The cleanyourhands campaign

1
Everyones business The cleanyourhands campaign
approach to hand hygiene improvement
Dr Helen Glenister Deputy Chief Executive
2
Hand hygiene promotion

• all things are difficult before they become
  easy
• Persian Proverb

3
Why we started the workUnderstanding the
problem 2002

• Hospital acquired infection is a local, national
  and international issue
• - 300,000 patients per year UK 2 million US
• - 5,000 deaths UK 90,000 US
• - 1bn UK US 17-29 billion
• Good hand hygiene compliance can probably reduce
  these statistics by 9-50
• Hand hygiene has an average international
  compliance of around 40

4
Making the right behaviour irresistible
5
Starting from the user perspective

• Humans arent machines. Designing solutions in
  the social
• context requires understanding the human
  experience and
• perspective and redesigning the system to
  promote, support
• And sustain optimal practice. We need to identify
  the
• barriers to the desired behaviour, dismantle them
  - and then
• build new ones which make it really hard not to
  do the right
• thing.
• We are also habit-forming. In clean hands
  Nirvana,
• performing hand hygiene at the right time, every
  time we
• should, is intuitive, involves no need to stop,
  to think, to
• choose.

6
The cleanyourhands campaign

• Learning from international and local examples of
  improvement (Geneva, Lewisham)
• Being clear about the desired behaviour
• - Decontaminating hands at every opportunity
• - Doing it at the point of care
• - Ensuring that patients can see healthcare
  staff
• cleaning their hands
• Understanding the barriers to compliance
• Employing social marketing techniques to overcome
  them
• Delivering sustainable, measurable improvements

7
Why a Social Marketing model?

• What is new about social marketing is that it
  brings all
• the necessary tools together in a comprehensive
• strategic framework which puts the target
  consumer
• (or stakeholder) at the centre of our thinking.
  
• Institute of Social Marketing (ISM)

8
(No Transcript)
9
The pilot

• Six month pilot in six trusts in 2004
• Evaluated through
• Staff surveys
• Patient interview survey
• Staff interview
• Staff diary
• Staff observation
• Usage of hand rubs

10
So - how irresistible was it?

• 84 staff stated posters influenced hand hygiene
• 39 staff asked at least once have you cleaned
  your hands?
• 97 staff comfortable being asked
• 71 patients thought they should be involved
• Product usage increased 2.5 times
• Evaluation showed compliance increased from
  28-76
• If replicated nationally, could save 450 lives
  and 140 million a year

11
National driver
12
National implementation in five phases

• Implementers
• Agreed to implement alcohol hand rubs
• Agreed to assign roles/responsibilities to ensure
  NPAH remains
• Agreed to assign roles/responsibilities to ensure
  materials are displayed and changed
• Engaged commitment from every level of the
  organisation
• 173/174 trusts in England and 100/100 in Wales

13
Pre-campaign preparation

• Getting all levels of organisation on board,
  monitoring compliance

14
Logistics
15
Point of care prompts (posters)
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Microsite

• Sharing implementation best practice (microsite)

20
Point of care hand rub
campaign implemented year 1
Year 2
Year 3
Year 4
Campaign Refreshed. Campaign evaluated
Campaign Refreshed. Campaign evaluated
Campaign Refreshed. Campaign evaluated
Marcomms/ research/ local egs
Marcomms/ research/ local egs
Marcomms/ research/ local egs
21
The broader HAI agenda
Going further faster
Department of Health
Towards Cleaner Hospitals
Saving Lives
Hand hygiene programme cleanyourhands campaign
RCA and HAI prevention
NPSA Safety improvement agenda
22
An international priority

• WHO Global Alliance on Patient Safety
• Clean Care is Safer Care

23
Learning en route
24
Reality at the coalface Key lessons from year
one

• Correlation between culture and progress
• Product acceptability
• Ownership issues
• Local flavour is a significant factor
• Knowledge levels about HCAI and the true risks
  are generally low
• Correlation between public information sources
  and ward
• based beliefs and practice
• Leadership and role models are critical to
  success
• The commitment and charisma of individuals make
  all the difference

25
Winners what and why

• Not just a capacity issue
• Evangelism and charisma
• Culture
• Local adaptation and enhancement
• Holistic hand care
• Leadership
• Social engagement
• Fun

26
10 - 40
? 100
Point of care hand rub
campaign implemented year 1
Year 2
Year 3
Year 4
Campaign Refreshed. Campaign evaluated
Campaign Refreshed. Campaign evaluated
27
Moving ahead through the product
cycleimprovement phase

• Year two - building on what weve learned
• Consolidating the brand
• Planning for letting go
• Partnerships
• Confronting the myths
• Refining the messages, expanding the category

28
(No Transcript)
29
Frontline involvement
30
Year two poster series
31
expanded resources to sustain the improvement

• Flowing with the go
• Sustainability hand hygiene check map
• Action cards
• Point-of-care prompts
• New scripts
• Mythbusters
• A new poster series

32
The Power of One

• A role for everyone in improvement
• Hand hygiene isnt the only factor. But its a
  big
• one. One in which there is a role for everyone to
  play,
• and where every individual has the power to make
  a
• difference.
• The core proposition, the message, is simple
• You are the agent for change.
• You can make a difference

33
(No Transcript)
34
(No Transcript)
35
Implementing in non-acute

• Huge diversity beyond acute
• Acute model not the right one
• Dedicated project to develop options
• Bespoke toolkits for different care settings
• Need to test and refine solutions

36
Further informationwww.npsa.nhs.uk/cleanyourh
andsThankyou