Hand Hygiene Survey:Preliminary Results

A. McGeer, K. Green, J. Lourenco, and G. Youssef for the Hand Hygiene

Research Steering Committee

Background

• The CPSI, CCHSA, PHAC and CHICA are working together to develop a national hand hygiene (HH) campaign

• Goal: To improve support to healthcare and public health organizations implementing HH initiatives across Canada

Background (cont.)

• HH Study Objective: to provide guidance to healthcare decision makers wishing to implement successful HH programs

• Help us to assess the following in Canadian healthcare facilities:– HH adherence– Current HH initiatives and which are

considered effective– What type of support is needed

Study Description

• The HH survey includes 52 questions on:– Respondent demographics– Current HH environment and practices– HH initiatives and their perceived effectiveness– Needed resources– Future HH plans

• Survey was available on the CHICA website from April to May 2007

• CHICA has 1327 members – Infection control professionals located across Canada – Come from different backgrounds including nursing, medicine,

microbiology, medical technology, and epidemiology• 171 CHICA members responded

Participants

Facility types of participants

3%2%2%

52%

10%

32%

10%13% 12%

9%

3% 2%

0

10

20

30

40

50

60

70

80

90

100

Acute

Car

e

Chron

ic C

are

Long

Ter

m C

are

Public

Hea

lth

Regio

nal H

ealth

Aut

horit

y

Men

tal H

ealth

Home

Care

Primar

y Car

e

Comm

unity

Hea

lth

Rehab

ilita

tion

Emer

genc

y M

edic

al S

ervi

ces

Other

Facility Type

Fre

qu

ency

Province in which participants are located

AB, 14, 8%

BC, 21, 13%

MB, 9, 5%

NB, 10, 6%

NL, 2, 1%

NT, 1, 1%

NS, 9, 5%

NU, 1, 1%

ON, 91, 54%

QC, 5, 3%

SK, 4, 2%

PE, 1, 1%

AB, 5, 6%

BC, 11, 13%

MB, 5, 6%

NB, 7, 8%

NL, 2, 2%

NT, 1, 1%

NS, 2, 2%

NU, 0, 0%

ON, 47, 53%

QC, 4, 5%SK, 3, 3%

PE, 1, 1%

All Facilities Acute Care Facilities

Participant’s role in their organization

0%0%2%

97%

2% 0% 0% 1%7%

0

10

20

30

40

50

60

70

80

90

Nurs

eM

anag

er/E

duca

tor/C

linic

alN

urs

e

Infe

ctio

n C

ontr

ol

Pra

ctitio

ner

/Consu

ltan

t

Chie

f N

urs

ing O

ffic

er/V

PN

urs

ing

Hosp

ital

CEO

/Man

agem

ent

Qual

ity

Man

agem

ent

Pat

ient Saf

ety

Occ

upat

ional

Hea

lth

Public

Hea

lth

Insp

ecto

r/N

urs

e

Res

pirat

ory

Ther

apis

t

Participant's Role

Fre

quen

cy

Hand Hygiene Survey Findings for Acute Care Facilities

Number of facilities in which there is a written HH policy and if the policy is signed

Provide sample hand hygiene policies

42%

47%

9

11%

79

10%

0

10

20

30

40

50

60

70

80

90

Policy No Policy

Policy Present

Fre

qu

ency

No Policy

Missing

Not Signed

Signed

90%

Number of facilities that provide HH educational programs to staff

In most sites, HH education is not mandatory Provide advice on how to ensure that most staff are educated

21%

48%

15

19%

73

17%

0

10

20

30

40

50

60

70

80

90

100

Program No Program

Program Present

Fre

qu

ency

No Program

Missing

Not Mandatory

Mandatory

83%

Types of HH products provided to staff by facilities

Very few are providing hand lotions and individual alcohol sanitizers

23%

81%

61%

85%

69%

100%

0

10

20

30

40

50

60

70

80

90

100

Alcohol HandSanitizers

Hand Lotions Anti-bacterialSoap

Non-antibacterial

Soap

SurgicalScrub

IndividualAlcohol Hand

Sanitizers

Hand Hygiene Product Types

Fre

qu

ency

Location of HH products in the facility

We’re doing a good job of getting products into public areas but not to point of care

Need to help facilities determine optimal product placement

92%86%

48%

88%85%

91%

3%

46%

0

10

20

30

40

50

60

70

80

90

Bedside On Beds Door toRoom

ExamRooms

StaffCommon

Areas

ElevatorBays

WaitingAreas

MainLobby

Area

Fre

qu

ency

Point of Care Areas Public Areas

Types of skin care programs provided to staff by facilities

• 41% of responding acute-care facilities provide skin care programs to staff

Provide skin care program tools

49%

66%

26%

0

5

10

15

20

25

Education Programs Programs for Staffwith Skin Problems

Other

Skin Care Program Types

Fre

qu

en

cy

Types of tools for monitoring HH adherence used by facilities

• 37% of respondents chose “None” Need to explain why monitoring is important and how good each

method is at determining adherence

44%

13%

1%

36%

0

5

10

15

20

25

30

35

40

Monitor Consumptionof Products

Electronic Monitoringof Sink or HandSanitizer Use

Self-assessment/ self-report

Adherence Audits

Tools

Fre

qu

ency

Reasons why facilities have not audited HH adherence

Provide sites with auditing tools Suggest strategies on how to make time for auditing and on how to

obtain necessary resources

79%

41%

52%

0

5

10

15

20

25

30

35

40

45

50

No Time No Tools No Resources

Reason

Fre

qu

ency

HH Initiatives

• 76% of organizations have implemented initiatives to improve hand hygiene in the last 2 years

