Hand Hygiene Survey:Preliminary Results
A. McGeer, K. Green, J. Lourenco, and G. Youssef for the Hand Hygiene
Research Steering Committee
Background
• The CPSI, CCHSA, PHAC and CHICA are working together to develop a national hand hygiene (HH) campaign
• Goal: To improve support to healthcare and public health organizations implementing HH initiatives across Canada
Background (cont.)
• HH Study Objective: to provide guidance to healthcare decision makers wishing to implement successful HH programs
• Help us to assess the following in Canadian healthcare facilities:– HH adherence– Current HH initiatives and which are
considered effective– What type of support is needed
Study Description
• The HH survey includes 52 questions on:– Respondent demographics– Current HH environment and practices– HH initiatives and their perceived effectiveness– Needed resources– Future HH plans
• Survey was available on the CHICA website from April to May 2007
• CHICA has 1327 members – Infection control professionals located across Canada – Come from different backgrounds including nursing, medicine,
microbiology, medical technology, and epidemiology• 171 CHICA members responded
Participants
Facility types of participants
3%2%2%
52%
10%
32%
10%13% 12%
9%
3% 2%
0
10
20
30
40
50
60
70
80
90
100
Acute
Car
e
Chron
ic C
are
Long
Ter
m C
are
Public
Hea
lth
Regio
nal H
ealth
Aut
horit
y
Men
tal H
ealth
Home
Care
Primar
y Car
e
Comm
unity
Hea
lth
Rehab
ilita
tion
Emer
genc
y M
edic
al S
ervi
ces
Other
Facility Type
Fre
qu
ency
Province in which participants are located
AB, 14, 8%
BC, 21, 13%
MB, 9, 5%
NB, 10, 6%
NL, 2, 1%
NT, 1, 1%
NS, 9, 5%
NU, 1, 1%
ON, 91, 54%
QC, 5, 3%
SK, 4, 2%
PE, 1, 1%
AB, 5, 6%
BC, 11, 13%
MB, 5, 6%
NB, 7, 8%
NL, 2, 2%
NT, 1, 1%
NS, 2, 2%
NU, 0, 0%
ON, 47, 53%
QC, 4, 5%SK, 3, 3%
PE, 1, 1%
All Facilities Acute Care Facilities
Participant’s role in their organization
0%0%2%
97%
2% 0% 0% 1%7%
0
10
20
30
40
50
60
70
80
90
Nurs
eM
anag
er/E
duca
tor/C
linic
alN
urs
e
Infe
ctio
n C
ontr
ol
Pra
ctitio
ner
/Consu
ltan
t
Chie
f N
urs
ing O
ffic
er/V
PN
urs
ing
Hosp
ital
CEO
/Man
agem
ent
Qual
ity
Man
agem
ent
Pat
ient Saf
ety
Occ
upat
ional
Hea
lth
Public
Hea
lth
Insp
ecto
r/N
urs
e
Res
pirat
ory
Ther
apis
t
Participant's Role
Fre
quen
cy
Hand Hygiene Survey Findings for Acute Care Facilities
Number of facilities in which there is a written HH policy and if the policy is signed
Provide sample hand hygiene policies
42%
47%
9
11%
79
10%
0
10
20
30
40
50
60
70
80
90
Policy No Policy
Policy Present
Fre
qu
ency
No Policy
Missing
Not Signed
Signed
90%
Number of facilities that provide HH educational programs to staff
In most sites, HH education is not mandatory Provide advice on how to ensure that most staff are educated
21%
48%
15
19%
73
17%
0
10
20
30
40
50
60
70
80
90
100
Program No Program
Program Present
Fre
qu
ency
No Program
Missing
Not Mandatory
Mandatory
83%
Types of HH products provided to staff by facilities
Very few are providing hand lotions and individual alcohol sanitizers
23%
81%
61%
85%
69%
100%
0
10
20
30
40
50
60
70
80
90
100
Alcohol HandSanitizers
Hand Lotions Anti-bacterialSoap
Non-antibacterial
Soap
SurgicalScrub
IndividualAlcohol Hand
Sanitizers
Hand Hygiene Product Types
Fre
qu
ency
Location of HH products in the facility
We’re doing a good job of getting products into public areas but not to point of care
Need to help facilities determine optimal product placement
92%86%
48%
88%85%
91%
3%
46%
0
10
20
30
40
50
60
70
80
90
Bedside On Beds Door toRoom
ExamRooms
StaffCommon
Areas
ElevatorBays
WaitingAreas
MainLobby
Area
Fre
qu
ency
Point of Care Areas Public Areas
Types of skin care programs provided to staff by facilities
• 41% of responding acute-care facilities provide skin care programs to staff
Provide skin care program tools
49%
66%
26%
0
5
10
15
20
25
Education Programs Programs for Staffwith Skin Problems
Other
Skin Care Program Types
Fre
qu
en
cy
Types of tools for monitoring HH adherence used by facilities
• 37% of respondents chose “None” Need to explain why monitoring is important and how good each
method is at determining adherence
44%
13%
1%
36%
0
5
10
15
20
25
30
35
40
Monitor Consumptionof Products
Electronic Monitoringof Sink or HandSanitizer Use
Self-assessment/ self-report
Adherence Audits
Tools
Fre
qu
ency
Reasons why facilities have not audited HH adherence
Provide sites with auditing tools Suggest strategies on how to make time for auditing and on how to
obtain necessary resources
79%
41%
52%
0
5
10
15
20
25
30
35
40
45
50
No Time No Tools No Resources
Reason
Fre
qu
ency
HH Initiatives
• 76% of organizations have implemented initiatives to improve hand hygiene in the last 2 years
• 31% of facilities receive financial support for HH initiatives
• Only 32% of these receive internal funding
Provide strategies for obtaining financial support
Individuals targeted by HH initiatives
22%
65%
55%
100%
0
10
20
30
40
50
60
70
80
Staff Patients Visitors Other
Individuals Targeted
Fre
qu
ency
Components of HH initiatives
Very few include staff in planning or have baseline or post-implementation audits
Provide staff education to ensure that it is adequate
31%
24%
23%
18%
14%
6%
35%
38%
44%
51%
93%
0 10 20 30 40 50 60 70
Staff Education
Toolkit
Baseline Adherence Audits
Other Promotional Material
Staff Involvement in Planning
Collection of Baseline Indicators
Post-Implementation Audits
Hand Hygiene Role Models or Resource Persons
Interviews with Staff
Community Education Programs
