Hand hygiene
Hand hygiene improvement strategies: US vs UK
Gerry Laceydiscusses the changes in emphasis that are being driven in the US by the Leapfrog Group Hand Hygiene Standard and the lessons that can be learned in the UK.
Hand hygiene compliance is not just an issue in the UK, but worldwide, with compliance rates as low as 6%-14% when both the World Health Organization (WHO) Five Moments and Six-Step Hand Hygiene Technique are assessed. Hand hygiene strategies in both the UK and the US share many similarities due to the universal importance of infection control in healthcare. However, there are some differences, with significant recent developments in the US in terms of their regulations/standards, hand hygiene initiatives, how they monitor hand hygiene, and the commitment and buy-in from senior management. Healthcare facilities need support from the top to improve hand hygiene compliance rates. This is the only way that lasting change will happen. This article will describe hand hygiene improvement strategies in the US, and how this compares to strategies in the UK.
Hand hygiene worldwide stats Hand hygiene compliance is a worldwide concern, and various scientific studies assess the extent of the problem, its consequences, and potential solutions. To measure hand hygiene effectiveness, we must examine both “the when” and “the how” i.e. performed at one of the ‘Five Moments’ and using the WHO Hand Hygiene Technique. The true compliance rate is when hand hygiene has taken place at the right time and performed correctly. Currently, compliance with the ‘Five Moments’ is as low as 40%. 1
However, for the quality of hand hygiene
compliance is much lower at 8-15% 2,3,4 Over the past two decades, a wide range
of interventions and strategies have been introduced and studied to address this crucial issue. However, for a hand hygiene improvement strategy to be effective, it
must combine multiple interventions and techniques to maximise compliance with hand hygiene protocols and reduce the risk of healthcare-associated infections (HCAIs). The goal of a multimodal strategy is to address various aspects of hand hygiene, including education, behaviour change, infrastructure, and monitoring, to create a culture of hand hygiene excellence. A global review of 57 studies conducted between 2014–2020 assessing hand hygiene interventions found that both single intervention and multi-modal hand hygiene strategies can achieve improvements in hand hygiene compliance among healthcare workers. These interventions included: education and training; provision of hand hygiene infrastructure; reminders; performance feedback; teamwork interventions; and leadership interventions/ administrative support.5 At the forefront is the WHO Multimodal Hand Hygiene Improvement Strategy. This strategy
Electronic hand hygiene monitoring systems have gained significant traction in the US healthcare sector with them being installed at a rapid rate. As a result, healthcare facilities are now seeing associated increases in compliance.
is designed to improve hand hygiene practices in healthcare settings and to help reduce HCAIs. It has been shown as the most effective approach that results in significant compliance and knowledge improvement among healthcare workers.6
According to the WHO, hand hygiene
improvement programmes can prevent up to 50% avoidable infections acquired during health care delivery and generate economic savings on average 16 times the cost of implementation. A new standard in the United States which includes five domains: monitoring, feedback, training and education, infrastructure, and culture, also encourages facilities to adopt a multimodal approach to hand hygiene, with a significant emphasis on the importance of monitoring and feedback.
The Leapfrog Group Hand Hygiene Standard The Leapfrog Group in the US is a non-profit organisation focused on healthcare quality and safety. In 2019, they added a new hand hygiene standard to both the Leapfrog Hospital Survey and Leapfrog Ambulatory Surgery Center (ASC) Survey, which focuses on adherence to “best practice” hand hygiene practices. It was developed by a national Hand Hygiene Expert Panel and adapted from the WHO’s Hand Hygiene Self-Assessment Framework. The Leapfrog Group collects, analyses, and publishes
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