The mobilization in France for improving hand hygiene through promoting alcohol hand rubbing

Background: The French infection control program has prioritized improving hand hygiene (HH) in hospitals. In 2001, the National Expert Committee on Nosocomial Infection recommended the use of alcohol hand rub (AHR) for hand hygiene. Since 2005, the use of AHR has been assessed through an indicator (ICSHA) based on the annual volume of AHR product used, and taken as a surrogate marker for compliance to hand hygiene.

Objective: To develop a national campaign promoting hand hygiene and assess its impact.

Methods: A nationwide campaign (« Mission clean hands », MCH) to promote HH was launched on May 23, 2008 (HH day) to encourage all hospitals and heath-care workers (HCW) to promote HH with AHR. The MCH campaign used mailed leaflets and posters, and an educational kit, including slides set, short video clips interviews of experts and key opinion leaders, an educational quiz for HCW, and written material, which were made available to infection control teams of all health care facilities (HCF) in France through a dedicated website at the MoH. In addition, a framework for auditing hand hygiene was provided, and facilities were encouraged to audit HH practices using standardized methods. Results of the campaign were assessed via a questionnaire distributed to all French HCFs (n=2830) in early 2009, and through changes of the national indicator. ICSHA is expressed as percent value of AHR volume used relative to the minimal expected consumption of the healthcare facility (HCF) according to its activity; the expected volume derives from a minimal number of handrubs expected per patient-day in each medical specialty, and the annual number of patient-days for each. This indicator is reported as a class of percentiles (<10, 10-30, 30-70, 70-90, and >90) for each HCF within the 13 categories of HCFs stratified by type of activity.

Results: The response rate to the questionnaire was 60% (1706 HCFs); overall, 1651 HCF (57%) had organized the HH day. Posters were used in 95% HCFs; 88% distributed leaflets to HCW and 84% to visitors and patients; 56% used the quizz and 23% the expert interviews. In total, 139,509 persons (professionals or visitors) within HCFs contributed to this national campaign on HH day. Results from the ICSHA indicator showed a marked improvement in 2008, with 43.4% HCFs attaining >70% minimal target value (classes A+B), as compared with 11.2% and 24.4% in 2006 and 2007, respectively. Within the context of the world challenge for patient safety conducted by WHO, French hospitals contributed to the 1^st annual hand hygiene day on May 5, 2009. France contributed the most HCFs to this event, with 1743 hospitals registered (30% of the 5801 HCFs registered worldwide), a testimony to the increasing awareness of the importance of hand hygiene in this country.

Conclusions: A nationwide campaign appears able to contribute to motivate health care personnel and to improve hand hygiene.