Conseil d’utilisation de ce ppt

• Le médecin hygiéniste se chargera de présenter le ppt, le message passera sans doute mieux mais toute l’équipe est la bienvenue

• Faites envoyer les invitations à la formation par le supérieur hiérarchique des médecins concernés qui s’engage à être présent (chef de service, chef de département, médecin-chef)

• N’oubliez pas de demander des points d’accréditation en rubrique « éthique et économie »

• Ne parlez pas d’hygiène des mains dans votre titre et choisissez par exemple un titre comme « Existe-t-il un moyen facile et pas cher pour prévenir les infections nosocomiales »

Conseil d’utilisation de ce ppt

• Idéalement à présenter à un public exclusivement médical (vu les performances moins bonnes comparées aux autres soignants)

• Idéalement à présenter à des petits groupes de médecins de la même spécialité

• Vous trouverez les performances des médecins de votre institution dans votre « feedback » personnel de l’ISP

• 30 diapositives nous semble un maximum pour la sensibilisation des médecins mais libre à vous d’aller en piocher dans les autres diaporamas de formation

• Prévoyez éventuellement une lampe UV et de la solution hydro-alcoolique contenant de la fluorescéine, cela frappe toujours l’imagination même des médecins

After 3 National hand hygiene campaigns in Belgian hospitals

What did we learn?

« Vous êtes en de bonnes mains »

20

40

60

80

10

0C

om

plia

nce

HH

(%

)

1st campaign (2005) 2nd campaign (2006) 3rd campaign (2008)

Before campaign After campaign

n=148 n=127 n=178 n=158 n=168 n=145N hop

48%53%

69%

58%69%68%

Distribution of average HH compliance

A qualitative exploration of reasons for poor hand hygiene among hospital workers

A qualitative study based on structured interview guidelines consisting of 9 focus groups (58 persons) and 7 individual interviews

• Nurse and medical students« Lack of positive role models ! » 

• Physicians:« Lack of convincing evidence that hand hygiene prevents cross infection »

Erasmus V et al ICHE 2009;30:415-19

Overall HH compliance by profession (all).2

.4.6

.81

nurse MD

Com

plia

nce

HH

(%

)

Graphs by hhfct

20%

Evolution of HH compliance among nurses en physicians

.2.4

.6.8

1

2005 2006 2008 2005 2006 2008

nurse MD

Before campaign After campaign

Com

plia

nce

HH

(%

)

Graphs by hhfct

54%

72%

72%59%

73%

64%

74%

36%

51%

40%

51%

45%

53%

HH Compliance by type of contact indications among Medical Doctors (all camp)

.2.4

.6.8

1C

om

plia

nce

HH

(%

)

Before camp After camp

Before contact indications

After contact indications

1. Before contact with patient

2. Before clean/invasive action

1. After contact with patient

2. After biological liquids exposure

3. After contact with patient environment

31%

48%

41%

58%

Role model

Pittet, D et al. Ann Intern Med 2004;141:1-8

Physicians Nbr of opportunities

HH compliance %

Odds ratio

Role modelLankford M. et al Emerging Infectious disease 2003: 9: 217-223

A qualitative exploration of reasons for poor hand hygiene among hospital workers

A qualitative study based on structured interview guidelines consisting of 9 focus groups (58 persons) and 7 individual interviews

• Nurse and medical students« Lack of positive role models ! » 

• Physicians:« Lack of convincing evidence that hand hygiene prevents cross infection »

Erasmus V et al ICHE 2009;30:415-19

Maternal mortality rates, first and second obstetrics clinics,

General Hospital of Vienna

0

2

4

6

8

10

12

14

16

18

1841 1842 1843 1844 1845 1846 1847 1848 1849 1850

First

Second

Intervention May 15, 1847

Per

cen

tag

e

Semmelweis IP 1861

Why did he fail?

Correct intervention but didn’t apply the basic principle for behaviour change

May not explain how death is transmitted! Too few knowledge!Autocratic decision: mandatory hand washing policy based on his observationsIntervention not based on educationVery agressive handdisinfection solutionHis supervisor didn’t accept his conclusions, ventilation system is responsable for death according to the popular miasmatic theory of disease He didn’t publish his findings until 14 years after his observations

