Global WHO Study Uncovers Mediocre IPC Performance in Higher-Income Countries

By Tal Cohen, CTO

Countries with lower average per-capital income generally lack the financial resources and facilities necessary for effective infection control and prevention (IPC), as one might expect. What's surprising, however, are the mediocre IPC results in higher-income countries with access to funding and with the ability to implement and monitor IPC programs including hand hygiene compliance monitoring.

A World Health Organization (WHO, 2021) statement on World Hand Hygiene Day on May 5 highlighted health discrepancies related to a country's average per-capita income. The discrepancies were found during the WHO's global study of 88 national IPC programs (Tartari, 2021).

For example, only 77% of higher-income countries have national IPC guidelines, 71% have a functional national IPC program, 63% monitor for hand hygiene compliance, 57% have IPC implementation plans and strategies, and 50% have a dedicated IPC budget. The WHO statement said that overall, only 22% of all countries monitored IPC implementation roll-out and impact, adding that few countries have the capacity to monitor the IPC effectively.

This state of unpreparedness made populations of all nations more vulnerable to COVID-19 infections. "This is a serious challenge at any time, but COVID-19 has dramatically demonstrated just how important good hand hygiene practices are in reducing the risk of transmission, when used as part of a comprehensive package of preventative measures," the statement said.

According to the WHO, half of healthcare-acquired infections (HAIs) and three of four deaths related to antimicrobial resistance could be avoided by implementing effective IPC practices and programs including hand hygiene improvement strategies. Investing in effective IPC strategies could also yield significant financial returns; the WHO stated that implementation of hand hygiene policies could generate economic savings averaging 16 times the cost of their implementation.

Strong evidence points to IPC effectiveness of hand hygiene compliance monitoring

The mounting evidence (Vitalacy, 2020; Banks, 2021; Swanson, 2020; Roshan, 2020; Leis, 2020) demonstrating the correlation between hand hygiene compliance monitoring and reduced HAIs have led both the Joint Commission and the Leapfrog Group to stiffen their requirements. The Joint Commission now considers an observation of any “individual failure to perform hand hygiene in the process of direct patient care. . . as a deficiency resulting in a requirement for improvement” under its infection control standard. Meeting the Leapfrog Group’s hand hygiene standard necessitates the use of electronic hand hygiene compliance monitoring or direct observation in collecting compliance data on at least 200 hand hygiene opportunities each month (The Leapfrog Group, 2020).

Meeting these standards through direct observation each month requires significant labor expense; data gained through direct observation also tends to inflate results due to the Hawthorne effect (Vitalacy, 2021). An increasing number of health care organizations are choosing instead to use electronic hand hygiene compliance monitoring solutions offered by companies such as Vitalacy to meet Joint Commission and Leapfrog Group standards.

Electronic monitoring can improve hand hygiene compliance rates and contribute to reduced infections. Contact Vitalacy today for a demo!


Banks M & Phillips AB. Evaluating the effect of automated hand hygiene technology on compliance and C.difficile rates in a long-term acute care hospital. American Journal of Infection Control, June 2021;46(6):727-732.

The Leapfrog Group. Leapfrog Hospital Survey. Factsheet: Hand Hygiene. Last revision: 4/1/2020.

Leis JA, et al. Introduction of group electronic monitoring of hand hygiene on inpatient units: a multicenter cluster randomized quality improvement study. Clinical Infectious Diseases, Nov. 15, 2020;71(10):e680-e685.

Nour-Omid J. 5 studies show how direct observation inflates hand hygiene compliance rates due to Hawthorne effect. Vitalacy blog, May 17, 2021.

Roshan R, et al. Rigorous hand hygiene practices among health care workers reduce hospital-associated infections during the COVID-19 pandemic. Journal of Primary Care & Community Health, July 19, 2020;11:1-4.

Swanson S, et al. Implementation of a hospital-wide electronic hand hygiene monitoring program reduces healthcare-acquired infections in a level I trauma hospital. American Journal of Infection Control, August 2020;48(8):S55.

Tartari E, et al. Implementation of the infection prevention and control core components of the national level; a global situational analysis. Journal of Hospital Infection, Feb. 2021;108:94-103.

Vitalacy case study. Can improved hand-wash duration lead to zero infections? September 2020.

World Health Organization. WHO calls for better hand hygiene and other infection control practices. May 5, 2021.

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