engagement is critical to success . Facilitating engagement also requires utilizing peer networking to encourage persistent salience of hand hygiene . Studies have suggested that institutions may consider rewards or recognition for wards modeling good hand hygiene behaviors or improvement . Role modeling is another strategy , particularly when using physicians as hand hygiene champions , and there is also evidence that encouraging patients to take an active role in reminding doctors to perform hand hygiene , can work .
Education and training around proper hand hygiene is essential . Studies suggest educating providers on recommended indications and techniques for hand hygiene . Experts advise using educational tools that clearly define hand hygiene indications and teach the logic behind each one ( 5 Moments for Hand Hygiene ). The studies also suggest targeting education to specific groups or facility-specific knowledge gaps or misconceptions . Additionally , it is advised to assess competency regarding hand hygiene with tests of didactic knowledge and demonstration of proper hand hygiene techniques .
When it comes to hand hygiene execution , studies recommend providing access to alcohol-based handrub ( ABHR ) which has been shown to increase hand hygiene adherence . Institutions should educate around when it is appropriate to use ABHR and when hands must be washed with soap and water . It is also suggested to implement a multi-modal hand hygiene improvement program . A 2014 meta-analysis evaluated several bundle combinations and found that hand hygiene improvement bundles that included enhanced access to ABHR , education , reminders , feedback , and administrative support had a significant collective impact on hand hygiene adherence ; these are the same key elements included in WHO ’ s implementation guide ( 2009 ). It must be recognized that interventions must be ongoing to maintain behavior change and improved adherence . One of the critical components of execution is identifying barriers to hand hygiene specific to the unit or institution . A helpful process is to conduct a root-cause analysis to elucidate the most relevant causes of hand hygiene failure in their setting . This information is then used to create interventions specific to their needs .
The next key step is to focus on targeted behavior change . Studies suggest that this messaging should be motivational in nature rather than simply conveying information , and that an emphasis on personal responsibility and altruism are important .
Evaluation is the next step , measuring hand hygiene adherence performance . A combination of approaches may be most appropriate , and measurement may need to be adjusted for facility-specific needs .
The literature suggests it is important to provide meaningful feedback on hand hygiene performance with clear targets and an action plan in place for improving adherence . Studies say that feedback of hand hygiene adherence rates has long been recognized as an important component of multi-modal hand hygiene improvement programs , although researchers acknowledge that the independent impact of feedback apart from other bundled hand hygiene interventions is not known . Experts suggest that feedback may be most effective when provided more than once , when both verbal and written feedback are provided , and when a superior or colleague is responsible for the audit and feedback . Additionally , providing overall hand hygiene adherence rates for a facility may not be as effective as unit-based or role-based reports at identifying problem areas and planning focused training efforts . Using feedback to engage healthcare personnel in identifying problems at the individual hospital or unit level and use data to tailor ongoing interventions . If individually identified hand hygiene adherence rates are used , consider providing feedback privately versus in a public staff setting . Some facilities report hand hygiene adherence data in conjunction with hospital-associated infection rates . Although an association between hand hygiene and HAI reductions has been reported in the literature , the association may not be evident in individual unit or facility data because of confounding factors ( such as environmental cleanliness and small sample sizes ).
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