JULES STORR

The theme of this year's World Hand Hygiene Day—which takes place on 5 May—is 'sharing knowledge'. In this blog, hub topic leader Julie Storr looks at the question of why it's still so important to share knowledge about hand hygiene. She highlights the power of sharing knowledge to save lives, the need to address research gaps and that hand hygiene should be integrated into all aspects of frontline care.  She also shares tools and resources that can be used to help train and equip frontline healthcare professionals. Knowledge is power, so the saying goes. This year, the World Health Organization (WHO) has made sharing knowledge the central theme for World Hand Hygiene Day (WHHD). The 2024 campaign slogan poses a question: “Why is sharing knowledge about hand hygiene still so important?” We will come back to the answer in a moment. Before that, the WHO global strategy on Infection Prevention and Control (IPC) published last year reminds us that the spread of microbes that cause healthcare-associated infections (HAI) almost always takes place at the point of care, and because of this, infection prevention and control (IPC) needs to be understood and practised by everyone who provides services at the point of care. Specifically, it highlights the criticality of integrating IPC measures into patient pathways and clinical care delivery. Rather than seeing hand hygiene and IPC per se as stand-alone “things”, the emphasis is on integration and embedding. On this latter point, Patient Safety Learning's hub is a refreshingly diverse community of patient safety professionals, clinicians and patients who are not solely IPC-adjacent—sharing knowledge on hand hygiene and IPC beyond the usual suspects can help to support the aspiration of integration and embedding. Back to the campaign question. There are many possible answers, but this is the campaign response–it’s short and simple: “Because it helps stop the spread of harmful germs in healthcare.” Sharing knowledge is one way to support healthcare workers to become competent in their day to day IPC practices, a competency that sees hand hygiene and IPC integrated and embedded in daily routines. Global data presented on the campaign pages tells us that training and education emerge as some of the weakest areas of IPC in countries and healthcare facilities. This is reflected in disparities in IPC curricula at both pre- and postgraduate levels in medicine, nursing and midwifery. This affects the quality and effectiveness of IPC training and ultimately the knowledge of the health workforce. Innovative and impactful training and education on IPC, including hand hygiene, is one way—the campaign suggests—of sharing knowledge effectively. This is an interesting angle and one that resonates with the ethos of Patient Safety Learning, who single out shared learning as one of the six evidence-based foundations of safer care. Sharing experiences, tools, resources and innovations is hard wired into the very structure of the hub as a mechanism to make healthcare safer. A recent editorial on WHHD highlighted available data on the global healthcare workforce “stock”, which is estimated to exceed 65 million people. Broken down, this comprises 29.1 million nurses, 12.7 million medical doctors, 3.7 million pharmacists, 2.5 million dentists, 2.2 million midwives and 14.9 million in additional occupations, including cleaners and healthcare waste workers but excluding management. These are staggeringly huge numbers, and yet in many countries nowhere near what is required for safe delivery of health care—but that would be another blog altogether. In the context of WHHD, what the data boils down to, the authors point out, is that each number represents a person requiring training and education in all matters necessary to deliver quality healthcare and maintain patient and health worker safety. This is where IPC comes into play. Active IPC programmes are a proven effective approach to protect patients, health workers and visitors to healthcare facilities by preventing avoidable infections. One element of an active IPC programme relates to hand hygiene improvement. The facts and figures on hand hygiene and the burden of healthcare-associated infection continue to receive attention in the academic literature with scores of publications on the matter in the first few months of 2024 alone. In a nutshell, based on available evidence, hand hygiene performed by health workers at the right moments in healthcare remains a problem not yet solved, with compliance sub-optimal across many countries of the world. This jeopardises patient safety. WHHD is a global campaign designed to support local efforts to end this problem. Like all campaigns, it aims to maintain a profile on the issue, specifically on the importance of hand hygiene in health care by bringing people together in support of improvement across the globe. Each year, on or around 5 May, WHO renews its support to countries and health facilities and promotes approaches to improve hand hygiene practices in healthcare. Raising awareness is therefore a constant objective. A second objective for this