Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Infection
Published in: Infection 5/2010

01-10-2010 | Review

Educating healthcare workers to optimal hand hygiene practices: addressing the need

Authors: E. Mathai, B. Allegranzi, W. H. Seto, M.-N. Chraïti, H. Sax, E. Larson, D. Pittet

Published in: Infection | Issue 5/2010

Login to get access

Abstract

The education of healthcare workers is essential to improve practices and is an integral part of hand hygiene promotional strategies. According to the evidence reviewed here, healthcare worker education has a positive impact on improving hand hygiene and reducing healthcare-associated infection. Detailed practical guidance on steps for the organization of education programmes in healthcare facilities and teaching–learning strategies are provided using the World Health Organization (WHO) Guidelines for Hand Hygiene in Health Care as the basis for recommendations. Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools developed by WHO for education, monitoring and performance feedback.
Literature
1.
Pittet D, Simon A, Hugonnet S, Pessoa-Silva CL, Sauvan V, Perneger TV. Hand hygiene among physicians: performance, beliefs, and perceptions. Ann Int Med. 2004;141:1–8.PubMed
2.
Kretzer EK, Larson EL. Behavioral interventions to improve infection control practices. Am J Infect Control. 1998;26:245–53.CrossRefPubMed
3.
Whitby M, McLaws M-L, Ross RW. Why healthcare workers don’t wash their hands: a behavioral explanation. Infect Control Hosp Epidemiol. 2006;27:484–92.CrossRefPubMed
4.
Sax H, Uckay I, Richet H, Allegranzi B, Pittet D. Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns. Infect Control Hosp Epidemiol. 2007;28:1267–74.CrossRefPubMed
5.
Whitby M, Pessoa-Silva CL, McLaws ML, et al. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect. 2007;65:1–8.CrossRefPubMed
6.
7.
Pittet D, Hugonnet S, Harbarth S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet. 2000;356:1307–12.CrossRefPubMed
8.
Larson EL, Early E, Cloonan P, Sugrue S, Parides M. An organizational climate intervention associated with increased handwashing and decreased nosocomial infections. Behav Med. 2000;26:14–22.CrossRefPubMed
9.
Grayson ML, Jarvie LJ, Martin R, et al. Significant reductions in methicillin-resistant Staphylococcus aureus bacteraemia and clinical isolates associated with a multisite, hand hygiene culture-change program and subsequent successful statewide roll-out. Med J Aust. 2008;188:633–40.PubMed
10.
Pittet D. Hand hygiene: improved standards and practice for hospital care. Curr Opin Infect Dis. 2003;16:327–35.PubMed
11.
Whitby M, McLaws ML, Slater K, Tong E, Johnson B. Three successful interventions in health care workers that improve compliance with hand hygiene: is sustained replication possible? Am J Infect Control. 2008;36:349–55.CrossRefPubMed
12.
Larson EL, Quiros D, Lin SX. Dissemination of the CDC’s hand hygiene guideline and impact on infection rates. Am J Infect Control. 2007;35:666–75.CrossRefPubMed
13.
World Health Organization. Guidelines for hand hygiene in health care. Geneva: World Health Organization; 2009.
14.
British Medical Association Board of Science. Tackling healthcare associated infections through effective policy action. London: British Medical Association; 2009.
15.
Boyce JM, Pittet D. Guideline for hand hygiene in health-care settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. Morb Mortal Wkly Rep. 2002;51:1–45.
16.
Allegranzi B, Pittet D. The role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73:305–15.CrossRefPubMed
17.
National Health Service Centre for Reviews and Dissemination. Getting evidence into practice. Effect Health Care Bull. 1999;5:1–15.
