Hand hygiene compliance: An internationally shared mission

The challenge of improving hand hygiene compliance in hospitals to prevent healthcare-associated infections is not confined to within the borders of the United States.

Hospitals in countries all over the world are constantly seeking new ways to improve hand hygiene compliance, but some are doing more than others, according to Didier Pittet, MD.

Dr. Pittet is the director of the Infection Control Programme at the University of Geneva (Switzerland) Hospital and director of the World Health Organization Collaborating Centre on Patient Safety. He is also external programme lead of WHO's First Global Patient Safety Challenge called Clean Care is Safer Care and professor of medicine and hospital epidemiology at the University of Geneva.

"While some hospitals are clearly prioritizing hand hygiene promotion, others are underestimating its importance," said Dr. Pittet.

Countries in which hospitals have integrated WHO's My Five Moments for Hand Hygiene concept into daily practice are making great strides, according to Dr. Pittet, and they are not the only ones.

"The countries leading the way are those with national hand hygiene campaigns — such as Australia with the National Hand Hygiene Initiative — as well as [places] such as Singapore, Hong Kong and countries where hospitals have been awarded with Hand Hygiene Excellence Awards, such as Brazil," he said.

Hand Hygiene Australia — which was created in 2008 — is the government organization tasked with implementing the National Hand Hygiene Initiative across the country. HHA has local coordinators appointed in Tasmania, South Australia, Western Australia, New South Wales and the Australian Capital Territory to create and execute strategies and campaigns to maximize the success of the NHHI and reports directly to the Australian Commission on Quality and Safety in Health Care.

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The NHHI was awarded the Centre of Hand Hygiene Excellence award by WHO in 2011. As of June 2014, the average hand hygiene compliance rate among 782 hospitals across Australia was 81 percent.

Although national campaigns that raise awareness for the importance of hand hygiene have made a difference in some countries, they may not be sufficient in and of themselves, according to Erin S. DuPree, MD, CMO and vice president for the Joint Commission Center for Transforming Healthcare.

"To sustain improvement and make a difference, a simple slogan or campaign is not enough; demanding that healthcare workers try harder is not the answer," said Dr. DuPree. "Comprehensive, systematic and sustainable change is the only solution."

To accomplish improved compliance, The Joint Commission accredits U.S. organizations through the National Patient Safety Goal program when they comply with either the U.S. Center for Disease Control and Prevention's hand hygiene guidelines or WHO's 5 Moments for Hand Hygiene.

Similarly, the Joint Commission International demands similar compliance measurements from its international hospitals seeking accreditation through the International Patient Safety Goals program under which organizations are required to adopt and implement evidence-based hand-hygiene guidelines to reduce the risk of HAIs. Not unlike the U.S., internationally acceptable guidelines are WHO's 5 Moment for Hand Hygiene, the CDC's guidelines or guidelines from other national and international organizations.

"The bottom line is some hospitals have prioritized hand hygiene and are addressing it in a reliable, data-driven systematic way, but those organizations are too few and far between," said Dr. DuPree.

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