year concerns the promotion of access to innovative hand hygiene and IPC training resources for health and care workers. Here are some of this year’s campaign assets: A 30 second video highlights important messages to encourage participation in WHHD 2024 A 2-minute animated video telling Maria’s story of work in a clinic and the need for hand hygiene training Main campaign posters in blue and orange Bespoke posters targeting: the general public, IPC practitioners, health care workers and policy makers Advocacy slide set outlining key activities individuals and organisations can undertake in support of WHHD 2024 A wide range of campaign materials including posters, social media assets, web banners, a short video in social media vertical format Commentaries in academic journals A third objective of this year’s campaign is to strengthen learning approaches to enable the implementation of innovative and effective training. Training should empower health and care workers with enhanced knowledge, skills and behaviours to improve hand hygiene and IPC at the point of care. A brand-new WHO curriculum for in-service IPC training is being launched on 5 May 2024 in support of this. And finally, something close to my heart—the launch of 'My 5 Moments: the Game'. On 5 May all five levels of 'My 5 Moments - The Game' will be available. This serious game is designed to encourage healthcare workers and students to creatively engage with the principles of hand hygiene. Set in the international alien hospital, players encounter a series of challenges to test their knowledge of the WHO My 5 Moments for Hand Hygiene, embedded within compassionate clinical care delivery. The game is an innovative, free resource, developed collaboratively by the WHO IPC Hub, the WHO Academy, Marist University and Serious Games Interactive, to support healthcare workers in translating the principles of hand hygiene into their real-life encounters with patients. Find out more in this short video preview of the game. WHHD 2024 has a very noble aspiration. Sharing knowledge and information on hand hygiene and IPC is necessary for patient safety. Looking to what happens after 5 May 2024, I also agree with colleagues at Patient Safety Learning who call for a more systematic approach to sharing knowledge and information about which patient safety initiatives and solutions work. That’s why the recent WHO research agenda for hand hygiene in health care 2023–2030 is important. There remain many research gaps that need to be addressed in order to improve understanding of the factors influencing hand hygiene behaviour and to strengthen appropriate interventions. The saying scientia potentia est—knowledge is power—was originally attributed to Hobbes and reportedly further expanded on by Thomas Jefferson, who proclaimed that knowledge also provides safety and happiness. World Hand Hygiene Day, like all healthcare-related campaigns, is essentially concerned with alleviating suffering and maintaining health and wellbeing. A knowledgeable, empowered workforce, sharing knowledge and sharing learning are at the heart of patient safety. 5 May helps to make sure this important matter remains on the agenda. To find out more join the WHO IPC Global Webinar: World Hand Hygiene Day 2024 - why is sharing knowledge about hand hygiene still so important? on 6 May 2024, 2:00-3:30 pm CET.

In this blog, hub topic lead Julie Storr talks about her new book Infection prevention and control: A social science perspective, which explores new perspectives on and approaches to infection prevention and control (IPC). The book examines how people and their behaviour affect IPC, and how they are in turn affected by IPC measures. Julie highlights the importance of compassion in IPC policy and implementation and outlines the unintended negative consequences that IPC measures can have. Among other contributors, Patient Safety Learning's Chief Executive Helen Hughes has written a chapter for the book highlighting the need for patient safety to be treated as a core purpose of health and social care. Almost every book or film review podcast I listen to these days starts with the author or director explaining that [insert name of book/film] was conceived or developed during the COVID-19 pandemic. My new book about infection prevention and control (IPC) and social sciences, written with two colleagues, is no different. We started work on the book well before 2020, and right in the middle of writing it, the COVID-19 virus dropped. Many of the themes we were focusing on suddenly materialised right before our eyes, and this inevitably influenced the book. Focusing on people, not germs From the outset, our focus was not on germs but on people–those at risk from germs and those who can stop or limit them from spreading. We were also interested in the impact germs have on those who go on to develop an infection, including how individuals with infection and their loved ones are treated by their fellow humans. For example, in the book we give a voice to some of the people directly affected by the restrictions that were imposed on access to health and social