- Email: [email protected]
UK handwashing initiative
Journal of Hospital Infection (1999) 43: 1–3
LEADER
UK handwashing initiative E.L.Teare, B. Cookson*, G.L. French†, E.A. Jenner‡, G. Scott§, A. Pallett¶, D. Gould||, M. Schweiger**, J. Wilson* and S. Stone†† (Chair) PHLS New Writtle Street, Chelmsford, Essex CM2 0YX, *PHLS, 61 Colindale Ave, London NW9 5HT, †Dept of Microbiology, UMDS, 5th Floor, St Thomas Hospital, Lambeth Palace Road, London SE1 7EH, ‡University of Hertfordshire, Hatfield Campus, College Lane, Hatfield, Hertfordshire, AL10 9AB, §University College Hospital, OPD Building, Grafton Way, London WC1E 6DB, ¶PHLS, South Laboratory Block, Southampton General Hospital, Southampton SO16 6YD, ||South Bank University, London SE1 0AA, **Leeds Health Authority, Blenheim House, Duncombe Street,Leeds LS1 4PL, ††The University Department Of Geriatric Medicine, Royal Free Hospital, Pond Street, London NW3 2QG
The Handwashing Liaison Group was formed in the UK in 1997 and consists of representatives from the Association of Medical Microbiologists, the UK Department of Health, the Hospital Infection Society, the Infection Control Nurses Association, the Public Health Laboratory Service and the Public Health Medicine Environmental Health Group. The mission statement of the group is ‘to modify the behaviour of health care workers to produce sustained improvement in compliance with agreed handwashing standards and so improve the quality of patient care’. The group strongly supports the guidelines on handwashing recently produced by the Infection Control Nurses Association.1 The group believes that many healthcare workers do not understand or easily forget the principle that failure to decontaminate their hands before and after close-contact procedures, poses a risk of hospital acquired infection both to their patients and themselves. The literature describes the many failed attempts to produce a sustained improvement.2-20 The Handwashing Liaison Group is looking at this issue afresh, in a concerted and multidisciplinary manner. Previous, current, novel
0195–6701/99/090001 + 3 $12.00
and/or innovative approaches are all being considered. Any contributions would be greatly valued. A high priority is to impress upon health service managers the need for a change in attitude to hand decontamination in relation to the quality of patient care. To date, the following initiatives have been achieved; i) Document entitled ‘Handwashing for Chief Executives, Why YOU need to be interested’ has been mailed to Chief Executives of NHS Hospital Trusts via the UK Department of Health. ii) An editorial on handwashing entitled ‘Hand washing a modest measure – with big effect’ has been published in the British Medical Journal.21 This is intended to be complimentary to the Chief Executive document and it is hoped that it will raise the profile of the subject with managers and clinicians and might also provide the basis of clinical audit sessions. iii) Papers on handwashing have been published or accepted for publication in the Journal of the Clinical Negligence Scheme for Trusts22 and the Annals of the Royal College of Surgeons.
© 1999 The Hospital Infection Society
2
E.L.Teare et al.
iv) The advice of an advertising company has been taken and innovative ways of getting the handwashing message across are currently being devised. v) A project is being devised to investigate the possibility of using alcoholic hand rub between every patient contact (and to have it sited at every bedside as a standard). vi) There are plans to involve other groups such as the Patients Association. Following the Department of Health communication, we hope that Infection Control Teams will discuss handwashing with their Chief Executives and consider how they can increase awareness of the importance of this issue. Hospital-acquired infection is inexorably linked to the quality of patient care and thus to Clinical Governance. Because of the importance currently attributed to these issues, the time seems right to interest Chief Executives in ways of reducing hospital-acquired infection. We would be pleased to receive feedback on the effect of initiatives in individual Trusts, and would also be grateful to hear from anyone with suggestions of other initiatives.
7.
8.
9.
10.
11.
12.
13.
14.
References 1. Guidelines for Hand Hygiene – a document developed by the ICNA. Infection Control Nurses Association – September 1977. 2. Emmerson AM & GL Ridgway, Teaching asepsis to medical students. Journal of Hospital Infection 1980; 1: 289–292 3. Kaplan LM & McGuckin M. Increasing handwashing compliance with more accessible sinks. Infection Control 1986; 7: 408–410. 4. Scott Geller E, Eason SL, Phillips JA, Pierson MD. Interventions to improve sanitation during food preparation. Journal of Organisational Behaviour Management 1980; 2: 229–240. 5. Conly J, Hill S, Ross J, Lertsman J, Louie TJ. Handwashing practices in an intensive care unit: the effects of an educational programme and its relationship to infection rates. American Journal Infection Control 1989; 17: 330–339. 6. Lohr JA, Ingram DL, Dudley SM, Lawton EL, Donowitz LG. Handwashing in paediatric
15.
