The Promotion of Hand Hygiene through Formal National/Sub-National Initiatives

Background: WHO's First Global Patient Safety Challenge (1^st GPSC) "Clean Care is Safer Care" (CCiSC) program recognizes, in WHO's Guidelines on Hand Hygiene in Health Care (2009), the importance of nationally coordinated activities in achieving its aim of supporting the reduction of healthcare-associated infection (HAI) through hand hygiene (HH).

Objective: To describe the results of a situational analysis of existing HH national/sub-national initiatives.

Methods: Campaigns and programmes promoting HH in health care from both national and sub-national level were identified through WHO regional offices and experts in the field. A baseline survey of existing HH national/sub-national initiatives had been conducted in 2007 and was repeated by conducting an online survey featuring a structured questionnaire early in 2009, to assess current status and to generate information on factors contributing to success. Quantitative and qualitative data analyses were conducted.

Results: In 2009, 38/38 campaigns/programmes identified, (18/20 in 2007), completed the survey. Of the 38, 29 (76%) were active national/sub-national level programs from all WHO regions, except for Africa; 21 (55%) were initiated after the launch of CCiSC in October 2005. The main targets of HH promotion were general, district and university hospitals, with increasing coverage of long-term care facilities and primary care. The stages of programs varied from awareness-raising to well scaled-up activities with ongoing evaluation. Key indicators were described for monitoring, including hand hygiene compliance and HAI data, with overall HAI prevention programs incorporating HH stated as common. Barriers to success were described as 'commitment' and 'resource availability' across all regions.  Through the 2009 survey, the facilitator role played by CCiSC in initiating activities and providing support emerged as a critical factor.

Conclusions: Hand hygiene is being promoted in health care in several countries at national/sub-national level where initiatives with defined objectives, strategies, indicators and governmental support exist. Embedding of these programs through policies, visible commitment and resource allocation will further be important for sustainability, as is support from a central facilitator, currently provided by WHO CCiSC. Indicators for measuring impact of programs could be more uniform to further enhance the reporting of successes in countries worldwide.