Infection prevention and control (IPC) is of paramount importance in health care, regardless of geographic location, and can make a significant impact on patient safety. Particularly, health care in Japan still lacks systematic approach for IPC interventions including hand hygiene. The overarching theme of this thesis is to assess the situation of IPC programmes at health facilities in Japan, transform and implement hand hygiene promotion in Japan, and measure its impacts on hand hygiene and IPC programmes in health care in Japan. The interventions included the promotion of the “SAVE LIVES: Clean Your Hands” campaign, a global HH campaign led by WHO, which is poorly followed at health facilities in Japan, and “Train-the-Trainers” (TTT) course on hand hygiene according to the WHO hand hygiene multimodal improvement strategy.

The researches indicated that IPC programmes were relatively advanced at facility level in Japan and influenced by the IPC-related national health policy with financial incentives but lacked systematic and national implementation strategies to promote IPC interventions in general. As a response, the PhD candidate initiated and continued TTTs annually in Japan alongside with local promotion of the WHO SAVE LIVES: Clean Your Hands campaign and proved that TTTs improved hand hygiene promotion and impacted institutional safety climate. Thus, TTT can be a good training and education model for health facilities to better understand the WHO hand hygiene multimodal improvement strategy, which could potentially contribute to improved IPC programmes through institutional safety climate with leadership engagement.