This document discusses the challenges of improving hand hygiene compliance in healthcare settings. It notes that while hand hygiene is clearly important for reducing infections, achieving high compliance is difficult due to issues with behavior, culture and leadership. One way to improve compliance is through strong leadership that prioritizes hand hygiene, collects data on compliance regularly, provides feedback, and supports initiatives to make hand hygiene easier like ensuring adequate hand washing supplies are available. Examples are given of hospitals that have achieved over 95% compliance through this approach and have seen reductions in infection rates.

1. Tedmed –Great
challenge questions
Karen A. Scott, MD ,MPH

2. Why is Hand Hygiene so hard to enforce and how
can we improve compliance?
 I’ve inserted just a few of the many campaign
efforts nationally and internationally focused on
hand hygiene in hospitals and health care settings.
Testament to the world-wide recognition of hand
hygiene as key to reducing health-care associated
infections – and that achieving highly reliable, high
compliance with this behavior is very challenging
everywhere.
 Why? Complexities of behavior, culture, leadership
–
 Surgeons don’t have to be reminded to wash their
hands before operating – the connection to safe
surgery as obvious, and the specific routine is drilled
into every medical and nursing student; more
challenging is maintaining that same level of
attentiveness when walking into a patient’s room on
rounds, or to speak with a patient – hand hygiene is
associated with physical procedures; the notion of the
ability to spread germs even if you haven’t directly
touched the patient for instance, is harder for people to
“see”.
World Health Organization

3. How do we improve hand hygiene compliance?
 Strong engaged leadership can result in changing behavior and culture, and ultimately,
reduced infection rates:
 At my hospital, leadership set hand hygiene compliance as one of several quality and
patient safety goals several years ago. Leadership identified this as a priority, invested in
“Secret shopper” data collection through our department of epidemiology, reviewed the data
monthly, maintains focus and high expectations for compliance, and supports staff
suggestions for how to facilitate good hand hygiene, such as placement and availabiltiy of
hand washing materials. The “secret shoppers” result in thousands of observations/month,
which are fed back to local units as well as hospital senior leadership. This data drove
improved compliance to now consistently well above 95%, and we believe is contributing to
reduced hospital infection rates.
 There are many impressive examples such as this, which can serve as resources –
 University Hospital of Geneva www.Hopisafe.ch
 Joint Commission Center for Transforming Healthcare, Hand Hygiene Project
www.centerfortransforminghealthcare.org/project
 World Health Organization Patient Safety Challenge, Clean Care is Safer Care
www.who.int/gpsc