SHORT COMMENTARY

‘Unite for safety – clean your hands’: the 5 May 2022 World Health Organization SAVE LIVES: Clean Your Hands campaign

Ermira Tartari^1,2, Claire Kilpatrick¹, Benedetta Allegranzi¹ and Didier Pittet^3*

¹Infection Prevention and Control Technical and Clinical Hub, Department of Integrated Health Services, World Health Organization (WHO), Geneva, Switzerland; ²Faculty of Health Sciences, University of Malta, Msida, Malta; ³Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

 

Comment: The authors alone are responsible for the views expressed in this article. It does not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

Keywords: hand hygiene; infection prevention and control; World Health Organization; healthcare-associated infection; public health; global health; safety climate; safety culture; organizational culture

 

 

Hand hygiene improvement is a critical part of effective infection prevention and control (IPC) and therefore constitutes a priority for patient and health workers’ safety. However, hand hygiene compliance in healthcare settings remains sub-optimal globally (1–3). The World Health Organization (WHO) recommends to implement an effective (4) Multimodal Hand Hygiene Improvement Strategy (MMIS) that includes five elements: 1) system change; 2) training and education; 3) monitoring and feedback; 4) reminders in the workplace/communications; 5) safety climate/culture change (4).

Systematic reviews have shown relationship among safety culture, IPC processes, and healthcare-associated infection (HAI) reduction (5, 6). Improving the organizational safety climate has been associated with enhanced hand hygiene compliance (7–10) and improved patient outcomes, including HAI reduction (11, 12), in particular vancomycin-resistant enterococci and Staphylococcus aureus (10, 13) and central line-associated bloodstream (14, 15) infections.

Employing the Hand Hygiene Self-Assessment Framework (HHSAF) (16) to assess the implementation of the WHO MMIS in healthcare facilities worldwide, the Institutional Safety Climate element repetitively scored the lowest (17, 18), suggesting that progress in improving safety climate has been slower across and within regions when compared with the four other elements of the MMIS. Therefore, it seems critical to direct attention to safety climate/culture change to ensure further and sustainable hand hygiene improvement. Safety climate, safety culture, and organizational culture are often used interchangeably, whereas their concepts are distinct. Organizational culture refers to the deeply embedded norms, values, beliefs, and assumptions shared by members within an organization (19). Safety culture considers leadership and health workers attitudes and values related to the perception of risk and safety. Safety climate is a subset of overall organizational climate that refers to employees’ perceptions about the extent to which the organization values safety (for patients, health workers, and the environment) (12, 19). The Institutional Safety Climate as part of the hand hygiene, MMIS refers to the environment and perceptions of patient safety issues in a healthcare facility in which hand hygiene improvement is given high priority and valued at all levels of the organization (20). This includes the perception and belief that resources are provided and available to ensure hand hygiene, particularly at the point of care. In summary, when a health facility’s ‘quality and safety climate or culture’ values hand hygiene and IPC, this results in both patients and health workers feeling protected and cared for. To prioritize clean hands at the point of care at the right times using the right agent and technique, people at all levels, including those using healthcare facilities, should focus on the importance of hand hygiene to save lives and act as key players in achieving and promoting the appropriate behaviors and attitudes toward it.

In light of the importance of this element and given the limited progress made in the last 20 years, the World Hand Hygiene Day, 5 May 2022 promotes institutional safety climate/culture change as a priority for hand hygiene improvement by adopting the slogan ‘Unite for safety – clean your hands’ (Fig. 1). To achieve unity for safety, WHO calls all key stakeholders to participate actively (Table 1).

Fig. 1. 5 May 2022: ‘Unite for safety – clean your hands’.
5 May 2022 WHO SAVE LIVES: Clean Your Hands campaign slogan and main promotional image (2022 hashtag: #HandHygiene).

Table 1. 5 May 2022 WHO SAVE LIVES: Clean Your Hands campaign calls to action

Campaign participants	Call to action
Healthcare workers	‘Thank you for leading by example and encouraging others to clean their hands’
IPC practitioners	‘Thank you for engaging health workers to be part of new hand hygiene initiatives’
Quality and safety leads	‘Thank you for working with infection prevention colleagues to support hand hygiene improvement’
Facility managers	‘Thank you for promoting a quality and safety culture to ensure clean hands’
Policy-makers	‘Thank you for prioritizing resources, training and programmes on hand hygiene’
People who use healthcare	‘Thank you for getting involved in local hand hygiene campaigns and activities’
All the information is available on the webpage WHO SAVE LIVES: Clean Your Hands campaign and World Hand Hygiene Day 2022 (https://www.who.int/campaigns/world-hand-hygiene-day/2022), including an advocacy toolkit offering guidance on the campaign’s objectives, key messages, and how to get involved.

Healthcare facilities can use the HHSAF (16) to track the level of progress with hand hygiene implementation, including safety climate and culture change, evaluating improvement over time. This tool also helps to develop an action plan to ensure long-term sustainability. Factors ultimately required to create and support an environment that raises awareness about patient safety and quality of care while ensuring that hand hygiene best practices are prioritized at all levels include: 1) a team dedicated to the promotion and implementation of hand hygiene in the facility; 2) leadership commitment and active participation, 3) promotional activities; 4) champions and role models; 5) engagement of patients and patient organizations; 6) institutional targets, accountability, and reporting. Additionally, self-efficacy and individual accountability should be supported in the organization as well as nurturing of role models and champions at every level.

