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Reducing HCAIs
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TOPIC: Hand Hygiene Compliance

Hand Hygiene Compliance 3 months, 3 weeks ago #1

As many of us already know, The Cleanyourhands campaign run by the NPSA was wound up in 2010 due to cuts in funding. Since the campaign was wound up many infection control nurses, clinicians, microbiologists and Trust Chief Executives have voiced their concerns at a "lack of awareness on such a worthwhile campaign". Many of these comments were raised at our March HCAIs Conference and we expect a similar response in June at our Manchester Conference.

So I would like to seek the views of registered users regarding hand hygiene compliance and ask, do you believe the NHS and Healthcare Organisations are doing enough to raise awareness towards washing hands for both patients and staff?

Re: Hand Hygiene Compliance 3 months, 3 weeks ago #2

It was a great campaign, but therein lies the problem with the word 'campaign'  There should be ongoing support, although we know that the most effective hand hygiene is at the point of care, I still believe that everyone should be encourage to sanitise their hands on entry and exits to wards. It is everyone's business. I have seen some excellent posters to remind people, changed on a regular basis so that we see them. I did visit a hospital last week that had no posters and the gel dispensers were not well placed. Patients and visitors need to be encouraged so that they know what standards to expect. I think posters should be in every bay so that the patient will know what is expected of healthcare workers, not just for hand hygiene, but for other procedures, such as inserting lines using aseptic non-touch technique, its very empowering having reminders on display, patients are told its OK to ask (they shouldn't have to), but everyone can forget from time to time.

Re: Hand Hygiene Compliance 3 months, 3 weeks ago #3

I think the NHS and Healthcare organisations can do better and more. More money should be invested in training, auditing and supply of resouces to promote good hand hygiene.

Re: Hand Hygiene Compliance 3 months, 2 weeks ago #4

Agnes, where does the NHS find the money for training? Maria, spot on, what about technology for monitoring hand hygiene for instance video monitoring or rfid?

Re: Hand Hygiene Compliance 3 months, 2 weeks ago #5

The campaign to improve hand hygiene in hospitals in England and Wales contributed to a significant fall in the rates of superbug infections, according to a report.

The study published on the BMJ website showed the amount of soap and hand gel being used tripled during the campaign.

At the same time, levels of MRSA and C. difficile infections in hospitals fell.

The government has since dropped the campaign, but said its ambition was to "wipe out" such infections.

Hospital superbugs were once a real fear for many patients. In response the Clean Your Hands campaign, funded by the Department of Health, was introduced in all hospitals by June 2005.

Alcohol gels were put by bedsides, posters reminded staff to wash their hands and there were regular checks to ensure hands were kept clean.

By 2008, the total amount of soap and alcohol gel being purchased by hospitals trebled, going from 22ml per patient per day to 60ml per patient per day.

Rates of MRSA more than halved in the same time period and C. diff infections fell by more than 40%.
'Success story'

One of the report's authors, Dr Sheldon Stone from the Royal Free University College London Medical School, estimated that around 10,000 lives were saved because of the campaign.

He told the BBC: "It's been a real British success story, we've gone from being the dirty man of Europe to being world leaders.

"What we need to do is keep up the momentum and stay at the forefront of world hand hygiene."

A spokesman from the Department of Health said: "The Clean Your Hands campaign was successful in its aim to highlight the importance of good hand hygiene practice across the NHS. We know this has been successful.

"The challenge now is to ensure the NHS embeds the good practice highlighted in the campaign to achieve our ambition to wipe out avoidable healthcare-associated infection.

"We know real progress has been made in this area as MRSA bloodstream infections have dropped by 41% and C. difficile by 30% across the NHS in England since 2009/10."

Re: Hand Hygiene Compliance 3 months, 2 weeks ago #6

One particular study, carried out at North Shore Hospital, Manhasset, New York, aimed to evaluate health care workers and hand hygiene compliance with staggering results. Donna Armellino, vice president of infection prevention of North Shore – the fourth-largest hospital in the New York metropolitan area one of the cornerstones of the North Shore-LIJ Health System, states how technology has dramatically increased hand hygiene compliance.

