De vierde campagne « U bent in goede handen » Ontwikkelingen en nieuwigheden Good after noon, today I would like to present you the results of 3 national hand hygiene campaigns organised from 2005 till 2009. The slogan of the camapigns was « you are in good hands »

As you know, hopsitals are dangerous places As you know, hopsitals are dangerous places. The concentration of microorganisms in no other place as high as in hospitals. The risk for transmitting pathogens from one patient to an other via the hands of HCW is high

Nationale en regionale handhygiëne campagnes (WHO)

Campagnes in Europa Niet alleen in acute ziekenhuizen maar ook in woonzorgcentra en in de ambulante praktijk Gebruik van hand hygiëne indicatoren in nationale kwaliteitssystemen (v.b. Frankrijk) Maar niet alle landen die de ‘WHO pledge’ hebben ondertekend, hebben al daad-werkelijk campagnes georganiseerd

EUROSURVEILLANCE Vol. 14 · Issue 17 · 30 April 2009 · www EUROSURVEILLANCE Vol . 14 · Issue 17 · 30 April 2009 · www.eurosurveillance.org

Methodologie van de Belgische campagnes Georganiseerd door werkgroep met financiële steun van overheid Objectieven Handhygiëne en gebruik van handalcohol promoten Doelpubliek Zorgverleners en gehospitaliseerde patiënten in acute, chronische en psychiatrisce ziekenhuizen So in 2004, a working group of the federal platform of hospital hygiene was constituted and they began to prepare the first national HH campaign. The objective of the campaign was raising awareness on good HH practices and promoting the use of alcohol based hand rubs. The campaign was mainly focused on HCW having contact with patients in hospitals , but the patients them self were also involved. We were targeting at the acute and chronic hospitals and during the second and third campaign also the psychiatric hospitals could participate to the campaign.

Methodologie van de Belgische campagnes Sensibilisatie met gratis gestandaardiseerd campagne-materiaal voor ziekenhuizen Impact van de campagne meten Naleving handhygiëne (compliance) Verbruik handalcohol Naleving basisvereisten voor goede handhygiëne (optioneel, 3e campagne) The methodology of the campaign was based on two components: first the awareness campaign. We provided the participating institutions with standardized material to organise the campaign in their institution in order to improve the HH compliance. On the other hand we also measured the impact of the campaign. There for we used several indicators. The most important one is the HH compliance: expressed as the percentage of observed hand hygiene with soap and/or hand alcohol divided by the number of observed hand hygiene opportunities. The second indicator was the consumption of alcohol rub expressed in liters per 10.000 patient days). During the 3rd campaign hospitals could also measure the respect of basic hygiene conditions concerning wearing jewel and wearing short and clean nail without nail polish or extension.

Planning Uitnodiging Meting PRE Sensibilisatie Eerste campagne: 2005 Gedurende 1 m Gedurende 1 m Gedurende 1 m Later Uitnodiging Meting PRE Sensibilisatie Eerste campagne: 2005 Tweede campagne: 2006-2007 Derde campagne: 2008-2009 Vierde campagne:2010-2011 Here A quick overview of the planning of a campaign The hospitals recieved a invitation to participate from the ministery of public health. The letter had to be returned and signed by the general director and the team of ICP. During one month pre campaign measurements of HH indicators are done. The awreness campaign itself began one month later. The second measurement post campaign began one month after the end of the sensitization and finaly 9 monthslater we invited all the Infection control practionnars who participated to give them the global feedback and to congratulate them for the terrific job and good results. Till now we conducted already 3 camapigns, the fourth one is planned for november 2010 Meting POST Terugkomdag 8

Multimodale interventie Geheugensteuntjes op werkvloer (posters) Vorming/bijscholing van zorgverleners gestandaardiseerde slide presentaties interactieve web based quiz Gadgets voor zorgverleners of patiënten Promotie van handalcohol Informatie voor patiënten (folder) Audit met feedback over compliance Several studies showed that promotional strategies must be multi modal to achieve any degree of success. Our strategy was based on several essential components to improve the HH compliance. First we provide hospitals with posters reminding HCW of how and when to disinfect their hands and why it is important. We developed also a standardised ppt presentation that could be used by the ICP for staff training. And we created an web based quiz that could be played by the HCW to enhance their knowledge. We distributed gadgets to HCW and patients to make the campaign even more visible. We promote alcool rubs with posters and the correct use was demonstrated with a black light and a fluorescent solution to indiacte the spots on the hands which are not well disinfected. The patients received a leaflet explaining why hh was important and last but not least. The HCW received a feedback of the results of the measurements of their compliance before and after the campaign.

