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How to improve hand hygiene in a limited resources environment?

Example from Senegal

Prof Babacar NDOYEICAN Board

5th ICAN/ICAZ/ISC ConferenceHarare, 3-7 November, 2014

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OUTLINE

I. Background

II. Methodology

III. Results

IV. Discussion

V. Conclusion

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I. BACKGROUND• Numerous efforts from WHO over the last

decade to develop Patient Safety, andspecially the process of hand hygiene (HH)

• Multimodal strategy proposed for improvingthe process, with many tools for itsimplementation, specially in limited resourcesenvironment

• African region still far behind despite theactions specially dedicated to him as theestablishing of APPS program

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Objective of the presentation:

to analyze the different gaps, difficulties to

overcome the gaps observed from the

Senegalese’s example,

to analyze the differents opportunities

available

to provide relevant recommendations for

the gradual reduction of the gaps

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II. METHODOLOGY

• Institutionalizing Patient Safety in thefacilities with administrative andorganizational measures

• Applying the WHO hand hygiene self-assessment framework (HHSAF) toSenegalese facilities (about one hundred),as part of a roadmap with administrativeand organizational measures to improvethe HH process

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• Supportive supervisions were then

performed each semester, during two

years, with a grid measuring

performance for each activity, sharing

all problems encountered by the

teams, and making adapted

recommendations for improving

performance

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Administrative and organizational

measures

• Local multidisciplinary committee for

Patient Safety with a Coordinator

• Local working group dedicated to

HH improvment with a pilot

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HHSAF• Allows to assess the 5 components of the

multimodal strategy to improve HH in

facilities

System change

Education and training

Evaluation and feedback

Reminders in workplaces

Institutional safety climate

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Supervision grid

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ACTIVITESSOURCES DE

VERIFICATIONNIVEAU DE REALISATION

NOTATIONS (COCHEZ UNE SEULE

NOTE PAR ACTIVITE)

OBSERVATIONS

Mise en place ou réactualisation

du cadre institutionnel avec composition, missions et

fonctionnement CLIN (Comité de lutte contre les infections

nosocomiales) ou

CHSCT(Comité d’hygiène et de sécurité des

conditions de travail)

PV de réunion

Note de service (NDS)

Aucune activité préparatoire 0

Activité préparatoire avec PV de réunion 1

NDS signée non-conforme 3

NDS signée conforme 5

Nomination d’un

coordonnateur

et d’un adjoint(avec missions et attributions)

PV de réunion

Note de service (NDS)

Aucune activité préparatoire 0

Activité préparatoire avec PV de réunion 1

NDS signée non-conforme 3

NDS signée conforme 5

Mise en place des groupes de

travail prioritaires avec

composition, missions et

fonctionnement :

-Hygiène des mains - Gestion des déchets

- Bio nettoyage - Référent AES - ATB

(pour les hôpitaux)

PV de réunion

Note de service (NDS)

Aucune activité préparatoire 0

Activité partiellement réalisée 3

Activité complètement réalisée 5

Hygiène des mains :

Analyse situationnelle

Elaboration d’un PA

Mise en œuvre et suivi

PV de réunion

Rapports d’activités

Documents de service

Aucune activité préparatoire 0

Activité partiellement réalisée 3

Activité complètement réalisée 5

FICHE DE SUPERVISION (ref : Activité A15 projet fonds mondial round 9 /RSS)

REPUBLIQUE DU SENEGAL Un Peuple – Un but – Une foi

………….

………..

Direction des Établissements de Santé

REGION MEDICALE :………………………………………………….………………………………………………………………………….

STRUCTURE SANITAIRE :….……………………………………………….………………………………………………………………..….

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III. RESULTS

• Administrative and organizational

measures (compliant only after 3

supervisions)

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Hospital’s performance (HHSAF)not validated

Eléments de la

stratégie HP

D

HO

GG

Y

FA

NN

H A

B N

D

PIK

INE

CH

NP

T

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AR

BA

RT

HIM

St

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TH

IES

KA

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AC

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TO

UB

A

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A

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CH

OR

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LD

A

TA

MB

A

ST

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UIS

ND

IOU

M

OU

RO

G

Dio

urd

el

HA

LD

1. Le changement

de système80 30 25 45 30 70 95 50 100 22 10 35 20 60 30 00 25 25 15 40 0

2. L’éducation et la

formation80 80 20 55 25 90 35 10 55 15 25 90 35 65 30 00 65 40 15 50 0

3. Les évaluations

et la restitution des

résultats

30 05 00 80 15 10 00 10 20 8 00 47.5 0 00 05 03 20 00 00 42.5 0

4. Les rappels sur le

lieu de travail70 30 37.5 35 72.5 62.5 27.5 55 47.5 11 00 65 55 25 30 00 42.5 70 00 15 0