18.
Grimshaw J, Eccles M, Tetroe J. Implementing clinical guidelines: current evidence and future implications. J Contin Educ Health Prof. 2004;24(Suppl 1):S31–7.CrossRefPubMed
19.
Jamtvedt G, Young JM, Kristoffersen DT, O’Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2006;2:CD000259.PubMed
20.
Naikoba S. Hayward A: the effectiveness of interventions aimed at increasing handwashing in healthcare workers—a systematic review. J Hosp Infect. 2001;47:173–80.CrossRefPubMed
21.
Aboelela SW, Stone PW, Larson EL. Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature. J Hosp Infect. 2007;66:101–8.CrossRefPubMed
22.
Safdar N, Abad C. Educational interventions for prevention of healthcare-associated infection: a systematic review. Crit Care Med. 2008;36:933–40.CrossRefPubMed
23.
Lee TC, Moore C, Raboud JM, et al. Impact of a mandatory infection control education program on nosocomial acquisition of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2009;30:249–56.CrossRefPubMed
24.
Wisniewski MF, Kim S, Trick WE, Welbel SF, Weinstein RA. Effect of education on hand hygiene beliefs and practices: a 5-year program. Infect Control Hosp Epidemiol. 2007;28:88–91.CrossRefPubMed
25.
Pessoa-Silva CL, Hugonnet S, Pfister R, et al. Reduction of health care associated infection risk in neonates by successful hand hygiene promotion. Pediatrics. 2007;120:e382–90.CrossRefPubMed
26.
Widmer AF, Conzelmann M, Tomic M, Frei R, Stranden AM. Introducing alcohol-based hand rub for hand hygiene: the critical need for training. Infect Control Hosp Epidemiol. 2007;28:50–4.CrossRefPubMed
27.
Trick WE, Vernon MO, Welbel SF, Demarais P, Hayden MK, Weinstein RA. Multicenter intervention program to increase adherence to hand hygiene recommendations and glove use and to reduce the incidence of antimicrobial resistance. Infect Control Hosp Epidemiol. 2007;28:42–9.CrossRefPubMed
28.
Raskind CH, Worley S, Vinski J, Goldfarb J. Hand hygiene compliance rates after an educational intervention in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2007;28:1096–8.CrossRefPubMed
29.
Caniza MA, Maron G, Moore EJ, Quintana Y, Liu T. Effective hand hygiene education with the use of flipcharts in a hospital in El Salvador. J Hosp Infect. 2007;65:58–64.CrossRefPubMed
30.
Benton C. Hand hygiene: meeting the JCAHO safety goal: can compliance with CDC hand hygiene guidelines be improved by a surveillance and educational program? Plast Surg Nurs. 2007;27:40–4.PubMed
31.
Howard DP, Williams C, Sen S, et al. A simple effective clean practice protocol significantly improves hand decontamination and infection control measures in the acute surgical setting. Infection. 2009;37:34–8.CrossRefPubMed
32.
Laustsen S, Bibby BM, Kristensen B, Moller JK, Thulstrup AM. E-learning may improve adherence to alcohol-based hand rubbing: a cohort study. Am J Infect Control. 2009;37:565–8.CrossRefPubMed
33.
Sandora TJ, Taveras EM, Shih MC, et al. A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home. Pediatrics. 2005;116:587–94.CrossRefPubMed
34.
Falsey AR, Criddle MM, Kolassa JE, McCann RM, Brower CA, Hall WJ. Evaluation of a handwashing intervention to reduce respiratory illness rates in senior day-care centers. Infect Control Hosp Epidemiol. 1999;20:200–5.CrossRefPubMed
35.
Bowen A, Ma H, Ou J, et al. A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. Am J Trop Med Hyg. 2007;76:1166–73.PubMed
36.
Luby SP, Agboatwalla M, Feikin DR, et al. Effect of handwashing on child health: a randomised controlled trial. Lancet. 2005;366:225–33.CrossRefPubMed
37.
