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Table 2 Details of the five steps of the step-wise approach in the 5-year cycle

From: The effect of a 5-year hand hygiene initiative based on the WHO multimodal hand hygiene improvement strategy: an interrupted time-series study

Year 1 (April 2014 to March 2015)
 Steps 1 & 2 •Annual aim: develop an effective system and provide adequate ABHR to each point of care.
•Annual target amount: 10 L/1000 PDs, approximately double the amount of the previous year.
 Step 3 •HH initiatives were planned and executed mainly by the ICT.
 Steps 4 & 5 •Moment 1 (before touching the patient) was found to be the most missed throughout the hospital.
•Target amount was achieved.
•Participation of the field HH leaders such as ICMs and the LNs remained a challenge.
Year 2 (April 2015 to March 2016)
 Steps 1 & 2 •Annual aim: Improve compliance for Moment 1.
•Annual target amount: 15 L/1000 PDs, referring to the report by Pittet et al. [1]
 Step 3 •Initiatives were still mainly planned and executed by the ICT, but ICMs and LNs were encouraged to take a more active role, especially in the Components 2 and 3.
 Steps 4 & 5 •Compliance differences between individuals became apparent.
•Target amount was achieved.
•The need for different approaches to match the differences in the individuals’ abilities was recognized, such as defining role models and providing adequate support to individuals having difficulties.
Year 3 (April 2016 to March 2017)
 Steps 1 & 2 •Annual aim: Encourage individual support for staff with low compliance and promote the activities of the staff with high compliance, at each local field level.
•Annual target amount: 25 L/1000 PDs, 1/2 the estimated adequate ABHR consumption.
 Step 3 •Many tools from Component 5 were utilized to reinforce field-based initiatives.
 Steps 4 & 5 •The compliance differences between the wards and departments became apparent.
•Target amount was 91.6% achieved.
•Field-level HH initiatives of fields with high compliances should be shared.
Year 4 (April 2017 to March 2018)
 Steps 1 & 2 •Annual aim: Share effective initiatives between wards and departments, focusing on Moment 1 again. This moment was selected as it was a common moment for every HCW, and sharing was expected to be effective.
•Annual target amount: 30 L/1000 PDs, 3/5 the estimated adequate ABHR consumption.
 Step 3 •Effective activities were shared in ICM meetings. The ICT provided 4 weeks of intensive support to several wards experiencing difficulties.
 Steps 4 & 5 •HH was found to be missed in certain routine procedures, which differed between fields.
•Target amount was 99% achieved.
•Voluntary activities of the ICMs and LNs should be further encouraged.
Year 5 (April 2018 to March 2019)
 Steps 1 & 2 •Annual aim: Focus on HH in the routine work of each ward and department.
•Annual target amount: 33 L/1000 PDs, 2/3 the estimated adequate ABHR consumption.
 Step 3 •ICMs and LNs reviewed and focused on the HH moment that tended to be missed in their everyday routine work procedures.
 Steps 4 & 5 •Target amount was achieved.
•HHSAF assessment showed that Component 5 had the most room for improvement.
  1. ABHR alcohol-based hand rub, ICC infection control committee, ICM infection control manager, ICT infection control team, HCW health care worker, HH hand hygiene, HHSAF Hand Hygiene Self-Assessment Framework, LN link nurse, PD patient day, Step 1 Facility preparedness, Step 2 Baseline evaluation, Step 3 Implementation, Step 4 Follow-up evaluation, Step 5 Ongoing planning and review cycle