National hand hygiene campaign in Korea-progress and challenges

Abstract

Hand hygiene (HH) is regarded as the most effective measure to prevent the spread of pathogens in healthcare settings. After the early success of the WHOHH multimodal implementation strategy and toolkit, HH campaigns have been initiated worldwide. As one of the countries participating in the WHO Clean- HandsNet, a global network of coordinators or leaders involved in the promotion of HH in healthcare, the Korean government planned to commence a national hand hygiene campaign (NHHC) and then incorporate HH as a measure of quality of care at the national level in the future. The aim of this campaign was to implement a standardized HH culture change program on the basis of the WHO multimodal HH improvement strategy throughout all the hospitals in Korea. The pilot study for the NHHC in Korea was instituted in 35 hospitals commencing in November 2013, based on the WHO “5 Moments for Hand Hygiene” program. Pilot sites were chosen by expressions of interest from over 90 hospitals participating in the KONIS (Korean Nosocomial Infection Surveillance) system. At first, the “Hand Hygiene Self-Assessment Framework” translated in Korean was distributed in order to evaluate the current status of HH promotion and practices and further to focus on future plans and challenges. The coordination center developed a generic guide as well as a training program including slide presentations, lectures, and practical workshops. Three indicators were measured, including not only HH compliance by direct observation and the number of liters of alcohol-based hand-rubs (ABHRs) ordered per 1000 patient days (PD) per month as process indicators, but also the number of MRSA bacteremia per 1000 PD per month as an outcome indicator. Even though most of the participating hospitals were assessed as intermediate or advanced level, the score for “institutional safety climate” was much lower than those for other components. The overall HH compliance rate was 69.2%, but compliance after touching a patient's surroundings was lowest. HH compliance was highest among nursing staff (72.8%) and worst among medical staff (54.2%).Mean ABHRs supply was 13.4 L per 1000 PD. The rate of nosocomial MRSA bacteremia was 0.14 per 1000 PD. While it is too early to achieve the outstanding results, a comprehensive and multifaceted program is needed to ensure further improvement in HH compliance. Before advance toward the national campaign, thorough assessment of current situation using the Korean version of “Hand Hygiene Self-Assessment Framework” might be a catalyst for implementing and sustaining a comprehensive HH program within a healthcare facility and also provide an opportunity to facilitate development of an action plan for NHHC. In addition, standardized HH auditing tools need to be defined and validated for the inter hospital comparisons.