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Published in: Current Infectious Disease Reports 7/2023

26-05-2023 | Healthcare Associated Infections (ME Doll and B Rittmann, Section Editors)

Healthcare Personnel Hand Hygiene Compliance: Are We There Yet?

Authors: JoDee Armstrong-Novak, Hui Yu Juan, Kaila Cooper, Pamela Bailey

Published in: Current Infectious Disease Reports | Issue 7/2023

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Abstract

Purpose of Review

Poor hand hygiene is well documented as a factor in healthcare-associated infections and excellent rates of hand hygiene remains elusive.

Recent Findings

There is increased use of universal or increased gloving to minimize hand contamination, but its use does not replace hand hygiene opportunities. There is significant interest in electronic hand hygiene monitoring systems, but they are not without their unique issues. Behavioral psychology remains a significant factor in motivating hand hygiene behaviors; even in COVID-19, hand hygiene rates initially improved but trended down back to baseline while still dealing with the pandemic.

Summary

More emphasis should be placed on the how to properly perform hand hygiene and why it is so important, as well as the role of gloves, is needed. Continued investment and awareness of their status as role models from both system leadership and senior healthcare providers are needed.
Literature
1.
go back to reference Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73(4):305–15.CrossRefPubMed Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect. 2009;73(4):305–15.CrossRefPubMed
3.
go back to reference • Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, deKay K, Hoffmann KK, et al. SHEA/IDSA/APIC Practice Recommendation: strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol. 2023;1–22. A 2023 update to the hand hygiene compendium from a collaboration of national groups based in the United States. • Glowicz JB, Landon E, Sickbert-Bennett EE, Aiello AE, deKay K, Hoffmann KK, et al. SHEA/IDSA/APIC Practice Recommendation: strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol. 2023;1–22. A 2023 update to the hand hygiene compendium from a collaboration of national groups based in the United States.
5.
go back to reference Bingham J, Abell G, Kienast L, Lerner L, Matuschek B, Mullins W, et al. Health care worker hand contamination at critical moments in outpatient care settings. Am J Infect Control. 2016;44(11):1198–202.CrossRefPubMed Bingham J, Abell G, Kienast L, Lerner L, Matuschek B, Mullins W, et al. Health care worker hand contamination at critical moments in outpatient care settings. Am J Infect Control. 2016;44(11):1198–202.CrossRefPubMed
6.
go back to reference King MF, López-García M, Atedoghu KP, Zhang N, Wilson AM, Weterings M, et al. Bacterial transfer to fingertips during sequential surface contacts with and without gloves. Indoor Air. 2020;30(5):993–1004.CrossRefPubMed King MF, López-García M, Atedoghu KP, Zhang N, Wilson AM, Weterings M, et al. Bacterial transfer to fingertips during sequential surface contacts with and without gloves. Indoor Air. 2020;30(5):993–1004.CrossRefPubMed
8.
go back to reference Morbidity and Mortality Weekly Report. MMWR. Recommendations and reports. U.S. Department of Health and Human Services: Public Health Service, Centers for Disease Control, Epidemiology Program Office; 2002. p. 336. Morbidity and Mortality Weekly Report. MMWR. Recommendations and reports. U.S. Department of Health and Human Services: Public Health Service, Centers for Disease Control, Epidemiology Program Office; 2002. p. 336.
9.
go back to reference Lim F. Why Florence Nightingale still matters. Nursing 2023. 2010;40(11):46. Lim F. Why Florence Nightingale still matters. Nursing 2023. 2010;40(11):46.
