INTEGRACION DEL COMITÉ TECNICOINTEGRACION DEL COMITÉ TECNICO

ensure that no patient is unavoidably harmed through lack of compliance with hand hygiene, consideration

should be given to nationally-coordinated programmes (in some cases campaigns) to promote and sustain

hand hygiene improvement, keeping the issue in the national spotlight

1072

_{and ensuring effective implementation}

of guidelines that have an impact on hand hygiene at the bedside. Noar

1066

_{emphasizes that even taking into}

account the numerous caveats associated with campaigning, it is likely that targeted, well-executed mass media

health campaigns can have some effects on health knowledge, beliefs, attitudes, and behaviour. The existence

of guidelines does not in itself improve hand hygiene compliance. Therefore, the added impetus provided by

a nationally coordinated campaign or programme, with some form of monitoring and evaluation, targets and

regulation, has been demonstrated to provide a powerful adjunct to local implementation. In particular, to raise

awareness of the issue and elevate it to a level of prominence that might not be realized in the absence of a

nationally coordinated activity. For hand hygiene improvements to succeed within an integrated safety and

infection control agenda, national-level approaches should be considered.

Table IV.8.1

The public information component of two national campaigns focusing on the prevention of health care-associated infection

Campaign Interventions and tools Target audiences Implementing bodies Significant results “cleanyourhands” England and Wales1029 (September 2004 to date) A multimodal campaign based on social marketing and sustainable methodology aimed at educating and providing prompts. It includes:

Implementation guide with supporting resources for HCWs with ongoing support through e-bulletins and local visits A series of three posters: the core campaign posters; the staff champion posters; the patient posters

Patient leaflets, badges, stickers to encourage patient involvement Printed information materials including staff leaflet, multi-purpose panels and pump indicators A media kit

A campaign web site Screen saver

Media launches of the campaign involving local celebrities

Conferences

National televised debate

HCWs Senior management within health-care settings Patients Hospital visitors Partner organizations NPSA NHS Trusts Department of Health Welsh Assembly Government 100% of all acute trusts in England and Wales signed up to the campaign

80% of trusts say hand hygiene is a top priority Use of alcohol handrub and soap has risen threefold

Initiated patient empowerment pilot Expanded programme to non-acute sector

Campaign Interventions and tools Target audiences Implementing bodies Significant results “100 000 Lives”

USA863

(December 2004- June 2006)

Information calls on the campaign and on each intervention

Campaign brochure Sign-up process: system, state and regional events Media kits, media events “Getting started” kits Campaign web site Information to existing partners on enrolling new partners Publicity of the successes of participating hospitals in implementing the campaign Health-care providers Partner organizations Patients IHI Hospitals Systems

3000 hospitals joined the campaign

Target lives saved achieved according to IHI data sources

Table IV.8.1

Table IV.9.1

Framework for action

Step Actions/issues for consideration References WHO implementation tools

1. Readiness for action

Considerations:

• Patient Safety Strategy:

— Is there an existing or planned regional (WHO) strategy on patient safety, hand hygiene improvement and infection control?

— Is the WHO country office driving infection control/hand hygiene improvement? — Is there national political support/

leadership for patient safety, hand hygiene improvement, and infection control? — Is there a national patient safety agenda? — Is there a national infection control

agenda?

— Is hand hygiene improvement integrated/ embedded within broader patient safety agenda?

— Is hand hygiene part of an accountability/ governance framework; does it link with accreditation?

• Commitment to “Clean Care is Safer Care”: — Has a national political pledge of support

to “Clean Care is Safer Care” been signed?

— Do national or regional policies/guidelines exist on hand hygiene improvement in health care?

— Is the WHO strategy consistent with national policies/guidelines on infection control/hand hygiene?

• Is there broad support from policy-makers, professionals and the public to prioritize effort and resource on hand hygiene at a national level?

• Will the programme be coordinated through the ministry of health or via another mechanism (e.g. regional or district authorities or a network of experts)?

• Do hand hygiene campaigns outside of health care already exist; can links be made?

798,1072,1074,1088,1094 _{• Pledge briefing pack}

• Country situation analysis • Facility situation analysis • Perception surveys

• WHO guide to local production of alcohol-based handrub

• WHO Guidelines on Hand Hygiene in

Health Care

• WHO Guide to Implementation of the multimodal strategy and associated toolkit

Step Actions/issues for consideration References WHO implementation tools

• Infrastructure and resources:

— Are national data available on the economic cost of HCAI?

