The history of National Hand Hygiene (HH) campaign goes back to 2004 were first preparations were started to facilitate Directorate of infection Control – Ministry of Health to launch the national campaign at 8th– 12th January 2005 in all Kuwait governmental hospitals.
Action plan started in early 2004, with the establishment of campaign committees to set up the general plan of the campaign, organized the preparation for launching, set up scientific materials that were used. Campaign was announced through various mass media (TV-Radio-Newspaper).
The campaigns were carried out in all Kuwait ministerial hospitals and primary health care centers (six general hospitals, fifteen specialized centers and ninety one primary health care centers).
To improve and sustain HH practices of healthcare workers.
The campaigns were ongoing since 2005. Annual HH campaigns were conducted every 5th of May. The campaign was adopted “CLEAN HANDS SAVE LIVES” as the slogan
The activities of 2005 campaign included but not limited to : field visits by local consulting team to all major hospitals to provide a workshop of HH. These lectures were accredited in continuing medical education (CME) at Kuwait Institute for Medical Specialization (KIMS). Additional Lectures for all hospital departments were performed by infection control team in each hospital. The distribution of booklets, leaflets, posters and video presentations around every hospital was carried out. Onsite training session s were performed through rounds to all hosp ital clinical and non- clinical departments e.g. wards, outpatient department, hospital services including laboratory, pharmacy, radiology and mortuary. High risk areas such as operation theaters, critical care units were given extra attention.
The key components of the campaign
- Educational program to healthcare workers: Why, when and how to perform hand hygiene to raise awareness, engage and educate HCWs at all levels.
- Availability and proper placement of alcohol hand rubs at point of care: to enable healthcare workers to clean their hands at the right time, quickly and effectively.
- Adoption and Implementation of 5 Moments for HH
- Reminders to prompt healthcare workers to clean their hands: including posters that convey powerful messages about hand hygiene.
- Engaging patients in improving hand hygiene: Information on why hand hygiene is important is provided and other materials, such as leaflets.
- Observation of hand hygiene using 5 moments approach
- HH questionnaire for HCWs.
- Data Analysis and Feedback Summary Report
Campaign Supporting Resources
A range of resources have been used and developed from World Health Organization (WHO) to support the campaign local initiative. These include:
- Series of campaign posters: In developing the new materials for campaign, clear and strong fact statements to reinforce messages were selected using various useful WHO tools. Durable posters stand out in the hospital environment to provide HCWS with information on why, when, and how to clean their hands.
Hand Hygiene poster – Life of patient between your hands
Hand Hygiene- When and how? Brochure
Your 5 moments for hand hygiene Brochure
- Patient-focused materials such as posters and leaflets.
Hand Hygiene: Why? Patient Leaflet
- Point of care prompts/posters that can be placed at the point of care. The new posters were designed to refresh and replenish the old posters.
5 Moments for Hand Hygiene Poster
How to Hand rub Poster
How to Hand wash Poster
- A template lecture was used for raising awareness and engaging staff at all levels of the healthcare setting.
5th May Template Lecture
- Forms for observation of hand hygiene using 5 moments approach
Observation of hand hygiene instruction form
Observation of hand hygiene form
Observation of hand hygiene calculation form
- The campaign was hosted on Infection Control Directorate website- http://www.icdkwt.com/
- The campaign was announced through various mass media (TV-Radio-Newspaper)
- The education materials that were used in the campaign included: posters, brochures, leaflets, Videos and CDs)
- Action Plan has been scheduled for all participating hospitals and primary health care centers.
- The activities of the campaign were carried out by infection control team in each hospital and included the following:
- On site education was carried out at each governmental hospital for a whole month.
- The distribution of booklets, leaflets, posters and video presentations around every hospital to raise awareness of HH.
- Lectures of hand hygiene for all hospital departments.
- Onsite training sessions were performed through rounds to all hospital wards, operation theatres, intensive care units (ICUs), outpatient department, and other services including laboratory, pharmacy, radiology and mortuary.
- The observation of hand hygiene compliance was carried out in all ICUs.
- HCWs were motivated by awards and certificates of appreciation for the highest compliance with HH. Appreciation letters were given to other bodies cooperated in the campaign.
Hand Hygiene Self-Assessment
Hand Hygiene Self-Assessment in Kuwait governmental hospitals was done on May 2011 according to WHO Hand Hygiene Self-Assessment framework. The result was very encouraging and shed light on the level of HH and showed the defective areas for improvement.
See the following table for subtotal scores.