11.
go back to reference Storr JA, Engineer C, Allan V. Save lives: clean your hands: a WHO patient safety initiative for 2009. World Hosp Health Serv Off J Int Hosp Fed. 2009;45(1):23–5. Storr JA, Engineer C, Allan V. Save lives: clean your hands: a WHO patient safety initiative for 2009. World Hosp Health Serv Off J Int Hosp Fed. 2009;45(1):23–5.
14.
go back to reference Boyce JM, Polgreen PM, Monsalve M, Macinga DR, Arbogast JW. Frequency of use of alcohol-based hand rubs by nurses: a systematic review. Infect Control Hosp Epidemiol. 2017;38(2):189–95.CrossRefPubMed Boyce JM, Polgreen PM, Monsalve M, Macinga DR, Arbogast JW. Frequency of use of alcohol-based hand rubs by nurses: a systematic review. Infect Control Hosp Epidemiol. 2017;38(2):189–95.CrossRefPubMed
15.
go back to reference Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010;31(3):283–94.CrossRefPubMed Erasmus V, Daha TJ, Brug H, Richardus JH, Behrendt MD, Vos MC, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010;31(3):283–94.CrossRefPubMed
16.
go back to reference Bredin D, O’Doherty D, Hannigan A, Kingston L. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect. 2022;1(130):20–33.CrossRef Bredin D, O’Doherty D, Hannigan A, Kingston L. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect. 2022;1(130):20–33.CrossRef
17.
go back to reference Erichsen Andersson A, Frödin M, Dellenborg L, Wallin L, Hök J, Gillespie BM, et al. Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study. BMC Health Serv Res. 2018;18(1):2.CrossRefPubMedPubMedCentral Erichsen Andersson A, Frödin M, Dellenborg L, Wallin L, Hök J, Gillespie BM, et al. Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study. BMC Health Serv Res. 2018;18(1):2.CrossRefPubMedPubMedCentral
18.
go back to reference Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis. 2013;13(10):843–51.CrossRefPubMed Allegranzi B, Gayet-Ageron A, Damani N, Bengaly L, McLaws ML, Moro ML, et al. Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: a quasi-experimental study. Lancet Infect Dis. 2013;13(10):843–51.CrossRefPubMed
19.
go back to reference • Smiddy MP, O’ Connell R, Creedon SA. Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. Am J Infect Control. 2015;43(3):269–74. This gives guidance to the motivating factors which should inform quality improvement efforts. • Smiddy MP, O’ Connell R, Creedon SA. Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. Am J Infect Control. 2015;43(3):269–74. This gives guidance to the motivating factors which should inform quality improvement efforts.
20.
go back to reference Pedersen L, Elgin K, Peace B, Masroor N, Doll M, Sanogo K, et al. Barriers, perceptions, and adherence: hand hygiene in the operating room and endoscopy suite. Am J Infect Control. 2017;45(6):695–7.CrossRefPubMed Pedersen L, Elgin K, Peace B, Masroor N, Doll M, Sanogo K, et al. Barriers, perceptions, and adherence: hand hygiene in the operating room and endoscopy suite. Am J Infect Control. 2017;45(6):695–7.CrossRefPubMed
21.
go back to reference Chang NCN, Reisinger HS, Jesson AR, Schweizer ML, Morgan DJ, Forrest GN, et al. Feasibility of monitoring compliance to the My 5 Moments and Entry/Exit hand hygiene methods in US hospitals. Am J Infect Control. 2016;44(8):938–40.CrossRefPubMed Chang NCN, Reisinger HS, Jesson AR, Schweizer ML, Morgan DJ, Forrest GN, et al. Feasibility of monitoring compliance to the My 5 Moments and Entry/Exit hand hygiene methods in US hospitals. Am J Infect Control. 2016;44(8):938–40.CrossRefPubMed
22.
go back to reference Armellino D, Hussain E, Schilling ME, Senicola W, Eichorn A, Dlugacz Y, et al. Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare. Clin Infect Dis. 2012;54(1):1–7.CrossRefPubMed Armellino D, Hussain E, Schilling ME, Senicola W, Eichorn A, Dlugacz Y, et al. Using high-technology to enforce low-technology safety measures: the use of third-party remote video auditing and real-time feedback in healthcare. Clin Infect Dis. 2012;54(1):1–7.CrossRefPubMed
