Blending self-motivation among healthcare workers to maintain hygiene at a tertiary care hospital in Madhya Pradesh, India

Dr. Megha Sharma, Associate Professor, R. D.Gardi Medical College Ujjain, MP, India

Improving compliance of hand hygiene is a matter of a complex behavior change process. Knowledge, awareness and self-motivation are pre-requisites to change the hygiene practices^1,2.Hand hygiene is a gold standard to prevent infections and to overcome its consequences such as increased cost of treatment and development of antibiotic resistance.WHO Global Action plan clearly states the importance of maintaining Hand hygiene in healthcare settings and in community³.

The healthcare workers at C.R. Gardi Hospital and Ujjain Charitable Trust Hospital and Research Center had been a part a programme named- ‘Improving Hygiene’ which is aimed to encourage, improve and maintain hygiene in day-to-day life of the healthcare workers and the community. Alcohol based hand rub (Micro Kavach) was prepared in-house and successfully introduced in the hospital in 2011¹. Repeated training sessions are being conducted by Dr. Megha Sharma and her hygiene team for all categories of healthcare professionals and the community^1,4. The training sessions include introduction, demonstration and practice ofthe WHOrecommended hand washing and hand rubbing techniques.

During these training sessions innovative ideas are implemented for better compliance of hygiene such as hygiene cross word puzzles and one to one meetings to prepare peer trainers. Reminders to perform hygiene actions are given using posters and mobiles’ Short Message Service (SMS). The need to inculcate self-motivation was felt and thus a strategic plan was developed. The plan was pilot tested where all nursing staff was encouraged to act as peer models for one day in a week.

The nursing staff of each ward was told to decide the most convenient time of a day in a week to perform the activity. At the selected time, the staff of the ward (duty doctors, nurses and auxiliary) stood in an open area and demonstrated the steps of hand hygiene to all patients, care takers, doctors, and nurses. After demonstration, the importance of maintaining hygiene and information about following standard precautions was also provided to the caregivers.

The whole process takes 5 minutes per week in total and is being appreciated by all categories of care givers and care receivers.During regular feedback meetings with Dr. M. Sharma, the healthcare workers stated that their commitment for maintaining hygiene has improved following these weekly self- motivating exercises and they feel as the leaders of the Hygiene campaign.

References:

1.    A step-wise approach towards introduction of an alcoholbasedhandrub, and implementation of front line ownership- using a, rural, tertiary care hospital in central India as a model. Sharma M, Joshi R, Shah H, Macaden R and Stålsby-Lundborg C. BMC Health Serv Res. 2015 Apr 29;15(1):182. doi: 10.1186/s12913-015-0840-1. PMID: 25924956 Published 29 April 2015

2.    Qualitative study on perceptions on hand hygiene among hospital staff in a rural teaching hospital in India. Joshi SC, Diwan V, Tamhankar AJ, Joshi R, Shah H, Sharma M, Pathak A, Macaden R, Stålsby-Lundborg C. J Hospi Infect (2012) 80(4), 340-344. Doi:10.1016/j.jhin.2011.12.017. PMID: 22321723

3.    Global action plan on antimicrobial resistance.http://www.who.int/antimicrobial-resistance/global-action-plan/en/  (Accessed on 13^th September 2018)

4.    Workshop on Hand hygiene at All India Institute of Medical Sciences (AIIMS), Bhopal. http://save-antibiotics.blogspot.com/2016/07/workshop-on-hand-hygiene-at-all-india.html. (Accessed on 13^th September 2018)