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“We need to inject energy into promoting hand hygiene”


Compliance with hand hygiene in healthcare presents an ongoing challenge. Without it, microbes have an opportunity to spread, carrying the risk of patient harm, which can be fatal. Hand hygiene action, at the right time, can quite simply save a life.

Compliance with hand hygiene in healthcare presents an ongoing challenge. Without it, microbes have an opportunity to spread, carrying the risk of patient harm, which can be fatal. Hand hygiene action, at the right time, can quite simply save a life.

Hand hygiene is often described as the most important infection prevention intervention. There have been local, national and global campaigns as well as the publication four years ago of the World Health Organization’s Guidelines on Hand Hygiene in Healthcare. We have come to accept organisation-related changes such as the wider availability of handrubs.

However, to prevent staff desensitisation, hand hygiene improvement approaches must evolve. This includes how we talk about the issue, promotional and training options available, the way we monitor and provide feedback on compliance, and a willingness to be open to new ideas and innovative approaches.

By embracing the concepts of quality improvement, human factors, anthropology and other expertise about influencing behaviour change, we can face the challenge of ensuring hand hygiene at the right time, every time. Collaboration between a range of frontline staff and experts is crucial. It requires innovative thinking to be sure the WHO’s Five Moments for Hand Hygiene are practised. We should no longer accept the conventional thinking around hand hygiene. We need to look with critical and evidence-informed eyes at the way we train colleagues. We must ask how energy might be more effectively used to enhance hand hygiene practices, in an era when time and resources are at a premium.

Long-term sustained behaviour change of hand hygiene practices is still a considerable challenge, influenced by a complex interplay of factors. Improving hand hygiene requires so much more than promotion of alcohol handrubs and posters on the walls. WHO recommends a multimodal strategy. This includes addressing systems within organisations, training and education to be valid and engaging, sound monitoring and feedback, marketing and reminder prompts and ultimately changes to the organisation’s culture.

This strategy reminds us of some of the things we need to be energised about now, to make it more likely that hand hygiene occurs when it should and that its importance is finally understood and accepted.

In this issue in our inter-related articles, we call for a refocus on hand hygiene. The first article considers the importance of WHO’s Five Moments for Hand Hygiene. The second, by Professor Tricia Hart, looks at the role of leadership in hand hygiene improvement - a theme that has yet to be fully explored. The final article concentrates on ideas for re-energising the approach towards hand hygiene.

The vision of the Infection Prevention Society is that no person is harmed by a preventable infection. Together we need to take a leap forward with hand hygiene and embrace this call to action now.

Julie Storr is independent patient safety and infection prevention consultant and president of the Infection Prevention Society


Readers' comments (6)

  • Oh yes, absolutely agree with everything you say.

    Incidentally, when was the last time (if ever) you worked in a busy acute setting for a sustained period?

    Just asking.

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  • Anonymous | 20-Sep-2013 4:54 pm

    I wonder about this Quacks credibility as well !

    Working in a busy A&E department I wash my hands many, many times a day !

    Maybe I should undertake a "study" related to the frequency of my hand washing and then pontificate some nonsense about how many "infections" I have prevented.

    Many "infections" originate from patients ! They arrive in hospital having acquired their "infection" from the community in which they live !

    I am sick of being preached to !

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  • I applaud any approaches that improve hand hygiene rates. However when I carried out an observational audit of hand cleansing practices whilst undertaking the infection control course a few years ago, I discovered that there were many health workers with close patient contact, besides nursing and medical staff, who were given very little infection control guidance, and whose hand hygiene practices varied between no cleansing at all to a quick rub with a bit of alcohol gel!

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  • I spend a lot of time visiting hospitals and the staff I spend time with instinctively use the hand sanitizer on entering and leaving each ward and always wash their hands after being with a patient. What I always find annoying is that washrooms for patients are always so sterile and white - walls, sinks, toilets, handsoap dispensers, paper towel holders etc - and as we keep being informed that 1 in 4 patients has dementia and probably sight impairments, how are they supposed to find the soap and towels and wash after going to the toilet? If hygiene in hospitals is so important, why not provide the right products and perhaps infection control will improve without putting more pressure on nursing staff

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  • anon 5.32 - Julie Storr is far from being a 'quack' - perhaps you would like to read about her nursing career and subsequent contribution to world health and infection control.
    if we are going to be so critical about our colleagues and attempt to belittle them what hope do our patients have.

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  • Anonymous | 26-Sep-2013 5:34 pm

    A bit of over reaction from you. Are you going to play the "unprofessional" card? I notice that you missed the wider point made by the commentator you criticise. Oh my, what hope for our patients???!!!

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