Hand hygiene training
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Cecilia Van Cauwenberghe from Frost & Sullivan’s TechVision Group, underlines the WHO’s annual Clean Your Hands campaign and comments on harmonisation in hand hygiene training to help prevent and control infections

The World Health Organization (WHO) declares healthcare-associated infections (HAIs) to be intimately associated with long-term morbidity and higher mortality, as well as, prolonged hospital days, economic burden and financial losses for hospitals and patients. According to the WHO, the prevalence of HAIs varies between 5.7% and 19.1% in low and middle-income countries. The studies assessed by the WHO estimate that of every 100 hospitalised patients at any given time, seven patients will acquire at least one HAI in developed countries, whereas 10 patients will be affected by HAI in developing countries.

Urinary tract infection is the leading infection in high-income countries, while surgical site infection is the first ranked in medium- and low-income countries, impacting one-third of intervened patients. Even in high-income countries, the percentage of patients in intensive care units, who are affected by HAI reach 30%, is two to three-fold higher in low-income countries. Newborns at risk of acquiring HAI, especially in developing countries, exhibit infection rates three to 20 times higher than in high-income countries (WHO, 2019a).

The role of organisations in promoting hand hygiene

According to a study of the WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland, in collaboration with institutes and research centres from Malta, Spain, Portugal, Canada, Mexico, Brazil, Costa Rica, Saudi Arabia, Iran and South Africa, there is a lack of harmonisation in hand hygiene training for infection prevention and control (IPC) professionals (Tartari et al., 2019a). The authors depict a standardised approach to training IPC professionals and evaluate its impact on hand hygiene understanding in these countries. This new concept is denominated “Train-the-Trainers” (TTT) and consists of a three-day simulation-based course grounded on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy (WHO, 2019). Based on the results, the researchers highlight that this new TTT approach in the hand hygiene model has demonstrated to be effective in fostering a deeper understanding and greater knowledge about the impact of hand hygiene on IPC. Moreover, encouraged to share experiences, IPC professionals feel confident in the use of this reference training method worldwide to further spread expertise to other healthcare workers.

Education as principal action in addressing the hand hygiene-related concerns

Core competencies for effective infection control and prevention

Beyond the fact that hand hygiene-related infections are certainly recognised as a global, unmet need for hand hygiene observers, it is important to highlight the remarkable heterogeneity in hand hygiene education among IPC professionals worldwide (Tartari et al., 2019a). Therefore, the WHO set education and training as a core component for effective IPC programmes (Peters at al., 2019). The WHO SAVE LIVES: Clean Your Hands global hand hygiene campaign was launched in 2009 and is celebrated annually on the 5th May (WHO, 2019b). This campaign highlights specific calls to action to encourage the engagement of different stakeholders through collaborations to enhance hand hygiene practices and knowledge based on the global movement towards universal health coverage (UHC).

Multidrug resistance and availability of antibiotics

The onset of HAIs constitutes a critical aspect because the number of antibiotics available to treat these infections is limited. Therefore, the prevention of transmission and control of multidrug-resistant organisms in healthcare settings by directly acting on hand hygiene campaigns is significantly meaningful. In fact, most of the hand hygiene-related concerns could be addressed through simple, cost-effective IPC measures focused on how hand hygiene is performed at critical moments (Tartari et al., 2019b). In an article published by von Lengerke et al., they propose the application of psychological frameworks of behaviour change to solve these issues (von Lengerke et al., 2019) by analysing the outcomes of the PSYchological optimised hand hyGIENE promotion (PSYGIENE-trial). According to the authors, the programme exhibits significant improvements in compliance after particular interventions on the Health Action Process Approach (HAPA), on rates of nosocomial infections (Nis) with multidrug-resistant organisms (MDROs).

Final remarks

The successful advancement in the WHO’s hand hygiene agenda critically involves monitoring both improvements and gaps at each location taking into consideration hand hygiene structures, processes, resources, promotion and practices. Different scenarios to simulate the completion of the WHO Hand Hygiene Self-Assessment Framework (HHSAF) at different locations are being depicted to assertively address hand hygiene-related concerns.

I would like to thank all contributors from the industry involved with the development and delivery of this article from Frost & Sullivan.


Peters, A., Borzykowski, T., Tartari, E., Kilpatrick, C., Mai, S.H.C., Allegranzi, B. and Pittet, D., 2019. “Clean Care for All–It’s in Your Hands”: the May 5, 2019 World Health Organization “SAVE LIVES: Clean Your Hands” Campaign. Dr. Sulaiman Al Habib Medical Journal, 1(1), pp.21-22. Tartari, E., Fankhauser, C., Masson-Roy, S., Márquez-Villarreal, H., Moreno, I.F., Navas, M.L.R., Sarabia, O., Bellisimo-Rodrigues, F., Hernán- dez-de Mezerville, M., Lee, Y.F. and Aelami, M.H., 2019a. Train-the-Train- ers in hand hygiene: a standardized approach to guide education in infection prevention and control. Antimicrobial Resistance & Infection Control, 8(1), p.206.
Tartari, E., Fankhauser, C., Peters, A., Sithole, B.L., Timurkaynak, F., Mas- son-Roy, S., Allegranzi, B., Pires, D. and Pittet, D., 2019b. Scenario-based simulation training for the WHO hand hygiene self-assessment frame- work. Antimicrobial Resistance & Infection Control, 8(1), p.58.
von Lengerke, T., Ebadi, E., Schock, B., Krauth, C., Lange, K., Stahmeyer, J.T. and Chaberny, I.F., 2019. Impact of psychologically tailored hand hy- giene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE. Antimicrobial Resistance & Infection Control, 8(1), p.56.
WHO, 2019a. Guide to Implementation of the WHO Multimodal Hand Hygiene https://www.who.int/gpsc/5may/Guide_to_Implementation.pdf WHO, 2019b. SAVE LIVES: Clean Your Hands – WHO’s global annual call to action for health workers https://www.who.int/infection- prevention/campaigns/clean-hands/en/

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