SAVE LIVES Clean Your Hands キャンペーン とは2024年5⽉10⽇
2024年
WHO世界⼿指衛⽣の⽇を祝おう︕オンラインセミナー
第1部
WHO世界⼿指衛⽣の⽇
キャンペーンを知ろう︕
⽇本環境感染学会
教育委員会

国⽴病院機構下志津病院 感染症内科 鈴⽊由美

⼿指衛⽣の改善＝「永遠の課題」
100%遵守は無理︕
いくらいってもやらない⼈はやらない︕

100%遵守は無理だし「終わり」はないけど…

取り組みをしてないわけではないけど効果は実感しないし、先が⾒えない

やるべき課題は⾒えている
伸び代がどこかわかっている

みなさまのご施設では、どちらに近いですか︖

institution, previously identified by visiting the wards andcommon areas with senior nurses. Location criteria were
maximal visibility during daily work and during transit
within the hospital.
81 (39)1046 (40)1202 (39)1052 (38)909 (35)
The content of the promotional material (available at
40 (44)1156 (44)1358 (45)1170 (43)1203 (47)
http://www.hopisaffe.ch, accessed Oct 3, 2000) was
98 (16)405 (16)484 (16)514 (19)457 (18)
prepared in association with collaborative groups of HCWs
dwifes, respiratory and mobilisation therapists, radiology technicians, nutrition therapists, a well as
octors. †Refers to the number of opportunities for hand hygiene per h of care. ‡Level of risk ofacross all wards and translated by an artist into a cartoonlike message. Subjects included: nosocomial infection, crossInfection Control
Programme,of InternalSwitzerland,
Medicine
cutive observational
studies,
University Departmentof Geneva Hospitals,
ARTICLEStransmission, hand carriage, hand hygiene, hand
(Prof D Pittet MD, S Hugonnet MD, S Harbarth MD, P Mourouga MD,
disinfection,
andhand
protection
withcreams.
Posters
were
V Sauvan RN, S Touveneau RN); Quality of Care Programme
ance
doctors’
University ofGeneva overall
Hospitals,complianceand Institutewith
of(TImportantly,
V Perneger MD)although
selected for use during regular meetings (six to eight times
e 1).
handandcleansingnot improve,switched
fromSocialPreventivedid
Medicine,
University theyof Geneva,
Geneva,per year) with a multidisciplinary group of HCWs. Thisd an
handwashing to hand disinfection during the study period.
Switzerlandgroup, the project team, included representatives (seniorrsing
On average, from one survey to the next, the odds ratio fornurses and doctors) from each medical department, senior
Correspondence
to:Prof
DidierPittet,Infection
Control
Programme,
CWs
hand disinfection (as opposed to handwashing) was 1·12
administrative managers, and representatives from other(95% CI 1·02–1·24;
p=0·023).
Department
of Internal Medicine,
University of Geneva Hospitals,
4, to
Based
on14,
annualhospital-wide
surveysHarbarth,at our hospital,
DidierPittet,StéphaneHugonnet, Stephan
Philippe Mourouga,
Valérie
Sauvan,Sylvie Touveneau,
hospital
servicedepartments.
Each poster featured the1211
GenevaSwitzerlandoughthe prevalenceof nosocomial infections decreased from(e-mail:didier.pittet@hcuge.ch)name of the ward that proposed the message so that
ThomasV Perneger,
and members of the Infection Control Programme

h of
med
mand
the
nsing
r the

ctice
2D).
and
ance
[SD
ends
ely).

1475 (48)648 (21)279 (9·2)678 (26)
1339 (52)435 (17)117 (4·6)

Effectiveness of a hospital-wide programme to improve compliancewith hand hygiene
16·9% in 1994 to 9·9% in 1998 (p=0·04; figure 3).
Furthermore, on-site surveillance showed that the attack
rate of newly detected MRSA patients decreased from 1994
onwards(p=0·021).
1994
THE
LANCET• Vol 356 •Between
October 14,
2000and 1998, the overall
Summaryincidence of MRSA infections decreased from 2·16 to 0·93
episodes per 10 000 patient-days (p<0·001). In particular,
Backgroundhygieneof prevents
cross infection
the annual Hand
incidence
hospital-acquired
MRSAinジュネーブ⼤での取り組み

Pittetら 2000 Lancet

⼿指衛⽣の遵守率
48 (1994) → 66% (1997)

