Hand Hygiene: Back to Basics in Infection Prevention

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:

• • The Centers for Disease Control and Prevention (CDC): Guideline for Hand Hygiene in Healthcare Settings
  • World Health Organization (WHO) “Save Lives: Clean Your Hands”
  • WHO: Guidelines on Hand Hygiene in Health Care
  • WHO:  Hand Hygiene: Why, How & When?
  • Hand Hygiene Resource Center: Hand Hygiene Presentation

Kate Ellingson is an epidemiologist at the Centers for Disease Control and Prevention (CDC) in the Division of Healthcare Quality Promotion (DHQP). She began her CDC career in 2006 in the Epidemic Intelligence Service, where she spent two years with DHQP investigating the transmission of infectious pathogens in healthcare settings and evaluating prevention initiatives designed to reduce such infections. She has worked on several projects specific to Methicillin-Resistant Staphylococcus aureus (MRSA), including an evaluation of an initiative to reduce MRSA transmission in VA hospitals, an assessment of antimicrobial resistance on the US-Mexico border, and a policy analysis of a state mandate for public reporting of hospital-associated MRSA infections. Dr. Ellingson has worked internationally in Kenya and Uganda to build infection control capacity and reduce amplification of outbreaks in East African hospitals. She has also led domestic investigations into quality of care for dialysis patients and for transfusion and transplant recipients. Her current position emphasizes quantitative statistical analysis and the translation of CDC-guidelines into feasible practices.