Dossier n. 189/2010 [Abstract] “Clean Care is Safer Care” - Final report of the WHO national campaign

The Clean Care is Safer Care campaign, launched worldwide by the World Health Organization, has been initiated with the aim of promoting hand hygiene in health care settings, through the definition of evidence based guidelines and their implementation with a multimodal intervention strategy. The intervention was based on the availability of alcohol-based hand-rub products, healthcare workers training, observation and feedback of hand hygiene compliance, reminders at workplaces, and interventions aimed at increasing awareness.

In Italy the participation in the campaign has been widespread: 15 Regions or independent Provinces, 127 Local Health Authorities, 175 hospitals and 285 operating units, for a total of more than 9,000 involved operators.

In 257 operating units, who have participated both at the pre- and post-implementation phases, 55,248 valid hand hygiene opportunities in the pre-implementation and 53,441 ones in the post-implementation periods were observed. Fifty percent observations were in ICUs, 34% in surgery, obstetrics and gynaecology units, and about 10% in medicine units.

As a result of the multimodal strategy, a significant improvement was observed in:

• availability of alcohol-based hand-rub products;
• knowledge in healthcare workers on hand hygiene issues, e.g. on the most frequent source of micro-organisms in healthcare associated infections or on appropriate indications for hand hygiene;
• perception by healthcare workers of the importance of a multimodal strategy to promote a proper hand hygiene;
• hand hygiene compliance: the proportion of opportunities where hand hygiene was actually performed increased from 42/100 to 64/100 opportunities after the campaign. The average relative increase was greater than 50% and the average absolute increase equal to 22%. The observed increase was almost entirely attributable to a more frequent use of alcohol-based hand-rub products. The improvement of hand hygiene compliance was more striking in those wards where, before the campaign, the level of compliance was lower.
• ICUs enrolled as pilot sites reported before the start of the campaign a more frequent availability of alcohol-based hand-rub products and a higher level of hand hygiene compliance, compared to the other ICUs (55/100 opportunities before vs 69/100 after campaign).

The satisfaction of healthcare workers for the campaign was high. Some tools were perceived by healthcare workers as less user-friendly, in particular the knowledge and perception questionnaires.