1307
Hand hygiene, either by handwashing or hand disinfection,
remains the single most important measure to prevent
nosocomial infections.1 The importance of this simple
hospitals, but compliance with recommended instructions is
ARTICLES
100
procedure without
is not sufficiently
recognised ofby health-carecommonlypoor. We attempted
to promotebyFor
personal
use only.
Nothandtohygiene
be reproduced
permission
The
Lancet.
workers (HCWs),2 and poor compliance has been
implementing a hospital-wide
Hand disinfection programme, with special
90
Behavioural theories and interventions based on these0·720
documented
repeatedly.3–5 Although some previous
emphasis on bedside, alcohol-based hand disinfection. We
theories have primarily targeted individuals. This may be
Handwashinginterventions to improve compliance have been successful,measured18
insufficient to effect sustained change.7,8,17 The inter80 nosocomial infections in parallel.
none has0·6achieved lasting improvement.2,6,7 This situation
dependence of individual factors (eg, knowledge, attitudes),environmental constraints (eg, access to washing facilities),
led to the creation of a Handwashing Liaison Group816
in theMethods
70 We monitored the overall compliance with handand organisational climate (eg, feedback, positive
0·5 whose mission is “to modify the behaviour
UK in 1997,
hygiene during routine patient care in a teaching hospital in
14 ofreinforcement) may have a key role in the success of
60 Switzerland, before and during implementation of a
HCWs to produce sustained improvement in compliance
Geneva,behavioural interventions.7,8,17,18
12
with agreed
hand-hygiene campaign. Seven hospital-wide observational
0·4 handwashing standards and so improve theAs observed by others,4 lower compliance rates were
50 were done twice yearly from December, 1994, toquality of patient care”.8
surveys10
associated with activities with a high risk of crossIn our0·3
hospital, we documented disappointing levels ofDecember, 1997. Secondary outcome measures weretransmission. This is a troublesome problem, which may
40
8
be explained by the difficulty in finding hand-hygiene
hand hygiene compliance and identified several risk factors
nosocomial
infection rates, attack rates of meticillin-resistant
opportunities in the sequence of busy patient care.5,6,18
for non-compliance.5 The observed relation between
Staphylococcus
aureus (MRSA), and consumption of handrub
630
0·2
Our intervention was not focused primarily on
increased workload and reduced compliance suggested thatdisinfectant.
improving compliance with high-risk activities, but
4promotion of bedside hand disinfection, less time20
subsequent educational efforts will specifically target this0·1 than handwashing, may improve compliance.5,9
consuming
Findings We observed more than 20 000 opportunities for2
aspect.
Hence, we implemented a hospital-wide campaign tohand hygiene.
Compliance improved progressively from 48% in
10Poor doctor compliance with hand hygiene remains an00
promote handhygiene and, in particular, the use of alcohol1994, to 66% in 1997 (p<0·001). Although recourse to
unsolved and vexing issue.2,5,6,8 Whether increased staff
1993
1994 1995 1996 1997 1998
7
rotation and lower campaign awareness among doctors
0based handrubs.
Wehypothesised that our programmehandwashingwith soap and water remained stable, frequency
Year
1
2
3
4
5
6
7
compared with other HCWs could explain the low
would not only increase compliance with hand hygiene, butof hand disinfection substantially increased during the study
compliance in our study requires further research.8 Previous
Numberof
study
Figure3:
Trendsinprevalenceofnosocomial
infections
andalso diminish meticillin-resistant Staphylococcus aureus
period (p<0·001). This result was unchanged after adjustment
interventions to change doctors’ behaviour have included
annualattack
rate
of
MRSA,
1993–98,
UniversityofGeneva1: Hand-hygiene
during seven(MRSA) transmission and nosocomial infection rates. We
forFigureknown
risk factorscomplianceof poor trend
adherence.
Hand hygiene
education, feedback, financial rewards and penalties, andHospitals
consecutive
hospital-wide
surveys,
Universityof Geneva
describe the programme and its effectiveness.
improvedsignificantly
amongnursesand nursing
assistants,
administrative changes.8,22 Research suggests that

Introduction

p<0.001

アルコール⼿指消毒剤消費量 L/1000患者･⽇
3.5 (1993) → 15.4L (1998) p<0.001

Noscomial infections ( )(cases per 100 admissions)

pital
the
wards
milar
·17),
rved
high
risk;
r the

571 (21)1383 (51)449 (16)333 (12)

⼿指衛⽣遵守の向上は医療関連感染を減らす

1284 (49)466 (18)
99 (3·8)

Attack rates of MRSA ( )(new cases per 100 admissions)

hing
hand
7·0%
1). Inohol1000
9·5 L
near
ation
ively
iated

See 758
Commentary
page
(29)
642 (21)1290

Compliance with hand hygiene (%)

08 (23)45 (41)36 (22)30 (14)

院内感染事例の年間有病率
16.9 (1994) → 9.9% (1998)

p=0.04

院内新規MRSA発⽣件数/10000患者･⽇
2.16 (1994) → 0.93 (1998) p<0.001

Hospitals, 1994–97

but remained poor among doctors. During the same period,
overall nosocomial infection decreased (prevalence of 16·9% in1994 to 9·9% in 1998; p=0·04), MRSA transmission1309
rates

