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Hand Hygiene: Back to Basics in Infection Prevention

Categories: Hand Hygiene, Healthcare-associated infections

Katherine Ellingson, PhD

Katherine Ellingson, PhD

Author – Kate Ellingson, Ph.D.
CDC Epidemiologist
CDC’s Division of Healthcare Quality Promotiona

Hand hygiene is a simple practice that has been at the core of infection prevention for over 150 years. Yet getting healthcare personnel to follow recommended hand hygiene practices in today’s complex and demanding healthcare environment continues to be a monumental challenge. Even in the developed world, adherence is estimated to be less than 50%, meaning healthcare personnel practice hand hygiene fewer than half of the times that they should.

In the past year, the visibility of novel strategies to improve hand hygiene in healthcare has increased — from technologies that can monitor and report hand hygiene performance in real time, to smartphone applications that streamline hand hygiene data collection by human observers, to financial incentive schemes that pay or fine healthcare personnel based on hand hygiene performance.  We at CDC are very interested and engaged in understanding how these strategies work, what their strengths and limitations are, and how feasible and affordable their implementation is. Creative or high-tech solutions must work in parallel with the fundamental building blocks of hand hygiene improvement: education, grassroots promotion, and leadership.

May 5th marks the annual call to action by the World Health Organization (WHO) to improve hand hygiene in healthcare settings across the world. To date more than 12,500 facilities have joined the "SAVE LIVES: Clean Your Hands campaign", including nearly 2,500 U.S. healthcare facilities.  This campaign is centers around the WHO’s multimodal hand hygiene improvement strategy, which includes as key elements: 1) system change, 2) training and education, 3) evaluation and feedback, 4) reminders in the workplace, and 5) institutional safety climate.

In support of this important global effort, we would like to highlight some important grass roots perspectives. In Part 2 of this blog, we will hear about efforts in the state of South Carolina, which has adopted WHO’s campaign strategy in a state-wide effort to improve hand hygiene. In Part 3 of this blog series, we will hear from Victoria Nahum, Executive Director of the Safe Care Campaign, who reminds us of the patient perspective and the valuable role that patients and family can play in patient safety.

We must do all we can to protect patients and ensure that patients within our healthcare facilities are receiving safe care.  We hope that some of the information provided in the next several blog posts will provide creative solutions for how to enhance hand hygiene compliance across healthcare settings.  In the meantime, tell us what has worked in your facility.

For more information about hand hygiene, including guidelines, promotional campaigns, and measurement tools and technologies, please visit the following websites:

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. March 15, 2012 at 9:43 am ET  -   Ng

    this is one of the things people take for granted at times.. I’m from Tallahassee and I’m not an OC, but I love washing my hands from time to time, especially when in contact with contaminated objects and the like… one thing though, what is the exact timing when washing hands? I mean how may minutes should it be done? I heard it’s about 2 min and then you rinse. Plus, people commonly use disinfectant, like alcohol, most of the time instead of water and soap. Is alcohol alone helpful? I mean, would it be okay to have disinfectant and not wash with water and soap ahead of time…?

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  2. December 13, 2011 at 3:36 pm ET  -   Deca durabolin 50 mg

    Congratulations on having one of the most sophisticated blogs I’ve came across in some time! Its just incredible how much you can take away from something simply because of how visually beautiful it is. Youve put together a great blog space great graphics, videos, layout. blogs.cdc.gov is definitely a must-see blog!

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  3. November 22, 2011 at 9:17 am ET  -   lighting manufacturers in the UK

    It’s nearly impossible to find knowledgeable individuals within this topic, however you sound like you know what you are speaking about! Thanks

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  4. October 17, 2011 at 12:47 pm ET  -   siriousfails

    Our hands containing so many infective germs because of working. This germs are able to harm our body parts.But this problem are solve able by using good hand hygiene.

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  5. August 13, 2011 at 12:28 am ET  -   Lucrecia Vidales

    Awesome article. I should comment a lot more but I am surfing on my small cell phone. I actually have saved this site and expect to comeback when I am home.

