The First UK Summit on Hand Hygiene Sustainability in Health Care
24th October 2012, London

The Alliance of Patients and Healthcare Workers led the hand hygiene summit at the GovToday conference on the 24th October. Andrea Jenkyns gave her very moving presentation "The Way Forward; from the Patient Perspective". Sheldon Stone outlined the success of the Cleanyourhands campaign, propagated in the context of a very high political focus.

A major three-year trial led by researchers at University College London, in partnership with the Health Protection Agency, has shown that giving one-to-one feedback to healthcare workers makes them twice as likely to clean their hands or use soap.

The Feedback Intervention Trial (FIT) is the first such trial to be done in a large number of hospitals anywhere in the world. The study was carried out across 60 wards in 16 hospitals that were already implementing the English and Welsh Cleanyourhands campaign, the study showed that an intervention that coupled feedback to personalised action planning improved hand-hygiene compliance by up to 18 per cent on Intensive Therapy Units and 13 per cent on Acute Care of the Elderly wards. It was also found that soap use increased by 30%.

It is the first trial to use behavioural sciences to change health care workers hand hygiene behaviour.

Sustained improvements in hand-hygiene are key to the World Health Organisation's SAVES LIVES strategy to reduce health-care associated infection, yet hand-hygiene compliance amongst healthcare workers remains poor, with levels of 25-40% being common.

The study suggests that the NHS should explore using the FIT intervention and learn how best to implement it, as used properly it can be a really powerful tool. The intervention, which couples feedback to personalised action planning, could be included in infection control teams' audit and appraisal systems in order to reduce the burden of healthcare associated infection on hospital wards.

The intervention process involved a four-week audit cycle, with healthcare workers observed for 20 minutes. Immediate feedback was given after the period of observation, and the person was then helped to form a personal action plan for better hand hygiene. The more frequently wards carried out the intervention, the stronger it's effect.

In addition to observing and measuring hand-hygiene compliance, the amount of soap and alcohol hand-rub used each month was also collected as another measure of hand-hygiene compliance for each ward. This also gave a better picture of the total weekly usage, as such data was not subject to any observational bias.

Although audit and feedback is often suggested as a way of improving hand hygiene, this study puts its use on a firmer footing than previous non-randomised studies, providing the strongest evidence yet that this is an effective way to improve hand hygiene when coupled with a repeating cycle of personalised goal-setting and action planning.



Andrea followed Sheldon's presentation and spoke of how the charity was formed and our purpose. Andrea's presentation focused on behaviours and how the minor and almost subconscious actions in everyday life can have gross and widespread effects on the future and cause an unpredictable chain reaction, this could be the doctor who examines the patient, and sits on the bed to chat to the patient, or the nurse who administer the medication who does not wash their hands. It could be the patients' family who do not wash their hands and sit on the bed or anyone in the healthcare environment who may have clutter or equipment that can present an infection risk to the patient.



Andrea quoted Mahatma Gandhi who once said "Be the change you want to see in the world" Those in positions of authority need to lead the way. We can all lead by example and take the time to care about the basics. Washing hands at the right time. Using good gloving technique. Sticking to aseptic non touch technique, making sure devices are single use or properly decontaminated - making sure they are not left in longer than they should be. For clinicians it's that simple, to prevent a lot of the bloodstream and wound infections as the bacteria get in from contaminated hands and equipment. Using antibiotics property and making sure patients don't get pressure wounds during aftercare are all part of the picture.

We all make choices but in the end our choices make us. Behaviours will NOT change without recognising the consequences of our actions. With authority comes responsibility and time to manage - On a daily basis, Observe if the team are administering the basics, Approach the team member and discuss their good and bad behaviour, then Coach/Train them on what they need to do differently. Following the three step approach, if poor behaviour persists, then operate the three strike rule and take disciplinary procedure.



Andrea told the conference there should be no more faceless statistics, every hospital trust should publish photographs, with the permission of families, of those lost to healthcare associated infections in their regular newsletters. Many of our loved ones could have been saved, she asked "Can you honestly put your hand on your heart and say over the last month you washed your hands every time that you were meant to.....?



Andrea's presentation featured Sammie Fallon who died of MRSA aged just 17 after having a bone marrow test. Sammie's mum said "I don't want any other mum to go through the pain my family has"



Andrea showed a very moving slide of her Dad during happier times. The slide was all the more shocking to the conference as this was recent, and it was easy for those in healthcare to sit back and think of how far they had come in reducing the numbers of avoidable infections, but only to realise that this was still happening as hand hygiene compliance and other essential elements of infection prevention and control were not as good as they should be.



Everyone was moved by the picture of Clifford at the end of his battle with MRSA, he was a very fit man and the illness had left him weighing just 7 stone.



30 seconds to wash hands to save someone's life, that's all. Andrea asked the conference "how hard can it be?" If a child can learn effective hand hygiene, we all should be able to do this simple act.