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Overview

Updated on December 21, 2015

Issue

Health care associated infections kill between 8,000 and 12,000 Canadians every year, of which 40% occur in Ontario.1 Patients seeking help for other health issues may inadvertently get an infection at the health care facility, leading to more serious illness, prolonged hospital stays, and possibly induce long-term disability or death. These preventable infections inflict an unexpected complication on the patients and their families, as well as a substantial financial burden on the health care system.2 Proper hand hygiene is a key part of an effective infection control and prevention program, and can help prevent unnecessary cost, illness and death.

It has been estimated that 220,000 health care associated infections occur in Canada each year, meaning that one in nine patients admitted to Canadian hospitals will acquire an infection as a consequence of their stay.2 About twenty years ago, hospital-acquired infection was the 11th leading cause of death in Canada. Today, it is the fourth leading cause of death in the country.2

 

Call to Action

It is recommended that there are four important moments of hand hygiene compliance: before initial patient/patient environment contact, before aseptic procedures, after body fluid exposure risk, and after patient/patient environment contact.2,3 The overall rate of hand hygiene compliance before patient contact in Ontario hospitals in 2012 was 72% (all hospitals, a slight improvement since 2011 where it was about 66%) and the rate of hand hygiene compliance after patient contact was 83%.4 In 2011, acute teaching hospitals had a lower rate of hand hygiene compliance before patient contact (57%) compared to other hospitals (small community, 51%; large community, 70%; mental health, 63%; chronic/rehabilitation 69%).6 In Ontario, eighty-five hospitals chose hand hygiene as their number one priority in 2012.5 There has been some improvement in this rate of compliance but compliance is too low, leaving room for improvement in Ontario hospitals.6

  1. Overcrowded hospitals, cutbacks to cleaning linked to infection outbreaks [Internet].

    Ontario Council of Hospital Unions; 2011 Oct 11 [cited 2012 Nov 19].
    Available from: http://www.ochu.on.ca/hai_tour.html

  2. Improving Hand Hygiene Among Health-Care Professionals [Internet].

    The College of Physicians and Surgeons of Ontario; 2009 July [cited 2012 Nov 19].
    Available from: http://www.cpso.on.ca

  3. Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene.

    Government of Ontario; [cited 2012 Nov 19].
    Available from: http://www.handhygiene.ca/English/Documents/Tools and Templates/Your 4 Moments for Hand Hygiene (Poster).pdf    

  4. Health Quality Ontario. Quality Monitor 2012.

    Toronto: Health Quality Ontario; 2012 Sept [cited 2012 Nov 19]
    Available from: http://www.hqontario.ca/portals/0/Documents/pr/qmonitor-full-report-2012-en.pdf

  5. Health Quality Ontario. 2012/13 Quality Improvement Plans: An Analysis for Improvement.

    Toronto: Health Quality Ontario; 2012 Nov [cited 2012 Nov 19].
    Available from: http://www.hqontario.ca/Portals/0/Documents/qi/qip-analysis-for-improvement-2012-en.pdf

  6. Health Quality Ontario. Quality Monitor 2011.

    Toronto: Health Quality Ontario; 2011 Sept [cited 2012 Nov 19]
    Available from: http://www.hqontario.ca/portals/0/Documents/pr/qmonitor-full-report-2011-en.pdf

Best Practices

Updated on December 21, 2015

“Not all changes lead to improvement, but all improvement requires change”
W. Edwards Deming

Evidence-informed best practices are based on quality evidence and should be implemented into practice to optimize outcomes.9 Listed below you will find best practices graded according to the type of evidence. To view a description of the types of evidence, click here.

To help you move from best evidence to best practice, click on the + button next to each best practice to find details on how to implement, as well as change ideas to test using a PDSA approach. 

Change ideas are specific and practical changes informed by experience and research that focus on improving specific aspects of a system, process or behaviour. To learn more about change ideas see the QI: Getting Started tab.

  1. Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care.

    Lancet. 2003 Oct 11;362(9391):1225-30.
    Available from: http://www.ncbi.nlm.nih.gov/pubmed/14568747

  2. Canadian Patient Safety Institute. Your 4 Moments for Hand Hygiene.

    Government of Ontario; [cited 2012 Nov 19].
    Available from: http://www.handhygiene.ca/English/Documents/Tools and Templates/Your 4 Moments for Hand Hygiene (Poster).pdf

Measurement

Updated on December 21, 2015

“Some is not a number, soon is not a time.”
Don Berwick, former President and CEO, IHI, December 2004, at launch of the 100,000 Lives Campaign

How will we know if a change is an improvement? Measurement is one of the critical steps in a quality improvement (QI) initiative that assesses the impact of your tests of change. Quality indicators are used to measure how well something is performing. There are three types of quality indicators used to measure your QI efforts: outcome (indicators that capture clinical outcomes and or system performance), process (indicators that track the processes that measure whether the system is working as planned), and balancing indicators (indicators that ensure that changing one part of the system does not cause new problems in other parts of the system).

Key Measurement Guidelines
  • Choose measures that support the team’s aim statement
  • Consider qualitative and quantitative measures
  • Use existing data collection systems, whenever possible
  • Integrate measurement into the daily routine
  • Use a set of five to seven measures to track progress throughout your QI project

Suggested measures for QI initiatives in hand hygiene are listed in the table below:

Type of Measure Measure
Process Measure Hand hygiene compliance before initial patient/patient environment contact
Process Measure Hand hygiene compliance before aseptic procedure
Process Measure Hand hygiene compliance after body fluid exposure risk
Process Measure Hand hygiene compliance after patient/patient environment contact
Process Measure Hand hygiene compliance across all four moments -  previously mentioned  see above
Outcome Measure Hospital-acquired infection rates

Tools & Resources

Updated on December 21, 2015

Tools

Hand Hygiene Tools
QI Tools

 

Resources

Hand Hygiene Resources
QI Resources