— Are national data available on likely costs of a hand hygiene programme?

— Is there a HCAI national/local surveillance system in place or anticipated?

— Is technical infection control expertise available to coordinate the campaign? — Are required products affordable/available

(soap and alcohol-based handrub)? — Is national or donor funding available for

the short, medium or long-term?

— Are partnerships with commercial sectors feasible?

— How feasible will it be to produce, adapt and translate (where necessary) the WHO implementation toolkit?

— How feasible will it be to produce the WHO alcohol-based handrub formulation nationally (if limited, affordable access to commercial sector products)?

— Does the national infrastructure support rapid spread of improvement?

Once a decision is made to run a national programme, proceed to step 2

2. Identify roles and responsibilities

Actions:

1. Establish a national task force, headed by an influential, technically competent (in infection control or patient safety) national lead and deputy to coordinate and champion the campaign (credibility of the messenger in conveying scientific information to the target audience is key)

2. Develop terms of reference for the task force relating to implementation of hand hygiene improvement programmes at local level, as an integral part of national infection control strategy

3. Task force membership should comprise national safety and infection control

professionals and national bodies for infection control

4. Task force membership should include ministry of health officials concerned with infection control/safety

5. Brief/sensitize a task force on all aspects of the improvement, including local implementation using the WHO Guide and technical and advocacy toolkit

1086 _{• WHO Guidelines on Hand Hygiene in}

Health Care

• WHO Guide to Implementation of the multimodal strategy and associated toolkit

• Regional advocacy guide on hand hygiene

Table IV.9.1

Step Actions/issues for consideration References WHO implementation tools 3. Develop a framework for monitoring and evaluation Considerations:

• What will the realistic deadline be for action? • What realistic targets will be used (e.g.

reduction in infection, increase in compliance and product usage)

• What parameters/baseline data are available to measure the impact of the programme? • Is there a system for accreditation and

regulation? How will the hand hygiene improvement fit into this system?

1074,1075,1088 _{• WHO Guide to Implementation and}

associated toolkit

• Evaluation tools (facility situation analysis; hand hygiene compliance; health care-associated infection rates; soap consumption; alcohol- based handrub consumption; knowledge surveys; perception surveys; ward structure surveys)

4. Establish and strengthen partnerships, community mobilization, and the media Considerations:

• Which agencies/professional bodies, coalitions, voluntary organizations, partners, and nongovernmental organizations will be involved?

• Will patient and public engagement feature in the programme?

• How will marketers and the mass media be involved to ensure local hygiene practices and beliefs are taken into account?

• Will behavioural/industrial psychologists be involved in the communications and promotions activity to ensure alignment with local culture?

1072,1086,1098 _{• Regional Advocacy Guide for Hand}

Hygiene Improvement Strategies

5. Implementation: National

Actions:

1. Prepare a national action plan, based on steps 1 to 4, including all issues raised in the WHO Guide to Implementation

2. Establish a process for refining the plan in response tolearning during implementation

Considerations:

• Consider a national and sub-national meetings for hospital directors, managers, and other key decision-makers (for sensitization, awareness- raising, and building commitment)

1074,1094 _{• Regional Advocacy Guide for Hand}

Hygiene Improvement Strategies • WHO Guide to Implementation Table IV.9.1

Step Actions/issues for consideration References WHO implementation tools

• Will a pilot test occur or is mass roll-out anticipated?

• Consider holding a training session(s) for infection control teams using the WHO training tools

• In parallel, work to ensure infection control and the WHO strategy is incorporated within existing education programmes

• Consider creation of networks to support changeat the front-line of care

Local

Actions:

1. Local health-care facilities are provided with the WHO Guidelines, Guide to Implementation and toolkit

2. Local health-care facilities work through the five-step implementation process

• Regional Advocacy Guide for Hand Hygiene Improvement Strategies • WHO Guide to Implementation and

associated toolkit Table IV.9.1

Framework for action (Cont.)

Figure IV.1 Action framework

Policy-makers

funders

Local

implementers

1. Readliness for action

2. Identify roles and responsibilities

3. Develop a framwork for monitoring and evaluation

4. Establish and strengthen partnerships, community mobilization and the media

Preparation and execution of national action plan

Work though 5-step implementation process

5. Implementation: national 5. Implementation: local

Parners

In document GUIA BASICA DEL CURSO (página 52-64)