National hand hygiene campaign has helped cut hospital infection rates
Findings support global initiative to save lives through better hand hygiene
Research: Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study
The Cleanyourhands campaign has had an important role in reducing rates of some healthcare associated infections in hospitals across England and Wales, finds a study published on bmj.com today. It is the first such campaign in the world to be rolled out nationally.
Publication of the study coincides with the World Health Organisation SAVE LIVES: Clean Your Hands campaign on 5 May 2012, part of a global effort to improve hand hygiene among healthcare workers and thus prevent often life threatening infections.
The Cleanyourhands campaign was rolled out from January 2005 to all acute NHS trusts in England and Wales following concern over high levels of infections and low levels of hand hygiene.
Its aim was to reduce high levels of Staphylococcus aureus infection - meticillin resistant (MRSA) and meticillin sensitive (MSSA) - and Clostridium difficile infection that spread through contamination of healthcare workers hands.
The campaign involved having alcohol hand rub at each hospital bedside, distribution of posters, regular audits and feedback, and provision of materials empowering patients to remind healthcare workers to clean their hands. Trusts were to order soap and alcohol hand rub from central NHS supply agencies, which had ensured that all products met efficacy, safety, and acceptability standards.
In the first study to investigate the effect of such campaigns, researchers from the Royal Free Campus, University College London Medical School and the Health Protection Agency, aimed to evaluate the impact of the Cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap and its association with infection rates. These were measured every three months across all 187 acute NHS hospital trusts between 2005 and 2009.
Results show that combined procurement of soap and alcohol hand rub tripled from 21.8 to 59.8 mL per patient bed day. Over the study period, MRSA infections fell from 1.88 to 0.91 cases per 10,000 bed days while C difficile infections fell from 16.75 to 9.49 cases. MSSA infection rates did not fall.
Increased procurement of soap was independently associated with reduced C difficile infection throughout the study, while increased procurement of alcohol hand rub was independently associated with reduced MRSA infection, but only in the last year of the study. These strong and independent associations remained after taking account of all other interventions.
The authors stress that increasing procurement was not the sole driver of these reductions, because publication of the Health Act 2006 and visits by Department of Health improvement teams were also both strong independent factors.
However, they conclude that the Cleanyourhands campaign is associated with higher procurement of soap and alcohol hand rub which has helped to reduce rates of some healthcare associated infections. “The study suggests that national infection control interventions, including a hand hygiene campaign, undertaken in the context of a high profile political drive, can successfully reduce selected healthcare associated infections,” they write.
"The WHO offers a similar intervention to all countries signed up to the SAVE LIVES: Clean Your Hands initiative, giving the study findings international significance," they add.