Proper hand hygiene is the simplest and most primary strategy to prevent hospital acquired infections, which can lead to sepsis and increased hospital stay. However, it has always been a challenge to achieve high compliance rates among healthcare professionals, even at big hospitals.
Determined to make it a safe place for patients, Bright Vision Hospital (BVH) set up their Hand Hygiene Team in early 2015. The main task for the Team is to devise an effective hand hygiene programme for BVH. Nursing Officer Rodona Labuanan leads the team.
After research, workshops and discussions, the Team came up with a multi-prong approach that includes training and education, monitoring and feedback, and a combination of rewards and competition.
To realise the goal, the team carried out their plan systematically.
Training and education
The Hand Hygiene Team did some research and found out that one of the main issues that many hospitals face is that the hospital staff were unaware of the low compliance rates.
A change of mind-set among all staff takes time and effort. With the strong support from the management, the Team planned and conducted a series of training sessions and education activities to keep staff informed and proactive about hand hygiene.
· Orientation programme for all new clinical staff
· Monthly training sessions during Continuing Nursing Education
· Talk on hand hygiene during BVH Continuing Medical Education
· Annual infection control refresher course
Monitoring and feedback
For a more efficient monitoring system, the Team adopted the standard SingHealth Hand Hygiene Audit Tool after attending the SingHealth Hand Hygiene Workshop on 10 March 2015. Coupled with the standardised auditing method, they conducted monthly hand hygiene compliance audits and encouraged the staff to provide feedback.
By gathering feedback, the Team realised another issue: limited resources. Hand rubs were not always easily available everywhere.
In November 2015, the Team did a pilot run by installing bed-foot-mounted alcohol-based hand rubs in the Hope Ward of BVH. In just one month, that ward scored the highest increase in Health Care Workers Hand Hygiene Compliance Rate among the five BVH wards in December 2015.
With the encouraging result, all the five wards were installed with bed-foot-mounted hand rubs in January 2016. Posters were also put up at the hospital to inform the staff of the additional hand rubs they can use for hand hygiene.
Rewards and competition
To encourage a consistent hand hygiene practice, the Team also employed a 'carrot-and-stick' tactic.
BVH staff identified as Hand Hygiene Champions were given a certificate and a supermarket voucher as a way of recognising of their effort.
To encourage the other staff of BVH, the Team sends out monthly reports on hand hygiene compliance rate to all departments, highlighting to the respective departments categories they can improve in.
The BVH Medical Department, as competitive as always, did an outstanding job by maintaining 100% compliance rate for six consecutive months from November 2017 to April 2018.
The stunning results
After over a year's implementation, it is quite clear that this multi-prong approach is working its magic.
During the Cross Institution Infection Control Hand Hygiene Audit for the third and fourth quarters of 2017, the compliance rate at BVH reached 100%, a significant increase compared to 66% in April 2015 when the Hand Hygiene Team was first set up.
Sister Rodona said, "This wouldn't be possible if it was not for everyone's commitment. This amazing achievement is the result of everyone's contribution, from the ground staff to the management members. The key is the change of attitude among all BVH staff: hand hygiene is everybody's business."
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