Hand Hygiene Compliance Requires Hospital Leadership Buy-in

Researchers from the VICNISS Coordinating Centre in Melbourne, Australia and from the Quality, Safety and Patient Experience of the Department of Health in Victoria, Australia, report on a hand hygiene-related project in a presentation at the International Conference on Prevention & Infection Control (ICPIC), held in Geneva, Switzerland June 29-July 2, 2011. In 2004, the Victorian Quality Council of Australia developed a state-wide model aiming to improve hand hygiene and reduce healthcare-associated infections (HAIs) across Victoria. Many aspects of this culture-change program were  incorporated into the National Hand Hygiene Initiative that commenced in 2008.

All 86 acute public health services in Victoria were funded to participate and submit three hand hygiene compliance audits per year. Education, resources and auditor training was provided. Healthcare worker hand hygiene compliance was assessed by direct observation using a tool based on the WHOs 5 Moments of Hand Hygiene.

In 2009, an organizational hand hygiene compliance benchmark was included in the Health Service Performance Management Framework of the Department of Health. Health service chief executive officers were provided quarterly feedback as to their performance against the agreed benchmark; this performance was also made known between organizations.

Bradford, et al. report that health services have progressively improved compliance and most recently, 95 percent achieved the current benchmark of 65 percent hand hygiene compliance. Feedback from infection control consultants has also been positive, reporting a marked increase in executive support for the hand hygiene initiative.

The researchers conclude that successful implementation and sustainability of any hand hygiene initiative requires leadership from all levels, including government, health service CEO, and ownership of the program by individual clinical areas and clinicians. Hand hygiene compliance as a performance indicator promotes executive commitment to the program and ensures hand hygiene is an institutional priority.

Reference: J Bradford, J Brett, A Bull, B Kennedy, S Borrell, A McMillan and M Richards. Changing behavior ensuring hand hygiene is an institutional priority. Presentation at International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):P111doi:10.1186/1753-6561-5-S6-P111. http://www.biomedcentral.com/1753-6561/5/S6/P111