Hand Hygiene Compliance

One of the biggest challenges facing infection preventionists is healthcare workers’ compliance with best practices, especially proper hand hygiene. ICT checked in with a few members of industry to see what advice they can share.

Identifying the barriers to hand hygiene compliance is a key step in the process, according to Jacquel Kelly, senior marketing development manager for Georgia-Pacific. “We work with healthcare professionals to identify the barriers to compliance, and they frequently state that issues such as a heavy workload (not enough time), inconveniently located sinks and dispensers, unfilled soap and paper towel dispensers, and skin irritation all contribute to lack of adherence to hand hygiene policies,” Kelly says. “To address these issues, Georgia-Pacific focuses on understanding the needs of this segment, and then develops innovative solutions to address those needs. For instance, we created high-capacity dispensers that stay full longer and are dependable, so that they don’t have to be constantly monitored. We are currently developing enMotion® with lotion, a product designed to address the skin irritation that results from constant handwashing. By providing a touchless hygienic dispenser, with a lotion embedded in the towel, we are hoping to enhance the handwashing experience and help healthcare professionals meet their goals regarding compliance.”

Based on conversations with infection preventionists, Kelly says that constant reiteration of the hand hygiene message is critical in preventing cross-contamination and the spread of healthcare-acquired infections (HAIs). Recent research conducted by Georgia-Pacific revealed that 82 percent of patients and visitors took notice of an installed automated touchless dispenser. “Having things like touchless dispensers and handwashing instruction posters posted sends the message that the hospital cares about hand hygiene. By letting people know that it’s everyone’s responsibility, the constant communication is the best tool for educating healthcare workers, patients and visitors,” Kelly says.

Jeanne Medvick, BAMT (ASCP), MBA, clinical studies group manager for STERIS Corporation, says many infection preventionists believe that successful hand hygiene compliance requires a multi-pronged approach. “The solution always starts with the right products – highly effective antimicrobial formulations that are also extremely mild on the skin,” Medvick says. “However, we realize that compliance also depends on the ideal placement of the products in a facility (wall dispensers, pockets, bedside tables, and wherever they will be most accessible) and on the empowerment of patients and staff. For example, the data collected by our Customers participating in the Partners in Your Care® Plus Web-based data management and education program indicate that patient empowerment and education has been helpful in increasing the number of hand hygiene events by clinical staff in hospitals.”

Medvick continues, “The importance of staff empowerment for hand hygiene compliance is aptly illustrated by an infection preventionist colleague of mine who explained her process: she collects information on available products through vendors and studies the formulation and research behind each product. She then recommends three formulations and presents the products to staff for their use and evaluation. The staff makes the final decision about which product will be used in the facility, because in the end, ‘if they don’t choose it, they don’t use it.’ In addition to antimicrobial efficacy, the product’s mildness (no dryness or irritation after multiple uses of the product) and aesthetics (scent and feel immediately after use) matter a great deal to healthcare professionals who must use the product many times a day.”

Jane Kirk, MSN, RN, CIC, clinical specialist for GOJO Industries, Inc., emphasizes that ongoing education of healthcare workers is essential. “According to the Centers for Disease Control and Prevention (CDC), hand hygiene is the single most important means of preventing the spread of infection. As an infection preventionist, I know from experience that hands are a major mode for germ transmission. Working for an organization dedicated to improving well-being through hygiene and healthy skin, I know that leading the initiative to boost hand hygiene compliance can be challenging. After educating staff as to why hand hygiene is critical and when hand hygiene should be performed, it is important to have staff engaged in the process of providing solutions to improve hand hygiene compliance.”

Kirk continues, “To help you understand how we approach this, here are some examples: One way to achieve staff buy-in is to provide hand hygiene products that the staff actually likes to use. PURELL® Instant Hand Sanitizer Skin Nourishing Foam kills 99.9 percent of most common germs that may cause illness. It is also clinically proven in a hospital setting to improve skin condition in 14 days.1 Another concept designed to improve compliance is the TFX™Touch Free Dispensing System. Healthcare workers do not have to worry about touching any part of the dispenser. They simply place their hands below the dispenser to receive the correct amount of hand sanitizer to achieve hand hygiene. According to a recent study, healthcare workers sanitized their hands 20.8 percent more often when PURELL was provided in a touch-free dispenser.”2

Patient-care requirements in acute-care settings are demanding, acknowledges Amy Garcia, director of marketing for Resurgent Health and Medical/Meritech, Inc. “Offering a realistic step-by-step and multi-faceted hand hygiene program can help alleviate the main barrier to hand hygiene compliance: lack of time and inconvenience,” Garcia says. “Healthcare facilities can promote compliance by providing easy access to hand hygiene products, introducing automated systems and processes to reduce the time required to perform and monitor hand hygiene, and offering a variety of hand hygiene and skin care products to fit the varying needs of each healthcare worker. The overall adherence to hand hygiene is not only the responsibility of the individual, but also of leadership. Making hand hygiene a priority, providing support and educational tools, keeping supplies available, maintaining the multidisciplinary approach, and empowering patients will all contribute to increased compliance.”

Infection preventionists can best educate healthcare workers about the importance of preventing cross-contamination by providing a greater understanding of the ramifications of a lack of hand hygiene, Kirk says. “It is important to provide the context for healthcare workers to think about and understand compliance and how many situations there are to fall out of compliance. One strategy that works is video, using employees from many disciplines to role play examples of cross contamination in the clinical area. This video is viewed by all employees, and can help create many opportunities for discussion of how we can potentially pass germs to our patients unintentionally. Ultimately this type of tool should lead to more awareness and better compliance.”

Kirk adds that additional strategies include educational programs that encourage administrative support and senior leader modeling, along with tools that empower patients and healthcare workers to ask each other to clean their hands. “Once you have done all of the above, it is still paramount to gain the personal commitment of each individual to change their own behavior to be more compliant to CDC guidelines,” Kirk says. “This requires an understanding of behavioral sciences and how to affect individual and organizational change.”

Gregory F. Skorczewski, OPA-C, of 3M Health Care, emphasizes, “Successful improvement in hand hygiene compliance must engage the entire caregiver team in the improvement process. Campaigns organized and driven by preventionists are generally successful in the near term. Sustained compliance requires the participation of an entire care team: physicians, nurses and an administrator or the chief medical officer who can help remove barriers to implementation, as well as a member of the materials management department which supplies hand hygiene agents. Healthcare workers are coping with fewer resources, more information and greater demands on their time and attention then ever before. In this challenging environment the importance of hand hygiene is easily lost. To be effective the hand hygiene education needs to be clear, concise, creative and continuous.”

Proper hand hygiene is facilitated by proper glove usage. Dr. Esah Yip of the Malaysian Rubber Export Council (MREPC) advises, “To get maximum protection against cross-infection, one should not only comply strictly to the best procedure of washing hands, but equally important is to wear the right medical gloves that are capable of providing very effective barrier protection against transmission of infectious agencies, such as viruses and bacteria. To this end, the use of the improved low-protein latex gloves should be considered, while for latex individuals, the use of quality synthetic gloves with good barrier capability should be the option although these gloves may be more costly.”


1. Clinical field evaluation No. 1. (Feb. 11, 2008 to March 21, 2008). GOJO Industries, Inc. Study ID 2008-01-F10176. Clinical evaluation No. 2, (Oct. 9-11, 2007). RCTS Study ID 2310.

2. Larson EL, Albrecht S, O’Keefe M. Hand hygiene behavior in a pediatric emergency department and a pediatric intensive care unit: comparison of use of 2 dispenser systems. Am J Crit Care. 2005 July; 14:304-11. Quiz 312.