1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
Header line 1
Header line 2
Header line 3
Hand Hygiene Education and Training Improvement
Strategy in an Acute Hospital setting.
Noreen Hynes, MSc in Healthcare Management.
Abstract
The aim of this organisational development (O.D.) project was to improve Hand Hygiene education and training compliance in an acute Hospital setting and by extension, improve hand hygiene compliance.
Rationale: Hand Hygiene is identified as the single most important intervention in reducing the transmission of Healthcare associated infections (HCAIs).
In 2009, the WHO published comprehensive evidence-based guidelines on Hand Hygiene in healthcare, which introduced a standardised approach to Hand Hygiene practices; ‘The Five Moments for Hand Hygiene’. These guidelines have been adopted and are core to our education and training programme.
Methodology: The Health Service Executive (HSE) Change model was used to guide this O.D project.
Evaluation: Kirkpatrick's model was employed to evaluate the Hand Hygiene education and training. A pilot class completed a pre and post education, knowledge survey. It was found that 10% of attendees had not previously received hand hygiene education and training despite it being mandated. The post education assessments pointed to a modest improvement in knowledge. Pre training assessment responses showed that 17% of participants did not routinely use hand-rub. A second (knowledge and perception) survey was circulated to a stratified purposeful cohort (10%) of employees in order to assess the attitudes and perceptions of Healthcare Workers (HCWs) with regard to hand hygiene. It was found that 8% of staff had not received mandatory training and 6% did not routinely use alcohol-based hand-rub.
Results and Conclusion: Results show that the education and training compliance rate at the start of the project in September 2014 was 73% and this had improved to 83% by April 2015, following the education programme .The hand hygiene compliance rate was unchanged. Continued re-enforcement of this quality and patient safety indicator will remain a key deliverable for each manager through 2015.

2. Introduction & Background Organisational Impact
Hand Hygiene Education and Training Improvement
Strategy in an Acute Hospital setting.
Noreen Hynes, MSc in Healthcare Management.
Introduction & Background
Methodology
Evaluation
Healthcare associated infections(HCAIs) describe those infections which are contracted by patients during a hospital stay or which develop among hospital staff. HCAIs are a major problem with regard to patient safety and its surveillance and prevention must be a priority for institutions committed to making healthcare safer. The impacts of HCAIs include prolonged hospital stays, long term disability, financial burden and fatalities1. European studies report HCAI rates of 4.6% to 9.3% 1.Specific to Ireland ,HCAI prevalence has been measured at 5.2%2. It is estimated that 25,000 patients contract a HCAI each year which has an associated cost of €11.8M3. However, while it is acknowledged that not all HCAIs are preventable, it is estimated that hand hygiene compliance among healthcare workers (HCW) could prevent an estimated 50% of HCAIs. Although education alone is insufficient to effect sustained changes in practice,it remains an essential component of all Hand Hygiene programmes 1.
Figure 1: Five Moments for Hand Hygiene1
The HSE change model was employed as the framework for this project.
Initiation:
Identification of barriers to effective implementation of hand Hygiene education attendance.
Enhancement of the Hospital Quality and Patient Safety culture.
A SWOT, Stakeholder analysis and Force Field analysis was undertaken.
Planning:
Leadership, management and governance defined.
Hospital Committees communication plan devised.
Implementation plan devised for the Infection Prevention and Control team.
Implementation:
All department/ ward managers tasked with responsibility to drive Hand Hygiene education and training attendance.
Hand Hygiene training staff attendance records validated.
Roll out of enhanced Hand Hygiene education by Infection Prevention & Control staff.
Mainstreaming:
Hospital Quality and Patient Safety culture in relation to mandatory two-yearly Hand Hygiene education and training for all staff who interact with patients.
Defined ownership for staff attendance at education.
Kirkpatrick’s model was used to evaluate the education and training.
Reaction: Post education Evaluation surveys conducted.
Learning: Pre and Post Knowledge assessment and perception survey conducted.
Behaviour: Direct Hand Hygiene audits and measurement of Alcohol Hand Rub usage completed.
Results: Overall 10% increase in Education attendance compliance.
Figure 2: HSE Change Model 4
Organisational Impact
To effect organisational change strong Leadership is Key to define and drive the need for change. A Quality and Patient Safety culture is the critical component to change employee behaviour. Communication is vital and hospital committees were used as the communication strategy. Continued re-enforcement of staff attendance at hand Hygiene education is a requisite among all managers.
Aims & Objectives
The aim of this project is to improve hand hygiene education and training systems for all healthcare staff who interact with patients in order to effect improved HH compliance.  
The objectives:
Determine baseline of hand hygiene education and training compliance rates.
100% of all staff who interact with patients have received Hand Hygiene education and training.
Conduct direct observation Hand Hygiene audits.
Conclusion
It is acknowledged that Hand Hygiene practices reduce HCAIs, yet HCW compliance with best practice remains suboptimal. Education is key to Hand Hygiene compliance however behavioural and cultural changes are complex challenges which can impact on the benefits of education.
References
1Switzerland. World Health Organisation (WHO) Guidelines on Hand Hygiene in Healthcare (2009a) First Global Patient Safety Challenge Clean Care is Safer Care’. Geneva: WHO
2Ireland. Health Service Executive-Health Protection Surveillance Centre (2012) ‘Report on Hand Hygiene Compliance in Acute Hospitals’, Dublin: Stationery Office. 3Ireland. Health Service Executive (2011) ‘Annual Report and Financial Statements’, Dublin: Stationery Office. 4Ireland. Health Service Executive (2008) ‘IMPROVING OUR SERVICES: A Users’ Guide to Managing Change in the Health Service Executive’ Dublin: Stationery Office.