World hand hygiene day is never just one day

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With World Hand Hygiene Hygiene Day celebrated every year in May, it’s a chance to review and revise hand hygiene in the workplace. On behalf of the AICPC Phil Russo writes that World Hand Hygiene Day should be celebrated every day. 

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Hand Hygiene is a general term referring to any action of hand cleansing. It includes washing hands with the use of a water and soap or applying a waterless antimicrobial hand rub to the surface of the hands (e.g. alcohol-based hand rub). 
On most occasions, healthcare workers do not need to wash their hands to perform hand hygiene, a simple application of an alcohol-based hand rub will be adequate. Alcohol-based hand rubs require less time to use, result in a significantly greater reduction in bacterial numbers than soap and water in many clinical situations, cause less irritation to the skin and can be made readily accessible to healthcare workers.
Based on the World Health Organization’s Guidelines for Hand Hygiene in Healthcare, the first Australian Five Moments of Hand Hygiene workshop was conducted in 2008, and in early 2009 the first hand hygiene compliance data was submitted from just over 100 hospitals. Now, five years later, after several hundred workshops across Australia, more than 680 hospitals now submit compliance data, and we have seen impressive improvements in hand hygiene compliance. The overall national hand hygiene compliance rate has recently been reported at 76.9 per cent.
This is a result of the commitment and hard work undertaken by those involved in the National Hand Hygiene Initiative (NHHI). Whilst Hand Hygiene Australia (HHA) has conducted workshops and provided resources, it has been those working in the hospitals that have brought about the genuine culture change that has become evident. And although there is still much work to do, particularly in tertiary institutions, every healthcare worker should now be familiar with the internationally renowned 5 Moments for Hand Hygiene.
So what do we know now that we didn’t in 2008 that has brought about the success of the NHHI? First, leadership is crucial. The important role of hospital leadership cannot be underestimated in such a program. Hospital executive staff must be engaged, and must support those charged with implementing and maintaining the NHHI. If there is no executive support, then quite simply any efforts to improve hand hygiene will be wasted.
Second, use the data. Great effort is required to collect hand hygiene compliance data, so it is important that the data is reported to those who need to know, and those who can authorise change. Reports should be provided to hospital executive, boards, heads of departments and of course patients. Clinicians also need feedback on their performance. So, data must also be provided back to the ward/department level. Furthermore, data needs to be reported back in a timely manner. Immediate feedback to a healthcare worker on their practice will be more effective than providing a compliance rate from data that was collected a month ago. The HCW may not be aware where they are going wrong, so immediate feedback after an episode of care provides a great learning opportunity.
Third, we know that healthcare workers are much better at performing hand hygiene after a patient care episode than before. In other words, they are better at protecting themselves than the patient. No healthcare worker deliberately goes out to put their patients safety at risk, so this is telling us we need to target educational messages about the importance of performing hand hygiene before patient care episodes. This knowledge comes about from using the data. We need to look at individual healthcare worker groups and moment type and identify where we need to target education.
Fourth, we still need to remind healthcare workers that they don’t always need to wash their hands to perform hand hygiene. As mentioned above, on most occasions, alcohol based hand rubs are adequate. Frequent and unnecessary use of soap and water instead of alcohol based products will be detrimental to skin and result in either no hand hygiene being performed as it will hurt the healthcare worker or skin infections of the healthcare worker.
And finally, we know that it’s never over! Continuous vigilance is required. While we have seen clear improvements across the board, the potential for lapses in concentration, changes to workflow and work environments and the increasing susceptibility of our patients demand that hand hygiene remain at the forefront of infection prevention.
HHA will continue to provide a suite of educational resources for all healthcare workers. The hand hygiene online learning packages are now available for a variety of healthcare worker groups including medical, nursing, allied health, non clinical and students as well as the standard package. These, coupled with tailored presentations and video demonstrations, are all available at the HHA website.
Australia has been recognized by the World Health Organization as a centre for its efforts in hand hygiene. Many countries have observed the success of the NHHI and are looking to implement similar programs. All those involved in the NHHI should be proud of their work, particularly those at the hospital level.
HHA and the NHHI is funded by the Australian Commission on Safety and Quality in Health Care. 
Phil Russo
Masters in Clinical Epidemiology.
National project Manager of Hand Hygiene Australia
Phil Russo has worked in infection prevention and control for more than 20 years and holds a Masters in Clinical Epidemiology.He is currently National project Manager of Hand Hygiene Australia and has written this column on behalf of the Australasian College for Infection Prevention and Control