We call on the international community to get involved in the World Hand Hygiene Day 2022 (https://www.who.int/campaigns/world-hand-hygiene-day/2022) and work together to accelerate progress across health services, reaffirm your commitment, unite, talk, and work together on hand hygiene for future progress, sustainability, and ultimately improve quality and safer care: ‘Unite for safety - Clean your hands!’

References

1. Lotfinejad N, Peters A, Tartari E, Fankhauser-Rodriguez C, Pires D, Pittet D. Hand hygiene in health care: 20 years of ongoing advances and perspectives. Lancet Infect Dis 2021; 21: e209–21. doi: 10.1016/S1473-3099(21)00383-2
2. Lambe KA, Lydon S, Madden C, Vellinga A, Hehir A, Walsh M, et al. Hand hygiene compliance in the ICU: a systematic review. Crit Care Med 2020: 1251–7. doi: 10.1097/CCM.0000000000003868
3. Vikke HS, Vittinghus S, Giebner M, Kolmos HJ, Smith K, Castrén M, et al. Compliance with hand hygiene in emergency medical services: an international observational study. Emerg Med J 2019; 36: 171–5. doi: 10.1136/emermed-2018-207872
4. Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, Mclaws M-L, Moro M-L, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis 2013; 13: 843–51. doi: 10.1016/S1473-3099(13)70163-4
5. Hessels AJ, Larson EL. Relationship between patient safety climate and standard precaution adherence: a systematic review of the literature. J Hosp Infect 2016; 92: 349–62. doi: 10.1016/j.jhin.2015.08.023.
6. van Buijtene A, Foster D. Does a hospital culture influence adherence to infection prevention and control and rates of healthcare associated infection? A literature review. J Infect Prev 2019; 20: 5–17. doi: 10.1177/1757177418805833
7. Wolfe JD, Domenico HJ, Hickson GB, Wang D, Dubree M, Feistritzer N, et al. Characteristics of inpatient units associated with sustained hand hygiene compliance. Journal of Patient Safety. 2021 Dec 1; 17(8): e1272–7. doi: 10.1097/pts.0000000000000488
8. Caris MG, Kamphuis PGA, Dekker M, De Bruijne MC, Van Agtmael MA, Vandenbroucke-Grauls CMJE. Patient safety culture and the ability to improve: a proof of concept study on hand hygiene. Infect Control Hosp Epidemiol 2017; 38: 1277–83. doi: 10.1017/ice.2017.209
9. Daugherty EL, Paine LA, Maragakis LL, Sexton JB, Rand CS. Safety culture and hand hygiene: linking attitudes to behavior. Infect Control Hosp Epidemiol 2012; 33: 1280–2. doi: 10.1086/668432
10. Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med 2000; 26: 14–22. doi: 10.1080/08964280009595749
11. Weaver S, Lubomksi L, Wilson R, Pfoh E, Martinez K, Dy S. Annals of internal medicine supplement promoting a culture of safety as a patient safety strategy. Ann Intern Med 2013; 158: 369–74. doi: 10.7326/0003-4819-158-5-201303051-00002
12. Singer SJ, Vogus TJ. Reducing hospital errors: interventions that build safety culture. Annu Rev Public Health 2013; 34: 373–96. doi: 10.1146/annurev-publhealth-031912-114439
13. Borg MA, Waisfisz B, Frank U. Quantitative assessment of organizational culture within hospitals and its relevance to infection prevention and control strategies. J Hosp Infect 2015; 90: 75–7. doi: 10.1016/j.jhin.2014.12.015
14. Pronovost P. Interventions to decrease catheter-related bloodstream infections in the ICU: the keystone intensive care unit project. Am J Infect Control 2008; 36: S171.e1–e5. doi: 10.1016/j.ajic.2008.10.008
15. Weaver SJ, Weeks K, Pham JC, Pronovost PJ. On the CUSP: stop BSI: evaluating the relationship between central line-associated bloodstream infection rate and patient safety climate profile. Am J Infect Control 2014; 42: S203–8. doi: 10.1016/j.ajic.2014.05.020
16. World Health Organization. Hand hygiene self-assessment framework. 2010. Available from: https://www.who.int/gpsc/country_work/hhsa_framework_October_2010.pdf [cited 15 February 2022].
17. De Kraker MEA, Tartari E, Tomczyk S, Twyman A, Francioli LC, Cassini A, et al. Implementation of hand hygiene in health-care facilities : results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019. Lancet Infect Dis 2022; 3099: 1–10. doi: 10.1016/S1473-3099(21)00618-6
18. Kilpatrick C, Tartari E, Gayet-Ageron A, Storr J, Tomczyk S, Allegranzi B, et al. Global hand hygiene improvement progress: two surveys using the WHO hand hygiene self-assessment framework. J Hosp Infect 2018; 100: 202–6. doi: 10.1016/j.jhin.2018.07.036
19. Schein EH. Organizational culture and leadership. 4th ed. Wiley: San Francisco, CA; 2010.
20. World Health Organization. WHO guidelines on hand hygiene in health care. Geneva: World Health Organization, Patient Safety; 2009. Available from: http://whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf [cited 15 February 2022].