The challenge for academic health partnerships

Belgian hand hygiene campaigns in ICU, 2005-2015

BACKGROUND

Healthcare-associated infections (HCAI) are still a major problem especially in most intensive care units (ICU). Incompliance by clinical staff with hand hygiene (HH) increases rates of preventable infections. We report the outcome of the Belgian national hand hygiene campaign from 2005 to 2015 with focus on intensive care units.

METHODS

Using the World Health organisation (WHO) standardised observation roster, trained infection control teams measured adherence to HH guidelines by direct observation. HH opportunities were counted and the actual episodes of HH were scored as no HH, HH with water and soap, or HH with alcohol-based hand rub. Measurements were repeatedly done before and after a one month awareness campaign every second year. Compliance was stratified by indication and by type of healthcare worker, and computed as a percentage of the number of HH episodes with water and soap or with alcohol-based hand rub, divided by the number of opportunities.

RESULTS

A total of 108,050 hand hygiene opportunities were observed in ICU during this period. HH compliance increased significantly from 49.6 % before campaign in 2005 to 72.0 % before campaign in 2015. Over the same time frame, post campaign compliance increased from 67.0 to 80.2 %. The number of opportunities observed substantially increased when automated feedback was installed.

CONCLUSIONS

In Belgian intensive care units, hand hygiene compliance is getting improved overtime, though consecutive campaigns with immediate feedback are required to achieve and sustain a high compliance rate.

Back to basics: hand hygiene and isolation

Purpose of review

Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions.

Recent findings

Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission.

Summary

Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.

Back to the future: rising to the Semmelweis challenge in hand hygiene

Hand hygiene is the single most important intervention for reducing healthcare associated infections and preventing the spread of antimicrobial resistance. This sentence begins most publications regarding hand hygiene in the medical literature. But why - as we mark 150 years since the publication of Ignaz Semmelweis' landmark monograph on the subject - do we continue to repeat it? One might be tempted to regard it as a truism. However, while tremendous progress has certainly been made in this field, a significant amount of work is yet to be done in both strengthening the evidence regarding the impact of hand hygiene and maximizing its implementation. Hand hygiene cannot yet be taken for granted. This article summarizes historical perspectives, dynamics of microbial colonization and efficacy of hand cleansing methods and agents, elements and impacts of successful hand hygiene promotion, as well as scale-up and sustainability. We also explore hand hygiene myths and current challenges such as monitoring, behavior change, patient participation and research priorities.