We invested in technology in our ICU unit which included a 3rd party remote video auditing service supplied by Arrowsight. When we started, the initial rates of hand hygiene compliance were found to be less than 10%. When we informed the staff of the rates and the measurement rules we saw a rapid increase in hand hygiene performance to over 80%. The current rates of hand hygiene compliance are roughly 90%, which represents the strongest value of the technology - sustainability. We have now monitored a surgical ICU which when we started was below 30% and once we started informing them of their rates, they increased their hand hygiene rates to roughly 90% and continue to perform at these high levels. Prior to installing the technology and LED boards, the hospital had utilized a hand hygiene monitoring methodology which led us to believe that we had ~60% compliance, but this method had limitations both in terms of accuracy and sustainability. With the implementation of technology we have gained a long-term solution. We are now monitoring hand hygiene 24/7 and creating a competitive culture where staff are determined to keep their unit’s standards high.

This study is groundbreaking since it is an innovative way to assess specific actions, delivers information, and generates results. The technology has the ability to measure and modify staff behaviour towards hand hygiene whilst also allowing assessment of how staff are ensuring the risk for infection is decreased. The Hospital staff welcomed the technology and understand the benefit it can bring to patients and the long-term care we deliver.
This is not Big Brother but an incentivized way that Arrowsight has developed that helps dramatically to reduce infection and undoubtedly will save lives.

At the end of the day US or UK we are all after the same thing to cure patients not infect them.
Please share with me your thoughts and concerns I am happy to reply.
Last Edit: 3 months, 2 weeks ago by Scott Buckler.

Re: Hand Hygiene Compliance 3 months, 1 week ago #7

I recently attended IPS local conference Yorkshire region. The good news is that Julie Storr et al are setting up and independant body to raise awareness in this field.

Re: Hand Hygiene Compliance 2 months, 2 weeks ago #8

Hi, as discussed in the previous thread, Training and Auditing/Monitoring are a definite "Must" for healthcare organisations in order to improve Hand Hygiene compliance. If the good campaigns that help raise awareness to staff, patients and visitors are cut then the effectiveness of this is highly reduced.
As for funding, if the NHS is struggling to fund training then I wonder how they will fund for the mentioned Video Monitoring. I ask myself what is the point of monitoring people on doing something they are not well trained to do? It seems like a setup for failure. In all, I don't believe one workswithout the other do a 50/50 investment needs to be made in order to increase both awareness and compliance.

Re: Hand Hygiene Compliance 2 months, 2 weeks ago #9

I am fortunate to work for an organisation that supports this issue and independently run an annual awarness campaign to support hand hygiene across all disciplines of staff, it also is supportive of Bare below elbows too.

Re: Hand Hygiene Compliance 2 months, 2 weeks ago #10

Hi Scott,

I believe that hand hygiene awareness and compliance has been improved massively due to this campaign and although the campaign is no more, many organisations are still embedding this important knowledge into their staff induction programmes and placing appropriate signage and messages within their premises. Infection Control Champions have emerged and are busy implementing the standards set by the campaign and are using up to date knowledge from WHO. Here is a clip from their website on this years annual campaign:-

Five steps to 5 May 2012 - What's YOUR plan?

Our 2012 call to action was "create your action plan based on your facility's results using the WHO Hand Hygiene Self-Assessment Framework".
Congratulations to everyone who has worked hard to be part of the celebrations for the fourth year of WHO SAVE LIVES: Clean Your Hands. The commitment again has been overwhelming and demonstrates that there is truly a global momentum for improving patient safety through clean hands year on year.

Hand Hygience Compliance - Fact or Fiction? 2 months ago #11

After attending many Govtoday Events and listening to many front line staff, I am amazed that there are still Trusts throughout the UK who feel that they are Hand Hygiene Compliant with their statistics displayed at 100%, as if they are honest and factual. In attending hospitals with family and from my position as Chair of MRSA Action UK I have seen a failure in total compliance of hand hygiene, as an example, in one A&E bay with one sink, in a space of twenty minutes, not one member of staff washed at the sink.