Observation of hand hygiene compliance
- The observation of hand hygiene compliance will be carried out in all ICUs in Kuwait governmental hospitals including adult, paediatric (PICU) and neonatal (NICU) with total of twenty four ICUs. Total ICUs are listed in table (2).
- Observation period was from May 1st to May 31st 2011 which is corresponding to 23 working days with daily session.
For type and bed capacity of all participating ICUs see table (2)
- The daily session will be of 30 minutes duration and should be alternating between early morning, midday and late morning.
- Gather data on minimum of 200 opportunities per ICU per observation period.
- Observer should introduce him/herself to the health-care worker, explaining his/her task.
- The observer should stand close to the point of care while observing.
- The observer may observe up to three health-care workers simultaneously, if the density of hand hygiene opportunities permits. Do not observe more than three health-care workers simultaneously.
- The observer should not interfere with health-care activities being carried out during the session.
- Observation should not be performed in extreme situations (emergency medical treatment, signs of uncontrolled stress in a health-care worker being observed) as they do not reflect a “standard” care situation.
- The observer should record only actions that he or she can clearly see and correspond to indications; the observer is not allowed to assume that an action has taken place. For example: the observer sees a health-care worker approaching a patient without having seen what the health-care worker did before approaching the patient (whether or not he/she performed hand hygiene). The indication cannot be recorded.
- Several indications may arise simultaneously, creating a single opportunity and requiring a single hand hygiene action. The opportunity is an accounting unit equivalent to the number of hand hygiene actions required, regardless of the number of indications.
- The moment the observer identifies an indication, it is counted as an opportunity to which there should be a corresponding positive or negative action. A positive action indicates compliance; a negative action indicates non-compliance.
- Record hand hygiene (either HW or HR) regardless the appropriateness of the technique.
- If the HCW performed HW and HR at the same time, record it as HW.
- health-care workers into four broad categories as follows:
- Medical doctor
- Auxiliary e.g. cleaners and porters
- Other health-care workers :
- therapist e.g. physiotherapist
- other (dietician, dentist, social worker , student and any health-related professional involved in patient care).
- Training and follow up
A local infection control team had visited some hospitals during the observation period.
- Visits were started from the first day of the observation period.
- Onsite training was conducted of the Infection control team ( nurses and doctors) for how to fill the form to standardize the methodology and to avoid inter-observer differences.
- The concept of opportunity, indications of hand hygiene (giving practical examples) and the method of calculation of compliance rate were explained in details.
- After training, all the ICUs in the corresponding hospitals were visited with the infection control team and observed with them Hand Hygiene Practices.
- In addition, filling of the forms, answering any queries arise were done during ICU visits.
- The visits were repeated three times for the selected hospitals to ensure that the IC team understands the observation and calculation methodology and perform them correctly.
- Photos were taken during the observation sessions in the ICUs of the visited hospitals.
- Calculation of compliance
Results were obtained as total compliance per ICU and per professional category according to observation tool of World Health Organization
- Kuwait HH compliance rate
The main purpose of performed direct observation according to the “My five moments for hand hygiene” approach was to demonstrate the degree of compliance with hand hygiene among health-care workers in each Kuwait governmental hospitals in the most accurate way. Also it allows producing large-scale data on national rate of compliance with hand hygiene.
According to WHO observation tool, compliance with hand hygiene is the ratio of the number of performed actions to the number of opportunities. Total compliance with HH in all Kuwait hospitals was 62.2%.
In 2012, Infection control directorate with the cooperation of the Kuwait Association for infection control prepared for the awareness campaign for hand hygiene (HH) with a great focus on the “five moments hand hygiene approach”. This campaign has introduced the new approach of patient empowerment as a powerful approach to improve health care safety climate. This campaign had incorporated all governmental healthcare centers and extended to include healthcare centers in the private sector the state of Kuwait.
To increase HH compliance by 5-8% every year, 5-10% in year 1-5 and 15% by 2020.
The campaign objectives were expanded as follows:
- To determine the effect of past campaigns since 2005.
- To evaluate perception of hand hygiene among healthcare personnel (HCP).
- To evaluate of the compliance of HCPs with HH during the health care.
- To compare the HH observation results of the last year, 2011.
- To determine of the baseline ward infrastructure for hand hygiene in hospitals.
- To increase awareness of the HCPs about the importance of HH and to shed light on the correlation between HH and the reduction of the rate of healthcare associated infection.
- To engage the public and patients in HH adherence (patient empowerment).
Activities of the campaign
Campaign had effectively targeted all Ministry hospitals and primary health care centers. It was announced in various media channels (TV – radio and newspapers). It was hosted on the Directorate of Infection Control website and posted on their facebook as well. Awareness flashes were broadcasted through a network broadcast in all cooperative societies.
