This document summarizes two successful hand hygiene programs in Australia and Mali that followed the World Health Organization's multimodal strategy and guidelines. Both programs saw increases in hand hygiene compliance and decreases in hospital-acquired infections through national initiatives, training healthcare workers using the "My Five Moments for Hand Hygiene" educational framework, and monitoring practices with feedback. The document emphasizes the importance of multidisciplinary, multimodal strategies adopted at national levels based on WHO guidelines to improve hand hygiene and reduce infections.

1. Reducing Hospital-Acquired Infections:
A Systematic Evaluation of Two Successful Hand Hygiene Programs
Anthony Valdez
Humboldt Center for Evolutionary Anthropology, Department of Anthropology, Humboldt State University, Arcata, California, 95521
Introduction
Nosocomial or hospital-acquired infections (HAI’s), remain a major cause of morbidity and mortality in healthcare settings. One of the major ways to reduce the number of HAI’s is the implementation of successful hand hygiene (HH)
programs (Pittet, 2000). Numerous studies have documented the importance of HH in health-care settings, yet HH compliance among health-care workers (HCW’s) is extremely low (Pittet, 2000). Here, I evaluated HH programs from
two countries and identified factors contributing to their success. Based on the data, it is clear that a major factor in developing successful hand hygiene compliance programs is the development of a multimodal, multidisciplinary strategy
that is adopted by local, state and federal levels as suggested by The World Health Organization guidelines on hand hygiene.
The World Health Organization (WHO)
Australian National Hand Hygiene Initiative The World Health Organization: Guidelines on Hand Hygiene
 Based on WHO’s “My five moments for Hand Hygiene” “My five moments for hand hygiene”
 A cultural change program that established a multi-site model which involved the employment of both central WHO Multimodal 5 step Hand Hygiene Strategy:
and state-based HH educators (Grayson et al, 2011). This approach allowed both the central development of
important culture change, education, and data recording materials. One System Change
 National Program with Government funding Alcohol-based handrubs at point of care and access to safe
 Executive Leadership and Jurisdictional Support (Grayson et al, 2011). continuous water supply, soap and towels.
 Conducted up to 200 training workshops in all Australian states and territories.
 Established a network of ‘gold standard’ auditors who helped train other HCWs. Two Training and education
 Results: Increase of HH compliance and drop in HAI prevalence. Providing regular training to all Health-care workers.
Three Evaluation and feedback
Monitoring hand hygiene practices, infrastructure,
perceptions, and knowledge, while providing results
feedback to health-care workers.
Four Reminders in the workplace
Prompting and reminding health-care workers.
Hand hygiene is a core element of patient
safety. Its promotion represents a challenge that Five Institutional safety climate
requires a multimodal strategy using clear and simple Individual active participation, institutional support, patient
conceptual framework. participation.
This graph illustrates an increase in educational engagement Knowledge of hand hygiene before and after the WHO’s ‘My five
through the National Hygiene Initiative. moments for hand hygiene’ in Mali, Africa. The development of “My five moments for hand
Hand Hygiene in Mali, Africa hygiene” involved a user-centered approach
 Full implementation of the WHO strategy at University Hospital, Bamako, Mali incorporating strategies of human factors and
 Local production of pocket bottles of the WHO hand rubbing formulation. cognitive behavior (Sax et al, 2007). It describes
 Increased ministerial engagement on national scale. fundamental reference points for HCWs in a time-
 Implementation of the WHO’s Multimodal 5 step HH space framework and designates moments when ??
 Key educational messages was based on the WHO’s “My five moments for hand hygiene.” hand hygiene is necessary (Sax et al, 2007).
 Participants attend an education session including training films. “My five moments for hand hygiene” bridges the
 Results: Increase of HH compliance and drop in HAI prevalence. gap between scientific evidence and daily health
practice (Sax et al, 2007). World Health Organization, figure 1
Implications
 Successful hand hygiene programs followed the World Health Organization Guidelines on hand hygiene in healthcare settings. The guidelines provide HCWs with a thorough review of evidence on HH in healthcare and specific
recommendations to improve practices. The WHO guidelines are unique in that they provide global perspectives in implementation, they bridge the gap between developing and developed countries, and provide innovated insight on
religious and cultural aspects.
 Educational and motivational programs for healthcare workers were also factors for successful hand hygiene programs, including factors that influence behavior. It is important to note that educational programs are not enough for
lasting improvement and other behavioral influences should be included. Education is important and critical for success and represents one of the cornerstones for improvement of hand hygiene (www.who.int).
 Political commitment is essential to achieve improvement in infection control, 38 countries have national or subnational campaigns, excluding the United States (Figure 1). It is important for national governments to make improving HH
adherence a national priority and consider a funded, coordinated implementation program while strengthening the infection control capacities within healthcare settings. Furthermore, national governments should encourage healthcare
settings to use hand hygiene as a quality indicator in patient safety (www.who.int).
 The United States needs to get on board with its own hand hygiene initiative to increase compliance, to lower HAI prevalence and costs, and to save lives.
Acknowledgments
I would like to thank the Department of Anthropology, the College of Arts, Humanities, and Social Sciences, the Office of Research and Supporting Programs, and May Patiño for help with this research.
References
1
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