Hand Hygiene Compliance and Accountability. Ann McQueen Hand Hygiene Co-ordinator NHS Lothian

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1 Hand Hygiene Compliance and Accountability Ann McQueen Hand Hygiene Co-ordinator NHS Lothian

2 The Bigger Picture October launch of the World Alliance for Patient Safety (WHO) 1st Global Patient Safety Challenge: Clean Care is Safer Care Road map for coordinated strategies/campaigns Evidence based methodologies for hand hygiene improvement - as a starting point To ensure clean, safe care of patients all of the time, everywhere.

3 Scottish Campaign 2005 Scottish Ministerial pledge to WHO Germs: Wash your hands of them Launched January 2007 Aim of reducing avoidable illness in staff, patients and visitors Led by HPS, overseen by a steering group and number of sub-groups Heavily supported by SGHD HAI Task Force

4 Why is hand hygiene so important?

5 Hand hygiene is the single most important factor in reducing and preventing avoidable illnesses e.g. Healthcare Associated Infections (HAI)

6 Who needs to practice effective hand hygiene? Healthcare Staff Patients and visitors General Public

7 When do healthcare staff require to carry out hand hygiene?

8 Audit Tool (WHO, IPS) 5 key moments Before patient contact before aseptic task after body fluid exposure risk after patient contact after contact with patient surroundings

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10 Staff groups being audited Nursing Medical Allied Health Professionals (AHP s) Ancillary

11 Clinical Settings being audited ICU/HDU General Surgical General Medical Orthopaedics Haematology Care of Elderly

12 1st phase audit results NHS Lothian (Feb. 07) Compliance Summary Score Legend Nurse Medical Staff AHP Ancillary/Others

13 Recommended Strategies to improve HH compliance Multimodal Multifaceted Multidisciplinary ( Pittet, 2000)

14 Development and Implementation of Local Audit Tool Charge Nurses to undertake HH audits Encouraging all staff groups to observe practice Performance feedback Local action plans Reinforce HH education/training

15 Infection Control Audit Tools: Hand Hygiene Audit - Data Collection Sheet Ward Deaconess Site Start Date Type of contact observed Designation Hand Correct Hygiene technique Perfomed 1 Before patient contact Nursing 2 Before patient contact Nursing 3 After patient contact Nursing 4 After patient contact Nursing 5 Before putting on gloves Nursing 6 After removing gloves Nursing 7 After patient contact Nursing 8 After patient contact Nursing 9 Before patient contact Nursing 10 After environment contact Nursing After environment contact Before patient contact Nursing Medical Before patient contact Before patient contact Medical Other 15 After patient contact Other 16 After removing gloves Nursing 17 After patient contact Nursing 18 After environment contact Nursing After environment contact Before patient contact Nursing Other 21 After patient contact Nursing 22 After patient contact Nursing 23 Before putting on gloves Nursing Before putting on gloves After patient contact Nursing Nursing 26 Before patient contact Nursing 27 After removing gloves Nursing 28 After patient contact Nursing 29 After removing gloves Nursing 30 After patient contact Nursing Watch / ring / false nails worn Overall End Date 16-Dec-07 Auditor Comments Watch worn False nails worn - removed after this shift! Did not wash hands after closing curtains Did not wash hands after wiping table Did not wash hands before patient examination Soap applied to dry hands Did not wash hands after moving chairs Soap applied to dry hands Used clean hands to lift bin lid instead of foot pedal 2 rings worn

16 Infection Control Audit Tools: Hand Hygiene Audit - Results & Actions Ward Deaconess Site Start Date End Date 16-Dec-07 Results will not be displayed until all 30 observations are complete. Auditor Alert Status of opportunities for hand hygiene were taken of opportunities taken were performed correctly of opportunities for hand hygiene were taken and completed correctly overall GREEN AMBER RED Overall compliance by type of contact and staff group: To be used to target training interventions Type of contact Staff group Wearing jewellery etc. After environment contact 25 RED Medical 50 RED Medical 0 GREEN Before patient contact 88 GREEN Nursing 60 RED Nursing 16 AMBER After patient contact 73 RED AHP N/A N/A AHP N/A N/A Before putting on gloves 67 RED Other 100 GREEN Other 0 GREEN After removing gloves 25 RED Action that is to be taken Feedback result to team Arrange local training Register red alert as an incident on DATIX Inform Infection Control Team Date Completed Name and Designation

17 Hand Hygiene Audits (vember 08) 100 Staff Group Compliance Summary Compliance Nurse Medical AHP Ancillary/Others Staff Group

18 HH Technique (vember 2008) 100 Overall Summary of Correct Hand Hygiene Technique Compliance Nurse Medical AHP Ancillary/Others Staff Group

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20 Key Success Factors to Improve HH Compliance & Accountability Support from Senior Executive and Management Teams Engaging with all staff groups Regular HH audit with performance feedback Local action plans Provision of HH education/training Availability and accessibility of hand hygiene facilities Ensuring all staff groups motivated to change Effective LEADERSHIP

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