Assanasen S, Edmond M, Bearman G. Impact of 2 different levels of performance feedback on compliance with infection control process measures in 2 intensive care units. Am J Infect Control. 2008;36:407–13.CrossRefPubMed
38.
Hugonnet S, Perneger TV, Pittet D. Alcohol-based handrub improves compliance with hand hygiene in intensive care units. Arch Int Med. 2002;162:1037–43.CrossRef
39.
Tibballs J. Teaching hospital medical staff to handwash. Med J Aust. 1996;164:395–8.PubMed
40.
Harbarth S, Pittet D, Grady L, et al. Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance. Pediatr Infect Dis J. 2002;21:489–95.CrossRefPubMed
41.
Duggan JM, Hensley S, Khuder S, Papadimos TJ, Jacobs L. Inverse correlation between level of professional education and rate of handwashing compliance in a teaching hospital. Infect Control Hosp Epidemiol. 2008;29:534–8.CrossRefPubMed
42.
Donowitz LG. Handwashing technique in a pediatric intensive care unit. Am J Dis Child. 1987;141:683–5.PubMed
43.
Lam BC, Lee J, Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics. 2004;114:e565–71.CrossRefPubMed
44.
Cole M. Exploring the hand hygiene competence of student nurses: a case of flawed self assessment. Nurse Educ Today. 2009;29:380–8.CrossRefPubMed
45.
Ferguson JK. Preventing healthcare-associated infection: risks, healthcare systems and behaviour. Intern Med J. 2009;39:574–81.CrossRefPubMed
46.
Buffet-Bataillon S, Leray E, Poisson M, Michelet C, Bonnaure-Mallet M, Cormier M. Influence of job seniority, hand hygiene education, and patient-to-nurse ratio on hand disinfection compliance. J Hosp Infect. 2010 (e-pub ahead of print).
47.
Seto WH, Ching TY, Chu YB, Ong SG. Brief report: a scheme to review infection control guidelines for the purpose of implementation in the hospital. Infect Control Hosp Epidemiol. 1990;11:255–7.CrossRefPubMed
48.
McKinley T, Gillespie W, Krauss J, et al. Focus group data as a tool in assessing effectiveness of a hand hygiene campaign. Am J Infect Control. 2005;33:368–73.CrossRef
49.
Erasmus V, Brouwer W, van Beeck EF, et al. A qualitative exploration of reasons for poor hand hygiene among hospital workers: lack of positive role models and of convincing evidence that hand hygiene prevents cross-infection. Infect Control Hosp Epidemiol. 2009;30:415–9.CrossRefPubMed
50.
Barrett R, Randle J. Hand hygiene practices: nursing students’ perceptions. J Clin Nurs. 2008;17:1851–7.CrossRefPubMed
51.
Ching TY, Seto WH. Evaluating the efficacy of the infection control liaison nurse in the hospital. J Adv Nurs. 1990;15:1128–31.CrossRefPubMed
52.
Anderson L, Krathwohl D. A taxonomy for learning, teaching, assessing: a revision of Bloom’s taxonomy of educational objectives. New York: Addison-Wesley, Longman; 2001.
53.
Sax H, Allegranzi B, Uckay I, Larson E, Boyce J, Pittet D. ‘My five moments for hand hygiene’: a user-centred design approach to understand, train, monitor and report hand hygiene. J Hosp Infect. 2007;67:9–21.CrossRefPubMed
54.
Thangaratinam S, Barnfield G, Weinbrenner S, et al. Teaching trainers to incorporate evidence-based medicine teaching in clinical practice: the EU-EBM project. BMC Med Educ. 2009;9:59.CrossRefPubMed
55.
Hautemaniere A, Diguio N, Daval MC, Hunter PR, Hartemann P. Short-term assessment of training of medical students in the use of alcohol-based hand rub using fluorescent-labeled hand rub and skin hydration measurements. Am J Infect Control. 2009;37:338–40.CrossRefPubMed
56.
Atack L, Luke R. Improving infection control competency through an online learning course. Nurs Times. 2009;105:30–2.PubMed
57.
Yu S, Chen IJ, Yang KF, Wang TF, Yen LL. A feasibility study on the adoption of e-learning for public health nurse continuing education in Taiwan. Nurse Educ Today. 2007;27:755–61.CrossRefPubMed
58.
