15 or 30 Seconds: Hand Hygiene Duration - Does it Matter?

Updated: May 11



Since Vitalacy published the original version of this blog article about two years ago, hand hygiene experts have gained further insights about the impact of hand-wash duration on controlling healthcare-associated infections (HAIs) – the most commonly occurring adverse events in healthcare settings worldwide.


The World Health Organization estimates that hundreds of millions of patients acquire HAIs every year. According to the Centers for Disease Control and Prevention (CDC, 2018), on any given day, about one in 31 hospitalized patients has at least one HAI. These infections can lead to highly unfavorable or fatal outcomes.


Success story correlates hand-wash duration with reduced infections


Infection control results achieved through Vitalacy’s partnership with St. Mary’s Healthcare System for Children demonstrated that extending hand-wash duration can indeed reduce infection rates. St. Mary’s long-term-care nursery unit began using Vitalacy’s hand hygiene compliance monitoring solution to measure hand-wash duration in November 2019. At this time, St. Mary’s team members were washing their hands for an average of less than five seconds, according to the solution’s duration measure.


In the successive months, staff extended average duration, reaching 5.2 seconds in February 2020, 8.0 seconds in March, 11 seconds in April, and 12.6 seconds in May 2020. Since then, St. Mary’s team members have held average duration between 10.3 and 14.0 seconds each month through March 2021.


Infections decreased significantly as hand-wash duration increased. St. Mary’s averaged 11.8 HAIs per month during 2018-2019. In January and February 2020, St. Mary’s averaged 9.0 infections per month, but in March infections dropped to only one, coinciding with longer hand-wash duration and with the turning on of hand-wash reminder notices received through Vitalacy SmartBands worn on care providers’ wrists. There were no infections from April through October 2020, and November and December averaged 1.5 infections. Low infections continued into 2021.


“This can definitely be attributed to Vitalacy’s hand hygiene program,” said Judith Fine, St. Mary’s infection control director. The ability of Vitalacy’s system to measure hand-wash duration enables St. Mary’s to measure the correlation between duration and the number of infections. Bency Mathew, St. Mary’s assistant vice president of nursing services and system quality, said establishing a benchmark internally of between 20 to 30 seconds per wash holds people to a higher standard. “So while 15 seconds may be acceptable, we’re not going to settle for that,” she stated. “We want 20 to 30 seconds because then we can assure that more than 50% achieve 15 to 20 seconds. That’s the reality of all of this.” (Vitalacy, 2020)


Finding the sweet spot between hand-wash duration and compliance


Published literature shows that frequent handwashing in hospitals is the best way of reducing HAIs. But how long should a healthcare worker wash or sanitize his or her hands to achieve optimal hand hygiene?


Four different studies (Bin Abdulrahman, et al., 2019; Harnoss, et al., 2020; Kramer, et al., 2017; Pires, et al., 2017) show that hand-wash durations of 15 seconds are as effective as longer durations in reducing infections, and two of these studies (Harnoss, et al., 2020; Kramer, et al, 2017) showed that the shorter 15-second duration time resulted in better hand hygiene compliance. St. Mary’s experience was consistent with these four published studies, as its nursery unit saw infections decrease virtually to zero with wash durations of less than 15 seconds.


The latest hand hygiene guidelines


Hand-wash duration was an arcane subject to most people, but the COVID-19 pandemic made this topic top-of-mind for most of us, who now have heard of the CDC’s 20-second guideline (2020). That’s the length of the song Happy Birthday sung twice through. The agency also offers other kinds of handwashing advice at its “Clean Hands Save Lives” webpage. For health care providers, CDC (2021) recommendations suggest that hand hygiene should be carried out at seven key moments in healthcare settings, including before and after contact with patients.



The Future of Hand Hygiene


Better education on the importance of hand hygiene and more regular reminders, such as the kind received through Vitalacy’s SmartBands, are likely to help to improve hand hygiene duration and compliance rates, which are difficult to measure accurately without an electronic monitoring system.


Direct observation measures only a small percentage of these opportunities and inflates the compliance percentage because health care workers tend to practice better compliance when they know they are being observed than when they are not. Automated monitoring has the ability to capture true compliance by including all hand-wash opportunities in the measure (Cohen, 2021).

Vitalacy’s automated hand hygiene compliance monitoring solution continuously captures compliance and non-compliance events throughout your facility with real-time hand-wash reminders and duration measurement at point-of-care. With the capability of measuring how long care providers wash their hands and how often throughout the day, this technology was recently recognized in Newsweek’s “Best in HealthCare 2020” in partnership with the Leapfrog Group as one of the best monitoring products for infection prevention.



References


Bin Abdulrahman AK, et al. Do various personal hygiene habits protect us against influenza-like illness? BMC Public Health (2019) 19:1324.


Centers for Disease Control and Prevention. HAI Data, Oct. 5, 2018.

Centers for Disease Control and Prevention. Handwashing: Clean Hands Save Lives. When and how to wash your hands, Nov. 24, 2020.


Centers for Disease Control and Prevention. Hand hygiene in healthcare settings, Jan. 8, 2021.


Cohen T. Five quality indicators to consider in an automated hand hygiene compliance solution. Vitalacy Blog, March 22, 2021.


Harnoss JC, et al. Hand antisepsis without decreasing efficacy by shortening the rub-in time of alcohol-based handrubs to 15 seconds. Journal of Hospital Infection, April 1, 2020;104(4):419- 424.


Kramer A, et al. Shortening the application time of alcohol-based hand rubs to 15 seconds may improve the frequency of hand antisepsis actions in a neonatal intensive care unit. Infection Control & Hospital Epidemiology, December 2017;38(12):1430-1434.


Pires D, et al. Hand hygiene with alcohol-based hand rub: how long is long enough? Infection Control & Hospital Epidemiology, May 2017;38(5):547-552.


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

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