401 / The 3/3 strategy: a successful multifaceted hospital wide hand hygiene intervention

SPAIN
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Hand hygiene
Infection control / Prevention of surgical site infections There is no specified text here
Topic of the reported practice
Quality improvement project
Aim and the benefit of the Patient Safety Practice
 
Healthcare worker's hands are known to be the most common vehicle for transmission of healthcare-associated pathogens. The importance of hand hygiene (HH) in preventing healthcare acquired infections (HAI) is well substained in evidence-base models, prospective studies and also HH promotion is included in all bundle interventions aimed to reduce HAI.
We undertook a 2 phase multifaceted hospital-wide HH intervention based on multimodal WHO approach and Continuous Quality improvement philosophy over 2 years, focusing on achieving a sustained HH cultural change in our institution. The objective of our intervention was to evaluate the impact and sustainability of this approach on HH compliance over time.
Description of the Patient Safety Practice
 
Setting: Delfos Hospital is a private 200 bed hospital with teaching nursing activity and about 12,000 admissions and 50,000 patient-days each year. Almost 90% of the rooms are single. There are eight medical-surgical wards and a polyvalent intensive care unit. A nosocomial Infection Control Unit was created in 2002 as part of the Infection Committee formed by a full-time specialist in epidemiology and infectious diseases and an infection control nurse. Study design: We developed a "pre-post intervention" study through statistical comparison of HH performance at a baseline and the two intervention phases. Interventions: a) Preintervention period (March 2007-December 2009), b) Phase I (January throughout December 2010): Based on WHO and hand hygiene multimodal (five steps) intervention approach, a standardized framework for training observers, performance of surveys and training of HCWs; c) Phase 2 (January throughout December 2011) was developed following the continuous quality improvement philosophy. The main interventions added during phase II as regards phase I were: a) Increase of AHR dispensers placement (from 0.57 dispensers/bed to 1.56); b) Increase in frequency audits (from 25 days to 51 days and audits were dispersed more evenly over time-2 vs 17 evaluation periods-; c) Feedback was more standardized and statistical control graphs were shown to healthcare workers in a bimonthly fashion; d) implementation of a standardized process for proactive corrective actions.
Outcomes variables: The primary outcome was HH compliance calculated by dividing the number of HH episodes by the number of potential opportunities. Secondary outcomes variables were bimonthly AHRs consumption and bimonthly healthcare-acquired colonisation/infection due to methicillin-resistant Staphylococcus aureus measures as the number of new cases per 10,000 patient-days identified from clinical, non-screening specimen. Results: During two years (2010-2011) 819 scheduled audit sessions were performed which produced data of 11,714 HH opportunities. Significant increase in HH compliance in the intervention periods was shown among all HH moments, HCWs and working areas. The mean increase in HH compliance was 25 percentage points. The complementary tables and images are freely accessible on the paper published on Plos One.
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Institution level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
Mestre G, Berbel C, Tortajada P, Alarcia M, Coca R, Gallemi G, et al. "The 3/3 strategy": a successful multifaceted hospital wide hand hygiene intervention based on WHO and continuous quality improvement methodology. PLoS One. 2012; 7(10):e47200.
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
Not known
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
There is no specified text here
Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
There is no specified text here
List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Motivated staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
Yes
Description of used incentives, if any.
During 2012 we have maintained our strategy adding "symbolic" positive incentives. We have constructed short phrases (thinking about what patients could have said to our healtcare workers in recognition to good HH practices, such as: "I am in your hands", "thanks for your care" and so on. This messages are attached to a "sweet" (Known in spain as "chupachups"). We give this sweet with the attached message to the HCW when the HH auditor team observe a good HH practice in a HCWs (they are given in a randomized manner, and is not coincident with the audit HH session)
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
There is no specified text here
Contact information
 
Name: Gabriel Mestre
Country: SPAIN
Organisation: Hospital Delfos, Catalonia
E-mail: mestre.ucin@delfos.cat
Phone: 650 22 79 21
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