23.
go back to reference Armellino D, Trivedi M, Law I, Singh N, Schilling ME, Hussain E, et al. Replicating changes in hand hygiene in a surgical intensive care unit with remote video auditing and feedback. Am J Infect Control. 2013;41(10):925–7.CrossRefPubMed Armellino D, Trivedi M, Law I, Singh N, Schilling ME, Hussain E, et al. Replicating changes in hand hygiene in a surgical intensive care unit with remote video auditing and feedback. Am J Infect Control. 2013;41(10):925–7.CrossRefPubMed
24.
go back to reference Schaffzin JK. Electronic hand hygiene monitoring systems are the wave of the future. Antimicrob Steward Healthc Epidemiol. 2022 ed;2(1):e89. Schaffzin JK. Electronic hand hygiene monitoring systems are the wave of the future. Antimicrob Steward Healthc Epidemiol. 2022 ed;2(1):e89.
25.
go back to reference Doll ME, Pierce JW. Electronic hand hygiene monitoring systems: not worth the costs. Antimicrob Steward Healthc Epidemiol. 2022 ed;2(1):e126. Doll ME, Pierce JW. Electronic hand hygiene monitoring systems: not worth the costs. Antimicrob Steward Healthc Epidemiol. 2022 ed;2(1):e126.
26.
go back to reference Le-Abuyen S, Ng J, Kim S, De La Franier A, Khan B, Mosley J, et al. Patient-as-Observer Approach: an alternative method for hand hygiene auditing in an ambulatory care setting. Am J Infect Control. 2014;42(4):439–42.CrossRefPubMed Le-Abuyen S, Ng J, Kim S, De La Franier A, Khan B, Mosley J, et al. Patient-as-Observer Approach: an alternative method for hand hygiene auditing in an ambulatory care setting. Am J Infect Control. 2014;42(4):439–42.CrossRefPubMed
27.
go back to reference Baloh J, Thom KA, Perencevich E, Rock C, Robinson G, Ward M, et al. Hand hygiene before donning nonsterile gloves: healthcare workers’ beliefs and practices. Am J Infect Control. 2019;47(5):492–7.CrossRefPubMedPubMedCentral Baloh J, Thom KA, Perencevich E, Rock C, Robinson G, Ward M, et al. Hand hygiene before donning nonsterile gloves: healthcare workers’ beliefs and practices. Am J Infect Control. 2019;47(5):492–7.CrossRefPubMedPubMedCentral
28.
go back to reference • Chang NCN, Reisinger HS, Schweizer ML, Jones ichael, Chrischilles E, Chorazy M, et al. Hand hygiene compliance at critical points of care. Clin Infect Dis. 2021;72(5):814–20. It is important to note that while we focus on the ‘Five moments,’ there may be more nuance than that. • Chang NCN, Reisinger HS, Schweizer ML, Jones ichael, Chrischilles E, Chorazy M, et al. Hand hygiene compliance at critical points of care. Clin Infect Dis. 2021;72(5):814–20. It is important to note that while we focus on the ‘Five moments,’ there may be more nuance than that.
29.
go back to reference Kirk J, Kendall A, Marx JF, Pincock T, Young E, Hughes JM, et al. Point of care hand hygiene—where’s the rub? A survey of US and Canadian health care workers’ knowledge, attitudes, and practices. Am J Infect Control. 2016;44(10):1095–101.CrossRefPubMed Kirk J, Kendall A, Marx JF, Pincock T, Young E, Hughes JM, et al. Point of care hand hygiene—where’s the rub? A survey of US and Canadian health care workers’ knowledge, attitudes, and practices. Am J Infect Control. 2016;44(10):1095–101.CrossRefPubMed
30.
go back to reference Cai H, Tyne IA, Spreckelmeyer K, Williams J. Impact of visibility and accessibility on healthcare workers’ hand-hygiene behavior: a comparative case study of two nursing units in an academic medical center. HERD Health Environ Res Des J. 2021;14(2):271–88.CrossRef Cai H, Tyne IA, Spreckelmeyer K, Williams J. Impact of visibility and accessibility on healthcare workers’ hand-hygiene behavior: a comparative case study of two nursing units in an academic medical center. HERD Health Environ Res Des J. 2021;14(2):271–88.CrossRef