care during the pandemic; where IPC was used as a blunt rationale for what became widely termed ’visitor bans’. Our book could not have been timelier, focusing on infection and the behaviour of human beings to stop its spread, and completed during this once-in-a-hundred-years global public health emergency. The journey to embed the social sciences in IPC In Leadership Without Easy Answers,[1] written almost 20 years ago, Ron Heifetz suggested that one of the most common leadership mistakes is expecting technical solutions to solve adaptive problems. This theme gained traction with patient safety advocates such as Peter Pronovost and colleagues[2] over the intervening years and had a profound influence on my own perceptions on what we need to focus on in our endeavours to improve healthcare practices through IPC. The COVID-19 pandemic has quite rightly elevated the importance of social sciences in patient safety and IPC, something we see in the World Health Organization’s (WHO’s) commitment to harness the power of behavioural science to improve health.[3] I could not agree more with this focus. As our book reveals however, there is considerable work to do to embed social sciences into IPC competence, decision making and practice. Each of the book’s authors have long held the view that an understanding of the concept of the social sciences and its implications within IPC is important. Our first book, Infection Prevention and Control: Perceptions and Perspectives,[4] published in 2015, sowed the seeds of this journey of exploration into the non-technical aspects of IPC and set the foundations for our latest book. Keeping people safe from the risk of infection in healthcare requires deep understanding of medical microbiology and the epidemiology of infectious diseases. You only have to look at the existing textbooks, conferences, academic publications and even podcasts to see this. But we need more than this. At present the scales are categorically tipped in the direction of the very technical, disease specific aspects of IPC. In our book, we are calling for a rebalancing in this regard. What’s in the book? Opening up the social science perspective As we state at the start of the book, there is a growing appetite in IPC to look beyond the technical and towards the social, psychological and philosophical factors that influence human behaviour. This is the ethos of the book. We acknowledge that we still only touch the surface of many matters that comprise the social sciences, but our ambition is that we build on existing work so that this thinking continues to trickle outwards. We want it to influence others to pick up this topic and build the body of knowledge in this important area of safety and quality. There are sixteen chapters and together with our 10 wonderful chapter authors who span several countries and disciplines, we consider a range of IPC issues and try to pull in some social science perspectives. We draw on psychology, sociology, anthropology and philosophy. In some chapters, this is done in a subtle and nuanced way and in others it is much more explicit. The book opens by considering the relevance of psychological theories and concepts and then builds on this across each chapter. It explores leadership and influence, power and compliance, patient safety and governance and compassion. Compassion as a social construct[5] is a permeating discourse within the field of healthcare quality[6] and I’m particularly delighted that we include a stand-alone chapter on communication and compassion that addresses the service user perspective. Given my own personal interest in compassion and IPC, the chapters I’ve penned reflect what happens in a ‘compassion void’. I use the example of the restrictions imposed across health and social care during the COVID-19 pandemic, explore the adverse consequences of this and outline the case for compassionate implementation of IPC guidance, explaining how the two are not mutually exclusive. The final part of the book looks at some real-world perspectives starting with a comprehensive exploration of human factors in IPC. It explores the use of words and the meaning of language in IPC, drawing on research that provides powerful insights into how the brain mediates behaviour. This focus on the words used in an IPC context has the potential to support guideline implementation. Other topics include social media, infectiousness and stigma and the unintended consequences of campaigns, including whether IPC campaigns make people anxious rather than reassured. Language is again a strong focus of scrutiny in this section. Some personal reflections from a frontline practitioner on the reality of IPC also add an important perspective to the book. The book concludes with some musings on philosophy and IPC, even considering the moral worth of microbes, and demonstrates that IPC has a value and philosophical imperative to continue to do what it does to protect humans from harm. We are not social scientists and it’s important to acknowledge that this book doesn’t purport to be an academic social science textbook. It is our attempt to unpack the social