The campaign included the following activities:
- • Evaluation of the awareness of our HCPs about the importance of HH in the acute care units by a well-designed questionnaire. This questionnaire had been inspired by the World Health Organization (WHO). It had been distributed on a well-planned sample of doctors and nurses in all acute care units which include: intensive care units (ICUs) – cardiac care units (CCUs) – high dependency units (HDUs) – units of special care for preterm infants (SCBU)- dialysis units. Perceptions of HH conducted in the period from February to April 2012 and the results were analyzed and prepared for display.
- • A survey of ward infrastructure acute care units was conducted to show the availability of the HH requirements in acute care units as suggested by the World Health Organization during the months of March and April 2012.
- • The rate of alcoholic based handrub (ABHR) consumption of acute care units was calculated on a monthly basis from the beginning of the month of September 2011.
- • Monitoring HH compliance in acute care units was performed in the period from March, 18 to April, 17, 2012. An infection control team in governmental hospitals- measured the extent of the commitment of the members of the health team to the 5 moments in all critical care units throughout the month. This was done by observing different professional categories through daily sessions, each lasting 30 minutes according to the standardized method adopted by the World Health Organization.
- • An infection control team conducted frequent field visits to hospitals throughout the month to follow up and supervise the observation method.
At the end of the month, averages HH compliance rate was calculated per unit in the hospital as well as per professional category (Nursing – doctors – auxiliary – others).
- • Launching the campaign
The campaign was launched with an opening ceremony held on 7/5/2012 to coincide with the International Day for HH at the headquarters of the Infection Prevention directorate- Sabah area with the presence of Assistant Undersecretary for Technical Affairs and a great number of HCPs including infection control committee members and those interested in that field. It consisted of the following events:
- • Distribution of trophies and prizes to all acute care units staff, which have shown high HH compliance during the observation period in recognition of their commitment.
- • Scientific lectures about the importance of HH in reducing the rates of healthcare associated infections in health care facilities and their effectiveness in reducing the transmission of resistant bacteria.
- • Demonstration of the results of HH compliance rates among different critical care units with comparison to the results of the year 2011. Critical care units results showed a surge in the proportion of hand hygiene compliance among different HCPs.
- • Distribution of trophies to the HH committee members in recognition of their efforts in the campaign.
- • Campaign activities in hospitals:
After campaign launching, the campaign activities began in all governmental and private hospitals in the state of Kuwait:
- • On site education was carried out at each hospital for a whole month.
- • The distribution of booklets, leaflets, posters and video presentations around every hospital to raise awareness of HH.
- • The distribution of gifts and promotional materials ( pens – diaries – Files – Flash Memory – Pens Highlighters – Bags ) bearing the logo of the campaign. These were distributed to HCPs and visitors.
- • Onsite training sessions were performed through rounds to all hospital wards, operation theatres, intensive care units (ICUs), outpatient department, and other services including laboratory, pharmacy, radiology and mortuary.
- • Announcement of the HH compliance rates among different critical care units with comparison to the results of the year 2011
- • HCPs were motivated by awards and certificates of appreciation for the highest compliance with HH.
Infection control teams conducted scheduled lectures in primary healthcare centers. Awareness materials such as posters, leaflets and gifts were distributed to HCPs and patients.
8. Infection control team has participation in Kuwait Faculty of Medicine exhibition in the period 15-17 May, 2012. This was accomplished through infection control booth where display educational posters, brochures and leaflets was distributed and explained to all attendees.
– To provide the proper ward infrastructure for HH in all the points of care.
– To increase awareness among HCPs about the importance of HH as an effective means to reduce health care associated infections and also reduce the transmission of anti microbial resistance.
– To continue HCP training on five moments approach the delivery of health care .
– To continue HCP training on the correct ways to wash and disinfect hands.
– To encourage HCPs to use alcoholic based handrub as effective and gold standard measure.
– To continue the evaluation of HH ward infrastructure for hand hygiene periodically.
– To continue monitoring compliance with hand hygiene during the delivery of health care periodically.
– To continue HCP evaluation of awareness and perception of HH.
– To continue the provision of educational materials to increase awareness in the health-care setting.
– To develop an annual goal to raise the HCP’s commitment to HH in each hospital according to their observation result.
– To keep on engaging patients and their families in HH compliance.
HH compliance rate
The result of compliance with hand hygiene among HCPs in critical care units in Kuwait governmental hospitals was evaluated. It showed a great improvement compared to 2011.