HM33 PDI Pic 2smallPennine Acute NHS Trust took part in a 90-day improvement cycle in January 2017 to July 2017, (a 90-day improvement cycle is a research process designed to improve quality and safety in the healthcare setting).

The Trust says: “An improvement to support the reduction of CDI for patients within the organisation was identified by the Infection Prevention and Control Team (IPCT) and the Quality Improvement Team as the focus for the 90-day cycle.

“To further improve our CDI rates, we revisited our CDI reduction plan and analysed our multi-modal strategy, this included a comprehensive staff hand hygiene programme (WHO, 2007). It was observed we had not tried a hand hygiene project specifically directed at patients. Therefore, the implementation of a patient hand hygiene programme was agreed as the test of change.”

The Test of Change

Two wards within the multi-sited trust were identified to test the change (one in Surgery and one in Medicine). At the start of the test both wards demonstrated that significant improvement was required for compliance with patient hand hygiene.

It was agreed that hand washing at a sink with soap and water is ‘gold standard’ but all bedbound patients should be encouraged to use a hand wipe as per ‘Five moments of patient hand hygiene’.

Design Stage

The IPCT with the graphic design team at PDI developed the concept of ‘Five moments of patient hand hygiene’ using a hand wipe. This is adapted from the ‘Five moments of staff hand hygiene’ (WHO, 2007) and developed into a poster (see below). The poster was also replicated in a patient hand hygiene leaflet and hand hygiene cards, which are displayed on each bed table.

How was the test of change implemented?

Baseline audits were completed on each ward
A robust training package was delivered to all staff
A poster (personalised to the ward) placed at the entrance to inform patients and relatives of the project
Patient hand hygiene posters were displayed in clinical areas
Leaflets given to all patients on admission (with an explanation of how to use the wipes – as per the ‘Five moments of patient hand hygiene’) along with a pack of 24 Hygea hand wipes
Bed table cards displaying the ‘Five moments of patient hand hygiene’ poster and product information
Continued auditing of the wards and feedback to staff on their progress
Patient evaluation forms, encouraging patient feedback were also completed on both wards


Compared to a baseline of 0 per cent for both wards, compliance with patient hand hygiene improved to an average of 80.5 per cent and neither wards reported any cases of CDI during the test of change. Other commonly reported healthcare acquired infections reduced by 40 per cent from 47 to 28 cases.


Evaluation and comments were sought from both staff and patients. Some slight resistance was noted from patients who felt they didn’t need to be reminded to wash their hands. However, most comments were very positive and patients took their own initiative with hand hygiene before meals.

A complex test of change in social behaviour for both nursing staff and patients requires comprehensive support. High levels of compliance with patient hand hygiene were achieved and a reduction in HCAI was demonstrated. The relationship between contamination of patient’s hands and transmission of HCAI has received little prominence and merits further consideration.

The Pennine Acute IPCT presented a poster at the Annual IPS conference and received lots of interest in the project. Other local NHS trusts asked for the team to come and present the test of change at their IPC meetings as they would like more information and adopt the change. Furthermore, the test of change has been presented to NHS improvement which demonstrated significant interest and discussions are on-going at present.

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