Poor compliance with hand hygiene is common among

HCWs. Reported reasons for not washing hands include
Methods

skin irritation, inaccessible handwashing supplies, wearing
Procedure
2,6,16–18

combinations of interventions targeted at multiple
behavioural factors are more likely to suceed than isolated
actions,23 but the best way to improve hand hygiene among
18,21アルコール⼿指消毒は効果的︕簡単にできる︕
根拠も明確。
やった⽅がいいのはよくわかった。
どうやるのかもわかった けど…

ん
ー
ふ

い
ー
は

アルコールは、短時間で最も効果的に微⽣物を減らします︕

けど、現場の
みんなはなぜ、やらないのか︖
みなさんが⼿指衛⽣をやらない理由って、何ですか︖

現場がやらない理由 は いくらでも、ある︕
⼿が届く
ところに
ないから
めんどう
・
・
・

こ︖
ど
剤
毒
⼿指消 にないぞ︖
時必要な「できているつもり」「しなくても指摘なし」
必要性が理解できず
現場での実践に落とし込めない・・・・

いざ、業務中はうっかり忘れる

の︖
⼿指衛⽣︖
な
ゃ
き
な
︖
し
て
なんで の︖どうやっ
おら、やってるしーる
いつす

勉強はしたん
だけど
現場では忘
れちゃ う

他みんなしてない
のに、⾃分だけ︖
そんなの嫌だなあ
・
・
・

リンクナ
ースとか
以
や ん なくてもいい 外はじ ゃ ね︖

institution, previously identified by visiting the wards andcommon areas with senior nurses. Location criteria were
maximal visibility during daily work and during transit
within the hospital.
81 (39)1046 (40)1202 (39)1052 (38)909 (35)
The content of the promotional material (available at
40 (44)1156 (44)1358 (45)1170 (43)1203 (47)
http://www.hopisaffe.ch, accessed Oct 3, 2000) was
98 (16)405 (16)484 (16)514 (19)457 (18)
prepared in association with collaborative groups of HCWs
dwifes, respiratory and mobilisation therapists, radiology technicians, nutrition therapists, a well as
octors. †Refers to the number of opportunities for hand hygiene per h of care. ‡Level of risk ofacross all wards and translated by an artist into a cartoonlike message. Subjects included: nosocomial infection, crossInfection Control
Programme,of InternalSwitzerland,
Medicine
cutive observational
studies,
University Departmentof Geneva Hospitals,
ARTICLEStransmission, hand carriage, hand hygiene, hand
(Prof D Pittet MD, S Hugonnet MD, S Harbarth MD, P Mourouga MD,
disinfection,
andhand
protection
withcreams.
Posters
were
V Sauvan RN, S Touveneau RN); Quality of Care Programme
ance
doctors’
University ofGeneva overall
Hospitals,complianceand Institutewith
of(TImportantly,
V Perneger MD)although
selected for use during regular meetings (six to eight times
e 1).
handandcleansingnot improve,switched
fromSocialPreventivedid
Medicine,
University theyof Geneva,
Geneva,per year) with a multidisciplinary group of HCWs. Thisd an
handwashing to hand disinfection during the study period.
Switzerlandgroup, the project team, included representatives (seniorrsing
On average, from one survey to the next, the odds ratio fornurses and doctors) from each medical department, senior
Correspondence
to:Prof
DidierPittet,Infection
Control
Programme,
CWs
hand disinfection (as opposed to handwashing) was 1·12
administrative managers, and representatives from other(95% CI 1·02–1·24;
p=0·023).
Department
of Internal Medicine,
University of Geneva Hospitals,
4, to
Based
on14,
annualhospital-wide
surveysHarbarth,at our hospital,
DidierPittet,StéphaneHugonnet, Stephan
Philippe Mourouga,
Valérie
Sauvan,Sylvie Touveneau,
hospital
servicedepartments.
Each poster featured the1211
GenevaSwitzerlandoughthe prevalenceof nosocomial infections decreased from(e-mail:didier.pittet@hcuge.ch)name of the ward that proposed the message so that
ThomasV Perneger,
and members of the Infection Control Programme

h of
med
mand
the
nsing
r the

ctice
2D).
and
ance
[SD
ends
ely).

1475 (48)648 (21)279 (9·2)571 (21)1383 (51)449 (16)333 (12)678 (26)
1339 (52)435 (17)117 (4·6)

ジュネーブ⼤:「多⾓的」に取り組み、成功

Effectiveness of a hospital-wide programme to improve compliancewith hand hygiene
16·9% in 1994 to 9·9% in 1998 (p=0·04; figure 3).
Furthermore, on-site surveillance showed that the attack
rate of newly detected MRSA patients decreased from 1994
onwards(p=0·021).
1994
THE
LANCET• Vol 356 •Between
October 14,
2000and 1998, the overall
Summaryincidence of MRSA infections decreased from 2·16 to 0·93
episodes per 10 000 patient-days (p<0·001). In particular,
Backgroundhygieneof prevents
cross infection
the annual Hand
incidence
hospital-acquired
MRSAinジュネーブ⼤での取り組み