Best M, Neuhauser D Qual Saf Health Care 2004;13 : 233-234

Impact of better handhygiene compliance on HCAI and incidence of nosocomial MRSA

Pittet et al. Lancet 2000;356:1307-1312

Impact of hand hygiene promotion

Year Hospital setting

Increase of hand hygiene compliance Reduction of HCAI rates Follow-up Reference

1989 Adult ICU From 14% to 73% (before pt contact)

HCAI rates: from 33% to 10% 6 years Conly et al

2000 Hospital-wide From 48% to 66% HCAI prevalence: from 16.9% to 9.5% 8 years Pittet et al

2004 NICU From 43% to 80% HCAI incidence: from 15.1 to 10.7/1000 patient-days 2 years Won et al

2005 Adult ICUs From 23.1% to 64.5% HCAI incidence: from 47.5 to 27.9/1000 patient-days 21 months Rosenthal et al

2005 Hospital-wide From 62% to 81% Significant reduction in rotavirus infections 4 years Zerr et al

2007 Neonatal unit From 42% to 55% HCAI incidence: overall from 11 to 8.2 infections/1000 patient-days) and in very low birth weight neonates from 15.5 to 8.8 infections /1000 patient-days

27 months Pessoa-Silva et al

2007 Neurosurgery NA SSI rates: from 8.3% to 3.8% 2 years Thu et al

2008 1) 6 pilot health-care facilities2) all public health-care facilities in Victoria (Aus)

1) from 21% to 48%2) from 20% to 53%

MRSA bacteraemia: 1) from 0.05 to 0.02/100 patient-discharges per month; 2) from 0.03 to 0.01/100 patient-discharges per month

1) 2 years2) 1 year

Grayson et al

2008 NICU NA HCAI incidence: from 4.1 to 1.2/1000 patient-days 18 months Capretti et al

Compliance: 21% → 42%

MRSA bacteraemia: 57% reduction

Med J Aust. 2005 Nov 21;183(10):509-14.

Compliance: 40% → 53%

HCAIs: 11.3 → 6.2 / 1,000 PD

Pediatrics. 2004 Nov;114(5):e565-71.

Compliance: 43% → 80%

HCAIs: 15.1 → 11.9 / 1,000 PD

Infect Control Hosp Epidemiol. 2004 Sep;25(9):742-6.

Compliance: 23% → 64.5%

HCAIs: 47.5 → 27.9 / 1,000 PD

Am J Infect Control. 2005 Sep;33(7):392-7.

Compliance: 42% → 55%

HCAIs: 11 → 8.2 / 1,000 PD

Pediatrics. 2007 Aug;120(2):382-90

Compliance: 20% → 53%

MRSA bacteraemia: 0.03 → 0.01 / 100 discharges per month

Med J Aust. 2008 Jun 2;188(11):633-40.

Compliance: 19% → 24%

HCAIs: 61.9 → 36.8 / 1,000 PD

Crit Care Med. 2004 Feb;32(2):358-63.

Relation between handhygiene compliance and MRSA prevalence

Girou E ICHE 2006 Oct;27(10):1128-30.

Jarlier, V. et al. Arch Intern Med 2010;170:552-559.

Changes in the use of alcohol-based hand-rub solutions (in liters per 1000 HDs) from 1993 to 2007

Change in MRSA incidence per 1000 HDs in ACHs and RLTCHs from 1996 to 2006

Jarlier, V. et al. Arch Intern Med 2010;170:552-559.

Evolution de l'incidence moyenne globale min. 5 participations : 1994-2009

Antibiotic use management teamsAntibiotic use management teams

MRSA new guidelinesMRSA new guidelines

1st Camp 20051st Camp 2005

2d Camp 20072d Camp 2007

3d Camp 20093d Camp 2009

National surveillance MRSA, Bea Jans

Factors related with the performance of a proper hand hygiene technique

• OBJETIVE: To identify factors related with the performance of a proper hand hygiene technique in a hand hygiene campaign.

• METHODS: We developed two cross-sectional studies on 15 hospital units. The outcome variable was complied HH with proper technique and the exposures variables were care factors (unit, professional group, etc) and other factors related with the HH campaign (training on hand washing). Statistical analysis: The strength of association was measured using odds ratios (OR) with their 95% confidence interval (CI). Adjusting for confounders was performed using multiple logistic regression.

• RESULTS: 12% of the observed 1241 hand hygiene were performed with proper technique. The strongest associated factors were ICUS (OR: 4.07 (CI 95% (1.95-8.51)), surgical wards (OR: 3.24 (CI 95% (1.52-6.92), procedures with high risk of contamination (OR: 2,56 CI 95% (1.34-4.70)), and physicians (OR: 2.52 CI 95% (0.93-6.85)). Training increased by 21% the probability of hand hygiene with proper technique for every 10% increase in trained health care workers (OR: 1.21 CI 95% (1.01-1.45).

• CONCLUSIONS: Hand Washing Training was associated with proper technique especially in surgical services and physicians

Dierssen-Sotos T, Med Clin (Barc). 2010 Aug 9.

Before rub

After rub

Efficacy of hand rub disinfection

Thank you for your attention!