5. La culture

institutionnelle de la

sécurité

60 60 70 75 20 45 30 25 30 8 20 35 25 00 05 00 35 20 05 50 0

TOTAL 320 205 152.5 290 162.5 277.5 187.5 150 252.5 64 55 272.5 135 150 100 03 187.5 155 35 197.5 0

NIVEAU

D’HYGIENE

BASIQUE INTERMEDIAIRE INADEQUAT

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Eléments de la

stratégie HP

D

HO

GG

Y

FA

NN

H A

B N

D

PIK

INE

CH

NP

T

HE

AR

BA

RT

HI

St

J d

e D

TH

IES

KA

OL

AC

K

TO

UB

A

LO

UG

A

ZG

CH

OR

KO

LD

A

TA

MB

A

ST

LO

UIS

ND

IOU

M

OU

RO

G

Dio

urb

el

HA

LD

1. Le changement

de système30 30 30 30 35 35 40 50 55 20 20 35 40 40 40 20 25 35 30 40 0

2. L’éducation et

la formation55 50 50 50 50 55 50 35 55 50 35 50 50 50 35 35 50 50 50 50 0

3. Les

évaluations et la

restitution des

résultats

20 5 0 5 0 0 0 5 10 0 0 5 0 0 0 0 5 0 0 0 0

4. Les rappels sur

le lieu de travail55 30 37.5 35 37.5 52.5 27.5 45 37.5 20 0 45 50 25 30 0 42.5 45 0 15 0

5. La culture

institutionnelle

de la sécurité

30 20 35 20 10 20 20 0 20 20 20 10 20 20 0 20 20 10 20 15 0

TOTAL 190 135 152.5 140 132.5 162.5 137.5 135 177.5 110 75 140 160 135 105 75 142.5 140 100 120 0

NIVEAU

D’HYGIENE

Hospital’s performancevalidated

BASIQUE INTERMEDIAIRE INADEQUAT

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0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

1 2 3

74.18

61.20

38.93

25.82

38.80

61.07

0.00 0.00 0.00

Aucuneactivitépréparatoire

Activitépartiellementréalisée

Activitécomplètement réalisée

Overall performance evolution for

HHHygiène des mains

1/Performance au Trimestre oct-nov-déc,

2011

2/Performance au Trimestre avril-mai-

juin, 2012

3/Performance au Trimestre oct-nov-déc,

2012

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IV. DISCUSSION

• Slow progress in relation to the roadmap

(long time to have administrative actions

consistent)

• Difficulty to obtain reliable data (self-

assessment, case of hospitals)

• Importance and multiplicity of gaps (no

facility reaching the intermediate level)

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African context, explaining all these

difficulties

• Shortage of human resources in the

field of Patient Safety

• Lack of material resources: no

availability of ABHR,even within the

reach by local production ( poor

funding dedicated to health systems)

• Lack of institutional safety culture

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Opportunities

• WHO: with many achievements

and sometimes specially

dedicated to Africa (APPS)

• ICAN: despite language barrier

for francophones

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Opportunity offered by ICAN and

actions taken• Many countries involved

• Many achievements and specially for HH, the

campaign « Make Africa Orange » in 2014, on

the occasion of the global campaign of WHO HH

« Save Lives, Clean your hands »

• Objective of « Make Africa Orange Campaign »:

in each African country, stting up a link between

national office of WHO and MOH to organize

activities based on WHO recommendations

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• Strategy- conference call gathering experts from

ICAN Board and from WHO (Afro and

Geneva)

- Appointment of a Coordinator

- Apointment of a focal point for each

African region

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• Results

- 627 facilities registered on May 1, 2013

- 787 facilities registered on June12, 2014

Despite the campaign didn’t receive any

support from WHO Afro

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Global map of HH 2013

African Region: 627 registered health-care facilities from 35 countriesRegister your healthcare facility at

http://www.who.int/gpsc/5may/register/en/index.html

1 May 2013 update

Help us make Africa orange!!!

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Global Map HH 2014

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Recommendations are based on the need

of important changes leading to

sustainable activities

• Institutionalization of Safety and HH

• Formalizing links ICAN/WHO-AFRO

• Training and monitoring frontline staffs on

adapted protocols

• Ensuring availability of resources ( ABHR)

• Performing regular supervisions training+++

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Supervision training and his keywords

(main issues to be adressed)

• Administrative and technical leadership

• Coordination and working groups

• Partnership

• Gaps reduction plan and continious

improvement

• Monitoring and evaluation

• Communication

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V. CONCLUSION

• Despite huge of the gaps and difficulties, HH

can be improved in Africa, even if it is

necessary to have an approach step by step

• Technical recommendations and tools

proposed by WHO can play a crucial role but

must be accompanied with national and local

measures to be taken by each country and

each facility

• Regular supervision training is fundamental

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Thanks for attention