Pittetら 2000 Lancet

⼿指衛⽣の遵守率
48 (1994) → 66% (1997)

1307
Hand hygiene, either by handwashing or hand disinfection,
remains the single most important measure to prevent
nosocomial infections.1 The importance of this simple
hospitals, but compliance with recommended instructions is
ARTICLES
100
procedure without
is not sufficiently
recognised ofby health-carecommonlypoor. We attempted
to promotebyFor
personal
use only.
Nothandtohygiene
be reproduced
permission
The
Lancet.
workers (HCWs),2 and poor compliance has been
implementing a hospital-wide
Hand disinfection programme, with special
90
Behavioural theories and interventions based on these0·720
documented
repeatedly.3–5 Although some previous
emphasis on bedside, alcohol-based hand disinfection. We
theories have primarily targeted individuals. This may be
Handwashinginterventions to improve compliance have been successful,measured18
insufficient to effect sustained change.7,8,17 The inter80 nosocomial infections in parallel.
none has0·6achieved lasting improvement.2,6,7 This situation
dependence of individual factors (eg, knowledge, attitudes),environmental constraints (eg, access to washing facilities),
led to the creation of a Handwashing Liaison Group816
in theMethods
70 We monitored the overall compliance with handand organisational climate (eg, feedback, positive
0·5 whose mission is “to modify the behaviour
UK in 1997,
hygiene during routine patient care in a teaching hospital in
14 ofreinforcement) may have a key role in the success of
60 Switzerland, before and during implementation of a
HCWs to produce sustained improvement in compliance
Geneva,behavioural interventions.7,8,17,18
12
with agreed
hand-hygiene campaign. Seven hospital-wide observational
0·4 handwashing standards and so improve theAs observed by others,4 lower compliance rates were
50 were done twice yearly from December, 1994, toquality of patient care”.8
surveys10
associated with activities with a high risk of crossIn our0·3
hospital, we documented disappointing levels ofDecember, 1997. Secondary outcome measures weretransmission. This is a troublesome problem, which may
40
8
be explained by the difficulty in finding hand-hygiene
hand hygiene compliance and identified several risk factors
nosocomial
infection rates, attack rates of meticillin-resistant
opportunities in the sequence of busy patient care.5,6,18
for non-compliance.5 The observed relation between
Staphylococcus
aureus (MRSA), and consumption of handrub
630
0·2
Our intervention was not focused primarily on
increased workload and reduced compliance suggested thatdisinfectant.
improving compliance with high-risk activities, but
4promotion of bedside hand disinfection, less time20
subsequent educational efforts will specifically target this0·1 than handwashing, may improve compliance.5,9
consuming
Findings We observed more than 20 000 opportunities for2
aspect.
Hence, we implemented a hospital-wide campaign tohand hygiene.
Compliance improved progressively from 48% in
10Poor doctor compliance with hand hygiene remains an00
promote handhygiene and, in particular, the use of alcohol1994, to 66% in 1997 (p<0·001). Although recourse to
unsolved and vexing issue.2,5,6,8 Whether increased staff
1993
1994 1995 1996 1997 1998
7
rotation and lower campaign awareness among doctors
0based handrubs.
Wehypothesised that our programmehandwashingwith soap and water remained stable, frequency
Year
1
2
3
4
5
6
7
compared with other HCWs could explain the low
would not only increase compliance with hand hygiene, butof hand disinfection substantially increased during the study
compliance in our study requires further research.8 Previous
Numberof
study
Figure3:
Trendsinprevalenceofnosocomial
infections
andalso diminish meticillin-resistant Staphylococcus aureus
period (p<0·001). This result was unchanged after adjustment
interventions to change doctors’ behaviour have included
annualattack
rate
of
MRSA,
1993–98,
UniversityofGeneva1: Hand-hygiene
during seven(MRSA) transmission and nosocomial infection rates. We
forFigureknown
risk factorscomplianceof poor trend
adherence.
Hand hygiene
education, feedback, financial rewards and penalties, andHospitals
consecutive
hospital-wide
surveys,
Universityof Geneva
describe the programme and its effectiveness.
improvedsignificantly
amongnursesand nursing
assistants,
administrative changes.8,22 Research suggests that

Introduction

p<0.001

アルコール⼿指消毒剤消費量 L/1000患者･⽇
3.5 (1993) → 15.4L (1998) p<0.001

Noscomial infections ( )(cases per 100 admissions)

pital
the
wards
milar
·17),
rved
high
risk;
r the

1284 (49)466 (18)
99 (3·8)

Attack rates of MRSA ( )(new cases per 100 admissions)

hing
hand
7·0%
1). Inohol1000
9·5 L
near
ation
ively
iated

See 758
Commentary
page
(29)
642 (21)1290

Compliance with hand hygiene (%)

08 (23)45 (41)36 (22)30 (14)

