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Successful global
promotional activities
1. Background
Hand hygiene is the most important preventive
measure against health-care associated
infections. To celebrate the 10th anniversary of
the “Clean Care is Safer Care” campaign, the
World Health Organization (WHO)
Collaborating Centre (WCC) launched the
“Global Hand Sanitizing Relay 2015”, inviting
hospitals worldwide to join this initiative
intended to further promote hand hygiene,
focusing on the quality of the hand rubbing
technique by health-care workers (HCWs). We
briefly describe the campaign and its
implementation, and highlight the main
challenges and achievements.
THE GLOBAL HAND SANITIZING RELAY Promoting hand hygiene through innovation
WHO Collaborating Centre
on Patient Safety
Infection Control & Improving Practices
University of Geneva Hospitals
and Faculty of Medicine, Geneva, Switzerland Figure: World map indicating countries with at least one hospital participating in the WHO Global Hand Sanitizing Relay, 2015.
Ermira Tartari1,
Daniela Pires1,
Tcheun-How Borzykowski1,
Fernando Bellissimo-Rodrigues1,
Claire Kilpatrick2,
Benedetta Allegranzi2,
Didier Pittet1.
Affiliations:
1 Infection Control Programme and
WHO Collaborating Centre on
Patient Safety, University of
Geneva Hospitals and Faculty of
Medicine, Geneva, Switzerland.
2 World Health Organization
(WHO) Service Delivery and
Safety Department, Geneva,
Switzerland.
Contacts:
Ermira Tartari
Key Words:
Hand hygiene;
World Health Organization;
hand sanitizing relay.
2. Materials/Method
The Hand Sanitizing Relay (HSRelay) consisted in
having as many HCWs as possible performing a
sequential chain of hand hygiene actions according
to the “How to Handrub” technique recommended
by the WHO. HCWs were encouraged to train and
practice with their colleagues the WHO 6 step-
technique to be able to perform it perfectly during
the event, as the gestures were supervised and
validated by infection control practitioners. To
promote this event, social media was used and the
activity was promoted on the WHO SAVE LIVES:
Clean Your Hands 5 May 2015 webpage, where
explanatory posters, video and instructions were
made available. Facilities participating in the
campaign were invited to submit their details
online.
Frequent reminders were also disseminated
through a range of media. Hospitals were
invited to send written feedback, photographs
and videos of their own HSRelay events.
3. Results
The call facilitated by WHO and the WCC was
issued on 29 April 2015 and hospitals
interested in participating completed the activity
by 10 Sept 2015. A total of 133 hospitals in 43
countries across all WHO regions registered
and completed a HSRelay (Figure). More than
15,000 enthusiastic HCWs reported to have
participated. By 26 Nov 2015, the WCC had
received 12 videos from 42 hospitals and
photographs and posters of events from 30.
Feedback from hospitals identified the HSRelay
as an excellent opportunity for team building
and reinforcement of team spirit between both
infection control practitioners and other HCWs
in hospitals. The event was perceived as an
excellent informal way to teach, train and raise
awareness on the quality of hand hygiene
procedures, and to possibly further promote
compliance with the WHO “My 5 Moments for
Hand Hygiene” concept. Hospitals reported as
the main difficulty the time factor necessary for
all HCWs to remain present during the
HSRelay activities and away from clinical
duties. Some hospitals adapted the
recommended HSRelay procedure to correct
for this issue.
4. Conclusions
The Global Hand Sanitizing Relay 2015
promoted by the WCC proved to be effective in
mobilizing hospitals worldwide, strengthening
HCWs’ commitment towards better hand
hygiene practices and improved patient safety.
Page 2
WHO Multimodal Hand Hygiene
Improvement Strategy
Page 4
It is divided into :
5 Major Components
of the WHO Multimodal HH
improvement Strategy
27 Indicators
• For self assessment
• Representing the key elements
for each component
• Based on evidence & expert
consensus
Total Score provides the level of HH promotion
and practice
1. Inadequate: HH practices and promotion are deficient.
Significant improvement is required.
2. Basic: some measures are in place, but not to a
satisfactory standard. Further improvement is required.
3. Intermediate: an appropriate HH promotion strategy is
in place and HH practices have improved. It is now crucial
to develop long-term plans to ensure that improvement is
sustained and progresses.
4. Advanced: HH promotion and optimal HH practices
have been sustained and/or improved, helping to embed a
culture of safety in the health-care setting.
Page 13
What is the HHSAF used for?
Hand Hygiene Self-Assessment
Framework (HHSAF) – The Purpose
▫ To implement and sustain a hand hygiene programme
▫ A global systematic tool used by health-care facilities
▫ A complete situation analysis
▫ Serves as a Benchmark
▫ A diagnostic tool
- to identify key issues requiring focus and improvement
▫ Facilitates the development of an action plan
▫ A comprehensive hand hygiene strategy
▫ Documentation of progress with time
Who should use the HHSAF?
▫ Healthcare professionals in charge of implementing
a strategy to improve hand hygiene
▫ IPC professionals
▫ Senior managers at the healthcare facility
directorate
▫ Hand hygiene working groups
▫ Infection control committee
▫ Acute and long term healthcare facilities
▫ Facilities at any level of progress of hand hygiene
promotion
Video HHSAF
The Hand Hygiene Excellence Award
WHO CAN APPLY?
