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Hand Hygiene Long Term Care LTX

Moving from Good to Great Hand Hygiene Pays Off

Megan DiGiorgio

8/29/2016


By Megan J. DiGiorgio, MSN, RN, CIC, FAPIC


Clinical Specialist, GOJO Industries

Is there a point of diminishing returns when it comes to hand hygiene? A newly published study conducted at University of North Carolina Hospitals recently helped us answer that very question and reported what many of us already suspected: more compliance with hand hygiene actually yields better results in terms of healthcare-associated infection (HAI) reduction.1 What’s impressive about this study is that the healthcare facility where it was conducted already had what is considered “high” compliance rates (82.6%).2 So, how did they accomplish this?

First, they altered the way they conducted hand hygiene observations, shifting from Infection Preventionists (IPs) directly observing healthcare workers (HCW) in a covert manner to HCW observing each other. Your initial reaction might be that of course hand hygiene improves when HCW observe each other because they are more likely to give “high marks” to their peers, but the study provides outcome data to support that this tactic did indeed work. (By the way, shifting the ownership of hand hygiene audits from IPs to frontline HCW is called “front-line-ownership” [FLO] 3 and by engaging the people who are closest to the problem, you are more likely to see success and sustain it).

Second, they simplified the message to “Clean In, Clean Out.” By doing so, they streamlined the process of conducting audits in a way that made it possible for anyone to conduct them, pretty much without training (although the authors did not state a lack of training). The authors noted an absence of measurement bias because the prior compliance as observed by IPs was very similar to the results of audits conducted by HCWs when they began the new FLO program.

Most importantly, staff was provided solid data in the form of healthcare-associated infection outcomes, which is the ultimate jackpot for any Infection Prevention program. In fact, the statistically significant decrease in HAIs was sustained over the course of the 17-month study period; further supporting this was not a case of “random things happen randomly.” In fact, during the study period, they saw 197 fewer infections and 22 fewer deaths.

Bottom line: Keep working at increasing your hand hygiene rates, even if they are already high. Better yet, if they aren’t high, work towards increasing your hand hygiene rates. It will pay off.  In fact, these researchers estimated savings of $5 million during their study.


1. Sickbert-Bennett EE, DiBiase LM, Schade Willis TM et al. Reduction of healthcare-associated infection by exceeding high compliance with hand hygiene practices. Emerg Infect Diseases. 2016;22:9 [Ahead of print/in press].
2. The Joint Commission. Measuring hand hygiene adherence: overcoming the challenges. 2009. Available from: http://www.jointcommission.org/assets/1/18/hh_monograph.pdf. Accessed December 11, 2015.
3. Zimmerman B, Reason P, Rykert L, Gitterman L, Christian J, Gardam M. Front-line ownership: generating a cure mindset for patient safety. Healthc Pap. 2013;13(1):6-22

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