院内感染事例の年間有病率
16.9 (1994) → 9.9% (1998)

p=0.04

院内新規MRSA発⽣件数/10000患者･⽇
2.16 (1994) → 0.93 (1998) p<0.001

Hospitals, 1994–97

but remained poor among doctors. During the same period,
overall nosocomial infection decreased (prevalence of 16·9% in1994 to 9·9% in 1998; p=0·04), MRSA transmission1309
rates

Poor compliance with hand hygiene is common among

HCWs. Reported reasons for not washing hands include
Methods

skin irritation, inaccessible handwashing supplies, wearing
Procedure
2,6,16–18

combinations of interventions targeted at multiple
behavioural factors are more likely to suceed than isolated
actions,23 but the best way to improve hand hygiene among
18,21

BMJ 2012;344:e3005 doi: 10.1136/bmj.e3005 (Published 3 May 2012)

Page 10 of 11

RESEARCH

他国もジュネーブ⼤式「多⾓的」な⽅法で成功
Fig 1 Estimated use of hand hygiene consumables, by quarter

Figures

BMJ 2012;344:e3005 doi: 10.1136/bmj.e3005 (Published 3 May 2012)

Page 1 of 11

ResearchRESEARCH
Evaluation of the national Cleanyourhands campaign
to reduce Staphylococcus aureus bacteraemia andClostridium difficile infection in hospitals in England andWales by improved hand hygiene: four year,
prospective, ecological, interrupted time series study
OPEN ACCESS

Fig 1 Estimated use of hand hygiene consumables, by quarterFig 2 Estimated quarterly rate of bacteraemia (per 10 000 bed days)

1

Sheldon Paul Stone senior lecturer, stroke physician, and general physician for older people ,22
Christopher Fuller project manager and nursing research fellow , Joan Savage research associate ,32
5 10
Barry Cookson director , Andrew Hayward senior lecturer , Ben Cooper mathematical modeller ,4
6Georgia Duckworth director , Susan Michie professor of health psychology , Miranda Murray47
consultant scientist , Annette Jeanes consultant nurse in infection control , J Roberts emeritus
8
professor of economics of infectious disease , Louise Teare consultant microbiologist and infection
910control doctor , Andre Charlett head of department
Royal Free Campus, University College London Medical School, London NW3 2PF, UK; 2Research Department of Infection and Population Health,Royal Free Hospital, London; 3Laboratory of HealthCare Associated Infection, Health Protection Agency, London; 4Department of Healthcare
Associated Infection and Antimicrobial Resistance, Health Protection Agency, London; 5Tropical Medicine Research Unit, Mahidol University,
Bangkok, Thailand; 6Department of Psychology, University College London; 7Department of Microbiology, University College London Hospitals,
London; 8Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London ; 9Department of Microbiology, Mid-Essex
NHS Trust, Chelmsford, Essex, UK; 10Department of Statistics, Modelling, and Economics, Health Protection Agency
1

Abstract
Objective To evaluate the impact of the Cleanyourhands campaign on
rates of hospital procurement of alcohol hand rub and soap, report trends
in selected healthcare associated infections, and investigate theassociation between infections and procurement.
Design Prospective, ecological, interrupted time series study from 1
July 2004 to 30 June 2008.
Setting 187 acute trusts in England and Wales.

assessed by mixed effect Poisson regression model (which also
accounted for effect of bed occupancy, hospital type, and timing of othernational interventions targeting these infections).
Results Combined procurement of soap and alcohol hand rub tripledfrom 21.8 to 59.8 mL per patient bed day; procurement rose inassociation with each phase of the campaign. Rates fell for MRSA
bacteraemia (1.88 to 0.91 cases per 10 000 bed days) and C difficile
infection (16.75 to 9.49 cases). MSSA bacteraemia rates did not fall.
Increased procurement of soap was independently associated with
reduced C difficile infection throughout the study (adjusted incidence
rate ratio for 1 mL increase per patient bed day 0.993, 95% confidence
interval 0.990 to 0.996; P<0.0001). Increased procurement of alcohol
hand rub was independently associated with reduced MRSA
bacteraemia, but only in the last four quarters of the study (0.990, 0.985
to 0.995; P<0.0001). Publication of the Health Act 2006 was strongly
associated with reduced MRSA bacteraemia (0.86, 0.75 to 0.98; P=0.02)
and C difficile infection (0.75, 0.67 to 0.84; P<0.0001). Trust visits by

Fig 2 Estimated quarterly rate of bacteraemia (per 10 000 bed days) Fig 3 Estimated quarterly rate of C difficile infection (per 10 000 bed da

イギリス・オーストラリアなど…直接ジュネーブ⼤を訪問してを学び、同様にして⼤々的に取り組んだところ、明らかな成果が得られた︕︕
Intervention Installation of bedside alcohol hand rub, materials promoting
hand hygiene and institutional engagement, regular hand hygiene audits,rolled out nationally from 1 December 2004.
Main outcome measures Quarterly (that is, every three months) rates
for each trust of hospital procurement of alcohol hand rub and liquidsoap; Staphylococcus aureus bacteraemia (meticillin resistant (MRSA)
and meticillin sensitive (MSSA)) and Clostridium difficile infection foreach trust. Associations between procurement and infection rates

Correspondence to: Sheldon Paul Stone s.stone@medsch.ucl.ac.uk

WHO⼿指衛⽣多⾓的戦略 (2009)「５つの要素」

多⾓的
multimodal「５つの瞬間」「正しい⼿指衛⽣」の基準
When?
Why?

