Clean Care is Safer Care

Case study

NHS Greater Glasgow and Clyde (NHSGGC), UK

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Submitted by:

Stefan Morton
LHBC Hand Hygiene

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

NHS Greater Glasgow and Clyde (NHSGGC) covers all types as listed but the main activities ar carried out in Acute Hospitals and Primary Care.

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

The national campaign was launched in 2007 and NHSGGC were involved at its start.
Before this our hand hygiene initiatives were led by Infection Control Nurses (ICNs) across 11 Acute hospitals and 10 Primary Care areas. Practice was low and there were several site based variations in materials and practices. There was local monitoring of compliance but this was used for site information but not Board wide reporting. ICNs are instrumental in the implementation of our initiatives and assist in the dissemination of info from WHO to frontline staff.

What were the goals of your initiative?

Our goals were to improve hand hygiene compliance to a level of at least 90%;
have an online based learning package for all infection prevention guidance;
train staff to carry out local ward based monitoring of compliance with hand hygiene, utilising a shared audit tool between Health Protection Scotland and the Scottish Patient Safety Programme;
increase trained Cleanliness Champions across the Board;
demonstrate public involvement.

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

Training and education sessions are offered monthly;
Local ward audits take place across all acute sites and planned for community sites;
The "Training Tracker" website utilised for online training and education;
We hold public health events across NHSGGC and nationally at events like the Royal Highland Show;
We have distributed ultraviolet glowboxes for ward use.

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

There were two main barriers:
1. The view held by some staff that this was an inappropriate use of resources and telling them something they already knew. This was resolved by awareness sessions, in particular with senior management staff, to highlight the need for a new campaign and the objectives of it.
2. The common misconception from Medical staff that there was no evidence to support Hand Hygiene initiatives and that an increase in compliance would not affect infection rates. This still remains an issue but is a less widely believed statement than in 2007. We hold specific sessions for medical staff and supply them with the appropriate guidance from WHO and CDC to support the campaign.

What were the outcomes of your initiatives?

Our rates of compliance in NHSGGC have risen from 62% in February 2007 to 92% in January 2009. This has been measured as part of our national audit data collection periods and highlights the good work undertaken by staff in NHSGGC. Infection rates have fallen in the same period and improved hand hygiene is believed to be one of the factors responsible for this.

What were your key learning points?

One important lesson has been to utilise the info gathered in audits to help reinforce the good practice and how this improves patient care. One way in which we are implementing this is by info stations outside wards to highlight to staff and the public the current hand hygiene compliance score and the impact that this and other initiatives are having on infection rates. The public response to this has been positive as it shows honesty and helps to reassure them that they are happy to be treated in that environment. It also boosts staff morale as they are more inclined to hear the bad aspects of audits, rather than the good.

What are your future directions?

Our current initiatives are ongoing and in addition we are planning more sessions aimed at specific staff groups, based on the 5 Moments for Hand Hygiene.