Four Secrets of Hand Hygiene Compliance From An Infection Preventionist

By Judith Fine, MSc, MPH, M(ASCP), e-CIC, Vitalacy Clinical Consultant

Working as an infection preventionist (IP), I have been called a spy, an observer, and big brother watching you. I have been called these names by surveyors, senior executives, and clinical staff while I was monitoring and evaluating hand hygiene compliance.

I have stood on units and watched the observations of staff by hand hygiene champions. Gold stars, pizza lunches, certificates, and various other rewards or motivational incentives were given to those who practiced good hand hygiene and contributed to infection prevention during these observations.

Did the compliance increase?

Hand hygiene improvement endeavors generally improve results during the audit and monitoring stage. But once the expected threshold is reached, the monitoring usually is decreased and the improvements gradually fade.

A few secrets about hand hygiene compliance I have learned

While experiencing many common frustrations in sustaining hand hygiene compliance, I also have learned a few secrets along the way that may help you in your efforts.

1. Give staff the agency to lead the hand hygiene initiative

I have identified significant increases in hand hygiene motivation when staff given the agency to lead the hand hygiene improvement working group. By organizing the initiative in this way, the buy-in and accountability lies with these team members, and the initiative doesn’t turn into a leadership vs. staff endeavor.

Team members whose workflow will be most affected by the hand hygiene initiative should lead the evaluation of the hand hygiene products, be they alcohol, soap, and the dispensers (automatic vs lever), as well as the placement of the dispensers. These team members also should lead the discussion of how hand hygiene performance will be monitored and evaluated.

2. Be visible and assist staff in overcoming barriers to hand hygiene improvement

As IPs, we must be visible on the units for all the functions and shifts. We must listen to and assist the staff members, who collectively own the process. Maybe the flow is not correct. Maybe the dispensers are not in the best location. It’s our job to listen to their suggestions and to help them overcome any barriers to compliance that they identify.

The beauty of this approach is putting the staff in charge. Rather than having observers watch these team members to identify the ”Aha I caught you” moment, we empower staff to identify the “aha moment for improvement.”

3. Consider an electronic hand hygiene monitoring system

Before joining Vitalacy, I was the director of infection prevention for St. Mary’s Healthcare System for Children in Queens, New York. St. Mary’s has been using an electronic monitoring system for 2½ years. The health system has experienced significant increases in hand hygiene performance and has plateaued at certain timelines of the project (Vitalacy Case Study).

While electronic monitoring has obvious benefits, the improvements at St. Mary’s also were highly associated with the visibility of the IP team members on the unit and the direct relationship of the staff with the IP team and the health system’s leadership. Staff members knew that they could send an email with a comment, complaint, or clarification and receive an immediate response.

A quality electronic hand hygiene monitoring system is the best option at this time for three primary reasons. First, depending on their location, most acute care facilities must submit hand hygiene observations to a regulatory agency. Most healthcare facilities do not have the staffing parameters to allow 24/7 direct observation of hand hygiene compliance on all units required to meet the Leapfrog Group’s hand hygiene standards. Second, most healthcare workers do not want to remind their peers and colleagues to performance hand hygiene (Ward, 2022). Third, direct observation often produces inflated results during the monitoring period, and these results are generally not sustained.

To shop for an electronic hand hygiene monitoring system, form an interdisciplinary team to evaluate the systems on the market. Include staff who can describe the exact workflow on the units on this team. The team must determine a pilot unit and a timeline for implementation and expansion. Contact references for all the systems under consideration.

4. Be patient

Be patient with the hand hygiene improvement process and understand that there will be peaks and troughs and timelines when outcomes have plateaued. We cannot give into the frustrations but dig deep to identify the strength to continue and maybe change direction. Remember, we are one member of the team which is our family. We listen, learn, act, and celebrate together.

Request a demo today to learn more about Vitalacy’s Automated Hand Hygiene Monitoring Solution.


Ward A. Barriers to hand hygiene include availability of products, lack of feedback. Infection Control Today, June 14, 2022.

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