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The effectiveness of the national cleanyourhands campaign.

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VOL: 101, ISSUE: 08, PAGE NO: 50

Julie Storr, RGN, RHV, BN, MBA, FRSA, Cert(Infection control), is safer practice lead, National Patient Safety Agency

The cleanyourhands campaign currently being rolled out across England and Wales is the first of its kind and is an ambitious attempt to improve hand hygiene on a national level. Nurses are vital to this effort as they are well placed to ensure that hand hygiene compliance is observed.

The cleanyourhands campaign currently being rolled out across England and Wales is the first of its kind and is an ambitious attempt to improve hand hygiene on a national level. Nurses are vital to this effort as they are well placed to ensure that hand hygiene compliance is observed.

Winning Ways (Department of Health, 2003), Towards Cleaner Hospitals and Lower Rates of Infection (DoH, 2004) and A Matron's Charter (Jones, 2004) all form part of a broad strategy to tackle HAIs.

It is anticipated that the combined effect of these different strands of work will result in the reduction of a range of avoidable infections, including those caused by methicillin-resistant staphylococcus aureus (MRSA) and other resistant microbes.

While the drive to improve cleanliness is being spearheaded by the chief nursing officer, the NPSA is working to ensure that the critically important practice of hand hygiene receives attention among staff and patients. Our aim is for it to be seen as one of the simplest and most effective methods to reduce rates of infection and harm to patients.

The risk factors for low compliance with hand hygiene by NHS staff are highlighted in the literature and efforts to improve compliance are targeted specifically at these factors (Larson et al, 1997; Pittet et al, 2000). The research shows that improvement strategies must employ a number of different approaches that address staff education and motivation, measures of performance and feedback, and most importantly, a strong commitment to improving hand-hygiene compliance from senior managers and leaders in health care.

Another important factor that contributes to a sustained improvement is a straightforward system change, making it easier for staff to access the means to clean their hands at the right time and in the right way. An alcohol-based hand rub at the point of care is the agent currently recommended by the NPSA.

The cleanyourhands campaign
The NPSA's cleanyourhands campaign was developed, tested and evaluated in the acute health care sector in England and Wales. Six trusts were involved in the pilot, which lasted for seven months and the full report is available on the campaign website at www.npsa.nhs.uk/cleanyourhands (National Patient Safety Agency, 2004). While feedback was secured from all staff groups, specific feedback was forthcoming from over 300 ward nursing staff and this has helped to shape the final campaign.

In September 2004, the NPSA issued its fourth Patient Safety Alert requiring all acute NHS trusts in England and Wales to implement disinfectant (alcohol-based) hand rubs at the point of care by April 2005. At the same time, all acute trusts in England and Wales were invited to apply to implement the cleanyourhands campaign.

The campaign is being rolled out in five phases to maximise the opportunity for long-term, sustained improvement. To date, over 120 NHS trusts have signed up to the campaign. The NPSA is now recruiting for phase five and interested trusts should visit the campaign website to complete an online application form.

Implementing the cleanyourhands campaign - Trusts signing up to each phase start off with a three-month preparation period that allows them to work through a series of activities designed to boost success once the campaign begins locally. The preparation period takes into account the varying ways in which trusts work and the different cultures that exist throughout the NHS, enabling the campaign to be implemented flexibly and effectively at local level. What matters most is that sites prepare themselves for a long-term improvement in hand-hygiene compliance, of which the 'go live' date is merely the beginning.

Every ward in an implementer trust receives campaign material (Box 1 and Fig 1). Also, trusts receive 200 patient posters for display in non-inpatient wards areas and other public areas of the hospital. After this, all wards are sent refresher posters on a monthly basis.

The NPSA has worked closely with the NHS Purchasing and Supply Agency to make available the best quality alcohol hand rubs for staff. It has also worked in partnership with NHS Estates, the Health Protection Agency (HPA), the Royal College of Nursing, patients, the public, and with a range of other stakeholders on the development of the campaign.

Evaluation - The campaign is being evaluated independently of the NPSA through the Department of Health's Patient Safety Research Programme. A four-year research project will assess the campaign's impact on a range of outcomes, with particular focus on rates of infection. The NPSA is now looking at the best way to transfer the campaign to the primary care sector.

Conclusion
The cleanyourhands campaign provides impetus and a range of tools and products to trusts committed to a long-term improvement in hand-hygiene behaviour. While improvements of this nature must transcend professional groups, nurses are perfectly placed to make a significant and long-lasting contribution that will enhance patient safety.

Details of the cleanyourhands campaign can be found on the National Patient Safety Agency website at www.npsa.nhs.uk/cleanyourhands

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