1 物品設備2 研修教育3 測定評価
4 現場掲⽰5 組織⽂化「５つのステップ」❶ 準備決意❷ 事前評価戦略的 strategical❸ 実施結果❹ 事後評価❺ 計画⽴案

「５つのステップ」年度計画例❶ 準備決意❷ 事前評価
4⽉

5⽉

6⽉

病院全体の
ステップ

❺❶❷❸

⼿指消毒剤
消費量調査

❷❹

stepwise ʻstepsʼ

ABHRL/1000pt･d

直接観察

Directobservations❷❸ 実施結果7⽉

8⽉

取り組み前/後で評価し「PDCA」を回す❹ 事後評価❺ 計画⽴案

9⽉

11⽉

10⽉

❸

12⽉

※下記は⾃施設の例
1⽉

2⽉

3⽉

❹❺

❹

強化⽉間ポスターCampaign posters

5⽉と10⽉にキャンペーン 5⽉は❶準備決意 3⽉にHHSAFも含めて❹事後評価＋❺計画⽴案

「5つの要素」⾏動変容を促す多⾓的アプローチ
1 物品設備必要な物品を
適切な場所に
配置する
こ︖
ど
剤
毒
⼿指消 にないぞ︖
時必要な

2 研修教育3 測定評価

4 現場掲⽰5 組織⽂化

なぜ、いつ どの程度実際に 学んだことを やりたくなる or
どのように︖ できているか
医療現場で やらざるを得ない知識を与える 定量評価する 思い出すしかけ 職場の雰囲気
の︖
⼿指衛⽣︖
な
ゃ
き
な
︖
し
て
なんで の︖どうやっ
おら、やってるしーる
いつす

勉強はしたん
だけど
現場では忘
れちゃ う

リンクナ
ースとか
以
や ん なくてもいい 外はじ ゃ ね︖

「５つの要素」ツール集
1.物品設備2.研修教育3.測定評価4.現場掲⽰5.組織⽂化

病棟インフラ調査

⼿指衛⽣改善推進担当者⽤スライド

テクニカルリファレン
スマニュアルテクニカルリファレン
スマニュアル

管理者に⼿指衛⽣改善を推奨するお⼿紙

教育担当者,観察者,
医療従事者⽤研修スライド直接観察記録⽤紙

５つの瞬間ポスター

遵守率計算⽅法

⼿指消毒⼿順ポスター

管理者に⼿指衛⽣改善計画への⽀持と⽀援を求めるお⼿紙教育動画

病棟インフラ調査

⼿洗い⼿順ポスター

教育動画と組み合わせるスライド

⽯けん・⼿指消毒剤消費量調査

ʻ⼿指衛⽣:なぜ･どう･
いつʼパンフレット

テクニカルリファレン
スマニュアル

医療従事者 認識調査

ʻ命を守る:きれいな⼿でʼスクリーンセーバー

⼿指消毒剤の導⼊計画と原価計算
⼿指消毒剤現地製造
案内 推奨処⽅⽯けん・⼿指消毒剤消費量調査
⼿指消毒剤忍容性調査
法１使⽤中/導⼊予定
製剤の評価
⼿指消毒剤忍容性調査
法２製剤間の⽐較

直接観察記録⽤紙
ʻ⼿指衛⽣:なぜ･どう･
いつʼパンフレット
ʻ⼿袋の使⽤について'
ちらし

管理者 認識調査
医療従事者 知識調査
⼿指消毒剤忍容性調査
法１使⽤中/導⼊予定
製剤の評価

５つの瞬間ポスター

⼿指消毒剤忍容性調査
法２製剤間の⽐較

FAQ

データ⼊⼒ツール

主要な科学的な⽂献

⼊⼒ツール説明書

改善を続けるために追加できる取り組み

結果報告⽤スライド

患者･患者団体と共に取り組むための案内
改善を続けるために追加できる取り組み
ʻ命を守る:きれいな⼿でʼプロモーション動画!"#$%&'()*

⼿指衛⽣⾃⼰評価フレームワーク︓HHSAF
1 物品設備2 研修教育3 測定評価

4 現場掲⽰5 組織⽂化

⾃施設にあったツール選びの「道しるべ」
AMR臨床リファレンスセンター HP

1 物品設備

・傾斜配点︓⾼配点項⽬に注⽬する（５点〜50点と、最⼤10倍の差）
・右端の推奨ツール︓該当するツールを活⽤することで改善が期待できる

項⽬5.3
1 物品設備

5/5 ⼿指衛⽣キャンペーン
2 研修教育3 測定評価

4 現場掲⽰10点
5 組織⽂化SAVE LIVES Clean Your Hands キャンペーン
5 組織⽂化Global

毎年5/5の「SAVE LIVES
Clean Your Hands Annual
initiative (campaign)」にあわせて、病院全体で『⼿指衛⽣推進活動』を⾏う計画

