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During the SARS epidemic, high compliance with hand hygiene by healthcare workers was primarily driven by fear. However, the post-SARS period confirmed that this practice was not sustainable. Infection control experts at Singapore General Hospital report that at their 1,600-bed acute tertiary care hospital, the hand hygiene program was revised in late 2006 following Singapore's signing of the pledge to the World Health Organization (WHO)s "Clean Care is Safer Care" program.
The WHO audit tool was used in the measurement of hand hygiene compliance from 2007. Innovative education and prominent cues to action were initial building blocks used in transforming behavior. Creative use of posters, stickers, advertisements on shuttle buses help to create awareness in staff, patients and the public. A giant poster placed on one of the hospital walls was a strong public statement expressing the hospital's commitment to patient safety through good hand hygiene practices. Incentives in the form of phone straps, magnets, bookmarks and vouchers given to staff members are other innovative means of staff engagement. The program was enhanced further with system changes, evaluation and feedback, as well as the fostering of institutional safety climate. Annually, the WHO Hand Hygiene day on May 5 was observed with creative fun activities involving both staff and public.
The researchers report that hand hygiene compliance rate improved from 20 percent (2007) to 61 percent (2010). Improvement was also seen annually in the compliance to each of the five moments of hand hygiene as well as in all staff categories. Healthcare-associated MRSA infections was reduced from 0.6 (2007) to 0.3 (2010) per 1,000 patients days.
The researchers conclude that leaderships support of the program through its visible presence, messaging and release of resources was the key factor in helping to make the program a success. The hospital was recognized as a Global Hand Hygiene Expert Centre in January 2011.
Reference: ML Ling, KB How, KY Tan and LC Lee. Creativity in hand hygiene program. Presentation at the International Conference on Prevention & Infection Control (ICPIC). BMC Proceedings 2011, 5(Suppl 6):P125doi:10.1186/1753-6561-5-S6-P125.