Cheung et al., (2013) describe how hand hygiene was introduced in the 850-bed Hong Kong Baptist Hospital (HKBH), using the promotional techniques recommended by the WHO, including a formal kick-off signing ceremony, hospital-wide posters, talks and use of role models. Significant improvement in compliance was observed in 2008 from 41 percent to 58 percent (p<0.01). Subsequently from 2009 to 2011, it remained below the 55 percent level in spite of various promotional activities. This might be related to campaign fatigue.
In their study, Cheung et al., (2013) sought to improve hand hygiene compliance with the involvement of infection control link nurses (ICLNs). HKBH has 99 ICLNs in 26 clinical areas and from these focus groups were formed. These identified four key deficiencies and for each a program was implemented to resolve with the help of the ICLNs:
1. Help your doctors achieve excellence in hand hygiene: ICLNs reverse the lowcompliance amongs doctors, the accompanying nurses would administer alcohol handrub for them during ward rounds.
2. Competition for "Speaking Walls" poster: ICLNs helped their own ward to produce self-made posters, as the present reminders were deemed ineffective. It was believed that self-designed posters would have a better effect.
3. Identification locations for point-of-care handrubs: ICLNs reported that there were strategic locations without handrub facilities; dispensers were installed.
4. Hand hygiene education program and daily checklist for healthcare assistants (HCAs): This was implemented by the ICLNs for the reduction in compliance for HCAs is the highest.
After implementing the four programs, the hand hygiene compliance rate increased to 83 percent in 2012 (n=1743, CI 81-85%), which is significant (p<0.01) compared to 2009 to 2011. The alcohol handrub consumption showed a similar trend in 2012, increasing from 8.1L per 1,000 patient-days in 2011 to 9.1L in 2012.
The researchers say their strategies could optimize the end users' participation as not only were ideas extracted from the ICLNs but they also helped in implementing their own ideas. They add that new innovations are vital, as hand hygiene has been introduced now for a significant time and campaign fatigue is likely to occur.
Reference: Cheung CWY, et al. Oral presentation O041 at the 2nd International Conference on Prevention and Infection Control (ICPIC 2013): Overcoming hand hygiene campaign fatigue by an effective innovation involving the infection control link nurses. Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):O41 doi:10.1186/2047-2994-2-S1-O41.