Healthcare-associated infections are among the top 10 causes of hospital deaths worldwide . According to the last point prevalence survey in Belgium executed in 2011, the prevalence rate of infected patients in Belgian acute care hospitals was 7.1% (95% confidence interval 6.1-8.3), resulting in an annual estimate of over 111,000 (95% confidence interval 73,556-159,292) infected patients in this setting . Over the years, hand hygiene (HH) compliance has been recognised as the most important factor in preventing transmission of infection to patients in healthcare settings [3-6]. Unfortunately HH compliance of healthcare workers especially physicians still remained suboptimal similarly to other surveys [7,8].
Countrywide HH campaigns have been organised since 2005 in Belgium, with multiple target groups and different focus depending on the outcome of the previous campaign . These campaigns aimed at raising awareness on good HH practices and promoting the use of alcohol based hand rubs. The 5th campaign focused on before ‘patient contact’ and before ‘aseptic tasks’. The methodology of the campaign was the same as for the previous campaigns, with direct observation using a standardized roster with the help of a new online data collection tool that is compatible with wireless tablets and provides online performance feedback to the hospitals .
A total of 155 hospitals introduced before campaign compliance observations (118 acute care hospitals, 11 chronic care hospitals and 26 psychiatric hospitals) and 143 hospitals introduced after campaign observations (114 acute care hospitals, 11 chronic care hospitals and 18 psychiatric hospitals) (Table 1). A total of 137 hospitals provided data both before and after campaign, thus for comparison between before and after only data from 137 hospitals were used. HH compliance (national weighted mean) increased significantly from 64.1% before to 75.8% post campaign (P <0.0001), with a decrease in variability between hospitals (Figures 1 & 2). Compliance rate increased for all types of health-care workers (around 7 to 12%), with nurses performing best and physicians still low, with high variability which could be explained by the low participation of physicians (Figure 4). As concerns the different types of services, there was a general increase in compliance rates with the highest rates recorded in pediatric/neonatal services (Figure 6). Though the focus of this campaign was on ‘before patient contact’ and ‘before aseptic tasks’, compliance rate was still very high for ‘after patient contact’ and ‘exposure to body fluids’, thus implying that healthcare workers tend to protect themselves more or less than to protect the patient, as earlier explained  (Figure 10).
In conclusion, the fifth national campaign was another success in terms of very high participation rates, and a marked increase in compliance rate bypassing the historical 70% margin by 5.8%. The main factors for this success could be explained by the multimodal methodology of awareness campaign, the repetition of the campaign, the nation-wide scale of the campaign and the political and financial support of the federal government. The latter made it possible for a user friendly online tool providing local feedbacks to the hospitals to be developed, and also for providing free tablets to all participating hospitals. Despite the fact that this year’s campaign focused on before patient contact and before performing aseptic procedures, the concerned compliance rates were still relatively low. As well the compliance rates among physicians compared to nurses remained low. Thus more attention still needs to be placed on these categories during future campaigns.