31.
go back to reference Yin J, Schweizer ML, Herwaldt LA, Pottinger JM, Perencevich EN. Benefits of universal gloving on hospital-acquired infections in acute care pediatric units. Pediatrics. 2013;131(5):e1515-1520.CrossRefPubMed Yin J, Schweizer ML, Herwaldt LA, Pottinger JM, Perencevich EN. Benefits of universal gloving on hospital-acquired infections in acute care pediatric units. Pediatrics. 2013;131(5):e1515-1520.CrossRefPubMed
32.
go back to reference Harris AD, Pineles L, Belton B, Johnson JK, Shardell M, Loeb M, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA. 2013;310(15):1571–80.PubMedPubMedCentral Harris AD, Pineles L, Belton B, Johnson JK, Shardell M, Loeb M, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA. 2013;310(15):1571–80.PubMedPubMedCentral
33.
go back to reference Fuller C, Savage J, Besser S, Hayward A, Cookson B, Cooper B, et al. “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol. 2011;32(12):1194–9.CrossRefPubMed Fuller C, Savage J, Besser S, Hayward A, Cookson B, Cooper B, et al. “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves are worn. Infect Control Hosp Epidemiol. 2011;32(12):1194–9.CrossRefPubMed
34.
go back to reference Alhmidi H, Gonzalez-Orta M, Cadnum JL, Mana TSC, Jencson AL, Wilson BM, et al. Contamination of health care personnel during removal of contaminated gloves. Am J Infect Control. 2019;47(7):850–2.CrossRefPubMed Alhmidi H, Gonzalez-Orta M, Cadnum JL, Mana TSC, Jencson AL, Wilson BM, et al. Contamination of health care personnel during removal of contaminated gloves. Am J Infect Control. 2019;47(7):850–2.CrossRefPubMed
35.
go back to reference Rock C, Harris AD, Reich NG, Johnson JK, Thom KA. Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?—A randomized controlled trial. Am J Infect Control. 2013;41(11):994–6.CrossRefPubMedPubMedCentral Rock C, Harris AD, Reich NG, Johnson JK, Thom KA. Is hand hygiene before putting on nonsterile gloves in the intensive care unit a waste of health care worker time?—A randomized controlled trial. Am J Infect Control. 2013;41(11):994–6.CrossRefPubMedPubMedCentral
36.
go back to reference Haac B, Rock C, Harris AD, Pineles L, Stein D, Scalea T, et al. Hand hygiene compliance in the setting of trauma resuscitation. Injury. 2017;48(1):165–70.CrossRefPubMed Haac B, Rock C, Harris AD, Pineles L, Stein D, Scalea T, et al. Hand hygiene compliance in the setting of trauma resuscitation. Injury. 2017;48(1):165–70.CrossRefPubMed
37.
go back to reference Moore LD, Robbins G, Quinn J, Arbogast JW. The impact of COVID-19 pandemic on hand hygiene performance in hospitals. Am J Infect Control. 2021;49(1):30–3.CrossRefPubMed Moore LD, Robbins G, Quinn J, Arbogast JW. The impact of COVID-19 pandemic on hand hygiene performance in hospitals. Am J Infect Control. 2021;49(1):30–3.CrossRefPubMed
38.
go back to reference Hess OCR, Armstrong-Novak JD, Doll M, Cooper K, Bailey P, Godbout E, et al. The impact of coronavirus disease 2019 (COVID-19) on provider use of electronic hand hygiene monitoring technology. Infect Control Hosp Epidemiol. 2021;42(8):1007–9.CrossRefPubMed Hess OCR, Armstrong-Novak JD, Doll M, Cooper K, Bailey P, Godbout E, et al. The impact of coronavirus disease 2019 (COVID-19) on provider use of electronic hand hygiene monitoring technology. Infect Control Hosp Epidemiol. 2021;42(8):1007–9.CrossRefPubMed
39.
go back to reference Makhni S, Umscheid CA, Soo J, Chu V, Bartlett A, Landon E, et al. Hand hygiene compliance rate during the COVID-19 pandemic. JAMA Intern Med. 2021;181(7):1006–8.CrossRefPubMedPubMedCentral Makhni S, Umscheid CA, Soo J, Chu V, Bartlett A, Landon E, et al. Hand hygiene compliance rate during the COVID-19 pandemic. JAMA Intern Med. 2021;181(7):1006–8.CrossRefPubMedPubMedCentral
