Boost hand hygiene rates by starting with a simple checklist

Anyone entering a hospital or other care facility—even during a pandemic—should be able to expect nothing less than safe, high quality care. And the most basic way to ensure this is by fostering a culture of safety where hand hygiene is second nature for everyone.

Still, when measured accurately, hand hygiene compliance rates generally fall below 50 percent.¹ It’s a matter that demands an evidence-based strategy and protocols that, together, drive hand hygiene compliance.

That’s why we’ve created “The 6 Essential Elements of Hand Hygiene™”:

• Advanced products
• Reliable delivery systems
• Point-of-care access
• Effective learning systems
• Safety culture
• Actionable feedback

When it comes to successfully building a culture of safety, the most important place to start is by creating an environment of “psychological safety”—that is, an “atmosphere where someone can take chances without fear and with sufficient protection.”²

On a practical level, this means that healthcare workers must hold true to the common value of patient/resident and staff safety and that no one—especially a supervisor or senior staff member—should embarrass, punish, reject, isolate or get back at a co-worker who respectfully and professionally points out that what they’re doing may be putting a patient or resident at risk.

To create positive change in your organization, consider using this simple checklist:

1. Empower individual units to take ownership for hand hygiene improvement and acknowledge their progress as they hit monthly/quarterly compliance growth targets.
2. Structure unit leaders’ annual performance appraisals and bonuses to reward achievement of hand hygiene improvement goals.
3. Routinely identify unit-based obstacles and barriers to hand hygiene performance and then put in place action plans to eliminate them. Encourage input and participation from frontline staff. Incidentally, one of the best possible uses of direct observation is as a tool for coaching and real-time feedback.
4. Routinely measure hand hygiene compliance (for example, weekly) and give feedback on staff performance using a non-biased and validated compliance monitoring system. This could be an electronic hand hygiene compliance monitoring system or direct observation by well-trained and properly validated observers.
5. Celebrate when monthly/quarterly goals are achieved and identify as a team what to do differently when they are not. When goals are met, raise the bar even higher.
6. Make psychological safety “the way we work.” Anyone can speak up in a professional and appropriate way when there is/was risk of harm (such as improper hand hygiene) without fear of embarrassment, rejection, isolation, retribution or other negative consequences.
7. Ensure that your organization’s senior leaders consistently model proper hand hygiene behavior and are authentically engaged in your hand hygiene improvement efforts.

Hand hygiene compliance happens only when your organization is following these steps consistently and with a spirit of shared accountability. As Wears and Sutcliffe put it in Still Not Safe, “Unless we in patient safety change, nothing will change in patient safety.”³

PAUL ALPER, BA
VP Patient Safety Innovation for Medline Industries, LP

Paul invented the first electronic hand hygiene monitoring system designed to improve hand hygiene performance while reducing infections and costs. He is an innovative and mission-driven leader with more than 35 years of experience in hand hygiene and patient safety solutions. Paul also shared hand hygiene insights as a past contributor to Healthcare Hygiene Magazine.

Disclosure: Medline was a 2021 member of the Leapfrog Partners Advisory Committee and has a collaborative relationship with a company that offers electronic hand hygiene monitoring services.

References:

1. CDC. Hand hygiene in healthcare settings core presentation. 2002. Available at: https://www.cdc.gov/HandHygiene/download/hand_hygiene_core.pdf
2. Schein EH, Bennis WG. Personal and Organizational Change Through Group Methods: The Laboratory Approach. New York, NY: Wiley; 1965.
3. Wears RL, Sutcliffe KM. Still Not Safe. Oxford University Press. 2020.