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World Health Organisation

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Simple measures
save lives

The focus is on
preventing infection
associated with
health care

www.who.int/patientsafety/events
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"Clean Care is Safer Care" Initiative

Objectives
Global Awareness
- raising

Country commitment and campaigns

Development and Implementation of the WHO


Guidelines on Hand Hygiene in Health Care

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Health care-acquired infection: the scale
At any time, over 1.4 million people worldwide are suffering from
infections acquired in hospital.
Between 5% and 10% of patients admitted to modern hospitals in the
developed world acquire one or more infections.
The risk of health care-associated infection in developing countries is 2 to
20 times higher than in developed countries.
In some developing countries, the proportion of patients affected by a
health care acquired infection can exceed 25%.
In the United States, 1 out of every 136 hospital patients becomes
seriously ill as a result of acquiring an infection in hospital; this is
equivalent to 2 million cases and about 80 000 deaths a year.
In England, more than 100 000 cases of health care-associated infection
lead to over 5000 deaths directly attributed to infection each year.

A NZ study of hospital-acquired infection estimated


prevalance rate of 9.5% (Graves 2003)
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Health care-acquired infection: the cost

Added to the considerable human misery caused by health


care
- associated infections is their economic impact.
In the USA, the risks of acquiring these infections have
risen steadily over the last decades with accompanying
extra costs estimated at US$ 4500–5700 million a year.
In England, health care- associated infections are estimated
to cost £1 billion annually to the National Health Service.
Predicted annual cost for hospital acquired
- infection in NZ
up to $136.61M

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Elements of the Global Safety Challenge

Blood Safety

Injection practices and immunisation

Environmental hygiene and waste management

Clinical procedures safety

Hand hygiene

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BLOOD SAFETY
Focus
preventing transfusion-transmitted infection
Between 5%-10% of HIV infections
world-wide transmitted through
transfusion of contaminated blood and
blood products in the past
Between 1990-92 in NZ at least 600 Actions:
patients were put at risk and • Promotion of optimal
transmission of Hepatitis C occurred (to
an unknown number) through hand hygiene associated with
transfusion of contaminated blood
procedures for collection,
Currently the risk of bacterial
contamination from transfusion processing and use of blood
exceeds the risk of HIV, HBV and HCV products
transmission in developed countries
•Comprehensive haemo-vigilance
Haemo-vigilance data from around the
world shows errors in procedures programmes
leading to ABO incompatibility is the
most common serious hazard of
transfusion
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Injection practices and immunisation
Focus
safe injection that does not harm the recipient,
does not expose the provider to any avoidable
risks, and does not result in any waste that is
dangerous. Actions
Raising awareness of risks of
One injury from a needle used on an unsafe injection practices and
infected patient carries 30% risk of adoption of safe injection practice
transmitting Hep B, 1.8% risk of
transmitting Hep C and 0.3% risk of Safe disposal of sharps and
transmitting HIV effective management of sharps
waste
In some countries up to 90% of
people seeking primary care receive Promote use of auto-disable
injections of which 70% are (single use) syringes in
unnecessary or could be replaced immunisation
with oral formulations
Vaccination of healthcare
workforce
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Environmental hygiene and waste
management
Focus
achieve safe environment needed for healthcare and
the safe disposal of waste generated
Action
Hygiene education and
1.8 million people die every year promotion of hand washing can
from diarrhoeal diseases lead to a reduction of cases by
more than 50%
Most legionella cases are
Safe disposal waste, particularly
nosocomial and concern healthcare
facilities worldwide needles, syringes and body fluids
Healthcare processes that
prevent the transmission by the
faecal-oral route
Environments that are low risk to
health from micro organisms that
grow in the environment
Adequate cleaning of facilities
and equipment
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Health care-associated infection
Focus
Preventing infection associated with
health care

