Pilot testing in the WHO Western Pacific Region (WPR)
China, Hong Kong Special Administrative Region (SAR) - four pilot hospitals
Four pilot hospitals (Queen Mary Hospital, Caritas Medical Centre, Tuen Mun Hospital, Yan Chai Hospital) including 20 study wards (surgery, internal medicine, adult ICUs, orthopaedics, and geriatrics) were enrolled to test the WHO Multimodal Hand Hygiene Improvement Strategy in Hong Kong SAR starting from April 2006.
Each test ward was associated with a control ward of the same type, and a long-term (one year) follow-up of hand hygiene compliance measurement was conducted in both test and control wards. The WHO formulations were produced by a local company at a very low price (US$ 0.50 per 100 ml) with very good results at the quality control testing. In the pilot wards main implementation activities included education of different professional categories, improved access to alcohol-based handrubs by increasing the number of dispensers at the point of care, making powder-free gloves available, development of a question and answer (Q&A) leaflet responding to HCWs’ concerns about the use of alcohol-based handrubs, feedback of hand hygiene performance to HCWs and role modelling.
During follow-up observations, hand hygiene compliance showed significant improvement in test wards whereas no significant change happened in the control wards. Compliance increased in all professional categories apart from doctors (15.5% average compliance at baseline) who showed no significant improvement at all follow-up measurements. According to the WHO tolerability and acceptability survey, 65% of HCWs indicated a preference for one of the two WHO alcohol-based handrub formulations compared to other products, although some considered it to have an unpleasant odour.
Key success factors
Commitment by the government and the leadership at facility level were essential for successful implementation and scaling up. Coordination of the pilot testing by high-profile infection control professionals was also critical for motivating staff.
Between July 2007 and January 2008 the hand hygiene campaign was extended hospital-wide in all pilot hospitals with an official launch ceremony and is currently still in progress. Hand hygiene awards, finger agar tests, seminars and weeks dedicated to hand hygiene promotion are among the innovative promotional activities conducted in the four hospitals after the testing phase. Alcohol-based handrub continues to be available without any interruption of stocks, and monitoring of its consumption as well as of hand hygiene compliance has been carried out on a regular basis. The evaluation of these indicators has demonstrated continuous improvement in all four pilot hospitals over time. Some factors have been identified as potential barriers to the sustainability of the campaign: work overload, understaffing, weak leadership involvement in some areas and poor compliance by medical staff. The latter may create a negative influence on other staff.
On 21 January 2008, following the success of the WHO strategy implementation in the pilot hospitals, the Hospital Authority, Hong Kong SAR, launched a national campaign aiming to create a strong institutional safety climate and improving hand hygiene in all public hospitals. The production of the WHO-recommended formulations was expanded on a large scale and all Hong Kong public hospitals are currently using them. Of note, the strategy was also adapted and successfully implemented in seven home-care facilities in Hong Kong SAR. Important events have been organized for the annual hand hygiene celebration on 5 May, both in 2009 and in 2010, with the participation of the national authorities.