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Table 1 Case Scenario 1 to simulate the completion of the WHO Hand Hygiene Self Assessment Framework (HHSAF)

From: Scenario-based simulation training for the WHO hand hygiene self-assessment framework

Case Scenario HHSAF Component Subtotal Score
The Bellevue University Medical Centre is a tertiary care institution with 1000 beds and three separate campuses.   
Hand hygiene (HH) products including alcohol-based hand rubs (ABHR) are available facility-wide with continuous supply and at the point of care. There are one to three sinks in every patient’s room together with non-medicated soap, paper towels and alcohol-based hand rub dispensers with proven efficacy and tolerability. System Change 90/100
The HH promotion strategy is based on the World Health Organization (WHO) 5 Moments for Hand Hygiene and includes mandatory HH training upon employment and at least annually for all health workers by trained and validated Infection Prevention and Control (IPC) practitioners. All WHO training materials are made available in the hospital’s intranet. Non-attendance is directly linked to closed access to the hospitals’ informatics systems. Training and Education 90/100
Availability of HH products (ABHR, soap, single use paper towels) is audited on a regular basis. A quarterly schedule of HH compliance monitoring has been established (Periods 1–4), and is conducted by validated IPC practitioners. Immediate feedback to health workers is encouraged. In 2012, 10,000 HH opportunities and 3740 actions were observed. In 2017, 10,000 HH opportunities and 6700 actions were observed. HH compliance before patient contact is 10–15% lower than after patient contact. HH compliance was highest among nursing staff (73.6%) and lower among medical staff (52.3%). The use of ABHR accounts for the majority of HH actions performed in the facility. Evaluation and Feedback 75/100
Visual reminders in the form of posters on “My 5 Moments for Hand Hygiene” and HH technique are displayed in strategic clinical areas within the health care facility. On admission, patients are provided with a brochure about the importance of HH and posters promoting patient participation are displayed in patient areas. There is no system in place to update posters regularly, however. Reminders in the workplace 47.5/100
The IPC/hand hygiene team (one full-time doctor and five full time nurses) have been implementing a HH culture-change program for the past five years, spearheaded by hospital’s leadership and leading a country wide national HH initiative aiming to improve health care workers’ HH compliance, increase use of ABHR and reduce HAIs. The hospital celebrates the world HH day on the 5th of May. A process that provides HH compliance performance feedback (every six months) is in place, and is driven and supported by the hospital leadership. High performing wards are publicly recognized within the hospital and their HH compliance levels set the HH targets for the following year. The hospital has a system of HH champions in all medical, surgical and high-risk wards. Institutional Safety Climate 65/100
Bloodstream infections (BSI), surgical site infections (SSI) and MRSA clinical cultures are monitored in high-risk areas and facility wide, and a point prevalence survey of HAIs is performed annually. A decrease in overall HAIs (prevalence of 17.3% in 2000 to 9.4% in 2015) was reported, MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days), and the consumption of ABHR increased from 12.5 to 22.4 L per 1000 patient-days in the past five years. HAI data are presented regularly to hospital leadership and to health workers together with HH compliance rates. Leadership 10/20
  Total Score 377.5/500
  1. Abbreviations: ABHR Alcohol-based handrub, BSI Bloodstream infections, HAIs Healthcare-associated infections, HH Hand hygiene, MRSA Methicillin-resistant Staphylococcus aureus, SSI Surgical site infections