Clean Care is Safer Care

Case study

Almana General Hospital, Khobar, Dammam, Saudi Arabia

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Submitted by:

Dr. A. Kumar
Almana General Hospital, Khobar, Dammam,
Saudi Arabia

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

Tertiary care level hospital (250 beds each)

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

We have had an effective hand hygiene programme since 2004 which is continuing till date. The health care workers in our hospital come from countries such as China, Phillipines, Indonesia, Pakistan, Srilanka, United Kingdom, United States of America, Egypt, Sudan, Ethiopia and Somalia. Hence the turn over of staff is very high and we receive new staff from different countries every 2 years. Thus education and orientation in hand hygiene are stressed throughout the year.

What were the goals of your initiative?

During our hand hygiene audits (observational, questionnaires, technique demonstration) we noticed that the compliance rate was 40% among doctors to 60% among nursing staff for the year 2009. Our hospital acquired infection rate was also 2.8% to 3% for July & August 2009 respectively which is beyond the national standards, Eastern province, Ministry of Health, Saudi Arabia . Hence we initiated an aggressive educational campaign for adequate hand hygiene for all health care workers for the year 2010.

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

We had made sure that all patient care locations had adequate hand hygiene facilities with wash basin and soap solution (4 % Chlorhexidine gluconate + 4% Isopropyl alcohol (Riyadh Pharma, Riyadh Saudi Arabia). In addition, all patient care areas, the corridor and the entrance to patient rooms had alcohol based hand rub (0.5% Chlorhexidine gluconate + 70% Isopropyl alcohol).

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

Doctors showed lower hand hygiene compliance and they fail to attend continuing medical education lectures on hand hygiene. They had a feeling that they were adequate in hand hygiene compliance which was not the case. The Medical Director of our hospital called upon all doctors to strictly abide by the infection control standards with special emphasis on hand hygiene and then we started to notice an increase in their compliance. We had posted hand hygiene awareness posters at all patient care locations. Large roll up banners on hand hygiene were also placed at all the hospital entrances. Hand hygiene awareness campaign was conducted on May 5, 2010.

What were the outcomes of your initiatives?

Following this initiative, our audit for the 2nd quarter of 2010 revealed an increase in hand hygiene compliance to 78% among doctors, 91% among nursing staff. Housekeeping staff showed the highest compliance with 96%. The respiratory therapists are still with 52% compliance.

What were your key learning points?

Yes, we are planning to provide incentives in the form of surprise gifts to health care workers who show 100 % compliance on hand hygiene during our monthly audits. At the same time, penalty during annual appraisal will be included which could affect the salary increments to the non-compliant staff.

What are your future directions?

We are planning to include the visitors and patient relatives in the hand hygiene program by making them participate during our lectures and are also considering allowing them to provide feedback to the hospital management on our hand hygiene and also the health care provided.