This document discusses epidemiology, hand hygiene, and the results of applying the World Health Organization's Hand Hygiene Self-Assessment Framework (HHSAF) in various healthcare facilities worldwide and in the Philippines. The HHSAF is a tool used to evaluate hand hygiene practices and promotion within a facility. It assesses five components to determine a facility's hand hygiene level. Facilities that achieve intermediate or advanced levels have generally implemented appropriate hand hygiene strategies and promotion. A 2016 study in the Philippines found that the majority of hospitals assessed achieved intermediate levels, indicating likely improvement in hand hygiene activities compared to prior years.

1. Nicolo Andrei Añonuevo PhD NA, RN
Former Manager – Infection Prevention and Control
Current Administrative Manager – Perioperative Services
Asian Hospital and Medical Center
Epidemiology and
Hand Hygiene

2. Epidemiology is the study of the distribution and
determinants of health-related states or events (including
disease), and the application of this study to the control
of diseases and other health problems.
 Various methods can be used to carry out epidemiological
investigations: surveillance and descriptive studies can be
used to study distribution; analytical studies are used to
study determinants.
http://www.who.int/topics/epidemiology/en/

4. Hand Hygiene
Self-Assessment Framework

5. Hand Hygiene
Self-Assessment Framework (HHSAF)
 A systematic tool which to obtain a situation
analysis of hand hygiene promotion and practices
within an individual health-care facility.
http://www.who.int/gpsc/country_work/hhsa_framework_October_2010.pdf?ua=1

6. Purpose
Acts as a diagnostic tool, identifying key issues
requiring attention and improvement.
The results can be used to facilitate
development of an action plan for the facility’s
hand hygiene promotion program.
Overall, this tool should be a catalyst for
implementing and sustaining a comprehensive
hand hygiene program within a healthcare-
facility.

7. Who should use the HHSAF?
This tool should be used by
professionals in charge of
implementing a strategy to improve
hand hygiene within a healthcare
facility.

8. How does it work?
 Each answer is associated with a score.
 After completing a component, add up the scores.
 During interpretation, these added scores will identify
the hand hygiene level of your health-care facility.
http://www.who.int/gpsc/country_wo
rk/hhsa_framework_October_2010.pdf
?ua=1

9. Based on the score achieved for the five
components, the facility is assigned to
one of four levels of hand hygiene
promotion practice:
Hand Hygiene Level Description
Inadequate Deficient HH practices and promotion
Significant improvement required
Basic Some measures are in place
Further improvement required
Intermediate Appropriate HH promotion strategy is in place
Long term plans to sustain and progress.
Advanced HH promotion and practices have been sustained
Culture of safety in the health-care setting.

10. 5 Components of the HHSAF
1.System Change
2.Education and Training
3.Evaluation and Feedback
4.Reminders in the Workplace
5.Institutional Safety Climate

11. HIGHLIGHTS of the
Hand Hygiene
Self-Assessment Framework
Achieving ADVANCED
Hand Hygiene Level

12. 1. System Change
Alcohol-based HR availability in the health-care facility:
 Available facility wide with continuous supply at each
point of care
 Point of care – should be accessible without having to
leave the patient zone, ideally within arms reach of the
healthcare worker.

13. 1. System Change
Alcohol-based HR availability in the health-care facility:
facility wide with continuous supply at each point of care

16. a. Sink:bed ratio
 1 sink : 10 beds; 1 sink : 1 bed in Isol Rooms and ICUs
 Continuous supply:
 Clean, running water
 Soap at each sink
 Single use towels at each sink
1. System Change

17. a. Training of Health-care workers
 Mandatory training for ALL professional categories
at commencement of the employment, then
ongoing regular training (at least annually).
b. WHO hand hygiene guidelines easily available to
all health-care workers
c. Professional with adequate skills to serve as a
trainer for hh educational program
2. Training and Education

18. a. Training of Health-care workers
2. Training and Education

19. a. Availability of handrub, soap, single use towels,
and other hh resources done regularly.
b. HCW knowledge on indications and correct
technique for hh are assessed
c. Indirect monitoring for hh compliance
a. consumption of hand rubs
b. consumption of soap
3. Evaluation and Feedback

20. d. Direct Monitoring of HH Compliance
3. Evaluation and Feedback
http://www.who.int/gpsc/5may/tools/en/

21. a. Feedback
> Immediate feedback given to healthcare workers
3. Evaluation and Feedback

22. a. Posters explaining the indications and correct
use of hand rub – should be displayed in all wards
/ treatment areas
b. Poster explaining correct HW technique – should
be displayed at every sink in all wards /
treatment areas
c. Workplace reminders located throughout the
facility – screen savers, etc
4. Reminders in the Workplace

23. Workplace reminders located throughout the facility – screen savers, etc
4. Reminders in the Workplace

24. Workplace reminders located throughout the facility – screen savers, etc
4. Reminders in the Workplace

25. Workplace reminders located throughout the facility – screen savers, etc
4. Reminders in the Workplace

26. a. Established hand hygiene team that regularly meets
b. Facility leadership commitment to hh
CEO, CMO, DON
c. Patients informed about hh
5. Institutional Safety Climate for HH

27. c. Has a clear plan for May 5 Save Lives Clean Your
Hands Initiative
5. Institutional Safety Climate for HH

28. http://www.who.int/gpsc/5may/hand-hygiene-report.pdf?ua=1

29.  In 2011, a first global survey was conducted by WHO and
the results were summarized in a report in 2012.
 Starting from June 2015, healthcare facilities were invited
to submit their HHSAF.

30.  In total, surveys from facilities in 91 countries were
received during the period of June 2015 to January 2016.
 This is 47% of all 194 member states.
 In the Philippines, 9 health facilities participated

31.  Intermediate / Advanced Levels – majority of the facilities
 Compared to 2011, indicates likely improvement of hh activities
 Linked to repeated use of HHSAF

32. How about the
Philippine
Data???

33. Hand Hygiene Levels of Philippine Hospitals: An
Application of the World Health Organization
(WHO) Hand Hygiene Assessment Framework
2016

35. Results
Out of 161 hospitals in NCR, 2 hospitals stopped
operations
Out of 159 hospitals in NCR, 106 or 67% responded
in the study (35 Government, 71 private hospitals
Majority of hospitals located in Quezon City

36. Results
*Appropriate HH promotion strategy is in place
**Long term plans to sustain and progress.

37. World Wide Philippines
Intermediate
Advanced
Intermediate