HAND HYGIENE

Multi – Modal Interventions at

MATER DEI HOSPITAL
Noel Abela
Infection Control Nurse
 St. Luke’s Hospital

•  Built in 1950’s
•  “Nightingale” wards with few sinks
 Ward sink to bed ratio at the Old Hospital

Old 1 Sink to 10 beds

Hospital
 100
90
80
70
Compliance %

60
50
40
30
20
10
0
Ward 1 Ward 2 Ward 3
St. Luke’s
Old Hospital New New after campaign
2007
More sinks Better soap More alcohol handrub
 Mater Dei Hospital
Migration in late 2007
 Ward sink density

Old New
Hospital Hospital
 100
90
80
Compliance %

70
60
50
40
30
20
10
0
Ward 1 Ward 2 Ward 3
St. Luke’s Old New
Mater Dei New after campaign
Hospital Hospital
2007 2008
 Products preferred for hand hygiene at
the old hospital

80
72.7
70

60

50

% 40
29.8
30
23.3
20

10

0
soap and water Alcohol based solution Hand disinfectant
 Hand hygiene campaign
•  A campaign called ‘Stop, Rub & Go’ was
launched in October 2008
•  Launched with ministerial press
conferences.
Hand Hygiene resources (passive)
 Supplemented by small group
teaching

•  Small group interactive teaching also

organised
–  over and above standard didactic education

•  Highly resource intensive

–  Unable to cover all wards
Compliance %

Posters + education
Posters only
 Increased accessibility of alcohol rub
Placed at foot of every hospital bed and at
each entrance of the ward
 Innovative new initiatives

ROAD SHOWS

MASCOT

BILLBOARDS
FOB WATCH
TO EVERY
HCW

Infection Control Play ‘JIMPURTANA’ (We Care)

Bare below the elbow
 Hand Working Group - MDH

•  Met every 2 months

•  Discuss ways and means to promote hand
hygiene amongst all healthcare workers
 Audits, audits, audits...

•  Initially done by the ICNs

–  First time that clinical audits were done
systemically in the hospital
–  CULTURAL shock
•  Defensive reactions
–  Attempts to get ward staff to do them were
unsuccessful
•  Infection control recruited scientific officer
–  specific auditing job description
•  Thousands of observations done
–  Staff member transferred and replaced a year later

21
 Feedback, feedback, feedback...

•  Results fed back to staff

•  ICNs targeted low performing wards and
increased training and support
•  Nurses in charge of wards invited to a six-
monthly review with Infection Control Head and
Nurse Director to review results
–  Support offered where needed
–  Follow up undertaken
•  Best performing wards recognised through an
award at annual infection control conference
22
 Hand hygiene compliance 2010-2013
100%

90%
Wash Rub
80%

70%

60%

50%

40%

30%

20%

10%

0%
Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4
2010 2011 2012 2013
 Hand hygiene compliance by
moment
0.8

0.7

0.6

0.5

0.4 Moment 1
Moment 2
0.3 Moment 3
Moment 4
0.2 Moment 5

0.1
Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4
 Hand hygiene compliance by
moment
0.8

0.7

0.6

0.5

0.4 Moment 1
Moment 2
0.3 Moment 3
Moment 4
0.2 Moment 5

0.1
Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4
 Hand hygiene compliance by
profession
100%
Nurses Doctors Other HCWs
90%

80%

70%

60%

50%

40%

30%

20%

10%

0%
Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4 Qtr1 Qtr2 Qtr3 Qtr4
2010 2011 2012 2013
 Hand hygiene among doctors

•  Whereas significant hand hygiene improvement

has been achieved among nurses, this has no
been mirrored in the medical professions
•  Not unique phenomenon
–  Widely reported in literature
•  Ownership remains a challenge
–  Feedback suggests that doctors regard HH
activities as external impositions and are not
convinced of its importance.
–  Change of approach is being attempted
•  Senior doctors have been recently appointed as
infection control leads in clinical departments
 Conclusions

•  Availability of better hand hygiene resources or passive

educational aids did not on the own improve HH
•  Audits, feedback and accountability were the critical
intervention
–  Nevertheless previous initiatives probably provided the
foundation for improvement
–  Centrally driven
•  ‘Multi-faceted approaches have a more marked effect
on hand hygiene and rates of HCAI’
H.P. Loveday. epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in
NHS Hospitals in England. Journal Of Hospital Infection 86S1 (2014) S1–S70

•  Two/three fold improvement achieved but not consistent

across all professions
•  A plateau has been reached
–  80/20 rule... is it cost effective to expend significant
resource to get further improvement or focus on other
infection control lacunae?
Mathematical models of hand hygiene frequency
required to eliminate MRSA transmission
Thanks for listening