1. The cleanyourhands campaign
Julie Storr
Safer Practice Lead NPSA

2. Understanding the problem
Local, national and international issue:
300,000 patients per year UK
2 million US
5000 deaths UK
90,000 US
£1bn UK
$17-29 bn US
Hand hygiene can probably reduce 9-50%

3. World Health Organisation (2004)
Clean hands
Clean environment
Clean procedures
Clean equipment
Clean products

5. Sum – greater than parts
Near to patient hand rubs
Posters which change every month
Posters featuring staff (champions)
Patient involvement (posters, stickers, leaflets - promoting patient involvement) – ‘it’s okay to ask’
General promotional and marketing materials
Observation and feedback
Methods to involve every level of staff in a hospital

6. Why Pilot? Reality check of prototype solutions
Check fitness for purpose
Assess usability
Identify issues for implementation
Evaluation
test perceptions of staff.
establish the patient perspective

7. How we evaluated Staff surveys: before and after
Visual impact of campaign
Perceptions of alcohol rubs
Patient involvement
Patient interview/ survey: one off
Staff interview: beginning & end
Staff diary: continuous
Staff observations: over time
Usage of hand rubs: before & after

8. Top line pilot results
84% staff stated posters influenced hand hygiene
39% staff asked at least once ‘have you cleaned your hands?
97% staff comfortable being asked
71% patients thought they should be involved
Observed compliance increased throughout pilot (2.5 times)
Product usage increased 2.5 times

9. Clean hands help to save lives
Call to action
All acute hospitals to install near patient rubs
Joint work with national purchasing body (NHS PASA)
All acute hospitals invited to join the cleanyourhands campaign
99% uptake
3 month preparation

10. Impact so far: alcohol hand rub - Increase in usage and Price Reductions

11. Benefits Estimator: Case study of early adopters Approx. Bed size
% Saving
% Increase
Hospital A
1100
12.4%
428%
Hospital C
800
49.1%
460%
Hospital D
900
42.8%
183%

12. The implementer wards will receive a starter pack made up of:
Posters for monthly change
Posters with a gap on which to stick staff photos
Posters targeting patients “its okay to ask”
Enamel badges
Sticky badges (it’s okay ot ask).
Patient leaflets
Don’t cite numbers at this stage – this is likely to change.

13. Here are some of the poster drafts.
Some of the posters have been toned down in order to be cleared for the national campaign (eg Weapon of mass destruction did not get through clearance).
The posters have been developed considerably in terms of their appearance (colour/ brightness) as a direct result of feedback from the pilot.
The glove abuse poster came into being as a result of feedback from patients who when asked: have you seen staff clean their hands in the last 24 hours stated that whilst they had not seen this – they had noticed many staff wearing gloves and were confused as to whether gloves indeed negated the need o clean hands.

14. Best evaluated part of the campaign – one of.
Choose a staff champion to appear in the posters and this personalises the campaign.
Has to be someone the staff and patients will recognise.
Can be a team.

15. Patient materials: leaflet, poster
Patient materials: leaflet, poster. There will also be sticker badges stating: “cleanyourhands – its okay to ask”.
The phrase “its okay to ask” came from patients.
Four simple words getting across a powerful message that patients should feel comfortable asking staff about hand hygiene if they want to. No compulsion. Many won’t like the idea – some will and some will ask.
This is one part of the campaign and says a lot about the culture of the trusts which embrace this.
Of course, not all patients can ask – not all will – but the point is you are creating an expectation in the trust that it is okay to do so and that staff will be expecting it. Staff do not know who will or won’t ask – but they know they might be asked and this is the driver for behaviour change.

16. The sticker badges look like this

18. Four year research evaluation
NOSEC – nosocomial study of the effectiveness of the cleanyourhands campaign.
Studying the impact on a range of outcomes.
Cluster randomised controlled trial from year 2.