Leslie A. Forrester, BA (Hons.), MA, MSc, Regional Hospital Epidemiologist, Vancouver Coastal Health, Powell River, BC Canada, Elizabeth A. Bryce, MD, Regional Medical Director, Anne K. Mediaa, BSc, Research Assistant, Vancouver Coastal Health, Vancouver, BC Canada.
Issue: Compliance with hand hygiene guidelines reduces cross-infection between patients and minimizes the transmission of infectious agents to HCWs. Yet, compliance with this simple activity is poor in the healthcare setting.
Project: In the fall 2005, Vancouver Coastal Health launched a one-year regional hand hygiene campaign. Adopting the PRECEDE model of health promotion as a theoretical framework, a multifaceted campaign was developed targeting individual, organizational and environmental factors with the aim of increasing HCW awareness and compliance with hand hygiene guidelines. A social marketing approach was used to implement and monitor the effectiveness of the campaign. The campaign included all directly funded acute and long-term care facilities (36 facilities & 13,249 staff) within the region and involved the rotation of ten novel posters (every 4-6 wks), two poster contests, and promotional items including 12,000 personal portable hand sanitizers. Evaluation of the campaign involved quality assurance surveys, staff surveys (pre- mid- and post-campaign), and focus groups.
Results: A total of 141 poster contest submissions were received, 5452 staff surveys completed, and 14 focus groups conducted. Individual Factors: Overall knowledge of outcomes and intention to hand wash scores were very high for HCWs that provide direct patient care (DPC) and those that do not (NDPC). The DPC group scored significantly higher on knowledge of outcomes than the NDPC group. No significant differences were observed for either group on knowledge of outcomes or intentions when mid- and post-campaign scores were compared to baseline. Focus groups agreed that HCWs have a good understanding of the importance of hand hygiene but that this does not necessarily translate into practice. Environmental Factors: 89.5% of HCWs reported that they preferred soap and water over alcohol hand gel. A significant increase in the reported use of alcohol hand gel was observed from baseline to post-campaign for the DPC group, whereas a significant increase for all hand hygiene products was observed for the NDPC group. Reported access to hand hygiene products was greatest for soap and water and lowest for personal portable hand sanitizers for both groups. A significant increase in access to personal portable hand sanitizers between baseline and post-campaign was observed for the DPC group. Focus groups reported environmental barriers to hand hygiene compliance including inappropriate placement of sinks, traffic flow issues, and problems of access to hand hygiene products in facility washrooms. Organizational Factors: Focus groups reported visible support from administration though confirmed that time constraints, workload issues and inappropriate glove use remain barriers.
Lessons Learned: Social marketing is an effective approach in engaging the HCW population. Ongoing monitoring of the campaign's implementation was instrumental in identifying and remedying problems as they occurred. Though hand hygiene campaigns have traditionally focused almost exclusively on educating the HCW, our evaluation revealed that knowledge and intent was high at baseline among HCWs and that other factors need to be targeted to increase compliance. The most frequent barriers to hand hygiene identified were environmental factors. The preference for soap and water over alcohol based products was interesting especially when the latter are more time efficient and time constraints were reported as a barrier.
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