Effective hand hygiene plays a critical role in preventing the transmission of pathogens in healthcare settings. Pathogens responsible for healthcare-associated infections (HAIs) can be transmitted through direct contact with contaminated hands, surfaces, or medical equipment. By practising proper hand hygiene, healthcare personnel can interrupt the chain of infection and protect patients from harm. The consequences of HAIs can be severe, leading to prolonged hospital stays, increased healthcare costs, and even mortality. Therefore, prioritising hand hygiene is essential for safeguarding patient well-being and maintaining the quality of healthcare delivery.

As Dr Janet Glowicz, an infection preventionist |at the Centers for Disease Control and Promotion’s Division of Healthcare Quality Promotion, explains how poor hand hygiene is one of the key factors contributing to the transmission of infections in healthcare facilities: “The hands of healthcare workers can easily spread infections in healthcare facilities. Very brief contact with surfaces in the patient environment, like bed rails, can allow germs to hitch a ride on the hands of healthcare workers and travel from one patient to the next.”

Infections that are transmitted as a result of poor hand hygiene are not necessarily being transmitted by skin-to-skin contact. “Also, people receiving care often have medical devices, like IVs, that might allow germs to enter their bodies,” continues Glowicz “There may be different germs in a healthcare facility than in the community, and there may be higher chances of encountering drug-resistant germs inside healthcare facilities.”

But just as important as practising hand hygiene is educating and promoting it. “Education and training for hand hygiene compliance and quality is very important and should be intended to not only improve healthcare providers’ practice but should also improve their attitude and morale towards patient safety,” explains Dr Shanina Knighton, associate professor at Case Western Reserve University and expert on infection prevention.

The total number of healthcare facilities used worldwide, where half lack the basic hygiene services and risk infection.

In a post-Covid-19 era, governments and healthcare organisations have become increasingly aware of the impact of HAIs. In fact, in 2023 the WHO released its first-ever research-based agenda on hand hygiene in healthcare settings. Working with experts from around the world over the space of two years, WHO were able to identify over 150 research priorities in the realm of hand hygiene, including the impact of hand hygiene on HAIs.

The report also found that most infections that are acquired in a healthcare setting can be completely prevented or avoided if basic hand hygiene services, such as hand washing facilities with water and alcohol-based hand rubs, were available in areas where patients receive care, and toilets. The report calculated that an estimated 3.85 billion worldwide use healthcare facilities and it is common knowledge that infections are more likely to be contracted in these settings.

Tackling challenges in hand hygiene compliance

Despite the clear benefits of hand hygiene, healthcare facilities often face challenges in ensuring consistent compliance among staff. Various factors contribute to suboptimal hand hygiene practices, including time constraints, inadequate resources, and lack of awareness. Additionally, cultural, and behavioural barriers may hinder adherence to protocols, as some healthcare workers may underestimate the importance of hand hygiene or perceive it as inconvenient. Addressing these challenges requires a multifaceted approach that addresses both individual behaviours and systematic issues within healthcare organisations.

It is no secret that healthcare workers are overworked and healthcare facilities are underfunded. “The sheer number of times that hand cleaning is needed is a challenge. Sometimes a healthcare worker may clean their hands up to a hundred times during a shift. Slowing down and taking time to clean one’s hands, during a busy work shift is a challenge,” Glowicz adds.

To improve hand hygiene practices, hospitals must implement comprehensive hand hygiene programmes that address the root causes of non-compliance. Key components of effective programmes include leadership commitment, education and training, access to hand hygiene products, monitoring and feedback mechanisms, and integration of technology for enhanced compliance.

“All the supplies needed to clean the hands of healthcare workers need to be available within their workflow. Having hand sanitiser dispensers at the entry to a room and inside the room can help them have quick and easy access to supplies right where they are needed,” advises Glowicz.

While implementation of sanitising stations seems like an easy solution, a 2023 article published in the Journal of Current Infection Disease Reports, ‘Healthcare Personnel Hand Hygiene Compliance: Are We There Yet?’, found that these stations are frequently empty, broken, hard to find, or obstructed. Analysis of qualitative data on barriers to hand hygiene also found that in instances where there are barriers, such as sanitisers being broken or empty, healthcare practitioners often do not go out of their way to seek out functioning stations.

Strong leadership is essential for setting expectations, fostering a culture of safety, and holding staff accountable for their hand hygiene practices. Education and training programmes should emphasise the importance of hand hygiene, provide practical guidance on proper techniques, and raise awareness about the consequences of HAIs.

The future of hand hygiene

A 2023 systematic review titled ‘Hand hygiene practices for prevention of healthcare-associated infections associated with admitted infectious patients in the emergency department,’ published in the Irish Journal of Medical Science found that the most effective hand hygiene interventions were those that came in the form of education and training, especially when complemented by posters, feedbacks, presentations or simulations.

“Hand hygiene training should occur at a minimum annually. Facilities should consider scenario-based virtual-reality training and video training. Strategies that utilise social-media-based platforms for healthcare worker knowledge have also been shown to be effective. Furthermore, there are validated hand hygiene education training systems that exist to teach and assess hand hygiene technique,” says Knighton.

However, education should not just be for healthcare staff, Knighton emphasises: “Patients are at the centre of care and should be educated about infections and the risks associated with receiving healthcare.”

Improving hand hygiene practices will also require collaboration and synergy across healthcare systems and governments. A multidisciplinary approach that engages healthcare workers, infection prevention specialists, administrations and patients is indispensable for fostering sustainable improvement.

Specifically, hospitals should not underestimate the value of infection preventionists (Ips), Knighton insists – “Ips are important as it relates to investigating the source of infections and reinforcing low hand hygiene compliance through adequate programmes and coming up with practical policies that are tailored to unique care settings. Ips having the support of leadership can be critical to helping hospitals create a culture of accountability from the system down to each individual.”

With the rise of technological-based interventions and artificial intelligence in the realm of medicine, the future of hand hygiene is likely to also evolve to enhance patient care and infection control. “I see more technologies and resources that are enhanced to ensure that staff are given reminders at the point of care around the most important hand hygiene indications such as WHO’s ‘5 Moments for Hand Hygiene’ for which they can optimise patient safety,” explains Dr Knighton.

“Hand hygiene is a human-based behaviour that takes practice, correction, and reinforcement. Artificial intelligence cannot replace the need of human touch and the relationship between patients and providers however it can serve as a guide to ensure that love and care is spread and not germs by providing behavioural support to good hand hygiene practice.”

Improving hand hygiene practices is essential for reducing the spread of healthcare-associated infections and protecting patient safety. By implementing effective hand hygiene programmes, promoting behavioural change, leveraging technology, collaborating with stakeholders, and sustaining efforts over time, hospitals can make significant strides in preventing HAIs and improving the quality of care.