A Journey of Hand Hygiene (HH) from Basic to Advance Level at a Tertiary-Care Hospital in Karachi, Pakistan

Abstract

Background: According to the WHO, hand hygiene is the primary measure to reduce infections. It is a simple act, but the lack of compliance among healthcare workers has been a great concern for all healthcare facilities. Healthcare facilities can perform a situation analysis of hand hygiene promotion and practices according to a set of indicators designed by the WHO in the form of a hand hygiene self-assessment framework. Results can be used to identify areas of improvement and to develop an action plan and strategies accordingly. Low- or middle-income country (LMIC) initial scoring within this framework was 195 points (ie basic level); thus, we aimed to achieve the advanced level, with a score of > 375. Methods: The WHO hand hygiene self-assessment framework is a diagnostic tool to identify key issues requiring attention and improvement. Repeated assessments are done to document the progress over time, which allows a health-care facility to track their progress in hand hygiene resources, to conduct promotion activities, to plan their actions, and to achieve improvement and sustainability. We developed an action plan under each category of WHO framework that included: system change, training and education, evaluation and feedback, reminders in workplace, and institutional safety climate for hand hygiene. We implemented the following measures: point-of-care hand hygiene stations were made available at all bedsides; mandatory training was introduced for all healthcare workers, and consumption of hand rub or hand sanitizers and liquid soap was monitored as a consumption indicator. In addition, posters were placed in all wards and clinics, time was dedicated for HH promotion, and a May 5th plan was implemented. HH leaders, role models, and champions were identified from each discipline. Patients were involved in HH promotion; HH leaflets were given to patients, HH e-learning tools were implemented, and a system for personal accountability was initiated, as well as a buddy system for new employees. Results: After implementation of multiple strategies in each section of the WHO self-assessment framework, we our overall score increased from basic (ie, 195) to advanced (ie, 395). In addition, category score increased in system change from 60 to 85, in training and education from 35 to 100, in evaluation and feedback from 52.5 to 100, in reminders in workplace from 17.5 to 45, and in institutional safety climate from 30 to 65. Conclusions: The WHO hand hygiene self-assessment framework should be utilized by all the hospitals in LMICs as a guide to improve hand hygiene levels.

Funding: None

Disclosures: None