Clean Care is Safer Care

Case study

Fortis Hospital, Mohali, India

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Submitted by:

Dr Anita Sharma
Fortis Hospital,

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

The hand hygiene initiative was started in 2007 in our hospital which is a 214 bedded tertiary care centre.

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

Before we started, the hand hygiene compliance as surveyed at that point of time was about 30%. Alcohol based hand rubs although available were not appropriately placed. Active support from management was not available although passive support was always there. The knowledge on the usage of product and technique was not uniform amongst various care givers.

What were the goals of your initiative?

The goal was to improve the compliance with hand hygiene to 90%, to make the education on hand hygiene effective and to bring down the rate of hospital-acquired infections. We gave ourselves about 9 months to do so as our JCI accreditation was going to be reviewed after that time. Targets were multipronged - standardising the product on hand hygiene and location of hand rubs; continuing awareness and education on hand hygiene, and changing the mindest and behaviour of people

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

Hand hygiene products (hand rubs, soap and paper towels) are standardised so that people associate that product with clean hands. The hand rubs are mounted at the foot end of every patient's bed for better accessibility. They are also made available at every Nursing station as well as entrance to ICUs.

Paper towels are readily available at all wash stations in the ICUs. Single use liquid soap is used all across the hospital in place of liquid soap in containers that were refilled earlier. Posters on hand hygiene (importance and technique) are displayed in all patient care areas and waiting areas. Hand hygiene is part of our induction programme as well as community programme in schools. Competency assessments and awareness weeks are organised periodically. Total commitment from the management is ensured as it is also a part of our performance assessment and gets reflected in our "quality dashboard".

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

The initial issues of availability of products have now been streamlined. The major bottlenecks have been the issues of mindset and behaviour amongst health-care workers. Doctors were observed to be poor role models. In spite of all these activities the hand hygiene compliance has not gone beyond 62% as people's perceptions of their own practice is higher than what it actually is. Not only that, people do not understand and appreciate the moments of hand hygiene and hence do not practice hand hygiene when they should.

What were the outcomes of your initiatives?

The hand hygiene initiative got a further boost with the launch of WHO initiative. It has lead to a decrease in surgical site infections, VAP and CA UTI. We have had two consecutive VAP and UTI free months now.

What were your key learning points?

The important learning has been that the hand hygiene programme requires to address the mindset and behaviour of the health-care workers more than anything else. A change comes when lots of people believe and speak the same langauge. New people are more open to change.

It also helps when the senior management is seen to be giving good importance to hand hygiene. It also invloves a lot of training as the attrition rates are high. Positive peer pressure works well.

We have had some very positive feedback from the parents of school children we engaged with. The children actually told their parents to correct their practices on hand hygiene and cough etiquette.

What are your future directions?

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 health-care 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.