Research for infection protection
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  • Adenovirus
  • Aspergillus niger
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  • Candida albicans
  • Candida albicans
  • Coronavirus
  • Corynebacterium
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  • Helicobacter pylori

Author: Son C et al. Source: American Journal of Infection Control. 2011; 39(9):716-24


Son C et al.

Practically speaking: Rethinking hand hygiene improvement programs in healthcare settings

Hand hygiene is known to be the single most effective means to reduce health care infections. It includes hand-washing with either soap and water or the use of an alcohol-based hand rub before entering and after exiting a room. Increased hand hygiene compliance is now required from leadership at both the individual hospital level and outside regulatory agencies. Despite the existence of hand hygiene guidelines, few concrete and practical strategies are available and most studies are limited to intensive care unit settings. The Memorial Sloan-Kettering Cancer Center in New York City developed a new approach to measuring, monitoring and increasing hand hygiene compliance. They implement a more sustainable program for peer-based direct observations of hand hygiene across all inpatient, outpatient and regional sites throughout their institution.


Multidisciplinary teams were assembled with representation from nurses, physicians, patient care technicians and environmental service staff. Each team comprised between five and ten health care workers, one quality assessment representative and one or more infection prevention practitioners. These teams set up their own hand hygiene compliance goal, based on the WHO hand hygiene guidelines. Within a time frame of twelve weeks they diagrammed detailed workflows of several of their most common patient care tasks like blood sample collection, physical assessment and bathing. Wherever hand hygiene was indicated, the workflow was marked with a number corresponding to one or more of the WHO’s “5 moments for hand hygiene”. At the end of the 12-week period, staff members were trained to observe each other and began officially collecting and submitting data to infection prevention. Trained observers performed direct observations once per quarter on a random, unannounced day within a designated month. All staff members were observed for either 15 minutes or 5 complete patient encounters.


To date, approximately 50 hand hygiene teams have completed the project and now perform quarterly observations. The program was implemented across the institution between 2008 and 2010. Between 2006 and 2008 the average hand hygiene compliance of the Memorial Sloan-Kettering Cancer Center held steady at 65%. After the new program was launched in 2008, compliance reached 97% and remained steady at this level ever since.


The implementation of workflow-diagrams, including the feedback of hand hygiene compliance rates, may help health care institutions to increase a sustainable compliance.

American Journal of Infection Control. 2011; 39(9):716-24

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Additional information on hand hygiene programmes is available under CENTER.