National handwashing campaign improved hygiene and reduced infection

An evaluation of the national cleanyourhands campaign shows for the first time that an effective hand-hygiene campaign, undertaken in the context of a high profile political drive, can successfully reduce some healthcare associated infections, according to a new study published in tomorrow's BMJ.

The national cleanyourhands campaign was rolled out to all 187 NHS Trusts from January 2005 with instructions to provide bed-side alcohol handrub (AHR), posters encouraging healthcare workers to clean their hands and a range of patient-empowering materials. It was one of a series of national initiatives intended to reduce levels of meticillin resistant/sensitive (MRSA/MSSA) bacteraemia and difficile (C. difficile) infection in hospitals in England & Wales.

The evaluation of the campaign was conducted by researchers at UCL's Medical School and the Health Protection Agency. They measured hospitals' quarterly procurement of AHR and soap between July 2004 and 2008. After adjusting for a number of factors, including the effect of bed occupancy, hospital type and the timing of other national interventions, they found a significant link between procurement levels and infection rates.

The research shows that during over the four-year period the combined procurement of soap and AHR almost tripled from 21.8mls per-patient-per-bed to 59.8mls. MRSA bacteraemia rates fell from 1.88 to 0.91 cases per 10,000 bed-days and C. difficile infection fell from 16.75 to 9.49 per 10,000 bed-days. Levels of MSSA bacteraemia did not fall.

The research also shows that the increased procurement of soap was independently associated with reduced C. difficile infection throughout the study, while increased procurement of alcohol hand rub was independently associated with reduced MRSA infection, but only in the last year of the study. These strong and independent associations remained after taking account of all other interventions.

"Until now we haven't been able to say whether national campaigns of this kind deliver tangible benefits for patients," says principal investigator Dr Sheldon Stone of the UCL Medical School. "What this study shows is that the cleanyourhands campaign, a centrally co-ordinated and funded strategy, produced sustained increases in the amounts of alcohol hand-rub and soap bought by hospitals, and that this in turn helped to reduce infection and improve health outcomes."

"The cleanyourhands campiagn has been a real British success story. It has really changed the culture amongst NHS staff," continues Dr Stone. "Now the campaign has stopped, many in the infection control community would like to see the progress maintained and built upon with a new national hand hygiene strategy or an updated campaign."

Professor Barry Cookson, Director of the Laboratory of Healthcare Associated Infection, at the HPA says: "This research paper shows that relatively simple measures such as handwashing and alcohol handrub can be exceptionally effective in combating the spread of harmful bacteria in healthcare establishments. Independent of all other measures we saw that the more soap and alcohol handrub were purchased the more levels of MRSA and C. difficile went down. Going forward it is these types of measures which will be at the forefront of the battle against the spread of bacteria."

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