Interview with Pierre Vanderavero, Infirmier Responsable Unité de Prévention et Contrôle de l'Infection, Hôpital neuchâtelois.

Mr Vanderavero, congratulations on winning this year’s Hand Hygiene Innovation Award. Your experience and opinion in the field of hand hygiene are very important to us. We would highly appreciate it if you could share some of your thoughts with us. 

How do you in general rate hand hygiene compliance in the hospital setting? What are the main obstacles and what may hinder compliance?

In general, caregivers think that they know how to practice hand hygiene (HH) correctly and that once learned, it is acquired for their entire career. Therefore, it is sometimes difficult to motivate healthcare workers (HCW) to participate in additional HH trainings. Improving compliance with hand hygiene recommendations depends on altering human behavior. Beyond that, one of the main barriers to adherence with hand hygiene practice recommendations are difficulties of HCWs to consistently apply WHO's five moments for HH in daily clinical practice.  It is very important to constantly emphasize the benefits and efficacy of hand hygiene with alcohol-based handrubs compared to soap and water handwashing, which is less efficacious, more time-consuming and less tolerated by the skin. HCWs need to be convinced of the evidence that consistent hand hygiene is the most effective measure to interrupt the transmission of microorganisms and thereby prevent healthcare-associated infections.

Hand hygiene is a fundamental action for ensuring patient safety. When did you start implementing a special hand hygiene programme?

In 2007, our institution created a Patient Safety Commission including a member of the infection control team. In 2010, the infection control unit was requested to plan a global hospital project on hand hygiene evaluation, integrating two sites of acute care and five rehabilitation and palliative care centers. A pilot phase in 2011 allowed us to test the concept in four hospital wards. Hospital management gave the final approval in 2012 and the first project phase began in September 2012.

What are the most powerful intervention methods to improve hand hygiene compliance in your opinion?

Monitoring hand hygiene is of crucial importance and considered as the gold standard to evaluate compliance and assess baseline conditions. In order to increase compliance, observations with direct feedback to HCWs is a vital component of any successful hand hygiene campaign. According to their current compliance status, the development of individually tailored interventions can help to foster the correct implementation of HH measures by HCWs.

Promoting and sustaining a hospital-wide, multifaceted hand hygiene program ideally also includes increased accessibility to hydroalcoholic solution by providing pocket clips and universal availability in areas of care. Benchmarking has also been recognized as an effective means of improving HH performance. Thus, internal (overt) benchmarking among medical wards with hospital-wide updates on the project development and results should be put into practice. Finally, a prolonged implementation phase and a subsequent maintenance phase ensure success in the long term.

Could you please briefly describe your team and your key activities?

The Infection Prevention Team includes an infectious diseases specialist (20% full time) and three infectious control nurses (290% full time). We are dedicated to promoting patient protection against healthcare-associated infections by preventing transmission of infectious diseases and resistant micro-organisms. With our work, we ensure that the risk of infection to patients, visitors and staff is minimized.

What is special about your hand hygiene program or action planning? 

Within our team, we developed special tools to support and promote the integration of the five WHO moments for hand hygiene in clinical practice. During an initial phase of two years, these tools were adjusted in accordance with the development and to meet the demands of the hospital crew.

These are the individual tools:

• Pocket-Guide recalling the 5 WHO moments
• Hospital-wide newspaper detailing project results and wards’ benchmarking, distributed to the entire hospital staff (not only HCWs)
• Specific poster campaign for hospital wards showing the indications for HH
• Development of an educational game in the form of a scratch card (Crazytest) for 7 different categories of HCWs
• Distribution of a hand hygiene kit to all HCWs and increased promotion of hand hygiene to new staff members
• Annual local promotion on the World Hand Hygiene Day

Overall 3,000 observations were repeated at each audit among 47 hospital wards at seven sites of the institution. We also included services that are generally omitted in similar projects such as: radiology, physiotherapy and occupational therapy. The project began in September 2012. Since 2014, we continue to audit all the units twice a year.

Did you observe an immediate decline in hospital-acquired infections as your hand hygiene compliance rate increased?

The size of our institution is too small to allow a clear realization of the impact of the hand hygiene compliance on the rate of hospital-acquired infections. Although we expect a favorable trend.

In efforts to prevent infection and improve patient safety, one area of priority focus has been the improvement of hand hygiene compliance among healthcare workers. How important is it to also involve patients and visitors? How did you manage to include them into your HH campaign?

During the project, we repeatedly tried to include patients' participation but this was rather unsuccessful. It seems that the patients remain trusting regarding HCWs, although they are occasionally critical. There may also remain a fear of reprisals if some criticism is made. As for the visitors, we did not integrate them initially into the project. They were only incorporated into the process during the World Hand Hygiene Day of 2015, i.e. after 3 years of implementation for HCWs. We installed hydroalcoholic solution dispensers, information sheets for the public and information regarding local epidemiology in entrance halls of the institution.