We believe in it: Hand Hygiene Promotion through implementation of alcohol-based hand rub product

Background: hand hygiene (HH) is regarded as the most important method of prevention of healthcare-associated infections, but its promotion is a challenging task, requiring multimodal interventions and a considerable commitment of resources.

Objective: to describe a HH promotion program in a private tertiary hospital, focusing on the implementation of an alcohol-based hand rub product and the multimodal strategies for improving the HH compliance.

Methods: the program was conducted in a 500-bed private tertiary hospital in São Paulo, Brazil. The first step was the choice of an alcohol-based product for hand antisepsis. We chose a hand-rub gel presenting good texture and different dispensers in order to improve the accessibility of HH in different wards (dispensers with 1000 mL, pump dispensers and pocket bottles). A pilot study was carried out in the adult intensive care unit from Sep 2003 to Feb 2004, aiming to measure HH compliance, dermal tolerance and skin reactions before and after the implementation of alcohol-based gel product. As the pilot testing results were satisfactory, the product and the implementation program were approved by the hospital administration for all hospital wards. An implementation schedule was elaborated, including training for the healthcare workers called “reminder project” and consisted of a 15-minute lecture on HH with alcohol hand-rub gel., the best places for installing the dispensers were previously evaluated by healthcare workers (HCWs) in order to make them available  next to point of care. After the implementation period, several strategies were applied – campaigns, behavioral methods, including the WHO Multimodal Strategy and educational programs (lectures and web training). More dispensers were made available in other areas of the hospital such as restaurants, cafeterias, waiting rooms, lounges, receptions, next to elevators and as part of cough etiquette recommendations.

Results: the implementation period lasted from September 2004 to February 2006, including all the wards, ambulatory, emergency unit, operating rooms and rehabilitation unit. Over 2.000 dispensers were installed. Hand hygiene compliance improved from 53.2% (2008) to 74.2% (2009). The alcohol-based hand rub product use increased from 81% (2008) to 90.3% (2009) and consumption increased from 79.0 L per 1000 patient-days (2008) to 162.1 L per 1000 patient-days (2009). Healthcare-associated infections (HAIS) incidence density rates decreased from 14.6 HAIs/1000 patient-days (2006) to 8.3 HAIs/1000 patient-days (Jan -Sep 2009).

Conclusions: Our results show the importance of multimodal strategies for improving HH compliance and administrative leadership support.