Hand hygiene practices and behaviors are some of the most important factors in preventing the spread of viruses and bacteria. In fact, the Centers for Disease Control and Prevention estimates 80 percent of all infections are transmitted by hands. It should, therefore, be in everyone’s best interest to make sure that hand hygiene compliance rates are high. But what does this mean in practice?
Good hygiene practice and handwashing compliance is highly variable and in some cases can be as low as 10%. In one study of trained staff which included observations of over 31,000 food handling activities, hand hygiene malpractices occurred more frequently than any other kind.
Establishing a hand hygiene culture, an organization-wide belief that compliance with handwashing requirements is essential is the collective responsibility of everyone working in an environment – from senior management to the summer interns. An effective handwashing culture means that high rates of hand hygiene compliance cannot be seen as one-off achievements.
A positive hand hygiene culture should be considered a core business value. This culture will need to be collective, stable, learned and consistent in order to be successful.
Hand hygiene management, leadership and standards
Positive handwashing culture requires a significant management effort. Those in senior leadership roles play a key part in motivating employees, setting the strategy, values, priorities, expectations and culture for handwashing and changing an inappropriate culture. They should provide hand hygiene documentation which highlights the goals, standards and clear expectations that employees need to meet.
Communication of hand hygiene requirements
Once expectations have been formalized, the requirements need to be communicated effectively to employees, for example, through training sessions or a formal hand hygiene communications policy. However, communicating effectively about handwashing is often difficult and even tailoring communication to different groups will only achieve limited success.
Establishing a hand hygiene culture, therefore, requires a multi-faceted approach that is both responsive and proactive.
Handwashing training and supervision
To make sure it is effective as possible, hygiene training is best performed on-site at the point of practice using an appropriate format. Organizations may also find that their effort to change behaviors will improve by introducing additional handwashing campaigns alongside training.
Demonstrating a commitment and support towards proper handwashing
If managers promote a positive hand hygiene culture where good hand hygiene is the norm and people feel safe to discuss issues openly, particularly when they see other co-workers being non-compliant, then they will feel motivated and committed to maintaining and enforcing hand washing for the long term.
Assessing and monitoring hand hygiene compliance
Hand hygiene assessment and monitoring will help organizations to determine if their hand hygiene culture is positive, and includes things like:
- The efficacy of the whole handwashing process
- The frequency of implementation
- The implementation of components of the handwashing process
- Paper towel usage
- Staff barriers to compliance
A number of methods exist to assess and monitor handwashing compliance, including recorded observations, electronic monitoring via sensors, and microbiological testing.
Provision of consequences
Behavior is often influenced by the perception of consequences. Unfortunately, undue emphasis is often placed on punishment (for non-compliance) rather than rewards for compliance. Performance can be improved by providing recognition, praise and financial incentives for good compliance. Equally any sanctions or reprimands should be preceded by an investigation into why individuals are not complying. Any organizational barriers identified can then be removed, and alternative strategies developed.
Finally, organizations should be aware that good hand hygiene is a journey, not a destination. Introducing a continuous cycle of improvement – for example, based on the Plan, Do, Check and Act (PDCA) methodology – is a particularly good idea if managers want to make sure their improvement is both well planned and responsive to change.
Hand washing is crucial in a collaborative work environment. But considerable ongoing effort is required to make this happen. Positive hand hygiene culture will not happen by accident. Developing a positive hand hygiene culture should be implemented as part of a series of steps of continuous improvement, which will result in a safer environment for all.