Research for infection protection


Best practice: Establishing hand hygiene programmes successfully

Multimodal hand hygiene programmes belong to the best practice when it comes to improving the hand hygiene behaviour among healthcare workers. The practical implementation, however, is a great challenge for clinics. Eva Redon, Spanish infection control nurse at the hospital in Mollet del Vallès reports on the successful implementation of an intervention programme named “IMPULSA”, a pilot programme of HARTMANN’s new Hand Hygiene Evolution Concept.

The success of hand hygiene programmes very much depends on the consent and commitment of the clinic management. How did you achieve this?

Eva Redon: Well, first of all, we had immediately been convinced of the IMPULSA programme that our HARTMANN contact introduced. We wrote an application briefly outlining what steps were necessary to implement the programme, what measures were to be conducted and what they would require in terms of care management. Then, we approached the management, who raised no objections and agreed immediately.

According to WHO, alcohol-based hand disinfectants are the gold standard in hand hygiene. How did the intervention programme help you implement this step?

Eva Redon: The dispenser checklists create the infrastructure necessary for good hand hygiene. Thus, it can be assured throughout the whole clinic that hand disinfectants are available where they are needed: in situations that may involve the transmission of infection but can be prevented by disinfecting the hands in accordance with the 5 Moments of WHO, i.e. at the point of care, e.g. at the patient bed. But that is not enough. The most important for us was to convince employees and explain that alcohol-based products are more effective and skin friendlier than handwashing and really help reduce the infection rate. A great help here were the provided training materials.

What are the main benefits of the intervention programme?

Eva Redon: The IMPULSA programme provides all tools needed to implement the multimodal strategy recommended by WHO. We substantially benefit from the comprehensive education and training service, namely the e-learning tools, the training devices to practice the rub-in technique, the checklists, etc.

Another excellent service is the Observe App, which we can use to digitally observe and evaluate the employees’ hand hygiene behaviour and give feedback on it – in real time.

Regular observation and feedback play a major role in increasing the compliance. How did you manage this before implementing the hand hygiene programme?

Eva Redon: Until 2014, we had conducted paper-based observations using the WHO questionnaire. They consumed a lot of time and resources, hence we could not conduct as many observations as actually needed to create a good data pool. Additionally, we spent more time on the data entry, evaluation and graphic creation than on the observation itself. We had a phase of stagnation, compliance rates did not improve or even decreased slightly. We needed a new approach.

What changed when you introduced the OBSERVE App?

Eva Redon: The digital App fundamentally changed our observation routine. We were able to monitor much more often and without great effort and provide immediate feedback. The high number of observations together with the immediate feedback has had a sustainable influence on the employees’ identification with the correct hand hygiene behaviour. Additionally, the high number of observations enabled us to also identify other weak points in hand hygiene and eliminate these by training, for example, wrong use of gloves, causes of skin dermatitis due to unnecessary combinations of soap and alcohol-based solutions, wrong rub-in techniques, etc.

What improvements resulted from the hand hygiene programme?

Eva Redon: The intervention programme allowed us to actively achieve a systematic change in hand hygiene. Training materials, reminders and continuous observation helped the employees recognise the connection between their action and the occurrence of infections as well as the advantages of acting compliantly. We have increased the compliance rate in our clinic and I am sure that we have prevented more than one infection.

Learn more about multimodal compliance-promoting hand hygiene programmes.

Please click here to read study abstracts on multimodal programmes.