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  6. May 7, 2011 at 10:17 pm ET  -   roberta mikles

    Back to Basics – this is what I have been stating forever.. As a dialysis patient safety advocate, aware that infection is the number two killer of this vulnerable population, I can not understand why staff can not implement correct practices in dialysis units. Of course, not all staff, but when one looks at dialysis facility surveys and notes that out of 25 surveys conducted the first six months of 2010, 23 facilities had cited deficiencies in infection control…. the most basic of basic practices were not followed. SHAME on those providers who do not insist on effective unit-level supervision. With the new NQF measures, esp related to infection, nothing will change until providers realize that there needs to be increased staff education with rationale for why practices must be followed, increased patient education as to what staff will be implementing so that if correct practices are not performed, patients can remind staff, hopefully, without retaliation as happens in some units. The surveys speak for themselves. Unfortunately, providers do not educate patients on HOW staff will prevent infections. The dialysis setting is unique…. Personally, my father, since passed away, experienced major retaliation from staff when he spoke out to ensure correct practices were implemented. How dare a patient remind a staff person to wash their hands, or change their contaminated gloves!!! The patient’s expectation to receive quality safe care has come to a halt. It is an expectation and patients should not be worried if their staff are implementing correct practices.
    Roberta Mikles RN QualitySafePatientCare

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  7. May 6, 2011 at 9:38 am ET  -   Cassandra Palmer RN, CLNC /ICP

    With education and knowledge of all the new MDRO pathogens out there, staff has done well at hand hygiene after pt care.
    I see very little in the way of studies, articles or discussion about all the germs encountered by a healtcare workers hands in the hospital without touching a patient.
    The difficult part is getting staff to comply with good H.H. “before” patient contact.
    ICP Nurses and Joint comm are looking for Hand Hygiene before and after pt contact.
    It would be nice to have studies with evidence of the bacterias picked up after washing, then doing all the nursing functions (not including touchng another pt or pt belongings) which could be used as a teaching tool for staff.
    The concept of washing before seeing a patient, if you washed 1 hour ago after pt contact, is not catching on.
    The other big problem that I see is physicians/There are very few that practice good hand hygiene outside the office setting. (in the office when it is obvious to the pt, they do wash, but in the hospital I do not see it happening as it should)
    In the hospitals when a physician leaves a patients room there are very few that bother washing (some do) and I have never seen a physician wash hands before going into the patients room. Hospital education needs to be geared to physicians as well and have them held accountable in some way.

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  8. May 6, 2011 at 7:33 am ET  -   Aracely

    Operating room nurse and I am fully convinced of the importance and urgent need for hand washing among health care workers. Every day in my work environment I look at my colleagues, nurses, anesthesiologists, surgeons, nurses …. and the percentage of professionals who meet hygiene and proper technique, hand washing was significantly smaller. Personally I look like “a policeman” (this attitude is very unpleasant) without exception every day I talk with professionals to wash their hands before preparing medication before handling materials etc, etc, etc, etc ….. It is shameful and unacceptable that health staff can answer that comes to your home to work and clean, you just shower at home …… I’m a little tired of this topic but my conscience will not let me stay quiet.
    The big challenge is still pending with the washing of hands is the awareness of health personnel and I think that is the most difficult to achieve. Should be studied in a serious way, how to achieve health for all this change in consciousness. This topic fascinates me and would do anything for it. Thank you for your attention. Aracely

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  9. May 5, 2011 at 11:50 pm ET  -   John S Buck

    A further comment if I may: CLEAN YOUR HANDS is a universal war cry to prevent transmission of germs. Various CDC estimates include one that says “Up to 80% of germs are transmitted via contacts by the hands” . I understand that this may be a high number, relative to airborne transmission, but my work in breaking the cycle of hand transmission as we travel from building to building, or room to room, is still valid. Washing and decontamination using alcohol lotions is of course the best way of killing germs. My work on ‘avoidance’ of germs is also valid. A little motto I have is ‘Clean your hands and then keep them clean’. The CDC has often quoted that door knobs are the worst, or one of the worst offenders of spreading germs. It would be expected that wide spread use of hands-free handles such as mine would show a statistical improvement in germ transmission.
    I sincerely hope my comments are seriously considered.

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