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IPAC News: Featured News

Hand Hygiene: The Road Ahead 

Ontario has been a leader in the field of hand hygiene since the launch of the Just Clean Your Hands (JCYH) program in hospitals 6 years ago. The result of collaboration between the Ontario Ministry of Health and Long-Term Care (MOHLTC) and hand hygiene leaders in the United Kingdom, JCYH was an innovative initiative that grew from both a provincial and global focus on patient safety.

The global focus on hand hygiene began in 2000 with a study from Geneva that described the effectiveness of a hospital-wide program to improve compliance with hand hygiene practices. In October 2004, the World Alliance for Patient Safety was launched, and a year later, Clean Care is Safer Care became its first global patient safety challenge. A key component of this program was hand hygiene, and today over 48 countries have signed on to the program. In 2009, WHO launched SAVE LIVES: Clean Your Hands, an annual campaign that encourages organizations to improve hand hygiene; in 2013, over 15,000 healthcare facilities participated in the campaign, and May 5 has now been identified as World Hand Hygiene Day.

In Ontario, the 2003 experience with SARS led to a review of infection prevention and control (IPAC) practices to identify needed changes to protect the health and safety of healthcare providers and patients. Through Operation Health Protection, the MOHLTC identified a number of initiatives to improve health and safety; the importance of hand hygiene was one of them. A pilot study with 10 hospitals was conducted in 2007. The program was extended to all Ontario hospitals in 2008, and to long-term care settings in 2009. Also in 2009, the MOHLTC began to require public reporting of hand hygiene compliance in hospital settings, highlighting the significance of improving compliance.

Today, successful hand hygiene programs are characterized by a number of factors. Ensuring buy-in and engagement on the part of senior leaders is essential, as is identifying champions at various organizational levels and integrating the program into broader patient safety initiatives. Report cards and performance feedback help organizations monitor progress, and organizations that have been successful in sustaining hand hygiene compliance rates have also focused their attention on culture change. More and more, we are seeing hand hygiene goals and metrics as key elements of hospital quality improvement plans.

So What’s Next?

Hand hygiene is a complex behaviour, and behaviour theory must be incorporated into future attempts to change hand hygiene practices. Our efforts to date have been on education and auditing; now, the focus needs to shift to motivating and facilitating behaviour change.

At the November JCYH Symposium hosted by Public Health Ontario, participants indicated that they wanted more support for promoting behaviour and cultural change. They also expressed an interest in greater collaboration with experts in the fields of behaviour change, human factors engineering and implementation science and noted the following:

  • Behaviour change theory will play an important role in how we move forward with hand hygiene programs in Ontario. Change is difficult, and relapse is part of the change cycle; we need to design programs that use multiple strategies to target the various stages of change and reach health care providers at all stages.
  • Human factors/systems engineering is “the study of how people interact physically and cognitively with the world around them, including environments, tools, processes, and procedures. It is ‘matching’ the work system to the ‘person’.” In complex systems such as hand hygiene and health care delivery, the parts of the system need to be considered not only separately but also in relationship to one another. For IPAC to move forward, we need to to develop systems that take into account how the physical environment shapes work flow and how the work can be completed, regardless of challenges.
  • We also want to build on recent technological improvements in the areas of monitoring and evaluation. A wide range of auditing tools are currently available, but more standardized processes and a more user-friendly methods of collecting data are also needed; not all organizations are in a position to adopt sophisticated electronic tools.

Public Health Ontario is committed to using the findings from the JCYH symposium to improve hand hygiene compliance over the next 5 years. We look forward to building on our successes and finding new and innovative ways to improve hand hygiene practices across the province.


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Page last updated: 2014-06-13 10:13 AM
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