Successful implementation of the WHO multimodal hand hygiene improvement strategy and tools: a survey of 230 hospitals worldwide

Abstract number: P1139

Allegranzi B., Bagheri Nejad S., Sax H., Mathai E., Richet H., Pittet D.

Objective: In 2006, the WHO multimodal hand hygiene (HH) improvement strategy and more than 40 implementation tools were made available to any healthcare setting (HCS) worldwide following web registration. We evaluated the use of the strategy and tools and their usefulness and importance for HH improvement and impact on HH practices.

Methods: In January 2008, all registered HCS (n = 329) were invited to complete an online form requesting general information with specific questions about progress with the WHO strategy and tool implementation. HCS at advanced/semi-advanced stages of implementation and having used most of the WHO tools were selected for a semi-structured interview with the project co-ordinators including both open and closed (7-point Likert scale) questions on the WHO strategy elements and tools. The objective was to receive feedback on the advantages and drawbacks of the strategy implementation, feasibility of the local production of the WHO alcohol-based handrub formulations (ABHF), and the validity and obstacles encountered in the use of the tools. Co-ordinators were also requested to send available data on key indicators such as HH compliance.

Results: A total of 114 responses to the web survey were received from both single hospitals and HCS networks. Among the advanced/semi-advanced sites, 47 co-ordinators were selected for interview, representing 230 hospitals from Egypt, France, Italy, Malta, Malaysia, Mongolia, Spain, and Viet Nam. The strategy was considered comprehensive, very detailed, and a successful model for other interventions by all co-ordinators; some parts were recommended for simplification. Median scores attributed to the WHO strategy elements and principal tools are shown in the table according to their ranked importance to achieve HH improvement. ABHF local production, in place in five sites, was reported to be feasible at very low cost and the product was well accepted by healthcare workers. Co-ordinators from some hospital networks (Italy, France, Spain) reported data on HH compliance and showed an average increase of 21% after implementation.

Conclusion: The WHO strategy and tools were implemented autonomously and without WHO support in many HCS worldwide. As reflected by the high scores attributed by co-ordinators, their use was considered to be very helpful and essential to improve HH. Very useful feedback on local adaptation and suggestions for improvement was obtained through this evaluation.


 Median score (range)*
Strategy element
System change (ABHF, clean water and soap availability)7 (4–7)
Staff education7 (5–7)
Observation and feedback7 (4–7)
Reminders6 (3–7)
Promotion of a patient safety climate6 (2–7)
Main tools
Guide to implementation6 (4–7)
Guide to local production6 (6–6)
Educational tools7 (6–7)
Manual for observers7 (1–7)
WHO posters6 (5–7)
*7-point Likert scale.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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