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Abstract
Background: During the Severe Acute Respiratory Syndrome (SARS) outbreak, high compliance in healthcare
workers to hand hygiene was primarily driven by fear. However, the post-SARS period confirmed that this practice
was not sustainable. At the Singapore General Hospital, a 1,600-bedded acute tertiary care hospital, the hand
hygiene program was revised in early 2007 following Singapore’s signing of the pledge to the World Health
Organization (WHO) “Clean Care is Safer Care” program.
Findings: A multi-prong approach was used in designing the hand hygiene program. This included system
change; training and education; evaluation and feedback; reminders in the workplace; and institutional safety
climate. Hand hygiene compliance rate improved from 20% (in January 2007) to 61% (2010). Improvement was
also seen annually in the compliance to each of the 5 moments as well as in all staff categories. Healthcareassociated
MRSA infections were reduced from 0.6 (2007) to 0.3 (2010) per 1000 patient-days.
Conclusions: Leadership’s support of the program evidenced through visible leadership presence, messaging and
release of resources is the key factor in helping to make the program a true success. The hospital was recognised
as a Global Hand Hygiene Expert Centre in January 2011. The WHO multi-prong interventions work in improving
compliance and reducing healthcare associated infections.
Keywords: hand hygiene, healthcare-associated infections, system change
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