SAN FRANCISCO – Good hand-hygiene practices at health care facilities appear to be taking hold worldwide, results from a large World Health Organization survey suggest.
"Health care facilities around the world have taken seriously the need for improving hand-hygiene practices at the point of care," Dr. Benedetta Allegranzi said in an interview before a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy. These efforts must be sustained, she urged.
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A World Health Organization survey suggests that worldwide, more and more health care facilities are practicing good hand-hygiene.
Dr. Allegranzi, a scientist in WHO’s World Alliance for Patient Safety in Geneva, reported results from the WHO Hand Hygiene Self-Assessment Framework (HHSF), a validated questionnaire that includes 27 indicators that support the five key components of the WHO hand hygiene–improvement strategy (namely system change, training and education, evaluation and performance feedback, reminders in the workplace, and institutional safety climate). The study is the first effort to provide a snapshot of hand-hygiene practices and promotion worldwide.
The survey’s maximum possible overall score is 500 points. Based on its overall score, each health facility was assigned to one of four levels of progress: inadequate (0-125 points), basic (126-250 points), intermediate (251-375 points), or advanced (376-500 points).
Courtesy Dr. Benedetta Allegranzi
Dr. Benedetta Allegranzi
Of the 9,032 health care facilities invited to participate, 2,119 facilities from 69 countries completed the survey, for a response rate of 25%. Nearly three-quarters of facilities (70%) were registered with the WHO SAVE LIVES: Clean Your Hands initiative, and 74% were involved in a national hand-hygiene campaign.
Nearly half of responding health care facilities (48%) delivered acute care and 48% delivered a mix of acute and long-term care. The overall score was a mean of 292.5 (intermediate level). Most facilities scored in the intermediate level (41%) or the advanced level (24%), Dr. Allegranzi said.
The researchers observed significant differences between regions, with the lowest overall score in Africa (mean, 218.5) and the highest in Western Pacific (mean, 351.8; P less than .001). The highest mean scores were observed in the HHSF sections regarding availability of facilities for hand hygiene (78.1), use of reminders (63.9) and staff education (61.4).
A majority of facilities (90%) reported having alcohol-based handrub available, 98% reported training staff on hand-hygiene best practices, and 92% reported displaying hand-hygiene posters in the wards (92%). However, "response to some specific questions indicate that substantial improvement is needed in the area of monitoring and feedback on hand-hygiene activities [a very important element of improvement strategies] and for the establishment of a comprehensive patient safety climate [well known to facilitate health care workers’ behavioral change]," Dr. Allegranzi said at the meeting, which was sponsored by the American Society for Microbiology.
Participating in the WHO global campaign for hand-hygiene promotion or in a national campaign and having dedicated infection control professionals "are factors independently associated by a good level of progress at the facility level," she added. "Each health care worker should show personal accountability and commitment by practicing optimal hand hygiene to reduce the transmission of harmful pathogens during care delivery."
She acknowledged that the study is limited by selection bias and by the fact that several countries "are not adequately represented because an insufficient number of facilities submitted their results."
Dr. Allegranzi said that she had no relevant financial conflicts to disclose.