For health care providers to improve their hand hygiene, clean hands must become part of their workplace culture. The Just Clean Your Hands program was developed to overcome the barriers to proper hand hygiene and improve compliance with hand hygiene best practices in hospitals. The program expanded to include long-term care and retirement homes.
If you have any hand hygiene questions or would like to speak with someone about the Just Clean Your Hands program, please contact us at firstname.lastname@example.org.
Hand hygiene is one important component in the battle against cross-infection. Minimizing risks of infection to patients depends on a range of factors. However, increasing hand hygiene alone can dramatically reduce the risk of a patient acquiring an infection. This is supported by scientific evidence, not just opinion, which demonstrates that the bacteria that cause infection in hospital are most frequently spread from one patient to another on the hands of health care workers.
In Canada, approximately 250,000 people admitted to hospital each year pick up infections while being treated for something else and more than 8,000 die from these infections. Patients can acquire bloodstream infections, surgical site infections, urinary tract infections or respiratory infections. Once patients acquire an infection, there is a possibility of the microorganisms, which cause the infection, being passed on to other patients. This is heightened by the frequency and extent of contact which health care workers have with patients. Even patients who are not known to have an infection may be carrying microorganisms which can be carried on the hands of health care workers from one patient to another.
There are many reasons: lack of sinks, activity levels on the unit, staffing levels, health care worker perceptions about soap and its irritant effect, lack of role models, lack of organizational support for hand hygiene. The Just Clean Your Hands program is designed to help hospitals address a range of reasons for low compliance.
It is necessary to understand the complexity of clinical and patient care. In an average day health care workers do a range of tasks. Some essential yet simple tasks like helping patients become comfortable in bed can result in thousands of microorganisms being transferred onto the hands of health care workers. Taking a pulse or blood pressure results in transfer of equally large numbers of microorganisms. A quick squirt of alcohol-based hand rub and the process of rubbing this on the hands until they are dry will destroy almost all of these potentially harmful microorganisms in a short time (15-30 seconds). An absence of hand hygiene at this point would mean that whichever patient the health care worker touches next would receive these microorganisms if hand hygiene is not performed.
Sometimes the microorganisms from patients will be transferred by health care workers onto the environment or equipment in the area close to the patient. This should not be a problem if the environment or equipment is cleaned before contact with another patient. However, the microorganisms can potentially contaminate the hands of health care workers and then be spread to other patients if the health care workers don’t clean their hands.
The evidence has been described as ‘completely overpowering’. Studies dating back to the 1950s and 60s found hand hygiene to be critical in preventing the spread of microorganisms in hospitals.
It is crucial to be aware that alcohol-based hand rub (or indeed hand washing at the sink) in isolation, is not the sole answer to the problem of hospital infections caused by poor compliance with hand hygiene. What is needed is a multifaceted approach along with senior management commitment.
Improving hand hygiene compliance will help to save lives.
The goal is to decrease health care-associated infections and the transmission of infections in health care settings. Hand hygiene is the single most important method of preventing infections in health care settings. Providing system supports and focused education on hand hygiene will assist in making hand hygiene easier for health care providers.
The Implementation Advisory Committee included representatives from:
To help hospitals and long-term care homes improve hand hygiene, the Ministry of Health and Long-Term Care developed the Just Clean Your Hands program. The program has been transferred to PHO and includes:
References follow table:
Duration of follow-up
Casewell & Phillips
Reduction in HAI caused by Klebsiella spp.
Maki & Hecht
Reduction in HAI rates
Massanari & Hierholzer
Conly et al.
No effect (hand hygiene improvement did not reach statistical significance)
Doebbeling et al.
Significant difference in HAI rates between two different hand hygiene agents
Webster et al.
Elimination of MRSA, when combined with multiple other infection control measures. Reduction of vancomycin use.
Zafar et al.
Elimination of MRSA, when combined with multiple other infection control measures
Larson et al.
Significant (85%) relative reduction of VRE rate in the intervention hospital; no significant change in MRSA
Pittet et al.
Significant reduction in the overall prevalence of HAIs and MRSA rates. Active surveillance cultures and contact precautions were implemented during the same time period
MacDonald et al.
Significant reduction in hospital-acquired MRSA cases
Swoboda et al.
Adult intermediate care unit
Reduction in HAI rates did not reach statistical significance
Lam et al.
No significant reduction in HAI rates
Won et al.
Significant reduction of HAI rates
ICU = intensive care unit; NICU = neonatal ICU; MICU = medical ICU HAI = health care-acquired infection; N.S. = not stated MRSA = methicillin-resistant Staphylococcus aureus; VRE = vancomycin-resistant enterococci
Reproduced with permission from “WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft, April 2006)” (5) [Table 1.19.1]
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