Anatomy of a successful multimodal hand hygiene campaign: Table 1

In 2005, in the far northeastern corner of the USA, Kirkland et al ,1 found themselves in a situation painfully familiar to many infection control professionals worldwide, including our institution in the early 1990s.2 Hand hygiene compliance amongst healthcare workers in their hospital was poor, healthcare workers were unenthusiastic about the importance of hand hygiene, and quality improvement interventions were ‘not consistently supported by organisational leaders’.1 In response, they undertook a comprehensive hand hygiene promotion programme, which evolved over the course of 2 years, that resulted in an institutional culture change, a dramatic increase in hand hygiene compliance from 41% to 87%, and most importantly, a significant reduction in healthcare-associated infections from 4.8 to 3.3 per 1000 inpatient days. These changes were sustained during a 1-year postintervention follow-up. So how did they do it and what can we learn from them? First, Kirkland et al used well-established strategies with local interpretation and adaptation. Their intervention included each of the five components of WHO multimodal hand hygiene improvement strategy (table 1),3 and each of these components was implemented with careful attention to the local landscape and available resources, similar to the earlier ‘Geneva hand hygiene promotion model’.2 System change involved carefully considered installation of alcohol-based hand-rub dispensers in locations designed to suit staff workflow as assessed by a workgroup comprised of senior biomedical engineering and clinical staff.1 Education and training of healthcare workers was facilitated by development of an electronic learning module. This was complemented by a voluntary—and well received—hand hygiene competency certification programme. The measurement and feedback component of this initiative is particularly …