Hand-hygiene strategies for healthcare workers--what really works?

Hand washing is a cornerstone of reducing hospital-acquired infections, yet effective techniques in ensuring long-term compliance for healthcare workers has eluded the industry for decades.

The problem of inadequate hand hygiene has persisted in hospitals partly because traditional strategies, such as awareness posters, have "grown stale," while inherent flaws in other initiatives, such as urging patients to remind clinicians to wash their hands, have limited their effectiveness, according to a research article from BMC Infectious Diseases.

Some potentially more promising hand-hygiene initiatives, according to senior hospital managers and researchers, include the following:

  • Improving patients' hand hygiene. While much of the discussion to date has focused on germs transmitted via healthcare workers, a study from health technology company Infonaut has revealed alarmingly poor hand hygiene among hospital patients themselves. Using monitoring technology, researchers found that in more than 12,000 bathroom visits, patients washed their hands only 30 percent of the time on average. As for meal times, data revealed that patients washed their hands only 30 percent of the time before breakfast and 45 percent of the time before dinner. Many pathogens commonly found in hospitals, including C. difficile, are transmitted via the "fecal-oral route," researchers noted. "Patients' mouths are surely touched the most by their own hands, not healthcare workers' hands," epidemiologist Colin Furness, Ph.D., M.P.H., Infonaut's director of research and knowledge development, said in an announcement. Thus, researchers concluded that there may be significant benefits to including patients in hand-hygiene promotion campaigns.

  • Leveraging consequences. "I cannot get my head around the fact that there seems to be very little performance management in relation to hand hygiene--even to the extent of disciplinary action being taken," a senior manager of non-clinical services told interviewers as part of the BMC study. "We're talking about professional practices. Considering how high the stakes are I just can't understand how it's taking so long. I think we are overdue to actually start to use a hammer." Other managers surveyed echoed the sentiment that hospitals' effort to build a "positive culture" may have led to an overly soft approach to addressing noncompliance. "I have no hesitation in penalizing people for that," stated another manager. "If they've been through a process that's fair and been given a warning and further education."

  • Refreshing and clarifying the message. It's time for the healthcare industry to take a lesson from advertisers and update messages about hand hygiene that are no longer capturing health workers' attention, argued other respondents. Meanwhile, others suggested that guidance needs to be less ambiguous, particularly for non-clinical staff. 

To learn more:
- read the article
- see the announcement