Nicol PW, Watkins RE, Donovan RJ, Wynaden D, Cadwallader H. The power of vivid experience in hand hygiene compliance. J Hosp Infect. 2009;72:36–42.CrossRefPubMed
59.
Seto WH, Ching TY, Yuen KY, Chu YB, Seto WL. The enhancement of infection control in-service education by ward opinion leaders. Am J Infect Control. 1991;19:86–91.CrossRefPubMed
60.
Seto WH. Staff compliance with infection control practices: application of behavioural sciences. J Hosp Infect. 1995;30(Suppl):107–15.CrossRefPubMed
61.
Institute for Healthcare Improvement. How-to guide: improving hand hygiene. Cambridge: Institute for Healthcare Improvement; 2006.
62.
Gould DJ, Chudleigh JH, Moralejo D, Drey N. Interventions to improve hand hygiene compliance in patient care. Cochrane Database Syst Rev. 2007;2:CD005186.PubMed
63.
Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis. 2001;7:234–40.CrossRefPubMed
64.
Larson EL, Bryan JL, Adler LM, Blane C. A multifaceted approach to changing handwashing behavior. Am J Infect Control. 1997;25:3–10.CrossRefPubMed
65.
Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Ann Intern Med. 1999;130:126–30.PubMed
66.
Pittet D. Improving compliance with hand hygiene in hospitals. Infect Control Hosp Epidemiol. 2000;21:381–6.CrossRefPubMed
67.
Lawton RM, Turon T, Cochran RL, Cardo D. Prepackaged hand hygiene educational tools facilitate implementation. Am J Infect Control. 2006;34:152–4.CrossRefPubMed
68.
World Health Organization Patient Safety. A guide to the implementation of the WHO multimodal hand hygiene improvement strategy. Geneva: World Health Organization Patient Safety; 2009.
69.
Rosenthal VD, McCormick RD, Guzman S, Villamayor C, Orellano PW. Effect of education and performance feedback on handwashing: the benefit of administrative support in Argentinean hospitals. Am J Infect Control. 2003;31:85–92.CrossRefPubMed
70.
Amazian K, Abdelmoumene T, Sekkat S, et al. Multicentre study on hand hygiene facilities and practice in the Mediterranean area: results from the NosoMed Network. J Hosp Infect. 2006;62:311–8.CrossRefPubMed
71.
Farmer AP, Legare F, Turcot L, et al. Printed educational materials: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2008;3:CD004398.PubMed
Metadata
Title
Educating healthcare workers to optimal hand hygiene practices: addressing the need
Authors
E. Mathai
B. Allegranzi
W. H. Seto
M.-N. Chraïti
H. Sax
E. Larson
D. Pittet
Publication date
01-10-2010
Publisher
Urban and Vogel
Published in
Infection / Issue 5/2010
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI
https://doi.org/10.1007/s15010-010-0047-7

Other articles of this Issue 5/2010

Infection 5/2010 Go to the issue

Clinical and Epidemiological Study

Seroepidemiology of parvovirus B19 in the Frankfurt am Main area, Germany: evaluation of risk factors

Brief Report

Long-term protection against hepatitis B after newborn vaccination: 20-year follow-up

Case Report

Molecular characterization of occult and overt hepatitis B (HBV) infection in an HIV-infected person with reactivation of HBV after antiretroviral treatment interruption

Clinical and Epidemiological Study

Long-term persistence of MRSA in re-admitted patients

Brief Report

Impact of herpes simplex virus detection in respiratory specimens of patients with suspected viral pneumonia

Brief Report

Candida rugosa: a possible emerging cause of candidaemia in trauma patients
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Pediatric Cardiology Video

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

Cardiopulmonary Comorbidity Video

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Valvular Heart Disease Video

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits