nails and keep your

nails clean Use gloves correctly

Measurement of HH compliance

• Direct (overt or covert) observation• By trained observers (IC practitioner or reference

nurses for hospital hygiene)• Standardised observation grid (WHO proofed)• Observation period of 30 minutes, 24/24, 7/7• Minimum 150 opportunities for HH per unit• At least intensive care units• Same methodology before and after campaign

RESULTS

N observed opportunities

Campaigns

N institutions (with both data before and after

campaign)

N opportunitiesBefore campaign After campaign

2005 129 73 663 72 705

2006-2007 158 88 480 84 883

2008-2009 142 107 653 109 826

TOTAL 269 796 267 414

1. HAND HYGIENE COMPLIANCE

2040

6080

100

Com

plia

nce

HH

(%

)

1st campaign (2005) 2nd campaign (2006) 3rd campaign (2008)

Before campaign After campaign

n=148 n=127 n=178 n=158 n=168 n=145N hop

48%53%

69%

58%

69%68%+20%

+16% +11%

Distribution of average HH compliance

HH compliance in psychiatric hospitals

43% 70%20

4060

8010

0

2005 2006 2008

Psychiatric

Before campaign After campaign

Com

plia

nce

HH

(%

)

Base -line acute hosp:

50% 43%

70%

58%

67%

Hand hygiene compliance by profession

020

4060

800

2040

6080

Nurse Aux.nurse

Medical doctor Kine

Before campaign After campaign

Com

plia

nce

HH

(%

)

Overall HH compliance by profession (all).2

.4.6

.81

nurse MD

Com

plia

nce

HH

(%

)

Graphs by hhfct

20%

Evolution of HH compliancein nurses en physicians

.2.4

.6.8

1

2005 2006 2008 2005 2006 2008

nurse MD

Before campaign After campaign

Com

plia

nce

HH

(%

)

Graphs by hhfct

HH compliance by HH indication (all).2

.4.6

.81

Co

mpl

ianc

e H

H (

%)

1 2

Before contact indications

After contact indications

Before campaign After campaign

33%

50%60%

75%

1. Before contact with patient

2. Before clean/invasive action1. After contact with patient

2. After biological liquids exposure

3. After contact with patient environment

.2.4

.6.8

1C

om

plia

nce

HH

(%

)

2005_2 2006_2 2008_2

1 2 1 2 1 2

Before contact indications

After contact indications

HH compliance by indication

Before After

27%

50% 54%

75%

+27%

+25%

27%27%

Before Before After After

2. HAND RUB SOLUTION USE

Proportion Alcool / Alcool + soap0

2040

6080

100

% A

lcoh

ol/(

Alc

oho

l+S

oap)

1st campaign (2005) 2nd campaign (2006) 3rd campaign (2008)

Before campaign After campaign

65%

76%67%

76% 73%78%

3 OBSERVATION OF JEWEL AND NAILS

( Basic requirements)

Participation

N institutions (%)

N observations

Before campaign 82 (52%) 9.863

After campaign 52 (38%) 6.187

• Optionnal participation (3rd campaign)

Impact of the campaign (all)0

510

1520

2530

35%

with

rin

g (

me

an)

before campaign after campaign

% wearing a ring before and after campaign 2008-2009 (all)

05

1015

2025

3035

% w

ith w

atch

(m

ean)

before campaign after campaign

% wearing a watch before and after campaign 2008-2009 (all)

05

10

15

20

25

30

35

% w

ith b

race

let (m

ea

n)

before campaign after campaign

% wearing a bracelet before and after campaign 2008-2009 (all)

Impact by institution category

05

1015

2025

3035

% w

ith r

ing

(m

ean

)

before campaign after campaign

% wearing a ring before and after campaign 2008-2009 (all)

05

1015

2025

3035

% w

ith r

ing

(m

ean

)before campaign after campaign

% wearing a ring before and after campaign 2008-2009 (all)

Acute hospitals Long term care and psychiatric institutions

Impact on professionnal categories

05

1015

2025

3035

4045

5055

stud nurse dr para sup care oth stud para nurse care dr sup oth

before campaign after campaign

% w

ith r

ing

(m

ean

)

Graphs by time0

510

1520

2530

3540

4550

55

stud nurse care sup para dr oth stud nurse care para sup dr oth

before campaign after campaign

% w

ith w

atch

(mea

n)Graphs by time

Ring Watch

Nails0

12

34

5%

with

lon

g na

ils (

me

an)

before campaign after campaign

% with long nails before and after campaign 2008-2009 (all)

01

23

45

% w

ith n

ail p

olis

h (m

ean

)

before campaign after campaign

% with nail polish before and after campaign 2008-2009 (all)

01

23

45

% w

ith n

ail

ext

en

sio

ns

(me

an

)

before campaign after campaign

% with nail extensions before and after campaign 2008-2009 (all)

01

23

45

% w

ith d

irty

nai

ls (

mea

n)

before campaign after campaign

% with dirty nails before and after campaign 2008-2009 (all)

Conclusions for basic requirements• Awareness campaign has a positif impact on

jewels wearing and nails hygiene• Ring and /or watches wearing are the most

frequent problems• Impact is variable depending on type of

institutions and professionnal categories (chronic < acute) and (<< physicians)

• Nails hygiene is good in 50% of the institutions• Students are the best !

General conclusions: Campaigns were succesfull

- High participation rate- Increase of HH compliance at short and long term - Alcohol rub is widely used

Key factors for succes: - Multi modal awareness campaign- Repetition of campaign- National implication- Political and financial support

Antibiotic use management teamsAntibiotic use management teams

1st Camp1st Camp

20052005

2d Camp2d Camp

2006-20072006-2007 3d Camp3d Camp

2008-20092008-2009MRSA new guidelinesMRSA new guidelines

Conclusions

Results:- HH compliance nurses > medical doctors- HH compliance after contact > before contact- Pre-campaign compliance still increases after 3 camp- Post-campaign compliance remains stable after 3 camp- Impact of the campaign on HH compliance decreases

Impact on content of 4th HH campaign

Thank you for your attention!