Strategies to Improve Hand Hygiene Practices

The Institute for Healthcare Improvement in its How-to Guide: Improving Hand Hygiene recommends a multidimensional approach (e.g., introduction of alcohol-based handrub, and educational and behavioral initiatives) to improve compliance with hand hygiene guidelines in healthcare settings.25 The science supporting a multidimensional approach to hand hygiene is sufficiently established to be considered the standard and consist of four components:2,3,11

  1. HCP demonstrate knowledge
    1. Predicated on educational exposure, HCP understand the rationale for hand hygiene:
      1. Types of patient care activities that result in hand contamination.
      2. Relative advantages and disadvantages of handwashing and the use of alcohol-based handrubs at the point of care
      3. Important role that contaminated hands play in transmission of healthcare-associated pathogens, including multidrug-resistant organisms.
      4. Morbidity and mortality caused by HAIs.
  2. HCP demonstrate competence
    1. Predicated on exposure to live demonstrations, video-presentations, and/or fluorescent dye-based training methods, HCP perform appropriate hand hygiene:
      1. Correct technique for handwashing, hand antisepsis, and surgical hand antisepsis
      2. Application of an appropriate volume of alcohol-based handrub, or a plain or antiseptic soap.
  3. Institution enables staff
    1. Predicated on institutional commitment to good hand hygiene practices:
      1. Alcohol-based handrub and gloves of various sizes are readily available to HCP near the point of use.
      2. Alcohol-based hand rub dispensers available in locations that are compliant with local and federal fire safety regulations.
      3. Established protocol with responsibility assigned for checking alcohol-based hand rub dispensers and glove boxes on a regular basis to ensure that (a) dispersers and glove boxes are not empty, (b) dispersers are operational, and (c) containers dispense the correct amount of the product.
      4. Evaluated the design and function of dispensers before selecting a product for use since poorly functioning dispensers may adversely affect hand hygiene compliance rates.
  4. Institution verifies competency of HCP and provides feed back
    1. Predicated on an established program to monitor that hand hygiene is performed and gloves are used appropriately by HCP as recommended by the CDC:
      1. Routinely using alcohol-based handrub when hands are not visibly soiled.
      2. Washing hands with plain or antimicrobial soap and water when hands are visibly dirty or contaminated with proteinaceous material or with blood and other potentially infectious material.
      3. Wearing gloves when contact with blood or OPIM (all body fluids, excretions, secretions [except sweat]), mucous membranes, and nonintact skin could occur
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