Clean Care is Safer Care

Case study

A. Adler Consulting

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Submitted by:

Diego Guimaraes
A.Adler Consulting,
Rio de Janeiro,

What type of health-care facility or organization are you?

We are a Brazilian health-care consulting firm focused on prevention and control of infections associated with healthcare. In the beginning of May 2009 the company planned and implemented a full campaign of education and mobilization for hand hygiene in the whole network of hospitals in which the company operates, such as: Sao Lucas Hospital, CardioTrauma Ipanema Hospital, Mario Lioni Hospital, Sao Miguel Hospital, Pasteur Hospital, Sao Jose Hospital & Maternity, Balbino Hospital, Nossa Senhora do Carmo Hospital. The interventions were implemented in all kinds of healthcare facilities covering areas from administrative and support services, to primary and intensive care units. Altogether more than 500 professionals were involved.

What was the situation at your facility with respect to hand hygiene and HAI before you initiated the hand hygiene initiatives?

Our trainings on prevention and control of infections associated with health care were fully informed by the WHO Guidelines on Hand Hygiene in Health Care. However behavioural aspects and staff resistance were always known as major barriers on promoting any hand hygiene programme. In addition, there were difficulties in monitoring the effectiveness of actions taken before the campaign.

What were the goals of your initiative?

Our main goals were promoting theoretical and technical knowledge about the importance and practice of hand hygiene through demonstrations and guidelines among all network staff and patients. Increasing compliance with hand hygiene among health care workers and a general call to action highlighting the risks of noncompliance with hand hygiene were other aims.

What actions have you planned or already put in place to improve hand hygiene at your facility?

Participation of the group "Happy Nursing", to make a close, good-humored and a direct approach of the subject, with group demonstrations of different techniques for hand hygiene, distribution of free samples of soap, brochures and guidelines; lectures and refresher training every month; stickers designed with step-by-step instructions for each method of hand hygiene, to be fixed in bathrooms, near sinks and in patient care areas; and the distribution of posters and folders with the "5 Moments for Hand Hygiene" recommended by WHO.

Did you encounter any particular problems while planning and implementing your strategy?

Key barrier: Finding extra-qualified professionals to work simultaneously in 8 hospitals;
Solution: recruitment of the "Happy Nursing" team.
Key barrier: Raising funds and approving budgets within hospitals to produce custom soaps and brochures.
Solution: Partnerships with suppliers and printers;
Key barrier: Full implementation of the campaign without affecting the progress of other consulting activities in all hospitals.
Solution: Volunteers recruitment and participation of the "Happy Nursing" team.

What were the outcomes of your initiatives?

At the end of the campaign we were able to see a bigger commitment from our team workers (nurses and doctors) and partners with the guidelines, specially the 5 Moments for Hand Hygiene from WHO;
- Moreover, changes were also observed in administrative areas, like sanitation and reception, a result of several posters and stickers that were posted in places with high volume movement of people and potential risks of exposure.
- In all hospitals we attended, the infection rates are decreasing gradually due to all efforts applied towards infection prevention and control.

What were your key learning points?

Through implementation of this campaign, we learned that a good-humored approach combined with some demonstration and technical lessons brings awareness to this subject and great results. All feedback we've got from this campaign were positive. Board directors and executive managers from big hospitals and clinics took part in the campaigns recognizing the importance of the initiative and were introduced to the guidelines and the techniques of hand hygiene

What are your future directions?

Our hand hygiene initiatives are permanent in all hospitals. We intend to conduct frequent training in measuring compliance and apply an audit system for a larger control of the infection rates. As a step further we are now involving the patients and their attendants in the programme in a pilot project. At the time of admission they are counselled on the requirement of hand hygiene and are encouraged to remind our staff to clean their hands before touching them. The healthcare staff are also being counselled to react in a positive manner to such feedback or requests from patients. The attendants are also engaged during our weekly attendant care programmes.

Additional comments
We also designed an email marketing and send it to all our employees and those who supported the campaign. The message was sent on May 5th 2009, to celebrate the Save Lives: Clean Your Hands annual initiative and showed the campaign's successful results.