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World Health Organization Framework: Multimodal Hand Hygiene Strategy in Piedmont (Italy) Health Care Facilities

Bert, Fabrizio; Giacomelli, Sebastian; Ceresetti, Daniela; Zotti, Carla, Maria

doi: 10.1097/PTS.0000000000000352
Original Article: PDF Only

Objectives In 2009, the World Health Organization (WHO) introduced the “Hand Hygiene Self-Assessment Framework” (HHSAF) to evaluate the level of the application of the Multimodal Hand Hygiene Improvement Strategy (MHHIS), which defines preventive interventions, standards, and tools conceived to improve hand hygiene in healthcare facilities. The aim of our study was to evaluate the implementation of the MHHIS in Piedmont healthcare units in 2014 using the HHSAF document.

Methods Our surveillance was performed through collection and analysis of the data from 50 Piedmont healthcare facilities recorded through the HHSAF in 2014. The HHSAF describes the hand hygiene level evaluating the following 5 parameters: system changes, education/staff training, evaluation and feedback, reminders in the workplace, and promotion of an institutional safety climate.

Results We reported that 70.4% of the healthcare facilities involved in the study achieved the intermediate hand hygiene level, 19% the advanced level, and 11% the basic level. No facility exhibited an inadequate level of WHO multimodal implementation. Only 55% of the healthcare units provided information about hand hygiene to patients, and only 15% actively involved patients and their families.

Conclusions The implementation of the MHHIS has achieved important results all over the world in terms of hand hygiene. Piedmont has reached an overall good level, particularly in terms of the supply and availability of hand washing products and staff education. Our results revealed, however, some critical issues related to direct and indirect monitoring of hand hygiene, providing reminders and the active involvement of patients, family members, and caregivers.

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From the Department of Public Health Sciences and Pediatrics, University of Turin, Italy.

Correspondence: Sebastian Giacomelli, MD, Department of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, 10126 Turin, Italy (e-mail:

The authors disclose no conflict of interest.

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