Regions

Home / Campaigns / World Hand Hygiene Day

SAVE LIVES - Clean Your Hands
Annual global campaign"

Select lang

SAVE LIVES Clean Your Hands キャンペーン
毎年、世界中の仲間が5/5に「WHO世界⼿指衛⽣の⽇」を祝っています︕

今年(2024年)のキャンペーン
メイン ビジュアル

キャンペーン参加登録
キャンペーン内容説明資料
キャンペーンツールダウンロード
キャンペーンメインページ

毎年、新しい ビジュアル や 標語
World Hand Hygiene Day
2024

Why is sharing
knowledge about
hand hygiene still
so important

2018

2019

2020

Because it helps
stop the spread ofharmful germs inhealth care

2021

2022

2023

SAVE LIVES
Clean Your Hands

2024

今年の標語「⼿指衛⽣の知識を共有しよう!」⾃由にアレンジ可能なPPT⾃由にアレンジ可能なPPT

アレンジの例︓⾃施設のその年の課題に合わせてその数十秒が命を救う

手指衛生を忘れずに

手指衛生 必要な場面で必ず& 正しく!

HH at the right moment, always, and correctly!

薬剤部

下志津病院 感染防⽌対策室
NHO Shimoshizu National Hospital

Infection Control Team

私たちは「⼿指衛⽣」を推進していますWe engage in hand hygiene improvement initiatives
WHOの⼿指衛⽣キャンペーンに参加しています︕

下志津病院
手指衛生強化月間

2021年 10月

10/15 は UNICEF手洗いの日

Proud to be part of the WHO’s hand hygiene campaign!
#HandHygiene#CleanYourHands#InfectionPrevention

世界との連帯感 共通デザイン & X (旧twitter)

Campaignへの登録 どの医療施設も、いつでも︕

GlobalRegionsHealthCountries

Newsroom

Emergencies

Data

Topics

About!

Select language

WHO

Home / Campaigns / World Hand Hygiene Day / Sign Up - SAVE LIVES: Clean Your Hands campaign

Sign up for SAVE LIVES: Clean Your Hands
campaign
Credits

Campaignへの登録︓web上の⼊⼒フォーム
左の申し込みフォームに⼊⼒すれば登録完了
登録済みの確認メール
や登録証の発⾏はなくある時点から左のようなニュースレターメールがWHOより送られてくる
施設名の公表はされない
登録したことによりWHOの⽅から、何かをするよう求められるようなことはない

Campaignへの登録︓個⼈ではなく「施設」として
GlobalRegionsHealthCountries

Newsroom

Emergencies

Data

Topics

About!

Select language

WHO

施設として
WHO⼿指衛⽣
キャンペーンに参加登録するためには「施設⻑の許可」
が必要

Home / Campaigns / World Hand Hygiene Day / Sign Up - SAVE LIVES: Clean Your Hands campaign↓

Sign up for SAVE LIVES: Clean Your Hands
campaign
Credits

・HHSAF 5.2a 10点
・戦略成⽴のための
必要最低限項⽬

項⽬5.3
1 物品設備

5/5 ⼿指衛⽣キャンペーン
2 研修教育3 測定評価

4 現場掲⽰10点
5 組織⽂化5.組織⽂化

Institutional safety climate

実践したくなる(せざるをえない)体制や雰囲気づくり
管理者の⽀持、⽀援の意思表明
管理者に⼿指衛⽣改
善を推奨するお⼿紙
管理者に⼿指衛⽣改善計画への⽀持と⽀援を求めるお⼿紙

⼿指衛⽣チーム
5/5キャンペーン計画

患者の参加

現場リーダー
改善を続けるための取り組み(⽬標値等)

患者･患者団体と共に取り組むための案内

ʻ命を守る:きれいな⼿でʼプロモーション動画
改善を続けるため追加できる取り組み

5.組織⽂化

Institutional safety climate

実践したくなる(せざるをえない)体制や雰囲気づくり
・病院として、院⻑以下⼀丸となって、⼿指衛⽣に真摯に取り組む⽂化の醸成
・職員全員を巻込み、意欲を育て、現場レベルでPDCAを回せる仕組を⽤意・患者さんも、感染対策⽂化の醸成の⼀員として巻き込む

