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Hand Hygiene Survey: Preliminary Results

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Title: Hand Hygiene Survey: Preliminary Results


1
Hand Hygiene SurveyPreliminary Results
  • A. McGeer, K. Green, J. Lourenco, and G. Youssef
    for the Hand Hygiene Research Steering Committee

2
Background
  • The CPSI, CCHSA, PHAC and CHICA are working
    together to develop a national hand hygiene (HH)
    campaign
  • Goal To improve support to healthcare and public
    health organizations implementing HH initiatives
    across Canada

3
Background (cont.)
  • HH Study Objective to provide guidance to
    healthcare decision makers wishing to implement
    successful HH programs
  • Help us to assess the following in Canadian
    healthcare facilities
  • HH adherence
  • Current HH initiatives and which are considered
    effective
  • What type of support is needed

4
Study Description
  • The HH survey includes 52 questions on
  • Respondent demographics
  • Current HH environment and practices
  • HH initiatives and their perceived effectiveness
  • Needed resources
  • Future HH plans
  • Survey was available on the CHICA website from
    April to May 2007
  • CHICA has 1327 members
  • Infection control professionals located across
    Canada
  • Come from different backgrounds including
    nursing, medicine, microbiology, medical
    technology, and epidemiology
  • 171 CHICA members responded

5
Participants
6
Facility types of participants
7
Province in which participants are located
All Facilities
Acute Care Facilities
8
Participants role in their organization
9
Hand Hygiene Survey Findings for Acute Care
Facilities
10
Number of facilities in which there is a written
HH policy and if the policy is signed
  • Provide sample hand hygiene policies

11
Number of facilities that provide HH educational
programs to staff
  • In most sites, HH education is not mandatory
  • Provide advice on how to ensure that most staff
    are educated

12
Types of HH products provided to staff by
facilities
  • Very few are providing hand lotions and
    individual alcohol sanitizers

13
Location of HH products in the facility
  • Were doing a good job of getting products into
    public areas but not to point of care
  • Need to help facilities determine optimal product
    placement

14
Types of skin care programs provided to staff by
facilities
  • 41 of responding acute-care facilities provide
    skin care programs to staff
  • Provide skin care program tools

15
Types of tools for monitoring HH adherence used
by facilities
  • 37 of respondents chose None
  • Need to explain why monitoring is important and
    how good each method is at determining adherence

16
Reasons why facilities have not audited HH
adherence
  • Provide sites with auditing tools
  • Suggest strategies on how to make time for
    auditing and on how to obtain necessary resources

17
HH Initiatives
  • 76 of organizations have implemented initiatives
    to improve hand hygiene in the last 2 years
  • 31 of facilities receive financial support for
    HH initiatives
  • Only 32 of these receive internal funding
  • Provide strategies for obtaining financial support

18
Individuals targeted by HH initiatives
19
Components of HH initiatives
  • Very few include staff in planning or have
    baseline or post-implementation audits
  • Provide staff education to ensure that it is
    adequate

20
Most effective component of campaign
  • Increased access to alcohol hand rub
  • Demonstration (Glo-germ, paint)
  • Personal hand rub
  • Feedback on performance
  • Identify positive strategies on how to inform
    staff of their performance

21
Least effective component of campaign
  • Posters/ signs/ buttons/ fridge magnets (without
    other components or without ability to change
    esp if negative)
  • Education (esp. one-time, large group, not
    interactive)
  • Alcohol hand rub at hospital entrance
  • Negative messaging from/punitive sense to audits
  • Identify positive strategies on how to inform
    staff of their performance

22
Most useful added resources
  • Audit tools
  • Posters and supplies (lanyards, shoelaces,
    pencils, erasers, etc.)
  • Downloadable from internet
  • Information from other projects (other countries,
    other hospitals)
  • Videos
  • Provide pre-tested promotional tools that can be
    adapted to other facilities

23
Greatest organizational challenge
  • Senior management commitment
  • Not considered important enough
  • Need strategies to get senior management on board
    with initiatives
  • Time for staff to come to in-services
  • Physician buy-in/participation
  • Hand care programs

