Aims To achieve and sustain a target of 70% hand hygiene compliance over a three month period.

Methods The authors spent 6 months working in partnership with local paediatric staff in a District Hospital in Myanmar as part of the RCPCH Global Links Programme. Improving hand hygiene was chosen in response to a high observed rate of Hospital Acquired Infection. Hand hygiene compliance was measured continuously through discrete once-weekly, ward-based observation using a structured template. Commitment to a compliance target of 70% was agreed at the outset among local stakeholders including the cleaners, nurses, doctors and the medical superintendent. Intervention was supported by the WHO multimodal five point strategy and included attaching hand-gel to bed frames throughout the wards, a trial of clinician-carried hand-gel, a poster campaign and structured training of local staff. Weekly data was made visible in the form of a large wall chart and fed back to the team in regular review meetings and ward rounds. This data was used to evaluate the impact of our interventions and to give ‘real time’ performance feedback to the staff groups. Local staff were involved in the collection and display of weekly data and were enabled to take full ownership of this during the project, thereby optimising sustainability.

Results At baseline overall hand hygiene compliance was 24%, which is in keeping WHO estimates of below 40% for a developing country. Preliminary data at 4 weeks of follow-up demonstrated a rise in overall hand hygiene compliance to 71% across the paediatric and neonatal wards and across all staff groups. Among nursing staff, hand hygiene compliance rose from 17% at baseline to 55%. For junior doctors, an improvement from 13% to 71% was demonstrated. Among consultants, compliance increased from 36% to 88%.

Conclusion Using these methods we were able to demonstrate an improvement in hand hygiene compliance across all staff groups. Providing that performance feedback is delivered in a culturally sensitive manner, it can be a powerful tool to optimise buy-in and engender a unified team-based approach in this setting.