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Implementation of the World Health Organization Multimodal Hand Hygiene Improvement Strategy in SMID (Severe Motor and Intellectual Disabilities) Patients' Wards in Japan

Worldwide, the number of SMID (severe motor and intellectual disabilities) patients continuously in need of profound medical care, such as mechanical ventilation, are increasing. Infection control is of great importance since such patients have high risk of multidrug resistant organism colonization. On the other hand, SMID wards have an “at home” atmosphere, and various specialists, including co-medicals, helpers and child-carers are directly involved in taking care of patients. Therefore, it is difficult to permeate hand hygiene awareness throughout the staffs. The SMID wards in our hospital are not the exceptions and the consumption rates of AHR have been very low. After experiencing a two drugs resistant Acinetobacter baumanii (2DRA) outbreak in 2014, we started to implement the WHO multimodal hand hygiene improvement strategy in 2014, applying both “the step-wise approach” and “the five components of the WHO multimodal hand hygiene improvement strategy”. The AHR consumption volume (mean value in a year) in ward A was 2.9 (2012), 4.2 (2013), 10.1 (2014), 15.0 (2015), and 26.7 L/1000patient/days (2016), and in ward B, 2.2, 2.8, 5.5, 11.8, 18.6 L/1000patient/days, respectively. Although “‘My 5 Moments for Hand Hygiene’ approach” is the most famous component in this strategy, we found that “the step-wise approach” which shows how to initiate and renew periodically a comprehensive hand hygiene program, was also critical to make a smooth start, and to sustain the improvement of hand hygiene. In addition, for an effective improvement in hand hygiene, the prioritization and modification of the tools in “the five components of the WHO multimodal hand hygiene improvement strategy” and “Hand Hygiene Self Assessment Framework” was important.