I have no doubt that the staff that carry out the audits set out to prove that their trust are doing a good job, but of course could do better. Organisations, hierarchy are very comfortable with a system that supports the view they are being transparent, however is self-assessment an acceptable form of scrutiny, or should this be independent?

I have found that from experience with working in the Nuclear Industry that if you are trying to be transparent and give real audits results you would not inform your staff that you are observing them in their compliance. For example standing next to them by the sink with a clipboard may give them an inkling that they are being assessed!

This is not a true audit, it’s at best a self-fulfilling prophecy or some may say a scam. In fact the staff are not telling lies, but because of the “hawthorn effect” it gives the effect of full compliance and it just makes sure the results support a story of acceptable compliance. The results are geared not to embarrass anyone however they do mask the reality...

Surely the first thing that must occur is a reality check to accept independent auditing otherwise any successes by dedicated professional staff are hidden behind a smokescreen of self assessment giving a fantasy illusion.

From my experience in the Nuclear Industry with self-audits having our own staff doing audit compliance on colleagues is like NHS Staff carrying out audits on their NHS colleagues and reporting to their joint NHS superior who passes this upwards and this is riddled with problems, starting with possibly protecting their positions which I have seen in my own industry.

As one NHS staff member said I “what’s the point of real figures, all it would do is upset my colleagues, my boss and his bosses whilst frightening patients...better to go for improvement and not rock the boat”.

Do you think that the Trusts who provide real independent audit figures are those who score the lowest?

Are they then chastised for their honesty?

What are your thoughts about this?
Last Edit: 2 months ago by Matthew Abbott.

Re: Hand Hygiene Compliance 1 month, 1 week ago #12

I don't believe that enough is currently being done to promote hand hygiene compliance within the NHS. Since hand hygiene is one of the most important procedures in prevention of cross contamination and cross infection, more should be being done to raise awareness of hand washing. In particular, hand washing is often a rushed procedure and emphasis should be placed on the length of time and the correct technique required to reduce contamination. Furthermore, with repeated hand washing, skin conditions can become a problem and referrals to occupational health and the use of moisturisers should be encouraged where required.

Re: Hand Hygiene Compliance 1 month, 1 week ago #13

I think we should give video monitoring a try. We know that if there is someone auditing you get the Halo effect and there is a conscious effort made to improve practice. Strategically placed cameras could pick up how often sinks are used and the technique, are we washing hands effectively? We shouldn't be over reliant on gels so using video monitoring at sinks is a good idea. Video monitoring with feedback has been proven to work well, its also used in simulation in training and is a useful tool for looking at other aspects of care.

Re: Hand Hygiene Compliance 1 month ago #14

Whenever we write to our elected representatives with concerns, we are offered sincere condolences and/or told how sorry everyone is when things go wrong, and how seriously complaints are taken. Then of course we are told about the great achievements that have happened and how the publication of weekly statistics will give us informed choice about where we can be treated. We are told how the Code of Practice for the NHS on the prevention and control of healthcare associated infections is going to bring about sustained improvements, usually a couple of paragraphs in a letter prepared by a public servant for Ministers.

Our view:
The Code of Practice for the NHS on the prevention and control of healthcare associated infections.

The Code of Practice for the NHS on the prevention and control of healthcare associated infections is enshrined in legislation and should be regarded as a minimum standard (not a maximum as some would like to think), however not all providers adhere to it. The CQC's own inspection regime and reports evidence this. Our charity also receives regular feedback from patients and relatives to suggest there is still widespread evidence of organisations where the culture change needed to adopt a zero tolerance to harm caused by avoidable infections is not in place. Private facilities where NHS operations are carried out should be adopting the Code of Practice, but feedback suggests this is not the case with patients being told there is no requirement for screening for MRSA for elective surgery as an example, only this month we heard from a patient who preferred to postpone surgery commissioned by the NHS for knee surgery, for this very reason.

