Introduction |
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PART I. REVIEW OF SCIENTIFIC DATA RELATED TO HAND HYGIENE |
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1 | (150) |
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2 | (2) |
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Guideline preparation process |
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4 | (2) |
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Preparation of the Advanced Draft |
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Pilot testing the Advanced Draft |
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Finalization of the WHO Guidelines on Hand Hygiene in Health Care |
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The burden of health care-associated infection |
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6 | (3) |
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Health care-associated infection in developed countries |
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Burden of health-care associated infection in developing countries |
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Historical perspective on hand hygiene in health care |
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9 | (1) |
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Normal bacterial flora on hands |
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10 | (1) |
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Physiology of normal skin |
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11 | (1) |
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Transmission of pathogens by hands |
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12 | (10) |
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Organisms present on patient skin or in the inanimate environment |
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Organism transfer to health-care workers' hands |
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Organism survival on hands |
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Defective hand cleansing, resulting in hands remaining contaminated |
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Cross-transmission of organisms by contaminated hands |
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Models of hand transmission |
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22 | (2) |
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Relationship between hand hygiene and the acquisition of health care-associated pathogens |
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24 | (1) |
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Methods to evaluate the antimicrobial efficacy of handrub and handwash agents and formulations for surgical hand preparation |
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25 | (5) |
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Shortcomings of traditional test methods |
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The need for better methods |
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Review of preparations used for hand hygiene |
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30 | (19) |
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Plain (non-antimicrobial) soap |
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Quaternary ammonium compounds |
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Activity of antiseptic agents against spore-forming bacteria |
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Reduced susceptibility of microrganisms to antiseptics |
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Relative efficacy of plain soap, antiseptic soaps and detergents, and alcohols |
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WHO-recommended handrub formulation |
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49 | (5) |
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Lessons learnt from local production of the WHO-recommended handrub formulations in different settings worldwide |
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Surgical hand preparation: state-of-the-art |
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54 | (7) |
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Evidence for surgical hand preparation |
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Objective of surgical hand preparation |
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Selection of products for surgical hand preparation |
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Surgical hand antisepsis using medicated soap |
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Surgical hand preparation with alcohol-based handrubs |
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Surgical hand scrub with medicated soap or surgical hand preparation with alcohol-based formulations |
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Skin reactions related to hand hygiene |
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61 | (3) |
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Frequency and pathophysiology of irritant contact dermatitis |
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Allergic contact dermatitis related to hand hygiene products |
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Methods to reduce adverse effects of agents |
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Factors to consider when selecting hand hygiene products |
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64 | (2) |
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Hand hygiene practices among health-care workers and adherence to recommendations |
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66 | (12) |
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Hand hygiene practices among health-care workers |
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Observed adherence to hand cleansing |
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Factors affecting adherence |
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Religious and cultural aspects of hand hygiene |
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78 | (7) |
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Importance of hand hygiene in different religions |
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Hand gestures in different religions and cultures |
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The concept of ``visibly dirty'' hands |
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Use of alcohol-based handrubs and alcohol prohibition by some religions |
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Behavioural considerations |
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85 | (4) |
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Social sciences and health behaviour |
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Behavioural aspects of hand hygiene |
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Organizing an educational programme to promote hand hygiene |
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89 | (4) |
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Process for developing an educational programme when implementing guidelines |
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Organization of a training programme |
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The infection control link health-care worker |
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Formulating strategies for hand hygiene promotion |
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93 | (6) |
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Elements of promotion strategies |
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Developing a strategy for guideline implementation |
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Marketing technology for hand hygiene promotion |
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The WHO Multimodal Hand Hygiene Improvement Strategy |
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99 | (25) |
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Key elements for a successful strategy |
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Essential steps for implementation at heath-care setting level |
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WHO tools for implementation |
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``My five moments for hand hygiene'' |
