Patient Safety

Clean hands save lives
– a WHO World Alliance for Patient Safety campaign


Hospitals and healthcare facilities around the world are being invited to participate in a global awareness exercise focused on reducing healthcare-associated infection by promoting hand hygiene at the point of care. Middle East Health reports.

“One of the easiest tasks any healthcare worker can do is clean their hands. By doing this, they can save lives. Simple but true,” explains Dr Cyrus Engineer, Project Manager, Save Lives: Clean Your Hands Campaign, WHO World Alliance for Patient Safety.

“On 5 May this year, the World Health Organisation launched a major global initiative to motivate hospitals and healthcare organisations around the world to sign up and show their support for hand hygiene improvement as a critical patient safety action that saves lives,” Dr Engineer says. “We are inviting all hospitals and healthcare facilities to participate in this project which we have called: SAVE LIVES: Clean Your Hands.”

How do we know the simple act of hand hygiene at the point of care is going to prevent healthcare-associated infection? In fact, research goes back as far as the 19th Century when a Viennese physician Dr Ignaz Semmelweiss discovered that fatal infections were spread among patients by doctors who failed to clean their hands between patient examinations. He initiated a hand cleaning routine for doctors to practice between these examinations with immediate results. The numbers of patient deaths declined rapidly.

Florence Nightingale who became famous as the ‘Lady of the Lamp’ during the Crimean War, made a similar discovery and urged that hand hygiene become a regular ‘habit’ for all nurses.

However, it is only relatively recently that further research has prompted a global focus on hand hygiene. Research has shown that millions of people develop infections from poor hand hygiene every year. Infections can be as deadly as MRSA and clostridium dificile, and as well known as the highly infectious norovirus. Germs are spread by hand contact from healthcare worker to patient. Vomiting and diarrhoea by their very nature encourage healthcare workers to clean their hands, but it is the invisible germs that are the deadliest. The healthcare worker who greets the patient with a hand-shake without first cleaning his hands, may be transmitting a deadly disease. Who can afford to take this risk?

The greatest push for increased hand hygiene at the point of care has developed through the energies of the WHO World Alliance for Patient Safety and the leader of the First Global Patient Safety Challenge: Clean Care is Safer Care – Professor Didier Pittet supported through the dedication of Sir Liam Donaldson, Chairman of the World Alliance for Patient Safety and Chief Medical Officer for England. Since 2005, Prof Pittet and his team have successfully encouraged 116 countries to pledge support for hand hygiene to reduce healthassociated infections. The emphasis now is on encouraging the development of hand hygiene programmes or campaigns in every pledged country so that all hospitals, healthcare facilities and ambulatory care services routinely clean their hands before and after patient contact.

Five Moments of Hand Hygiene

This ‘Five Moments of Hand Hygiene’ has been developed by WHO and has gained immediate support.

Download this image, print and pin-up on notice board

“Practising the ‘Five Moments’,” says Dr Engineer, “is the simplest and easiest way of reducing infections and thereby saving lives, and it is the cornerstone of this year’s project ‘SAVE LIVES: Clean Your Hands’.

“We have set ourselves a global target of 5,000 hospitals/ healthcare facilities to register their interest in this initiative to be achieved in one year. The initial response has been overwhelming and already several hundred hospitals have registered from countries around the world. This is exciting not only for us, but for the people who are registering.”

To help healthcare facilities, WHO is revising the current hand hygiene implementation toolkit and is also developing a self assessment framework so that everyone can check their progress on a five step programme. The toolkit is a major exercise by itself. It has been developed taking account feedback received from pilot and complementary test sites and in its revised format will mean easier navigation of resources. It will also direct users at the healthcare facility level towards the tools that will be most appropriate for their stage in the improvement cycle. Tools will include model action plan templates, booster training tools and advocacy materials. The five-step self assessment framework will enable healthcare facilities to identify their current position on a continuum of improvement.

“We are developing a special microsite within the WHO Alliance website where people can access the tools and learn more about the programmes. They can also see the countries from where other hospitals and healthcare facilities have registered. Ultimately, we would like to have a global ‘family’ of organisations who practice hand hygiene to save lives.’

This ‘family’ will become a network to which any country or region can belong, where information can be shared about best practice in hand hygiene, the latest research results can be disseminated, and a greater level of interaction between facilities can take place.

But this isn’t just a web-based initiative. Dr Engineer readily acknowledges that many thousands of hospitals and healthcare facilities throughout the world do not have ready access to the Internet. Emphasis in these countries will be on providing information in print. At the same time, he says, many hospitals and healthcare facilities do not have access to running water, soap or handrub.

“These are the hurdles we need to overcome and we are the first to recognise this is not the simple part of the task. However, the enthusiasm with which countries, regions and people have shown for this project suggests we will be able to work together to find the best solutions.’

The First Global Patient Safety Challenge team has been working with pilot sites around the world for the past five years, results of which are now starting to come through. Some of the sites are in developing countries where access can be complex. At the same time, a new patient safety initiative is beginning in some African countries. These projects were due to be included in a two-day technical meeting to be held in Geneva on 4 and 5 May this year where representatives from countries that have existing hand hygiene campaigns or programmes will get together.

“Our emphasis will always be on the coalface,” says Dr Engineer, “taking the act of hand hygiene to the point of care, whether it is a hospital bedside, a patient in an ambulance or an older person receiving home care, for example. The environment is not as important as practicing good hand hygiene between the patient and the healthcare worker.”


At the same time, it is critical that healthcare organisations know and understand the importance of using hand hygiene to reduce healthcareassociated infections. And, this is the key task in engaging countries at the political level.

“When hospital administrators, chief executives, board directors, managers and the people who manage the organisation’s finances understand the importance of hand hygiene they will help to make it happen at the point of care. We know we have set ourselves an ambitious target, however we also know that the burden of disease is such that actions specifically focused and relatively easily implemented will greatly reduce the rate of infections and thereby save lives. This is our aim.

Our vision is that by 2020 all 116 countries of the world who have pledged to establish national and ongoing action on hand hygiene improvement will have an infection control programme operating as well. An annual event, centred around 5 May is expected to help move healthcare facilities closer to this vision. Each year, in the build-up to and outcome of 5 May, the SAVE LIVES: Clean Your Hands project will inspire continual, sustainable best practice in hand hygiene in all healthcare settings, with a strong focus on measurement of impact. Compliance is clearly the basis of long-term sustainability, and WHO will work to establish effective systems to assess and track outcomes.

Hand hygiene improvement is not a one-off endeavour, as those who are already on the journey of improvement are aware. Behaviour change, culture change and training take many years and require ongoing actions across all organisational levels. Each consecutive year will move the ‘Five Moments for Hand Hygiene’ from theory to practice in every healthcare facility in the world as we advocate for sustainable global action on hand hygiene in health care. Together, we will make it happen.

Register your hospital

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Clean Your Hands visit:                        

ate of upload: 16th May 2009

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