Evolutie van boodschappen campagnes Eerste campagne: Handhygiëne, doe het gewoon … en gebruik handalcohol Tweede campagne: Handhygiëne, doe het correct Derde campagne: Geen juwelen, korte en propere nagels, geen kunstnagels Gebruik hanschoenen correct The campaign messages varied according to the campaign. During the first campaign the message was: HH just do it and with alcohol rubs. During the second camapign the message was refined: HH , do it correctly and during last campaign we added 2 messages: Do not wear jewellery or artificial nails and keep your nails clean an Use gloves correctly

Boodschap van de vierde campagne Voor artsen Handhygiëne voorkomt infecties U bent een belangrijk rolmodel voor andere zorgverleners Voor gehospitaliseerde patiënten U kan een actieve partner zijn in het zorgproces Vraag zorgverleners hun handen te ontsmetten

Here some examples of the posters Here some examples of the posters. The general poster of the first and the second campaign, where NOSOR the micro organism was very present. And the general poster of the third camapign were nosor is nearly disappearing and a droplet of alcohol is coming in, making the message more positive.

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Meting van handhygiëne compliance Directe observatie (gouden standaard) door getrainde observatoren met een gestandaardiseerd observatierooster Zelfde methodologie vóór en na interventie/ sensibilisatie Minstens 150 opportuniteiten voor hand-hygiëne per (verpleeg)eenheid (representatieve observatieperioden) Altijd ICU includeren in acute ziekenhuizen Direct observation of HH is considered the gold standard of measurment methods

Feedback van individuele resultaten met benchmarking

Participatie van ziekenhuizen Acute Chronische Psychiatrische ‘05 96.5% 61% nvt ‘06-07 97% 73% 63% ‘08-09 69% ‘10-11 91.5% 69.5%

Aantal geobserveerde opportuniteiten vóór na 2005 73 663 72 705 2006-07 88 480 84 883 2008-09 107 653 109 826 TOTAAL 269 796 267 414

Distributie van handhygiëne compliance n=148 n=127 n=178 n=158 n=168 n=145 N hop 48% 53% 69% 58% 68% +20% +16% +11% Median Overall baseline compliance rate of 40%-50% (96 articles) + animation!!!ligne

Compliance van verpleegkundigen versus artsen - 20%

Compliance vóór versus na indicatie Before After 75% 60% 50% 33% Before contact with patient Before clean/invasive action After contact with patient After biological liquids exposure After contact with patient environment 27

Ontsmetten met handalcohol 76% 76% 78% 73% 65% 67%

Vorige campagnes: successen Zeer hoge deelnamecijfers Compliance steeg tijdens elke campagne Gestage toename van compliance vóór campagnes Handalcohol wordt veel gebruikt Sleutelfactoren voor het succes: Multimodale interventie Campagnes tweejaarlijks herhaald Politieke en financiële steun

Vorige campagnes: aandachtspunten Lagere compliance van artsen Lagere compliance vóór patiëntencontact Compliance na campagnes blijft steken rond 70%

Vierde campagne: artsen Evidentie voor efficaciteit van handhygiëne in de preventie van infecties tonen Hun verantwoordelijkheid als rolemodel voor andere zorgverleners beklemtonen Poster “Ik neem deel” (foto van hoofd-geneesheer, …) PowerPoint presentatie voor artsen

A qualitative exploration of reasons for poor hand hygiene among healthcare workers Gestructureerde interviews – 9 focus groepen (58 personen) en 7 individuele interviews Verpleegkundigen en medische studenten « Gebrek aan positieve rolmodellen » Artsen « Gebrek aan overtuigende evidentie dat handhygiëne kruisinfectie voorkomt » Erasmus V et al ICHE 2009;30:415-19

Pittet, D et al. Ann Intern Med 2004;141:1-8

National surveillance MRSA, Bea Jans 4 Antibiotic use management teams MRSA new guidelines 2d Camp 2007 3d Camp 2009 1st Camp 2005 National surveillance MRSA, Bea Jans

Vierde campagne: ‘patient empowerment’ Maak patiënten actieve partners in het zorgproces en moedig hen aan om zorgverleners te vragen hun handen te ontsmetten Patiëntenfolder

If the HCWs invited you to remind them to disinfect their hands, would you feel able to do this? WHO Alliance for Patient Safety Hand Hygiene Survey Results from Phase One October 2007

When you asked your HCW to disinfect his hands, what response(s) did you receive? WHO Alliance for Patient Safety Hand Hygiene Survey Results from Phase One October 2007

SCOOP

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Werkgroep Christophe Barbier Boudewijn Catry Michiel Costers Francine De Meerleer David De Wandel Norbert Eggermont Roger Haenen Anne Simon Aldo Spettante Patricia Taminiau Sofie Vaerenberg Evelyne Van Gastel An Willems