Hand Hygiene Remains a Top Priority

National organizations join global push for increased hygiene tracking, facilitation, and education

Female doctor using hand sanitizer at the hospital

More than three years since the start of the COVID-19 pandemic, the World Health Organization (WHO) still lists the impact of hand hygiene on health and healthcare as one of its highest research priorities.

According to WHO, hand hygiene practice remains suboptimal worldwide despite being essential for health—with significant disparities existing between high- and low-income countries. Many infections acquired in healthcare settings can be prevented and avoided by proper hand hygiene. Yet, according to WHO, half of healthcare facilities worldwide lack the necessities for hand hygiene such as water, soap, or alcohol-based hand rub. Roughly 3.85 billion people use these facilities, putting them at greater risk of infection—including 688 million people who receive care at facilities with no hygiene services at all.

On May 5—World Hand Hygiene Day—WHO released its first-ever research agenda on hand
hygiene. Its Infection Prevention and Control (IPC) Technical and Clinical Hub launched a
variety of resources, including a new web page on basic intervention and prevention control and a new assessment tool for primary care facilities, as well as an inventory document and infographics for primary care settings.

U.S. healthcare centers aim for improved hygiene

On a national level, the Association for Professionals in Infection Control and Epidemiology (APIC) hosted a conference at the end of June where two health systems—University of Michigan Health in Ann Arbor, Michigan, and Newark Beth Israel Medical Center in Newark, New Jersey—reported improved hand hygiene compliance through the implementation of new programs.

According to Marie H. Wilson, APIC infection preventionist and chair of its communications
committee, the conference offered an opportunity for industry leaders in infection prevention to learn about different worldwide quality improvement initiatives.

“All of us recognize that hand hygiene is the single most effective way of preventing the spread of infections. And so certainly, though it’s not in itself a novel activity, it is definitely something that is at the foundation of every infection prevention and control program,” Wilson said. “We’re trying to break down any barriers that there may be to facilitating awareness, education, and excitement.… We were all taught how to wash our hands—and hopefully when to wash our hands—as young children, and we understand that it takes constant reminders to make sure that that gets facilitated.”

Measuring real-time compliance

In August 2018, University of Michigan Health transitioned from using static charts to creating dashboards that visualize hand hygiene compliance in real time. The medical
center’s staff generated weekly and monthly compliance reports and calculated the rate at
which healthcare workers cleaned their hands at appropriate moments. Details about specific missed opportunities, like failure to perform hand hygiene prior to utilizing personal protective equipment, were included.

A month after the infection prevention team implemented the dashboards, 19 of its units
improved to 95% compliance or greater from rates that were in the high 80s. From November 2018 to February 2020—the beginning of the pandemic—the hospital sustained a 95% or greater rate of adherence. Rates fell to 86% in March 2021 because the program was paused during the pandemic, but have risen to 98% as of April through the reintroduction and use of the new system.

Marissa Yee, University of Michigan Health infection preventionist, reported a 97% hand hygiene compliance for the month of May.

“We fully track right now, for reporting, cleaning before and after entering a patient space,” Yee said. “It’s really about education—educating patients and their family members, if they’re going to be taking care of the patient—to understand how important hand hygiene is.”

Monitoring hand-hygiene opportunities

Meanwhile, Newark Beth Israel Medical Center reported a 98% increase in hand hygiene
compliance with its new automated hand hygiene monitoring system (AHHMS). Initially trialed in 2019 and practiced for a three-week period in February 2022, medical center staff further utilized the AHHMS during a 56-week period from March 2022 to April 2023.

The AHHMS tracks opportunities for hand hygiene to calculate hand hygiene compliance,
which increased the median hand hygiene rate between 67% and 132%.

“The way to create an impact for hand hygiene is for us to understand the importance of hand hygiene, as it also is for us to understand the impacts of our hand hygiene behavior,” said Ndubuisi Eke-Okoro, Newark Beth Israel Medical Center infection preventionist and epidemiology specialist. “As we continue to incorporate that personal accountability that leads to change of culture towards prevention and control of any infection—that will always be in the mind of any employee or any person that is using hand hygiene.”

Keeping patients infection-free

WHO’s 2022 report states that seven out of 100 patients in high-income countries will acquire at least one healthcare-associated infection (HAI), while the same holds true for 15 out of 100 patients in low-income countries.

A 2019 survey that was part of the report revealed the urgent need to strengthen IPC intervention in primary care. No facility met all WHO minimum requirements for IPC in low-income countries, while only 26% did in high-income ones.

However, proper hygiene practices can achieve a 35 to 70% reduction in HAIs. WHO recommends better global education, prioritization, and research of factors that influence hand hygiene behavior.

According to the U.S. Centers for Disease Control and Prevention (CDC), proper hand
washing prevents not only illnesses but also spreading infections to others. Germs can get into the body through the eyes, nose, and mouth via unwashed hands, as well as into foods and drinks while people prepare or consume them.

In order to stay healthy, the CDC recommends that everyone wash their hands often—especially during these key times where the odds of getting and spreading germs are increased:

  • Before, during, and after preparing food
  • Before and after eating food
  • Before and after caring for someone who is
    sick with vomiting or diarrhea
  • Before and after treating a cut or wound
  • After using the toilet
  • After changing diapers or cleaning up a child who has used the toilet
  • After blowing your nose, coughing, or sneezing
  • After touching an animal, animal feed, or animal waste
  • After handling pet food or pet treats
  • After touching garbage.

Washing away fatal germs

The Global Handwashing Partnership reports that diarrhea and pneumonia are two of the most prominent illnesses that can be transmitted via hands. Globally, 525,000 children die from diarrheal diseases each year. Diarrheal diseases and pneumonia together account for more than 20% of deaths of children under 5 years old.

Though people worldwide often clean their hands with water, only an estimated 19% demonstrate proper rates of handwashing after using the toilet. Yet, a review of more than 40 studies published in the journal Tropical Medicine & International Health found that handwashing with soap can prevent nearly four of every 10 cases of diarrhea. Children living in households where soap is available and handwashing is actively promoted were also reported to have half the rates of diarrhea, compared to children living in households without these factors.

“According to the CDC, maintaining good hand hygiene is one of the most effective ways
to prevent infection. Hospitals having that dedication, enhancing patient outcome and
patient safety, is highly important for us to cultivate that kind of hygiene behavior in order
to improve our hand hygiene compliance postpandemic and toward the future,” Eke-Okoro
said. “It’s important for us to understand that hand hygiene is one of those tools that can be
used effectively to prevent any infection. So, cultivating those habits will drive a long way for
any healthcare provider or healthcare employee to understand the importance of hygiene.”

The Global Handwashing Partnership also reports that handwashing education within a
community can reduce the number of people who get sick with diarrhea by 23% to 40%, diarrheal illness in people with weakened immune systems by 58%, and respiratory illnesses in the general population by 16% to 21%.

“We still can prevent the next pandemic; we can still make sure that we are ready and that we are properly managing ourselves and our different tools to prevent infection,” Wilson said. “While it is related to the pandemic, it’s something that we’re always going to have to be making sure stays at the top of mind, of mainly healthcare workers, but really anybody that’s taking care of other people. The basics never stopped being the fundamental part of what we’re doing. We can add in exciting new initiatives or exciting new tools, but we’ll never stop needing these basic tools, of which hand hygiene is one.”

Ryan Kupperman

Ryan Kupperman, a former intern for CMM, is a class of 2025 undergraduate student at Elon University studying journalism with a minor in criminal justice studies. Kupperman also serves as managing editor of, the website of Elon University’s student-run, collegiate news organization. Contact him at [email protected].

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