Guide to Implementation
A Guide to the Implementation of the WHO
Multimodal Hand Hygiene Improvement Strategy
GUIDE TO IMPLEMENTATION
CONTENTS
DEFINITION OF TERMS
KEY TO SYMBOLS
I.1.
OVERVIEW
I.2.
I.2.1.
ABOUT HAND HYGIENE IN HEALTH CARE
Rationale for a Guide to Implementation
I.2.2.
The problem of health care-associated infections and the importance of hand hygiene
I.2.3.
A global response to the problem
I.3.
I.3.1.
ABOUT THE GUIDE TO IMPLEMENTATION
Purpose of the Guide to Implementation
I.4.
I.4.1.
WHO MULTIMODAL HAND HYGIENE IMPROVEMENT STRATEGY
The strategy components
I.4.2.
The implementation toolkit
I.4.3.
The step-wise approach
PART I
PART II
II.1.
II.1.1.
SYSTEM CHANGE
System change denitions and overview
II.1.2.
Tools for system change tool descriptions
II.1.3.
Using the tools for system change
examples of possible situations at the health-care facility
II.2.
II.2.1.
TRAINING / EDUCATION
Training / education denitions and overview
II.2.2.
Tools for training / education tool descriptions
II.2.3.
Using the tools for training / education
examples of possible situations at the health-care facility
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WHO/IER/PSP/2009.02
Revised August 2009
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GUIDE TO IMPLEMENTATION
II.3.
EVALUATION AND FEEDBACK
II.3.1.
Evaluation and feedback denitions and overview
II.3.2.
Tools for evaluation and feedback tool descriptions
II.3.3.
Using the tools for evaluation and feedback
examples of possible situations at the health-care facility
II.4.
II.4.1.
REMINDERS IN THE WORKPLACE
Reminders in the workplace denitions and overview
II.4.2.
Tools for reminders in the workplace tool descriptions
II.4.3.
Using the tools for reminders in the workplace
examples of possible situations at the health-care facility
II.5.
II.5.1.
INSTITUTIONAL SAFETY CLIMATE
Institutional safety climate denitions and overview
II.5.2.
Tools for institutional safety climate tool descriptions
II.5.3.
Using the tools for institutional safety climate
examples of possible situations at the health-care facility
22
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29
PART III
III.1.
PREPARING AN ACTION PLAN
33
III.2.
2
III.2.1.
IMPLEMENTING THE STEP-WISE APPROACH
Step 1: facility preparedness readiness for action
39
III.2.2.
Step 2: baseline evaluation establishing knowledge of the current situation
III.2.3.
Step 3: implementation introducing the improvement activities
III.2.4.
Step 4: follow-up evaluation evaluating the implementation impact
III.2.5.
Step 5: ongoing planning and review cycle developing a plan for the next 5 years
APPENDIX
Action plan
USEFUL WEBSITES
47
A detailed, carefully-prepared scheme of activities to be
DISCLAIMER
47
initiated or continued in order to improve hand hygiene
HUG ACKNOWLEDGEMENT
47
at a given health-care facility.
Alcohol-based handrub
An alcohol-containing preparation (liquid, gel or foam)
designed for application to the hands to reduce the
growth of microorganisms. Such preparations may
contain one or more types of alcohol with excipients,
other active ingredients and humectants.
Efcacy / efcacious
The (possible) effect of the application of a hand hygiene
formulation when tested in laboratory or in vivo situations.
Effectiveness / effective
The clinical conditions under which a hand hygiene
product has been tested for its potential to reduce
the spread of pathogens, e.g. eld trials.
Hand cleansing
Action of performing hand hygiene for the purpose of
physically or mechanically removing dirt, organic material
or microorganisms.
GUIDE TO IMPLEMENTATION
DEFINITION OF TERMS
Hand hygiene
A general term referring to any action of hand cleansing.
Hand hygiene
co-ordinator
The person at a facility assigned to coordinate the
preparation and implementation of the hand hygiene
improvement programme.
Handrubbing
Applying an antiseptic handrub to reduce or inhibit
the growth of microorganisms without the need for an
exogenous source of water and requiring no rinsing
or drying with towels or other devices.
Handwashing
Washing hands with plain or antimicrobial soap and water.
Health care-associated
infection (HCAI)
An infection occurring in a patient during the process
of care in a hospital or other health-care facility which
was not present or incubating at the time of admission.
This includes infections acquired in the hospital but
appearing after discharge, and also occupational
infections among staff of the facility.
