Hand Washing Compliance


The Centers for Disease Control and Prevention first released formal written guidelines on handwashing in hospitals in 1975. That’s more than 40 years ago.  So…. why is this still an issue?  A variety of authors have provided both reasons for lack of compliance as well as strategies for improvement.  And, The Joint Commission continues to include hand washing compliance as a National Patient Safety Goal.  I’ve listed some good resources below:


APIC: Hand Hygiene

Beckers: 7 ways to improve hand hygiene, from hospital managers

CDC: Handwashing:  Clean Hands Save Lives

IHI Open School: How to Guide – Improving Hand Hygiene

  • TJC: Sustaining and Spreading Improvement in Hand Hygiene Compliance
    • The Joint Commission Journal on Quality and Patient Safety, January 2015, Volume 41, Number 1. Sustaining and Spreading Improvement in Hand Hygiene Compliance

World Health Organization: Five Moments


I frequently see examples of non-compliance with hand hygiene when I am doing mock surveys – even though – the data provided may show good compliance.  I also hear frustration from Infection Control Clinicians, Quality Managers and Senior Leaders about how to best measure hand hygiene compliance as well as how to motivate staff and providers.

So here’s seven tips that may help.

  1. Review the literature. Find out what experts are recommending and other hospitals are doing to increase compliance with handwashing.
  2. Don’t rely exclusively on secret shoppers. It’s OK to observe directly – and let staff know you’re observing.
  3. Ensure you have a statistically valid sample (3 observations is not enough)
  4. Include ALL Departments –including non-clinical departments – all levels of staff – and providers
  5. Develop audit tools specific to what you are observing (medication administration, catheter care, passing meal trays, preparing food, etc.)
  6. Observe procedures such as Wound debridement, PICC Line Insertion, IV insertion and document hand hygiene compliance
  7. Give Immediate Feedback! Don’t just aggregate the numbers.  Let staff know how they did.

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