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Lessons learnt from the testing of the WHO Hand Hygiene Improvement Strategy in pilot and complementary sites |
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Impact of improved hand hygiene |
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124 | (4) |
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Practical issues and potential barriers to optimal hand hygiene practices |
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128 | (18) |
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Importance of hand hygiene for safe blood and blood products |
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Fingernails and artificial nails |
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Infrastructure required for optimal hand hygiene |
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Safety issues related to alcohol-based preparations |
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Hand hygiene research agenda |
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146 | (5) |
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PART II. CONSENSUS RECOMMENDATIONS |
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151 | (6) |
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Ranking system for evidence |
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Indications for hand hygiene |
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Recommendations for surgical hand preparation |
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Selection and handling of hand hygiene agents |
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Other aspects of hand hygiene |
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Educational and motivational programmes for health-care workers |
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Governmental and institutional responsibilities |
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For health-care administrators |
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PART III. PROCESS AND OUTCOME MEASUREMENT |
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157 | (17) |
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Hand hygiene as a performance indicator |
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158 | (6) |
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Monitoring hand hygiene by direct methods |
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The WHO-recommended method for direct observation |
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Indirect monitoring of hand hygiene performance |
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Automated monitoring of hand hygiene |
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Hand hygiene as a quality indicator for patient safety |
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164 | (4) |
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Assessing the economic impact of hand hygiene promotion |
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168 | (6) |
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Need for economic evaluation |
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Cost-benefit and cost-effectiveness analyses |
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Review of the economic literature |
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Capturing the costs of hand hygiene at institutional level |
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Typical cost-savings from hand hygiene promotion programmes |
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Financial strategies to support national programmes |
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PART IV. TOWARDS A GENERAL MODEL OF CAMPAIGNING FOR BETTER HAND HYGIENE - A NATIONAL APPROACH TO HAND HYGIENE IMPROVEMENT |
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174 | (15) |
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175 | (1) |
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175 | (1) |
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176 | (1) |
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Public campaigning, WHO, and the mass media |
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177 | (1) |
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National campaigns within health care |
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Benefits and barriers in national programmes |
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178 | (1) |
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Limitations of national programmes |
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179 | (1) |
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The relevance of social marketing and social movement theories |
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180 | (1) |
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Hand hygiene improvement campaigns outside of health care |
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Nationally driven hand hygiene improvement in health care |
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181 | (1) |
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Towards a blueprint for developing, implementing and evaluating a national hand hygiene improvement programme within health care |
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182 | (1) |
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182 | (7) |
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PART V. PATIENT INVOLVEMENT IN HAND HYGIENE PROMOTION |
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189 | (10) |
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190 | (1) |
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Patient empowerment and health care |
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190 | (1) |
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Components of the empowerment process |
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191 | (1) |
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Creation of a facilitating environment and positive deviance |
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Hand hygiene compliance and empowerment |
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192 | (2) |
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Patient and health-care worker empowerment |
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Programmes and models of hand hygiene promotion, including patient and health-care worker empowerment |
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194 | (1) |
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WHO global survey of patient experiences |
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195 | (1) |
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Strategy and resources for developing, implementing, and evaluating a patient/health-care worker empowerment programme in a health-care facility or community |
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196 | (3) |
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PART VI. COMPARISON OF NATIONAL AND SUB-NATIONAL GUIDELINES FOR HAND HYGIENE |
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199 | (7) |
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206 | (33) |
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239 | (19) |
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Definitions of health-care settings and other related terms |
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240 | (2) |
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Guide to appropriate hand hygiene in connection with Clostridium difficile spread |
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242 | (4) |
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Hand and skin self-assessment tool |
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246 | (1) |
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Monitoring hand hygiene by direct methods |
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247 | (3) |
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Example of a spreadsheet to estimate costs |
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250 | (1) |
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WHO global survey of patient experiences in hand hygiene improvement |
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251 | (7) |
Abbreviations |
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258 | (1) |
Acknowledgements |
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259 | |