Pilot testing in the WHO Eastern Mediterranean Region (EMR)
Saudi Arabia - King Saud Medical Complex
King Saud Medical Complex (KSMC), in Riyadh, is a 1446-bed teaching hospital delivering primary, secondary, and tertiary care, under the government of the Saudi Arabia Ministry of Health. Prior to the pilot testing, a strong infection control unit had been established at KSMC and commercial alcohol-based handrubs were already available.
During the pilot phase, the WHO strategy was implemented hospital-wide and branded with an original campaign specific logo. The campaign’s focus and strong point was the use of an original approach to educating both staff and patients, which involved a large number of training sessions for all health-care workers and distribution of promotional items.
A screen saver adapted from the WHO Clean Care is Safer Care one was installed on relevant computers; videos, educational brochures and pocket leaflets were developed for health-care workers, patients and visitors, including a drawing book for children, and translated into Arabic, English, Tagalog and Urdu; a theatrical play on germ transmission in health care was performed in the hospital; and fingertip print cultures were used to educate health-care workers and patients. A wide range of new posters on hand hygiene with more visual impact were developed and displayed across all wards; several gadgets with the logo of the campaign were distributed to health-care workers. A stand for patient information on hand hygiene was placed at KSMC entrance. A local company was appointed by the Ministry of Health to produce different samples of alcohol-based handrub based on the WHO recommendations.
Four types of solutions were produced: the WHO formulation I (based on ethanol), and three others with modifications such as different fragrances or emollient. According to quality control-tests performed at the University of Geneva Hospitals in Switzerland, all four products were found to be consistent with WHO requirements. A survey was conducted according to a WHO protocol and the best tolerated and most appreciated product was selected to replace the already available product; it was then distributed in wall dispensers at the point of care. Hand hygiene compliance monitoring was carried out monthly in selected areas.
At follow-up, overall hand hygiene compliance increased significantly by 7.6%, with rates at approximately 80% in obstetrics and paediatrics. Improvement was observed in all hand hygiene indications and all professional categories. Feedback was given to all health-care workers and to the hospital directorate.
Key success factors
A strong infection control team, the full dedication of the pilot site coordinator and the support from the hospital directorate were keys to success.
After the testing phase the campaign continued with the essential elements described above. Monthly hand hygiene compliance monitoring has been carried out in high-risk areas. In addition to wall dispensers, big bottles of handrub were placed on trolleys and at the point of care. Infection control nurses began to deliver training at the bed-side in high-risk areas and weekly sessions, with mandatory attendance for new staff, have continued. A national hand hygiene campaign had been launched in the country before testing at KSMC. The success of the WHO pilot site work was used to sustain the national campaign and also to support hand hygiene promotion in the private sector. High staff turnover, the coexistence of very different cultures, and the need for stronger influence by leaders remain partial obstacles to more satisfactory improvement in some areas.