science dimension of IPC so that those responsible for keeping people safe from healthcare associated infection–be they leaders or front-line implementers—consider the social influences and implications of the evidence-based guidance on this topic. We start the book by suggesting that the social sciences are the beating heart of infection prevention and control and hope that by the end, readers can make their own mind up on the extent to which this is true. Related reading Infection prevention and control: A social science perspective (1 June 2023) Patient Safety Spotlight interview with Julie Storr, global infection prevention and control expert Infection Prevention and Control should be an enabler, not a barrier to safe, compassionate human interaction References 1 Heifetz R. Leadership Without Easy Answers. Harvard University Press, 1998 2 Pronovost P. Navigating adaptive challenges in quality improvement. BMJ Qual Saf, 21 May 2011 3 Altieri E, Grove J, Lawe Davies O et al. Harnessing the power of behavioural science to improve health. Bull World Health Organ, 1 November 2021 4 Elliott P, Storr J & Jeanes A. Infection Prevention and Control Perceptions and Perspectives. Routledge, 2016 5 Blackstone A. Doing Good, Being Good, and the Social Construction of Compassion. Journal of Contemporary Ethnography, 1 February 2009 6 Fotaki M. Why and how is compassion necessary to provide good quality healthcare? Int J Health Policy Manag, 16 March 2015

hub topic lead Julie Storr highlights World Hand Hygiene Day and why hand hygiene in healthcare is one small but important part of keeping people safe. Hand hygiene has had a high prominence in the context of COVID-19 during the past year. World Hand Hygiene Day, celebrated each year on the 5 May, and led by the World Health Organization (WHO), presents an annual opportunity to keep this important patient safety intervention firmly on the international and national agenda beyond a global pandemic. This year we are prompted not to forget the critical times for hand hygiene, and particularly the valuable role that healthcare workers and all those who support them play, in achieving effective hand hygiene action at the point of care. Campaigns play many roles, not least an important one in sustainability,[1] periodically boosting interest and focus on an issue of concern, in this case hand hygiene in healthcare. They prompt their stakeholders to remember important things that can get overlooked in the day to day noise. This year’s theme builds on the 2020 COVID-19 driven call for universal hand hygiene.[2] However, while COVID-19 placed a spotlight on hand hygiene like never before, other infectious diseases are still out there (including those resistant to antibiotics). As a public health problem, one of the last published global reports highlighted that healthcare-associated infections constituted the most frequent adverse event in healthcare.[3] These infections continue to cause harm and death in hospitals and other care settings across the world, destroying too many lives. Hand hygiene at the right moment[4] is therefore a powerful intervention to stop their spread and historically was referred to as the single most important measure in infection prevention and control. But I do like the emerging mantra of Do It All. Hand hygiene is in fact often one of many interventions that when undertaken reliably and at the right time keep people safe. We should perhaps gravitate more towards this way of framing and embedding hand hygiene (and other activities and interventions). COVID-19 is a great example of the need for integrated and synergistic action. Measures that protect people from harm and keep them safe should not be pitched in competition with each other, and those involved must collaborate for greatest impact. In a previous blog post[5] I recalled an excellent piece in the New Yorker by Michael Specter written on the back of the Ebola outbreak of 2014/15.[6] In it he reflected on our response to pandemics: “First, there is the panic. Then, as the pandemic ebbs, we forget. We can’t afford to do either.” We should not forget anything about this pandemic. Hand hygiene in healthcare is one small but important part of keeping people safe. As WHO state, yes we should “do it all”, and yes, hand hygiene at the point of care is important and should be a constant feature of safe, high quality healthcare. We shouldn’t forget that. This and every World Hand Hygiene day helps to make sure that we don’t. References Mathai E, Allegranzi B, Kilpatrick C et al. Promoting hand hygiene in healthcare through national/subnational campaigns. J Hosp Infect 2011:77(4):294-8. doi: 10.1016/j.jhin.2010.10.012. WHO. Recommendations to Member States to improve hand hygiene practices to help prevent the transmission of the COVID-19 virus. Interim guidance. 1 April 2020. WHO. Report on the Burden of Endemic Health Care-Associated Infection Worldwide. Clean Care is Safer Care. 2011. WHO. Your 5 moments for hand hygiene. 2009. Kilpatrick C, Storr J. The 13,268. SafeSaferSafest. 8 November 2014. Specter M. The fear equation. The New Yorker. 12 October 2014.