Championing hand hygiene in Latvia

Meet Agita Melbarde-Kelmere, an infection control nurse at Latvia’s Eastern University Hospital and a champion for hand hygiene in primary care clinics and hospitals across the country.

In 2007, the hospital where Agita worked was identified as having one of the highest rates of nosocomial infections in the country. Infection with multidrug-resistant organisms, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and highly resistant Enterobacteriaceae (HRE), occur with increasing frequency in hospitals worldwide, especially in intensive care units (ICUs). Yet, hand hygiene is generally low in ICUs. The resulting health care-acquired infections can have a significant economic impact at the patient and population level due to increased length of hospital stay or frequent visits and expensive treatments for antibiotic-resistant pathogens.

In response to observed low rates of hand hygiene, Agita’s colleague, Professor Dumpis, head of the Department of Infection Control and Surveillance, invited her to take a leadership role in monitoring and managing infection control within the hospital. Given this opportunity, Agita was quick to demonstrate passion, commitment and leadership in this area, which is so vital to securing positive patient outcomes. It was immediately clear to Agita that the problem was not that staff didn’t care about improving hand hygiene practice; rather, staff members were extremely busy and were not equipped with information on the extent of infection rates in their work setting. Moreover, the working environment was not set up to support the WHO five moments of hand hygiene – a set of five recommended points at which health-care workers should clean their hands.

So Agita set off for various European and international trainings to learn about the dynamics of infection by multidrug-resistant organisms. These opportunities also allowed her to join cross-country studies, such as the MOSAR study from the Netherlands. Along the way she gathered ideas for how to develop learning strategies – particularly from the PROHIBIT study – that brought reflective practice and hands-on learning closer to staff. Taking the WHO Hand Hygiene Monitoring Tool and paying attention to the learning needs and settings in which she worked, Agita began to develop a learning package for her hospital.

Efforts to boost hand hygiene yield impressive results

The impact was enormous. In just six months, Agita and her team showed how infection rates could be decreased by 50%. The work by Agita and her colleagues reinforces the findings that effective infection prevention control programmes lead to a more than 30% reduction in health care-acquired infection rates and active surveillance itself may contribute to a 25–57% reduction. These rates, however, cannot be sustained or improved without continuously maintaining the interventions.

Word spread quickly about the success of Agita’s work and before she knew it she was receiving demands from across the country to bring her learning strategies to both primary care and hospital settings. Learning strategies encompassed both theoretical and practical training of medical staff, including reporting the results of passive observation in the clinical setting in question, the use of hand washing training using ultraviolet lights, video presentations, group development of reminder systems, and group analysis that brings together all medical staff – not only nurses and nurse assistants, but also doctors, interns and administrative staff. Not only did Agita bring new learning strategies and information to staff in a way that was applied and relevant, she also offered insights into the importance of setting up practice-based research to document and continuously improve practice. This method of applied training has been well received by staff, she says, and she hopes her colleagues can also adapt these new strategies to a range of problems that are challenging clinical settings.

When asked what really made this work successful, Agita responds, “Where this initiative has been most successful is where both physicians and nurses have joined to collaborate on seeing the problem, but also the solutions, as belonging to them as a team – it never works when just one group in the clinical setting is trying to change something”.

This year, WHO hopes to see the number of facilities committed to improving hand hygiene increase from the already 19 000 facilities across 177 countries. Health facilities can sign up using the link below.