16.
17.
18.
19. 20.
ambulatory settings. American Journal Diseases Children 1991; 145: 1198–1199. Bartzokas CA, Williams EE, Slade PD. A psychological approach to hospital-acquired infections. Studies in Health and Human Sciences 1994; 24: Edwin Millen Press. Stone SP, Wessier A, Boursicot KA and Pratt C. Now Please Wash Your Hands – The behaviour of Final MB BS candidates. Personal communication. Gould D. Can ward-based learning improve infection control? Nursing Times 1996; 92: 42–43. Casewell M, Phillips I. Hands as a route of transmission for Klebsiella sp. British Medical Journal 1997; 2: 1315–1317. Porter SR, El-Maaytah M, Afonso W, Scully C, Leung T. Cross-infection compliance of UK dental staff and students. Oral Diseases 1995; 1: 198–200. Van de Mortel T, Heyman L. Performance feedback increases the incidence of handwashing by staff following patient contact in Intensive Care. Australian Critical Care 1995; 8: 8–13. Wurtz R, Moye G, Jovanic B. Handwashing machines, handwashing compliance and potential for cross-contamination. American Journal of Infection Control 1994; 22: 228–230. Marcil WM. Handwashing practices among Occupational Therapy personnel. The American Journal of Occupational Therapy 1993; 47: 523–528. Mayer JA, Dubbert PM, Miller M, Burkett PA, Chapman SW. Increasing handwashing in an Intensive Care Unit. Infection Control 1986; 7: 259–262. Van de Mortel T, Heyman L. Performance feedback increases the incidence of handwashing by staff following patient contact in Intensive Care. Australian Critical Care 1995; 8: 8–13. Tibballs J. Teaching hospital medical staff to handwash. Medical Journal Australia 1996; 164: 395–398. Pritchard RC, Raper RF. Editorial, Doctors and handwashing: instilling Semmelweis’ message. Medical Journal Australia 1996; 164(7): 389–390. Pritchard V, Hathaway C. Patient handwashing practice. Nursing Times 1988; 84: 68–72. Sutherland S. Irrationality. The Enemy Within. Penguin London 1992.
UK handwashing initiative
21. Teare E L, Cookson B, French G et al. Handwashing – A modest measure with big effects. British Medical Journal 1999; 318: 686.
3
22. Teare E L, Cookson B, French Get al. Now wash your hands. NHSLA Review 1999; 15: 8–9.
LEADER
UK handwashing initiative E.L.Teare, B. Cookson*, G.L. French†, E.A. Jenner‡, G. Scott§, A. Pallett¶, D. Gould||, M. Schweiger**, J. Wilson* and S. Stone†† (Chair) PHLS New Writtle Street, Chelmsford, Essex CM2 0YX, *PHLS, 61 Colindale Ave, London NW9 5HT, †Dept of Microbiology, UMDS, 5th Floor, St Thomas Hospital, Lambeth Palace Road, London SE1 7EH, ‡University of Hertfordshire, Hatfield Campus, College Lane, Hatfield, Hertfordshire, AL10 9AB, §University College Hospital, OPD Building, Grafton Way, London WC1E 6DB, ¶PHLS, South Laboratory Block, Southampton General Hospital, Southampton SO16 6YD, ||South Bank University, London SE1 0AA, **Leeds Health Authority, Blenheim House, Duncombe Street,Leeds LS1 4PL, ††The University Department Of Geriatric Medicine, Royal Free Hospital, Pond Street, London NW3 2QG
The Handwashing Liaison Group was formed in the UK in 1997 and consists of representatives from the Association of Medical Microbiologists, the UK Department of Health, the Hospital Infection Society, the Infection Control Nurses Association, the Public Health Laboratory Service and the Public Health Medicine Environmental Health Group. The mission statement of the group is ‘to modify the behaviour of health care workers to produce sustained improvement in compliance with agreed handwashing standards and so improve the quality of patient care’. The group strongly supports the guidelines on handwashing recently produced by the Infection Control Nurses Association.1 The group believes that many healthcare workers do not understand or easily forget the principle that failure to decontaminate their hands before and after close-contact procedures, poses a risk of hospital acquired infection both to their patients and themselves. The literature describes the many failed attempts to produce a sustained improvement.2-20 The Handwashing Liaison Group is looking at this issue afresh, in a concerted and multidisciplinary manner. Previous, current, novel
0195–6701/99/090001 + 3 $12.00
and/or innovative approaches are all being considered. Any contributions would be greatly valued. A high priority is to impress upon health service managers the need for a change in attitude to hand decontamination in relation to the quality of patient care. To date, the following initiatives have been achieved; i) Document entitled ‘Handwashing for Chief Executives, Why YOU need to be interested’ has been mailed to Chief Executives of NHS Hospital Trusts via the UK Department of Health. ii) An editorial on handwashing entitled ‘Hand washing a modest measure – with big effect’ has been published in the British Medical Journal.21 This is intended to be complimentary to the Chief Executive document and it is hoped that it will raise the profile of the subject with managers and clinicians and might also provide the basis of clinical audit sessions. iii) Papers on handwashing have been published or accepted for publication in the Journal of the Clinical Negligence Scheme for Trusts22 and the Annals of the Royal College of Surgeons.
