HANDWASHING


appropriate hand hygiene procedure, the badge will vibrate to remind the healthcare worker to leave the patient area and perform hand hygiene. In order to monitor and evaluate compliance, MCH personnel reviewed the data reports generated by the database (The HyGreen system uses low-power wireless chip technology from NXP Semiconductors to capture and transmit data). To evaluate the efficacy of the


HyGreen EHHS system, the infection control department conducted a study to determine the impact of the system on hand hygiene adherence rates among healthcare workers and HCAI occurrence in the paediatric inpatient oncology unit. The study was conducted from


September 1, 2010 throughMarch 28, 2011. During the study period, 79 healthcare workers participated – representing 25,554 hand wash sensor interactions and 12,789 bed monitor interactions (hand wash sensor interactions are approximately twice that of bed monitor interactions because they


reflect MCH’s ‘wash-in, wash out’ policy). The results of the study showed 100%


correlation between badge and monitors and 100% correlation between the badge and hand wash stations. The mean daily compliance to hand hygiene among physicians and nurses was similar at 94%, respectively, while the mean overall compliance among all healthcare workers was 92% (range: 75% to 100%). All data were accurately transmitted to


the database; the system detected all attempts by healthcare workers to approach a monitor or bed without conducting prior hand hygiene and appropriately reminded the respective persons to do so. Hand hygiene observations increased from <50/month to >5,000/month and overall adherence in the unit was maintained consistently over 92% across all shifts. The MCH oncology unit has been


monitoring HCAIs since 2008. Compared with the respective fourth quarters of 2008 and 2009, the overall number of


infections during the fourth quarter of 2010 (i.e. the time during which the system was instituted) was significantly lower. Continuing the comparison, the number of HCAIs in the first quarter of 2011 was significantly lower than the respective quarter for 2008, 2009, and 2010. During the study period, when the only change in infection control practices


Nominate your Hand Hygiene Champion of 2012


The search for the ‘Hand Hygiene Champion of 2012’ has now commenced. The awards, instigated by Schülke, aim to recognise and reward hand hygiene initiatives. The winner will be an individual who has gone the extra mile to help improve hand hygiene – whether this has included the initiation of an audit, awareness day or innovative hand hygiene campaign. Last year’s winner was Dr Stephen


Fowlie, medical director/director of infection prevention and control, Nottingham University Hospitals NHS Trust. He was nominated for his ‘never ending enthusiasm’ in championing hand hygiene, leaving ‘no stone unturned’ to promote good practice. Infection prevention and control have


always been a priority at Nottingham City hospital and the Queen’s Medical Centre (QMC), but when the two hospitals merged in 2006 to become Nottingham University Hospitals (NUH) NHS Trust, infection prevention and control became a top priority for the Trust. QMC had been one of the pilot sites


in the cleanyourhands campaign. Prior to national roll-out, the cleanyourhands toolkit and marketing materials were piloted and pre-tested in six acute Trusts from July 2003 to January 2004, including QMC. The programme used a marketing mix to educate, prompt and enable healthcare staff to clean their hands at the right time, every time, during their care of patients. The key


36 THE CLINICAL SERVICES JOURNAL


message of the campaign was for staff to clean their hands at the point-of-care, using either alcohol handrub or soap and water. Following on from the experience


gained during the pilot, it was agreed to extend the principles of the cleanyourhands campaign across the whole Trust. An Infection Control Operational Group (ICOG) was set up, chaired by the Trust’s chief executive, Dr Peter Homa and Dr Fowlie. ICOG initially met every week with senior representatives from each directorate. The seniority of the staff participating in ICOG underlines the importance given to infection prevention and control. A key part of the meetings is ‘Exception Reporting’ from each directorate; in which reports are made of any standards not achieved and measures put in place to achieve these standards. Hand hygiene scores are monitored


and any standard falling below ‘excellent’ has measures put in place to rectify the situation. Dr Fowlie works with his consultant colleagues to cascade hand hygiene information to the various clinical teams. Auditing showed that a key target group


for increasing hand hygiene compliance was medical staff i.e. doctors. Dr Fowlie worked on the principle that, if staff are prompted repeatedly and in a sustained manner to clean their hands at key moments, the action would eventually become routine and habitual. A policy of


zero tolerance was adopted in terms of following hand hygiene procedures including the ‘bare below the elbow’ rule in all clinical situations. All staff knew that compliance was mandatory and not an option. This was communicated in a firm but diplomatic way and Dr Fowlie instigated an ‘open door’ policy for staff to communicate any issues or concerns directly to him. Communications channels included the


ICOG group, intranet, emails and forums about hand hygiene practices for all staff. The aim was to engage all staff in following best practice hand hygiene procedures. Dr Fowlie regularly visits the wards and clinical areas to see what is happening in practice and his high profile presence has earned respect which has translated into excellent hand hygiene compliance rates. Hand hygiene compliance is measured


through an observation audit and is Five Moments (WHO) specific. Positive scores are only given for compliance at the right times and locations. Using the Five Moments highlights which of the moments requires more attention. Audit results from each directorate can be viewed internally, meaning that extra training and interventions can be specifically targeted to those areas which need to improve standards. Audits take place weekly, unless an area has earned the right, through consistent excellent compliance, to move to fortnightly auditing. Patients and the public also play a role


and members of the Patient Partnership Group (PPG) observe the audits taking place


MARCH 2012


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