ealthcare-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 . 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 remains suboptimal [7, 8].
ountrywide hand hygiene 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 6th campaign focused on the active participation of the patient and their families, with campaign message being “Hand Hygiene, Together with the Patient”. The methodology of the campaign was the same as for the previous campaigns, with direct observation using a standardized roster with the help since the 5th campaign of an online data collection tool that is compatible with wireless tablets and provides real-time performance feedback to the hospitals .
total of 152/193 (78.7%) hospitals delivered before (pre) campaign compliance observations (123 acute care hospitals, 11 chronic care hospitals and 18 psychiatric hospitals) and 141 hospitals introduced after (post) campaign observations (115 acute care hospitals, 9 chronic care hospitals and 17 psychiatric hospitals; Table 1). A total of 136 hospitals provided data both before and after campaign, thus for comparison between before and after only data from 136 hospitals were used. A summary of the results from both pre and post campaign can be found in annex 1. HH compliance (national weighted mean) increased significantly from 69.1% before to 77.7% post campaign (P <0.0001). Compliance rate increased for all types of healthcare workers (around 6% to 12%), with nurses performing best and physicians still low (Figure 9). As concerns the different types of services, there was a general increase in compliance rates with the highest rates recorded in pediatric/neonatal and intensive care units (Figure 4). Compared to the previous campaign, compliance rate was still substantially higher for ‘after patient contact’ and ‘exposure to body fluids’, compared to ‘before patient contact’, implying that healthcare workers consistently tend to protect themselves more or less than to protect the patient, as earlier explained .
In conclusion, the sixth 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 7.7%. The main factors for this success could be explained by the multimodal methodology of the awareness campaign, the repetition of the campaign, the nation-wide scale of the campaign and the political and financial support of the federal government. In addition a user friendly online tool for data entry and real-time local feedbacks to the hospitals may have contributed to its success. Lower compliance rates among physicians compared to nurses, before patient contact and before performing aseptic procedures still remain challenges for future campaigns.