5.組織⽂化

Institutional safety climate

…
て
し
か

活
を
会

⼿
の
5⽉

機
の
ン
ー
ペ
ン
キャ

⽣
衛
指

病院⻑、診療部⻑、看護部⻑（病院幹部）による 明確な⽀持表明
全員で「5つの瞬間」⼿指衛⽣

事務部⻑
企画課⻑

経営
企画
室⻑

臨床
研究
室⻑

地域
連携
室⻑

HH at the ”5 moments” by everybody in the hospital- いつも⼿をきれいにしてくれて、ありがとう︕- Thank you for your each HH action! -

統括
診療部⻑
看護部⻑

副看護部⻑ 病院⻑ 副院⻑ 管理課⻑2022年5⽉
下志津病院
⼿指衛⽣強化⽉間
5/5はWHO世界⼿指衛⽣の⽇薬剤部⻑

5.組織⽂化

Institutional safety climate

…
て
し
か

活
を
会

⼿
の
5⽉

機
の
ン
ー
ペ
ン
キャ

⽣
衛
指

うちの部署で今年作った
リマインダー
効果的でした！

先⽣！
⼿で
きれいな
ね
さわって

各部署で新たに考案された「効果的な取り組み」を部署間で共有↓（応⽤して考える）
各施設で新たに考案された「効果的な取り組み」を施設間で共有

5.組織⽂化

Institutional safety climate

世界の仲間と⼀緒に、⼿指衛⽣⽂化を醸成

⼀緒に｢⼿指衛⽣の⽇｣を祝う︕
WHO World Hand Hygiene Day

仲間をたたえ合う︕

Hand Hygiene Excellence Award

https://www.who.int/campaigns/world-hand-hygiene-day

https://www.hhea.info/en.html

WHO ⼿指衛⽣ Campaign に参加することで…
SAVE LIVES Clean your hands

・施設として、院⻑の了解の下で、WHO⼿指衛⽣多⾓的戦略に取り組む︕という「決意表明」となる（５の要素・１のステップ）・キャンペーンのニュースレターが届き、世界の仲間と⼀緒に毎年刷新される(カッコイイ)キャンペーンツールを使うことで、「世界の⼿指衛⽣仲間」と繋がる「連帯感」を感じることができる︕

5⽉ ⼿指衛⽣キャンペーン を 毎年の年間計画に︕❶ 準備決意❷ 事前評価
4⽉

5⽉

6⽉

病院全体の
ステップ

❺❶❷❸

⼿指消毒剤
消費量調査

❷❹

stepwise ʻstepsʼ

ABHRL/1000pt･d

直接観察

Directobservations❷❸ 実施結果7⽉

8⽉❹ 事後評価❺ 計画⽴案

9⽉

11⽉

10⽉

❸

12⽉

※下記は⾃施設の例
1⽉

2⽉

3⽉

❹❺

❹

強化⽉間ポスターCampaign posters

5⽉と10⽉にキャンペーン 5⽉は❶準備決意 3⽉にHHSAFも含めて❹事後評価＋❺計画⽴案

⼿指衛⽣キャンペーン を「始める」「巻き込む」名⽬に︕
⾃施設の例

始めるのに「勇気が必要」なものを、「キャンペーン」として楽しく︕

2014年 年に2回の全病棟の「直接観察」︓キャペーン企画として開始
2016年 ロールモデル「⼿指衛⽣マスター」選出︓キャンペーン企画として開始
2020年 WHO式の⼿順の「⼿遊び歌」動画作成︓キャンペーン企画として実施
2021年 院内全⼿順ポスターをWHO式に貼り替え︓キャンペーン企画として実施

WHO⼿指衛⽣多⾓的戦略「５つの要素」

多⾓的
multimodal

1 物品設備すでに「WHO⼿指衛⽣多⾓的戦略」に取り組まれているご施設からも実際の様⼦を共有していただきます︕

4 現場掲⽰5 組織⽂化「５つのステップ」❷ 事前評価の詳細について細かく掘り下げていくことはせず、「５つの瞬間」

ご参加いただいたご施設で実践されている「⼿指衛⽣推進のための取り組み」の共有等を中⼼に進めていく予定です。

2 研修教育3 測定評価❶ 準備決意本⽇のイベント後半では、

戦略的 strategical❸ 実施結果❹ 事後評価❺ 計画⽴案⼿指衛⽣改善のための取り組み

⼿指消毒剤
個⼈携帯

何のため︖ 遵守率︖ 消費量︖ (業績︖ 論⽂︖)

⼿指消毒剤
個⼈携帯

患者さんの命を救うため の ⼿指衛⽣︕
SAVE LIVES!

Clean Your Hands!

⼿指衛⽣ を ⽂化に︕
全国の仲間と、多⾓的に、楽しく︕
SAVE LIVES! Clean Your Hands!

WHO⼿指衛⽣多⾓的戦略
関連教育ツールweb公開
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