Evidence Based Practice

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basedInfection (2010) 38:349–356 DOI 10.1007/s15010-010-0047-7

REVIEW

Educating healthcare workers to optimal hand hygiene practices: addressing the need ¨ E. Mathai • B. Allegranzi • W. H. Seto • M.-N. Chraıti H. Sax • E. Larson • D. Pittet •

Received: 14 May 2010 / Accepted: 14 July 2010 / Published online: 21 September 2010 Ó Urban & Vogel 2010

Abstract The education of healthcare workers is essential to improve practices and is an integral part of hand hygiene promotional strategies. According to the evidence reviewed here, healthcare worker education has a positive impact on improving hand hygiene and reducing healthcare-associated infection. Detailed practical guidance on steps for the organization of education programmes in healthcare facilities and teaching–learning strategies are provided using the World Health Organization (WHO) Guidelines for Hand Hygiene in Health Care as the basis for recommendations. Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools

developed by WHO for education, monitoring and performance feedback. Keywords Healthcare workers Á Hand hygiene Á Healthcare-associated infection Á WHO recommendations Á Educational programmes Á Behavioural change

Introduction Hand hygiene is the single most effective measure to prevent the transmission of healthcare-associated pathogens. Several studies have shown that ensuring sustained compliance with this very simple task is a constant challenge for healthcare workers (HCWs), even in settings without any resource constraints. The attitudes and behaviour of different professional groups significantly affect hand hygiene compliance [1–6], and interventions to motivate behavioural changes are of critical importance in bringing about improvement. Appropriately, most successful hand hygiene promotional strategies in health care have been multimodal and focused primarily on activities that facilitate behavioural change [6–11]. A key factor is to ensure that HCWs have an adequate knowledge of the role their hands play in the spread of healthcare-associated infection (HCAI) during different patient care activities that can result in hand contamination. This awareness is necessary to help them understand their capacity to contribute to prevent HCAI through effective and sustained behaviour change (self-efficacy). Knowledge influences behaviour directly and is essential for the individual to be able to evaluate the extent of the threat and to understand that a given behaviour can counteract or increase that threat. Conversely, lack of knowledge about the need for hand hygiene, the appropriateness and efficacy of agents used as

WHO takes no responsibility for the information provided or the views expressed in this paper. E. Mathai Á B. Allegranzi Á D. Pittet First Global Patient Safety Challenge, World Health Organization Patient Safety, Geneva, Switzerland W. H. Seto Department of Microbiology, Queen Mary Hospital, Hong Kong, Hong Kong Special Administrative Region, China ¨ M.-N. Chraıti Á H. Sax Á D. Pittet Faculty of Medicine, Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland E. Larson Columbia University School of Nursing and Joseph Mailman School of Public Health, New York, NY, USA D. Pittet (&) Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland e-mail: didier.pittet@hcuge.ch

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well as a lack of awareness of the very low adherence rates to hand hygiene protocols among HCWs can contribute to poor hand hygiene compliance [1]. Guidelines provide evidence-based information and influence HCW practices. However, the successful implementation of recommendations requires additional strategies, including educational interventions, to ensure that guidelines are translated into daily practice and become part of HCWs’...
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