Baseline hand hygiene compliance rates in 126 hospitals participating in the national German hand hygiene campaign

Background: The national German hand hygiene campaign “AKTION Saubere Hände” started at January 1^st 2008. The campaign is based on the WHO “Clean Care is Safer Care” campaign and is funded for three years be the German ministry of health. By November 1st 2009, 624 health institutions are actively participating. Among other measures, hand hygiene compliance observations are an essential but voluntary part of the campaign.

Objective: We present baseline compliance data from 126 hospitals stratified by indication and type of unit.

Methods: All participants used defined observation tools and where trained by the campaign team members. The definition of hand hygiene opportunities is based on the WHO Model “My 5 moments of hand hygiene”. Observations were done before any intervention took place in order to define the baseline situation. A minimum of 200 observations per unit and 20 observations per indication was defined.

Results: The overall median baseline compliance in 126 hospitals was 62.5% (interquartile range (IQR) 50.5 - 73.1%). The compliance per indication is shown in table 1. There was no difference between ICU’s (overall median 62.2%) and non-ICU’s (overall median 62.9%). The highest compliance rate was found in neonatology units (median 72.2%, IQR 66.7- 78.6%), the lowest in interdisciplinary units (median 60.2%, IQR 51.9 - 72.2%).

Table 1: Baseline compliance rates of 126 German hospitals stratified by indication

			Compliance in %
Indication	No. of observations	No. of positive actions	P 25	Median	P 75
Before patient contact	30522	16689	39.1	54.4	70.7
Before aseptic task	7978	4743	40.8	60	76.5
After contact with infectious material	7762	5756	61.5	77.5	92.4
After patient contact	31111	22009	61	71.9	81.7
After patient surroundings contact	15212	7863	36.8	51.1	66.4

Conclusions: So far only few observation data were available for German hospitals, so this is the first large scale dataset. Compared to other international campaigns and considering the Hawthorne effect, Germany starts at a fairly high level of compliance. Considering the relatively low compliance before patient contact and before aseptic tasks and the importance of these indications for patient outcome, the campaign will be focussing within the next year on interventions of these two indications.