• 31% of facilities receive financial support for HH initiatives

• Only 32% of these receive internal funding

Provide strategies for obtaining financial support

Individuals targeted by HH initiatives

22%

65%

55%

100%

0

10

20

30

40

50

60

70

80

Staff Patients Visitors Other

Individuals Targeted

Fre

qu

ency

Components of HH initiatives

Very few include staff in planning or have baseline or post-implementation audits

Provide staff education to ensure that it is adequate

31%

24%

23%

18%

14%

6%

35%

38%

44%

51%

93%

0 10 20 30 40 50 60 70

Staff Education

Toolkit

Baseline Adherence Audits

Other Promotional Material

Staff Involvement in Planning

Collection of Baseline Indicators

Post-Implementation Audits

Hand Hygiene Role Models or Resource Persons

Interviews with Staff

Community Education Programs

Patient Involvement in Planning

Co

mp

on

ent

Frequency

Most effective component of campaign

• Increased access to alcohol hand rub

• Demonstration (Glo-germ, paint)

• Personal hand rub

• Feedback on performanceIdentify positive strategies on how to

inform staff of their performance

Least effective component of campaign

• Posters/ signs/ buttons/ fridge magnets (without other components or without ability to change; esp if negative)

• Education (esp. one-time, large group, not interactive)

• Alcohol hand rub at hospital entrance• Negative messaging from/punitive sense to

audits Identify positive strategies on how to inform staff

of their performance

Most useful added resources

• Audit tools• Posters and supplies (lanyards,

shoelaces, pencils, erasers, etc.)– Downloadable from internet

• Information from other projects (other countries, other hospitals)

• VideosProvide pre-tested promotional tools that

can be adapted to other facilities

Greatest organizational challenge

• Senior management commitment – Not considered important enoughNeed strategies to get senior management on

board with initiatives

• Time for staff to come to in-services

• Physician buy-in/participation

• Hand care programs

Additional Findings

• 8% have a dedicated budget for promotional material

• 46% reported hospital rules and regulations that limit their use of promotional material

• 17% of facilities include adherence in staff performance reviews– 13% of those facilities take disciplinary actions for

non-adherenceProvide ideas on how to include adherence in

performance reviews and on what disciplinary actions should be taken

Additional Findings

• 16% of facilities include adherence to HH policies in their job descriptions

• 12% of facilities have monitored patient impressions of adherence in satisfaction surveysProvide patient satisfaction surveys

Acute vs. Other Facility Types 1• Facilities that identified themselves as acute and those that did not

were at equal risk of:– Having a written HH policy– Providing HH educational programs to staff– Providing staff with alcohol hand sanitizers, non-antibacterial soap, and

individual alcohol hand sanitizers– Providing HH products on beds– Providing HH skin care programs to staff– Monitoring consumption of products, electronic monitoring, self-

assessment, or using no tools for auditing HH adherence– Not auditing HH due to no time, no tools, and no resources– Implementing a HH initiative in the last 2 years and receiving financial

support for their HH initiatives– Targeting their HH initiatives towards staff, patients, and visitors– Most components of their HH initiatives– Hospital rules limiting their use of promotional material– Including adherence in staff performance reviews and taking disciplinary

measures for non-adherence– Monitoring patient impressions of adherence in satisfaction surveys

Acute vs. Other Facility Types 2

• Facilities that identified themselves as acute were at greater risk of:– Providing staff with:

• hand lotion (RR=1.93, 95% CI=1.35-2.78)• anti-bacterial soap (RR=2.59, CI=1.46-4.60)• surgical scrub (RR=4.60, CI=2.98-7.10)

– Providing HH products in the:• Elevator bays (RR=1.32, CI=1.03-1.69)• Waiting areas (RR=3.76, CI=2.13-6.63)• Main lobby (RR=6.67, CI=1.17-6.11)• Staff common areas (RR=2.60, CI=1.38-4.91)• Bedside (RR=1.56, CI=1.26-1.93)• Exam rooms (RR=4.40, CI=2.60-7.45)• Door to room (RR=8.25, CI=4.21-16.17)

– Among those that did provide skin care programs, providing programs for staff with skin problems (RR=2.13, CI=1.29-3.51)

– Using adherence audits to monitor HH adherence (RR=1.37, CI=1.10-1.71)

– Collecting baseline indicators as part of their HH initiatives (RR=1.27, CI=1.05-1.52)

Acute vs. Other Facility Types 3

• Facilities that DID NOT identify themselves as acute were at a greater risk of:– Having a dedicated budget for promotional

material (RR=1.18, 95% CI=1.03-1.34)– Including adherence to HH policies in their job

description (RR=1.15, 95% CI=1.04-1.28)

Future Actions

• 1636 surveys were mailed out to 1144 hospitals in July 2007

• Thus far, 307 people have responded• In October 2007 surveys will be sent out to long-

term care, rehabilitation, and mental health facilities, public health units, and emergency medical services

• Focus groups starting in October 2007 will delve further into findings concerning HH initiatives

Summary of Recommendations 1

• Only 23% of facilities are providing individual alcohol sanitizers

• Need tools that describe optimal product placement (especially at point of patient care) and how to determine this

• Since 37% of respondents indicated that they have no tools for monitoring HH adherence and 41% cite no tools as the reason for not auditing, provide auditing tools and information on how good the different methods of monitoring are at determining adherence

• Provide pre-tested promotional tools

Summary of Recommendations 2

• Describe HH initiatives that have been effective in other facilities beyond (staff education)

• Provide sites with strategies on how to make time for auditing and on how to obtain the necessary resources

• Provide strategies to obtain financial support• Since very few sites are providing hand lotion and only

41% are providing skin care programs for staff, we need to provide sites with skin care program tools

• Provide ideas on how to include HH in staff performance reviews

• Identify positive strategies on how to inform staff of their performance