40.
go back to reference Erasmus V, Brouwer W, van Beeck EF, Oenema A, Daha TJ, Richardus JH, 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(5):415–9.CrossRefPubMed Erasmus V, Brouwer W, van Beeck EF, Oenema A, Daha TJ, Richardus JH, 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(5):415–9.CrossRefPubMed
41.
go back to reference • Park HY, Kim SK, Lim YJ, Kwak SH, Hong MJ, Mun HM, et al. Assessment of the appropriateness of hand surface coverage for health care workers according to World Health Organization hand hygiene guidelines. Am J Infect Control. 2014;42(5):559–61. It is not sufficient to just tell people how to wash their hands, but make sure they know how to do it, as this study effectively demonstrates the poor compliance with the actual technique. • Park HY, Kim SK, Lim YJ, Kwak SH, Hong MJ, Mun HM, et al. Assessment of the appropriateness of hand surface coverage for health care workers according to World Health Organization hand hygiene guidelines. Am J Infect Control. 2014;42(5):559–61. It is not sufficient to just tell people how to wash their hands, but make sure they know how to do it, as this study effectively demonstrates the poor compliance with the actual technique.
42.
go back to reference Korhonen A, Ojanperä H, Puhto T, Järvinen R, Kejonen P, Holopainen A. Adherence to hand hygiene guidelines – significance of measuring fidelity. J Clin Nurs. 2015;24(21–22):3197–205.CrossRefPubMed Korhonen A, Ojanperä H, Puhto T, Järvinen R, Kejonen P, Holopainen A. Adherence to hand hygiene guidelines – significance of measuring fidelity. J Clin Nurs. 2015;24(21–22):3197–205.CrossRefPubMed
43.
go back to reference Cure L, Van Enk R. Effect of hand sanitizer location on hand hygiene compliance. Am J Infect Control. 2015;43(9):917–21.CrossRefPubMed Cure L, Van Enk R. Effect of hand sanitizer location on hand hygiene compliance. Am J Infect Control. 2015;43(9):917–21.CrossRefPubMed
45.
go back to reference Talbot TR, Johnson JG, Fergus C, Domenico JH, Schaffner W, Daniels TL, et al. Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives. Infect Control Hosp Epidemiol. 2013;34(11):1129–36.CrossRefPubMed Talbot TR, Johnson JG, Fergus C, Domenico JH, Schaffner W, Daniels TL, et al. Sustained improvement in hand hygiene adherence: utilizing shared accountability and financial incentives. Infect Control Hosp Epidemiol. 2013;34(11):1129–36.CrossRefPubMed
46.
go back to reference Mackert M, Lazard A, Champlin S, Liang MC, Mabry A, Stroever S, et al. Take time. Save lives. Clean hands protect. A comparison of two hand hygiene health promotion posters. Am J Infect Control. 2014;42(5):530–2. Mackert M, Lazard A, Champlin S, Liang MC, Mabry A, Stroever S, et al. Take time. Save lives. Clean hands protect. A comparison of two hand hygiene health promotion posters. Am J Infect Control. 2014;42(5):530–2.
47.
go back to reference Temime L, Opatowski L, Pannet Y, Brun-Buisson C, Boëlle PY, Guillemot D. Peripatetic health-care workers as potential superspreaders. Proc Natl Acad Sci. 2009;106(43):18420–5.CrossRefPubMedPubMedCentral Temime L, Opatowski L, Pannet Y, Brun-Buisson C, Boëlle PY, Guillemot D. Peripatetic health-care workers as potential superspreaders. Proc Natl Acad Sci. 2009;106(43):18420–5.CrossRefPubMedPubMedCentral
Metadata
Title
Healthcare Personnel Hand Hygiene Compliance: Are We There Yet?
Authors
JoDee Armstrong-Novak
Hui Yu Juan
Kaila Cooper
Pamela Bailey
Publication date
26-05-2023
Publisher
Springer US
Published in
Current Infectious Disease Reports / Issue 7/2023
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI
https://doi.org/10.1007/s11908-023-00806-8
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