Product Usage Measurement, Feedback Boost Hand Hygiene Compliance


The message that hand hygiene can prevent healthcare-acquired infections (HAIs) is clear, yet compliance remains an infection preventionist (IP)’s significant challenge. McGuckin, et al. (2009), in their 12-month multi-center collaboration assessing hand hygiene compliance rates at U.S. healthcare facilities, demonstrate that compliance can increase when monitoring of product usage is combined with feedback. McGuckin, et al. (2009) state, “Product usage is a cost-effective, less time-consuming method that provides the ICP with an overall compliance rate for each unit, representative of all shifts, and avoids the biases of selection and self-reporting.”

The researchers explain that although a number of federal agencies and other organizations (such as the Centers for Disease Control and Prevention, Joint Commission, and Institute of Healthcare Improvement) emphasize the importance of monitoring hand hygiene compliance, there is no standard for measuring it. McGuckin, et al. (2009) state, “Standardization of hand hygiene measurement should be the foundation of a compliance program and the process of applying a standard methodology will increase the probability of improving hand hygiene compliance.” They further point to a literature review by Haas, et al. (2007) that identified the three most frequently reported methods of measuring compliance: direct observation, self-reporting by healthcare workers and indirect calculation based on hand hygiene product usage.

McGuckin and colleagues monitored healthcare workers’ use of soap and sanitizer by collecting and counting empty product containers and separating the soap containers from the sanitizer containers. The total number of empty containers was provided by either the facility’s environmental services staff or by other staff members; this number was recorded either separately by each unit, or tallies for all units were combined and reported as a single facility-wide effort. Each facility’s IP was asked to record and submit patient bed-day data for each unit monitored for the study.

The hand hygiene product usage was monitored and reported beginning at a baseline and then monthly. Each month staff would report the total number of containers as well as patient bed-days for each unit, and the process would repeat for each subsequent month. The data was submitted to the researchers by the facility’s IP.

Three hundred-plus hospitals and other healthcare facilities submitted data from a total of 1,531 units, including intensive care units (ICUs), non-ICU units, pediatric units, rehab/LTC units and ER-OP. McGuckin and colleagues results’ show that hand hygiene compliance at baseline is 26 percent for ICUs and 36 percent for non-ICU units. After 12 months of measuring product usage and providing feedback, the researchers report that compliance increased to 37 percent for ICUs and 51 percent for non-ICU units. (ICU, P = .0119; non-ICU, P < .001).

McGuckin, et al. (2009) conclude, “Our findings have documented three important facts: 1. monitoring and feedback can result in a modest but statistically significant increase in hand hygiene compliance; 2. hand hygiene in the United States continues to be near or below 50 percent, with compliance slightly higher for non-ICUs than for ICUs; and 3. monitoring compliance through product volume is a time-efficient, cost-effective way to provide feedback to staff and provide direction for observation and education.”


McGuckin M, Waterman R and Govednik J. Hand hygiene compliance rates in the United States: A one-year multicenter collaboration using product/volume usage measurement and feedback. Am J Med Qual. May 2009.

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