Stepwise approach to implementation
The following outlines a step-wise approach as a model to gradually implement a comprehensive hand hygiene programme at the facility level (taken from the „Guide to Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy“, WHO 2009b). More detailed information can be found within this document and within the tools provided in this tool box. The approach represents a cycle that should be adapted locally and renewed periodically by any facility aiming to sustain hand hygiene improvement.
1. Facility preparedness
This includes obtaining necessary resources, putting infrastructure in place, and identifying key leadership to head the programme including a coordinator and his/her deputy. Proper planning must be done to map out a clear strategy for the entire programme. Facilities are recommended to consider implementing initially in wards where motivation and interest are high and the health gain is likely to be substantial and subsequently have an impact on others.
2. Baseline Evaluation
A baseline evaluation of hand hygiene practice, perception, knowledge and the infrastructure available should be conducted. This will provide reference information for any comparison and assessment of progress as the multimodal strategy is being implemented.
This is the key phase to achieve improvement and it consists of implementing all the interventions planned in step 1 and using the core findings from step 2 to motivate improvement. Ensuring the availability of an alcohol-based hand rub at the point of care is vitally important, as is conducting staff education and training and displaying reminders in the workplace. Well-publicized events involving endorsement and/or signatures of commitment from leaders and individual health care workers will generate great participation.
4. Follow-up evaluation
A follow-up to the baseline evaluation should be conducted to assess the effectiveness of the programme (i.e., infrastructure, perception and knowledge surveys should be conducted and hand hygiene observation and soap/hand rub consumption data collected according to the plans). Since this evaluation will be carried out shortly after implementation, it will provide information only about the immediate impact of the programme. To gather long-term impact data it is necessary to undertake further evaluation on the basis of a longer follow-up and to invest in continuous monitoring of key indicators.
5. Ongoing planning and review cycle
Developing and implementing ongoing action plans while ensuring that there is a constant review cycle is essential if the overall aim to embed hand hygiene as an integral part of the health care facility culture is to be achieved long-term. Hand hygiene improvement is not a time-limited process: hand hygiene promotion and monitoring should never be stopped once implemented.