Patient Involvement in Planning
Co
mp
on
ent
Frequency
Most effective component of campaign
• Increased access to alcohol hand rub
• Demonstration (Glo-germ, paint)
• Personal hand rub
• Feedback on performanceIdentify positive strategies on how to
inform staff of their performance
Least effective component of campaign
• Posters/ signs/ buttons/ fridge magnets (without other components or without ability to change; esp if negative)
• Education (esp. one-time, large group, not interactive)
• Alcohol hand rub at hospital entrance• Negative messaging from/punitive sense to
audits Identify positive strategies on how to inform staff
of their performance
Most useful added resources
• Audit tools• Posters and supplies (lanyards,
shoelaces, pencils, erasers, etc.)– Downloadable from internet
• Information from other projects (other countries, other hospitals)
• VideosProvide pre-tested promotional tools that
can be adapted to other facilities
Greatest organizational challenge
• Senior management commitment – Not considered important enoughNeed strategies to get senior management on
board with initiatives
• Time for staff to come to in-services
• Physician buy-in/participation
• Hand care programs
Additional Findings
• 8% have a dedicated budget for promotional material
• 46% reported hospital rules and regulations that limit their use of promotional material
• 17% of facilities include adherence in staff performance reviews– 13% of those facilities take disciplinary actions for
non-adherenceProvide ideas on how to include adherence in
performance reviews and on what disciplinary actions should be taken
Additional Findings
• 16% of facilities include adherence to HH policies in their job descriptions
• 12% of facilities have monitored patient impressions of adherence in satisfaction surveysProvide patient satisfaction surveys
Acute vs. Other Facility Types 1• Facilities that identified themselves as acute and those that did not
were at equal risk of:– Having a written HH policy– Providing HH educational programs to staff– Providing staff with alcohol hand sanitizers, non-antibacterial soap, and
individual alcohol hand sanitizers– Providing HH products on beds– Providing HH skin care programs to staff– Monitoring consumption of products, electronic monitoring, self-
assessment, or using no tools for auditing HH adherence– Not auditing HH due to no time, no tools, and no resources– Implementing a HH initiative in the last 2 years and receiving financial
support for their HH initiatives– Targeting their HH initiatives towards staff, patients, and visitors– Most components of their HH initiatives– Hospital rules limiting their use of promotional material– Including adherence in staff performance reviews and taking disciplinary
measures for non-adherence– Monitoring patient impressions of adherence in satisfaction surveys
Acute vs. Other Facility Types 2
• Facilities that identified themselves as acute were at greater risk of:– Providing staff with:
• hand lotion (RR=1.93, 95% CI=1.35-2.78)• anti-bacterial soap (RR=2.59, CI=1.46-4.60)• surgical scrub (RR=4.60, CI=2.98-7.10)
– Providing HH products in the:• Elevator bays (RR=1.32, CI=1.03-1.69)• Waiting areas (RR=3.76, CI=2.13-6.63)• Main lobby (RR=6.67, CI=1.17-6.11)• Staff common areas (RR=2.60, CI=1.38-4.91)• Bedside (RR=1.56, CI=1.26-1.93)• Exam rooms (RR=4.40, CI=2.60-7.45)• Door to room (RR=8.25, CI=4.21-16.17)
– Among those that did provide skin care programs, providing programs for staff with skin problems (RR=2.13, CI=1.29-3.51)
– Using adherence audits to monitor HH adherence (RR=1.37, CI=1.10-1.71)
– Collecting baseline indicators as part of their HH initiatives (RR=1.27, CI=1.05-1.52)
Acute vs. Other Facility Types 3
• Facilities that DID NOT identify themselves as acute were at a greater risk of:– Having a dedicated budget for promotional
material (RR=1.18, 95% CI=1.03-1.34)– Including adherence to HH policies in their job
description (RR=1.15, 95% CI=1.04-1.28)
Future Actions
• 1636 surveys were mailed out to 1144 hospitals in July 2007
• Thus far, 307 people have responded• In October 2007 surveys will be sent out to long-
term care, rehabilitation, and mental health facilities, public health units, and emergency medical services
• Focus groups starting in October 2007 will delve further into findings concerning HH initiatives
Summary of Recommendations 1
• Only 23% of facilities are providing individual alcohol sanitizers
• Need tools that describe optimal product placement (especially at point of patient care) and how to determine this
• Since 37% of respondents indicated that they have no tools for monitoring HH adherence and 41% cite no tools as the reason for not auditing, provide auditing tools and information on how good the different methods of monitoring are at determining adherence
• Provide pre-tested promotional tools
Summary of Recommendations 2
• Describe HH initiatives that have been effective in other facilities beyond (staff education)
• Provide sites with strategies on how to make time for auditing and on how to obtain the necessary resources
• Provide strategies to obtain financial support• Since very few sites are providing hand lotion and only
41% are providing skin care programs for staff, we need to provide sites with skin care program tools
• Provide ideas on how to include HH in staff performance reviews
• Identify positive strategies on how to inform staff of their performance
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