Compliance increase in 62 hospitals participating in the German hand hygiene campaign

Background:

The national German hand hygiene (HH) 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 six years be the German ministry of health. By November 1st 2010, over 720 health institutions are actively participating. Among other measures, hand hygiene compliance observations are an essential but voluntary part of the campaign.

Objective:

We present compliance rates before and after intervention in 62 hospitals.

Methods:

All participants used defined observation tools and where trained by the campaign team members. The definition of hand hygiene opportunities (HHO) 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 and after intervention. A minimum of 200 observations per unit and 20 observations per indication was defined. Results were stratified by HHO, type of health care worker and specialty. P-Value was calculated using the Chi-Square test.

Results: 

139 360 hand hygiene opportunities were observed at 317 units in 62 hospitals. The overall increase of compliance was 9%. The median compliance rates stratified by HHO increased by 11% before patient contact, by 12% before aseptic tasks, by 8% after contact with infectious material, by 7% after patient contact, and by 10% after contact with patient surroundings. The increase in all types of HHO’s were significant (p<0.01). Physicians improved by 10% from 54 to 64 % (p<0.01) and nurses by 9% from 70 to 79 % (p<0.01). Stratified by type of unit, increase of compliance was highest in pediatric units (from 59 to 81%) (table 1).

Conclusions:

Hospitals participating in the campaign have to implement several key intervention tools, among them leadership support, education, increase of alcohol hand rub availability, surveillance of alcohol based hand rub and compliance observations. These 62 hospitals contain a variety of hospitals from large tertiary care to small (more than 800 and less than 400 beds) primary care hospitals. Our results show, that our multimodal intervention model based on the WHO “Clean Care is Safer Care” campaign lead to compliance improvements in different kinds of settings.

Table: Increase of compliance rates before and after intervention stratified by type of unit in 62 hospitals

Type of unit	Median compliance in % before intervention	Median compliance in % after intervention	Increase in %	p-value
Internal Medicine	65	71	6	<0.001
Interdisciplinary	65	74	9	<0.001
Surgical	62	72	10	<0.001
Other surgical	67	81	4	<0.001
Other conservative	62	70	8	<0.001
Pediatric	59	81	22	<0.001
Neonatology	72	83	11	<0.001