Health care-associated infection is one of the leading


causes of premature mortality in some countries.
International studies show 5% -10% of patients acquire
infection
In intensive care, health care-associated infection affects
about 30% of patients and the attributable mortality may
reach 44%. Action
The infection rate associated with vascular devices Increasing good
among neonates is 3 to 20 times higher in developing
than in developed countries hand hygiene
NZ study estimated prevalance rate of 9.5% (Graves
practice
2003) Use of an alcohol-
During the SARS pandemic, the proportion of infected based hand rub
health-care workers ranged from approximately 20% to
60% of cases worldwide. 10
Clinical procedures safety
Focus
Preventing surgical site infections

Surgical site infection accounts for


about 14% of possible adverse
events threatening patient safety in
hospitals in developed countries.
Surgical site infection occurs in at
least 2% to 5% of the 27 million Action
patients undergoing surgical
procedures every year. Correct surgical hand preparation
Surgical site infection accounts for
Environmental hygiene
about 25% of health care- Surgical training experience
associated infections.
and supervision
In the United States, surgical site Best practice wound care
infection prolongs hospital stay by
an average of 7.4 days at an Appropriate antibiotic
average cost of US$ 400 to US$
2600 per wound infection. prophylaxis and treatment
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Hand Hygiene

Clean Hands
are
Safer Hands

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Guidelines on Hand Hygiene
in Health Care
Objective of the Guidelines:

To provide health-care workers,


WHO GUIDELINES ON HAND administrators and health
HYGIENE IN HEALTH CARE
(ADVANCED DRAFT): authorities with:
A SUMMARY

• a thorough review of hand


hygiene
• in-depth information to
help them overcome
obstacles to improvement

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Guidelines main recommendations

Hand washing with soap and water when hands


are visibly dirty

Adoption of alcohol-based hand rub as the gold


standard

Use multiple strategies including


• education
• leadership
• patient participation

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Perceived barriers to appropriate
hand hygiene

Lack of active participation in hand hygiene promotion


at individual or institutional level

Lack of role model for hand hygiene

Lack of institutional priority for hand hygiene

Lack of administrative sanction of


noncompliers/rewarding of compliers

Lack of institutional safety climate

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Factors influencing poor adherence to
recommended hand hygiene practices
Working in intensive care
Working during the week (vs. week
- end)
Wearing gowns/gloves
Automated sink
Activities with high risk of cross
- transmission
Understaffing or overcrowding
High number of opportunities for hand hygiene per hour
of care
Nursing assistant status (rather than a nurse)
Physician status (rather than a nurse)
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Self-reported factors for poor adherence
Hand-washing agents cause irritations and dryness
Sinks are inconveniently located or shortage of sinks
Lack of soap, paper, towel
Often too busy or insufficient time, patient needs take priority
Hand hygiene interferes with health-care worker–patient relationship
Low risk of acquiring infection from patients
Wearing of gloves or belief that glove use obviates the need for hand hygiene
Lack of knowledge of guidelines and protocols
Not thinking about it, forgetfulness
No role model from colleagues or superiors
Scepticism about the value of hand hygiene
Disagreement with the recommendations
Lack of scientific information of definitive impact of improved hand hygiene
on health care-associated infection rates
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Risk factors associated with poor
adherence to hand hygiene
Individual level:

• lack of education or experience

• lack of knowledge of guidelines

• being a refractory noncomplier

• skin irritation by hand hygiene agents.

Team level:

• lack of education or lack of performance feedback

• working in critical care or in high workload conditions

• downsizing or understaffing

• lack of encouragement or role modelling from key staff

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Risk factors associated with poor
adherence to hand hygiene
Organisational level:
• lack of written guidelines
• lack of suitable hand hygiene agents
• lack of skin-care promotion or agents
• lack of culture or tradition of compliance
• lack of administrative leadership, sanctions, rewards or support.
System level:
• lack of awareness and commitment regarding the importance of health
care-associated infection
• lack of specific regulations and policies on prevention of health care-
associated infection
• lack of guidelines on hand hygiene in health care
• lack of promotion of national or regional campaigns to improve hand
hygiene 19
Clean Care is Safer Care
Risks to consumers are minimised when there is:

• Leadership and commitment

• Well designed processes and systems

• Clean hygienic environment

• Safer practices

• Concerted and coordinated actions

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