Participation is open to all hospitals which have
adopted the implementation of the WHO multi-
modal strategy and have shown at least a 3 year
sustainability of their programme
1
THE PROCESS
2. Hospital visit and
audit by expert
members
3. Expert panel
decision
1. Application based
on the Hand
Hygiene Self
Assessment
Frameowrk
THE AUDIT PROCESS
◦ Two IPC experts visit the nominated
hospital
◦ Random departments/ wards are
audited
◦ Experts question front line workers
in the clinical areas about their
knowledge on hand hygiene
HAND HYGIENE EXCELLENCE AWARD
TAKING THE WORLD…
Asia Pacific Europe Latin America
since 2010 since 2012 since 2014
HAND HYGIENE EXCELLENCE AWARD COUNTRIES
our office
In AFRICA in 2017
“
The HHEA is the best tool to verify the
successful implementation of the WHO
Multimodal Hand Hygiene
Improvement Strategy
THE HAND HYGIENE EXCELLENCE AWARD
The award is conceived as a
platform to identify, honor
and celebrate those
hospitals and HCWs who
have contributed to
improving patient safety
through their excellence,
enthusiasm and innovative
methods.
>30 Hospitals have been awarded the
Hand Hygiene Excellence Award
WANT BIG IMPACT?
Use big image.
Aims at:
◦ Recognizing outstanding improvements
◦ Identifying role models
◦ Awarding professionally active and engaged IPs
◦ Sharing expertise
◦ Learn from success stories
The AWARD FOR EXCELLENCE…
Thank you!
https://www.youtube.com/user/hygienedesmains/videos
The Global Hand Santizing Relay
Every 5 MAY: WHO brings people together
to improve & sustain Hand Hygiene
Baseline Compliance amongst HCWs 38.7%
WHO guidelines on hand hygiene in health care (First global patient safety challenge clean care is
safer care) WHO, 2009
What is the Hand Hygiene compliance?
Feeling alone in the desert?
… what next
Facing a hand hygiene campaign fatigue?
The 1st Hand Sanitizing Relay
Hong Kong Baptist Hospital, May 2014
Hand hygiene compliance increased from 72% (95% CI,
70%-74%) in 2013 to 83% (95% CI, 83%-87%) in June-July
2014
The 1st Hand Sanitizing Relay
Guinness World Record
Record of 277
HCWs
The HSRelay challenge
a sequential chain of
HH actions
WHO “How to Handrub”
technique
As many HCWs as
possible during a single
event.
The 1st Hand Sanitizing Relay
Launched by the WHO CC in April 2015
Countries called to arrange a HSRelay as part of their 5th of May promotional activities
I. To perform a HSRelay
II. To set a new Guinness World Record
III. To measure hand hygiene compliance before-and-after the event
Hand Sanitizing Relay 2015
>15,000 Health care workers
43 Countries
133 Health care facilities
The Global Hand Sanitizing Relay
2015: Results
27 hospitals submitted to WHO CC videos/ photos
or posters of the organized HSRelay event
19 hospitals registered to set a new Guinness
World Record
HCWs participating:
Nurses, Doctors, Allied medical professionals,
Nursing, medical and pharmacy students
The Global Hand Sanitizing Relay 2015
133 hospitals in 43 countries across all WHO regions
Africa
n=31
Europe
n=23
Western Pacific
n=22
East Mediterranean
n=15
South East Asia
n= 15 Americas
n=27
India
Iran
Romania
Australia
Vietnam Philippines
Canada
Indonesia
14 hospitals from 10
countries measured
hand hygiene
compliance rates
Pre-event period:
April-May 2015
Hand Sanitizing
Relay: May 2015
Post-event period:
June-September
2015
Do you want to improve hand
hygiene compliance in your
hospital?
Pre-and-post HH
compliance
Pre-and-post HH compliance
0%
20%
40%
60%
80%
100%
Pre-Relay
Post-Relay
*
*
* *
*
*
*
*
Hand Hygiene compliance
Hospital Pre-Relay Post-Relay % Change CI
Philippines 1 30% (133/448) 62% (581/940) 32.1% (26.9-37.4%)
South Africa 57% (287/500) 87% (780/895) 29.8% (24.9-34.6%)
Sri Lanka 57% (57/100) 78% (78/100) 21% (8.3-33.7%)
Hong Kong 1 59% (596/1,007) 78% (184/237) 18.5% (12.3-24.6%)
Vietnam 59% (2231/3,748) 65% (1,887/2,925) 4.9% (2.6-7.3%)
Philippines 2 76% (212,021/277,175) 79% (77,342/97,051) 3.2% (2.9-3.5%)
Hong Kong 2 82% (257/315) 93% (386/415) 11.4% (6.5-16.4%)
Kenya 55% (220/400) 67% (268/400) 12% (5.3-18.7%)
Table 1. HH compliance before-and-after the HSRelay with the change difference
Chi2 test used to compare proportions, using the Bonferoni correction for multiple
Comparisons. 8 out of 14 hospitals showed a significant increase in HH compliance
The Global Hand Sanitizing Relay 2015
Certificate to participants from the WHO CC
LIMITATIONS
A non-controlled before-after study design
◦ Unmeasured confounders could
potentially account for some of the
improvement in hand hygiene compliance
◦ WHO Global call for action
◦ Selection bias
◦ 14/133 submitted pre-and-post HH
compliance data
◦ No long-term follow up
◦The time factor necessary for all HCWs to remain
present during the HSRelay activity, away from clinical
duties.
◦Facilities adapted the recommended HSRelay
procedure to correct for the time factor.
◦HSRelay in wards/departments at different time
Conclusions
◦ Hand Sanitizing Relay, an excellent opportunity:
for team spirit between IPC and HCWs in hospitals
◦ for promoting WHO 6-step technique and
◦ “My 5 Moments for Hand Hygiene”
◦ for mobilizing HCWs to maintain the hand hygiene
momentum
Uncontrolled before-after study design,
but the majority of participating facilities reported a
significant increase in hand hygiene compliance rates
…because together we are stronger
Hand Sanitizing Relay 2015
Thank you!
ANY QUESTIONS?