24
Additional Findings
  • 8 have a dedicated budget for promotional
    material
  • 46 reported hospital rules and regulations that
    limit their use of promotional material
  • 17 of facilities include adherence in staff
    performance reviews
  • 13 of those facilities take disciplinary actions
    for non-adherence
  • Provide ideas on how to include adherence in
    performance reviews and on what disciplinary
    actions should be taken

25
Additional Findings
  • 16 of facilities include adherence to HH
    policies in their job descriptions
  • 12 of facilities have monitored patient
    impressions of adherence in satisfaction surveys
  • Provide patient satisfaction surveys

26
Acute vs. Other Facility Types 1
  • Facilities that identified themselves as acute
    and those that did not were at equal risk of
  • Having a written HH policy
  • Providing HH educational programs to staff
  • Providing staff with alcohol hand sanitizers,
    non-antibacterial soap, and individual alcohol
    hand sanitizers
  • Providing HH products on beds
  • Providing HH skin care programs to staff
  • Monitoring consumption of products, electronic
    monitoring, self-assessment, or using no tools
    for auditing HH adherence
  • Not auditing HH due to no time, no tools, and no
    resources
  • Implementing a HH initiative in the last 2 years
    and receiving financial support for their HH
    initiatives
  • Targeting their HH initiatives towards staff,
    patients, and visitors
  • Most components of their HH initiatives
  • Hospital rules limiting their use of promotional
    material
  • Including adherence in staff performance reviews
    and taking disciplinary measures for
    non-adherence
  • Monitoring patient impressions of adherence in
    satisfaction surveys

27
Acute vs. Other Facility Types 2
  • Facilities that identified themselves as acute
    were at greater risk of
  • Providing staff with
  • hand lotion (RR1.93, 95 CI1.35-2.78)
  • anti-bacterial soap (RR2.59, CI1.46-4.60)
  • surgical scrub (RR4.60, CI2.98-7.10)
  • Providing HH products in the
  • Elevator bays (RR1.32, CI1.03-1.69)
  • Waiting areas (RR3.76, CI2.13-6.63)
  • Main lobby (RR6.67, CI1.17-6.11)
  • Staff common areas (RR2.60, CI1.38-4.91)
  • Bedside (RR1.56, CI1.26-1.93)
  • Exam rooms (RR4.40, CI2.60-7.45)
  • Door to room (RR8.25, CI4.21-16.17)
  • Among those that did provide skin care programs,
    providing programs for staff with skin problems
    (RR2.13, CI1.29-3.51)
  • Using adherence audits to monitor HH adherence
    (RR1.37, CI1.10-1.71)
  • Collecting baseline indicators as part of their
    HH initiatives (RR1.27, CI1.05-1.52)

28
Acute vs. Other Facility Types 3
  • Facilities that DID NOT identify themselves as
    acute were at a greater risk of
  • Having a dedicated budget for promotional
    material (RR1.18, 95 CI1.03-1.34)
  • Including adherence to HH policies in their job
    description (RR1.15, 95 CI1.04-1.28)

29
Future Actions
  • 1636 surveys were mailed out to 1144 hospitals in
    July 2007
  • Thus far, 307 people have responded
  • In October 2007 surveys will be sent out to
    long-term care, rehabilitation, and mental health
    facilities, public health units, and emergency
    medical services
  • Focus groups starting in October 2007 will delve
    further into findings concerning HH initiatives

30
Summary of Recommendations 1
  • Only 23 of facilities are providing individual
    alcohol sanitizers
  • Need tools that describe optimal product
    placement (especially at point of patient care)
    and how to determine this
  • Since 37 of respondents indicated that they have
    no tools for monitoring HH adherence and 41 cite
    no tools as the reason for not auditing, provide
    auditing tools and information on how good the
    different methods of monitoring are at
    determining adherence
  • Provide pre-tested promotional tools

31
Summary of Recommendations 2
  • Describe HH initiatives that have been effective
    in other facilities beyond (staff education)
  • Provide sites with strategies on how to make time
    for auditing and on how to obtain the necessary
    resources
  • Provide strategies to obtain financial support
  • Since very few sites are providing hand lotion
    and only 41 are providing skin care programs for
    staff, we need to provide sites with skin care
    program tools
  • Provide ideas on how to include HH in staff
    performance reviews
  • Identify positive strategies on how to inform
    staff of their performance
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