Worryingly there are wide variations in training for both Acute and Primary care staff, the last CQC's staff survey findings showed that only 63% of hospital staff agreed with the statement "If a friend or relative needed treatment, I would be happy with the standard of care provided by this Trust". For Primary Care Trusts even fewer staff agreed with the statement at 55%.

Only 67% of hospital staff said hand washing materials are always available when they need them, compared to 68% of staff in Primary Care Trusts.

Only 70% of hospital staff said they had received infection control training in the last 12 months, and a staggering 35% in Primary Care Trusts. In any other industry these figures for a safety initiative would be deemed an abject failure of the policies for that organisation.

These are appalling statistics if you take into consideration the Code of Practice sets out that training is a requirement in all aspects of infection prevention and control. The NHS never fails to find the monies to treat patients after and infection, yet complains it never has the monies for prevention such as training.

Aseptic technique

Aseptic technique is mentioned in the Code of Practice; however there is no requirement for a standardised practice either in NHS or private healthcare.
The Association of Safe Aseptic Practitioners (ASAP), is a registered charity, whose mission is to “help reduce healthcare associated infections and improve the patient experience by establishing a universal practice framework for aseptic technique”. We have recognised the need for a standard in such a critical area, and share ASAP’s concern that no other industry would leave such a critical issue of safety unstandardised, and that a standard should be legislated for and a required competency for all clinical staff.

Hand hygiene compliance.

If staff do not want to bother to wash hands between patients then they are in the wrong profession, a view given by Sir Liam Donaldson at the launch of year 3 of the Cleanyourhands. He is correct in our view. Not enough attention is being given to this fundamental area of preventing infection. Audits are inaccurate and should be carried out independently. It is common to see a sink at the end of a bay being ignored by staff when moving between patients. We have experienced this first hand, we shouldn’t have to ask. If staff don’t comply then they need to be told, if they still don’t comply then they can leave the profession, we concur with Sir Liam, they are in the wrong job if they don’t think they have to comply with this simple measure.

Meaningful choice and the provision of information.

In terms of making meaningful choices about care, there is wide variation in terms of what is reported.
Not every hospital sends samples for testing when it comes to Clostridium difficile. Surgical site infections are not monitored consistently and not included in the weekly statistics. What is more, there are many infections caused by other organisms that are not included in the numbers. The data is not comprehensive enough to be able to make informed choices, but more worryingly there is a false sense of security by the proclamations of huge success, when there are an estimated 300,000 infections acquired in hospital a year which will cause considerable distress to patients, and sadly in many cases death. MRSA and Clostridium difficile alone caused more than 3,600 deaths between 2009 and 2010. Taking other organisms into consideration the best estimates are more like 15,000 deaths caused by healthcare associated infections a year (Public Accounts Committee).

Hand hygiene is a fundamental basic of good infection prevention and control that patients have right to expect when receiving care, yet in spite of 5 or more years of the Cleanyourhands campaign the figures above for hand hygiene compliance are abysmal. Let us be under no illusions we may have reduced the numbers of recordable healthcare infections over the past few years, but the figures show that these are just the tip of a very large iceberg, hand hygiene can only be a part of a comprehensive infection control system to reduce harm to patients.

Re: Hand Hygiene Compliance 1 month ago #15

I agree with everything Derek has said, and hand hygiene must be combined with other good practice to keep infection risk to a minimum. Good aseptic technique, preferably non-touch - not touching key parts - has to be practised. I believe posters showing the correct hand hygiene technique and the general principles of asepsis should be displayed in wards and healthcare facilities where clinical care is given so that those of us who are brave enough to ask can make reference to them - this could be quite empowering. Staff shouldn't have to be reminded but on the occasions when I have had to do this I wish I could have had something to hand to refer to, such as a poster saying what standards to expect. We are encouraged to give feedback, but when we do we often feel patronised by the response, and as a result feel disheartened, patients are willing to give good feedback too, all can be learned from.
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