© 1999 The Hospital Infection Society
2
E.L.Teare et al.
iv) The advice of an advertising company has been taken and innovative ways of getting the handwashing message across are currently being devised. v) A project is being devised to investigate the possibility of using alcoholic hand rub between every patient contact (and to have it sited at every bedside as a standard). vi) There are plans to involve other groups such as the Patients Association. Following the Department of Health communication, we hope that Infection Control Teams will discuss handwashing with their Chief Executives and consider how they can increase awareness of the importance of this issue. Hospital-acquired infection is inexorably linked to the quality of patient care and thus to Clinical Governance. Because of the importance currently attributed to these issues, the time seems right to interest Chief Executives in ways of reducing hospital-acquired infection. We would be pleased to receive feedback on the effect of initiatives in individual Trusts, and would also be grateful to hear from anyone with suggestions of other initiatives.
7.
8.
9.
10.
11.
12.
13.
14.
References 1. Guidelines for Hand Hygiene – a document developed by the ICNA. Infection Control Nurses Association – September 1977. 2. Emmerson AM & GL Ridgway, Teaching asepsis to medical students. Journal of Hospital Infection 1980; 1: 289–292 3. Kaplan LM & McGuckin M. Increasing handwashing compliance with more accessible sinks. Infection Control 1986; 7: 408–410. 4. Scott Geller E, Eason SL, Phillips JA, Pierson MD. Interventions to improve sanitation during food preparation. Journal of Organisational Behaviour Management 1980; 2: 229–240. 5. Conly J, Hill S, Ross J, Lertsman J, Louie TJ. Handwashing practices in an intensive care unit: the effects of an educational programme and its relationship to infection rates. American Journal Infection Control 1989; 17: 330–339. 6. Lohr JA, Ingram DL, Dudley SM, Lawton EL, Donowitz LG. Handwashing in paediatric
15.
16.
17.
18.
19. 20.
ambulatory settings. American Journal Diseases Children 1991; 145: 1198–1199. Bartzokas CA, Williams EE, Slade PD. A psychological approach to hospital-acquired infections. Studies in Health and Human Sciences 1994; 24: Edwin Millen Press. Stone SP, Wessier A, Boursicot KA and Pratt C. Now Please Wash Your Hands – The behaviour of Final MB BS candidates. Personal communication. Gould D. Can ward-based learning improve infection control? Nursing Times 1996; 92: 42–43. Casewell M, Phillips I. Hands as a route of transmission for Klebsiella sp. British Medical Journal 1997; 2: 1315–1317. Porter SR, El-Maaytah M, Afonso W, Scully C, Leung T. Cross-infection compliance of UK dental staff and students. Oral Diseases 1995; 1: 198–200. Van de Mortel T, Heyman L. Performance feedback increases the incidence of handwashing by staff following patient contact in Intensive Care. Australian Critical Care 1995; 8: 8–13. Wurtz R, Moye G, Jovanic B. Handwashing machines, handwashing compliance and potential for cross-contamination. American Journal of Infection Control 1994; 22: 228–230. Marcil WM. Handwashing practices among Occupational Therapy personnel. The American Journal of Occupational Therapy 1993; 47: 523–528. Mayer JA, Dubbert PM, Miller M, Burkett PA, Chapman SW. Increasing handwashing in an Intensive Care Unit. Infection Control 1986; 7: 259–262. Van de Mortel T, Heyman L. Performance feedback increases the incidence of handwashing by staff following patient contact in Intensive Care. Australian Critical Care 1995; 8: 8–13. Tibballs J. Teaching hospital medical staff to handwash. Medical Journal Australia 1996; 164: 395–398. Pritchard RC, Raper RF. Editorial, Doctors and handwashing: instilling Semmelweis’ message. Medical Journal Australia 1996; 164(7): 389–390. Pritchard V, Hathaway C. Patient handwashing practice. Nursing Times 1988; 84: 68–72. Sutherland S. Irrationality. The Enemy Within. Penguin London 1992.
UK handwashing initiative
21. Teare E L, Cookson B, French G et al. Handwashing – A modest measure with big effects. British Medical Journal 1999; 318: 686.
3
22. Teare E L, Cookson B, French Get al. Now wash your hands. NHSLA Review 1999; 15: 8–9.