Barriers to Hand Hygiene Include Availability of Products, Lack of Feedback


Health care worker hand hygiene compliance ticked up during COVID, but levels remain low nationwide. A 3-hospital network in Illinois wanted to know why.

person washing hands with soap and water

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Hand hygiene (HH) compliance experienced a bump during the COVID-19 pandemic when the practice came under the microscope, but health care worker (HCW) adherence remains low nationwide. To gain a more accurate understanding of why, a 3-hospital network in Illinois conducted a HCW survey and presented the results at the Association for Professionals in Infection Control and Epidemiology (APIC) 2022 Annual Conference, held June 13-15, 2022, in Indianapolis, Indiana.

Infection prevention and quality investigators across the 3 health care facilities—Advocate Christ Medical Center in Chicago, Illinois; Advocate Trinity Hospital in Chicago; and Advocate Aurora Healthcare in Mokena, Illinois—developed a 14-item anonymous survey comprising Likert, Yes/No, and open-ended questions. The goal was to gain more insight into HCW’s current HH practices and perceived barriers to compliance in order to identify opportunities for improvement. The team set a goal outcome of 3 potential interventions that could be implemented across the network.

Led by John P. Delano, MPH, CIC, manager of infection prevention at Advocate Christ Medical Center in Chicago, Illinois, investigators distributed the survey via email beginning in July 2021, allotting 2 weeks for HCW completion. Some of the items on the survey included “clarity of HH education received, perceived HH effectiveness, willingness to provide and/or receive real-time feedback, assessment of potential perceived barriers, and evaluation of effectiveness of potential targeted interventions,” according to the poster.

The resulting data were analyzed and results were provided in a Microsoft Excel sheet in August 2021.

In all, 1001 HCWs completed the survey. HCWs acknowledged the benefits of proper HH, with 92% responding that HH is “very effective” at preventing patients and self from acquiring infections and 93% saying they would be receptive to someone asking them to perform HH if they were seen not doing so.

However, only 45% of HCW surveyed admitted that they would “always” remind a team member to perform HH if he or she forgot to do so.

When it comes to barriers, only 15% of HCWs surveyed said that availability of HH products (ie, dispensers are often empty) either always, most of the time, or some of the time contributed most to them not performing proper HH. More than 80% of those surveyed felt supplementing the network’s existing secret shopper HH auditing program with real time feedback and coaching would be somewhat or very effective at boosting HH compliance.

Armed with the survey data, investigators developed an action plan, presented it to leadership, implemented interventions, and then audited via a secret shopper program in December 2021.

During a 4th quarter audit conducted post-intervention, HH compliance scores increased for 2 out of the 3 hospitals in the network, with 1 hospital registering a > 20% improvement in HH compliance.

“Survey and preliminary HH audit results suggest that interventions aimed at improving the availability of [alcohol-based hand rub], encouraging peer-to-peer reminders, and supplementing existing auditing processes with real time feedback and coaching may have greater impact on HH compliance than education alone,” investigators concluded.

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