Credit WHO Hand Hygiene Campaign
# 8332
One hundred and sixty-seven years ago, a Hungarian physician named Ignaz Semmelweis published a controversial medical book called Etiology, Concept and Prophylaxis of Childbed Fever.
Childbed, or puerperal fever, was a major cause of mortality and morbidity among postpartum women, and Semmelweis demonstrated in his Viennese hospital that its incidence could be greatly reduced by having doctors wash their hands before performing gynecological exams.
His theories were considered radical (Pasteur wouldn’t come up with his `germ theory’ for another 17 years), and went against all currently accepted medical science. Besides, it was outrageous to suggest that doctors might actually be causing disease and death among their patients.
Today, while we know the importance of good hand hygiene – both inside and outside of medical settings – each year lapses in good hand cleansing practices lead to hundreds of thousands of avoidable hospital acquired infections (HAI’s) around the world, causing uncounted misery and costing tens of thousands of lives.
Which is the reason that the CDC, the ECDC, and the World Health Organization (among others) have promoted enhanced hand hygiene as the first – and most basic – step in reducing HAIs. A few of their campaigns I’ve covered in the past include:
Aye, There’s The Rub
Study: Exam Gloves, Dispensers & Bacterial Contamination
Fomite to Fingers To Face: A Triple Play Combination
A Movement With Five Moments
Global Clean Your Hands Day
Although alcohol hand sanitizers are not without their limitations – particularly when dealing with norovirus and C.diff (see CDC C. Diff FAQ & CMAJ: Hand Sanitizers May Be `Suboptimal’ For Preventing Norovirus) – their speed, availability, and ease of use make them an important part of any health facility's infection control program.
Yet, despite ongoing awareness campaigns, the latest report published in the American Journal of Infection Control indicates that there are still significant lapses in the WHO hand hygiene guidelines, even in the United States.
Between April and December 2011 health-care facilities around the world were invited to participate in a Hand hygiene self-assessment framework on the completion of the above Framework. The first analysis of that data (Summary report of the Framework global survey) was released in May of 2012, is available on the WHO website.
Between July and December of 2011, 2238 US facilities participating in the WHO global campaign were invited to complete the Hand Hygiene Self-Assessment Framework online. Disappointingly, only 168 facilities (7.5%) responded, which limits the conclusions that can be drawn.
First a press release from Columbia University Medical Center, then a link to the study.
One in 5 US hospitals don't put hand sanitizer everywhere needed to prevent infections
Research from WHO and Columbia University School of Nursing
(NEW YORK, NY, February 27, 2014) – Approximately one in five U.S. health facilities don't make alcohol-based hand sanitizer available at every point of care, missing a critical opportunity to prevent health care-associated infections, according to new research from Columbia University School of Nursing and the World Health Organization (WHO) published in the American Journal of Infection Control. The study, which examined compliance with WHO hand hygiene guidelines in the U.S., also found that only about half of the hospitals, ambulatory care, and long-term care facilities had set aside funds in their budgets for hand hygiene training.
A research team jointly led by Laurie Conway, RN, MS, CIC, PhD student at Columbia Nursing, and Benedetta Allegranzi, MD, lead of the WHO infection control program Clean Care is Safer Care, surveyed compliance with WHO hand hygiene guidelines at a sample of 168 facilities in 42 states and Puerto Rico. Overall, 77.5% of facilities reported that alcohol-based sanitizer was continuously available at every point of care, the study found. About one in ten facilities reported that senior leaders such as the chief executive officer, medical director, and director of nursing didn't make a clear commitment to support hand hygiene improvement, according to the study.
"When hospitals don't focus heavily on hand hygiene, that puts patients at unnecessary risk for preventable health care-associated infections," says Conway. "The tone for compliance with infection control guidelines is set at the highest levels of management, and our study also found that executives aren't always doing all that they can to send a clear message that preventing infections is a priority."
The full AJIC report is linked below:
Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of America health care facilities
- Benedetta Allegranzi, MD, Laurie Conway, RN, MS, CIC, Elaine Larson, RN, PhD, FAAN, CIC, Didier Pittet, MD, MS
Results
Of 2,238 invited facilities, 168 participated in the survey (7.5%). A detailed analysis of 129, mainly nonteaching public facilities (80.6%), showed that most had an advanced or intermediate level of hand hygiene implementation progress (48.9% and 45.0%, respectively). The total Hand Hygiene Self-Assessment Framework score was 36 points higher for facilities with staffing levels of infection preventionists > 0.75/100 beds than for those with lower ratios (P = .01) and 41 points higher for facilities participating in hand hygiene campaigns (P = .002).
Conclusion
Despite the low response rate, the survey results are unique and allow interesting reflections. Whereas the level of progress of most participating facilities was encouraging, this may reflect reporting bias, ie, better hospitals more likely to report. However, even in respondents, further improvement can be achieved, in particular by embedding hand hygiene in a stronger institutional safety climate and optimizing staffing levels dedicated to infection prevention. These results should encourage the launch of a coordinated national campaign and higher participation in the WHO global campaign.
This oft quoted assessment from the CDC on the burden of Hospital Acquired Infections in the United States is from 2010.
A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:
- 32 percent of all healthcare-associated infection are urinary tract infections
- 22 percent are surgical site infections
- 15 percent are pneumonia (lung infections)
- 14 percent are bloodstream infections
We live in a germ laden world, and you don’t have to work in a hospital or a doctor’s office to be concerned with good hand hygiene. For more on all of this I’d invite you to visit:
And can also visit the CDC’s hand hygiene website, where you will find many resources, including information on how to complete the Hand Hygiene Self-Assessment Framework.
