SHEA’ s recommendations say facilities should monitor adherence to hand hygiene, considering the advantages and limitations of each type of monitoring.”
The SHEA Compendium is a great document. We use that as the basis for our system’ s hand hygiene policy because it’ s very well written and accessible.”
— Erica Shenoy, MD, PhD contamination when part of contact precautions. There is evidence that gloved hands have lower microbial load than bare hands, and according to Greene( 2015), gloves reducing fomite-to fingerpad and fingerpad-to fomite transfer.
“ A bare hand might transfer 24 percent efficiency fomite from a surface to the fingerpad, but a latex glove only at a 10 % efficiency transfer efficiency rate,” she explained.“ So, there are definitely some benefits to gloves and they serve an important role in our hand hygiene programs, but there are also some of the disadvantages. We know that when people use gloves, unfortunately, they sometimes wear them for too long and then we worry about environmental contamination from inappropriate glove use.”
She explained further that there is increased environmental contamination from inappropriate glove use, during tasks when there is no risk of exposure to infectious matter, or failures to change gloves at appropriate moments during care. Additionally, there is increased hand contamination from gloves that are too large and from doffing processes, as well as increased risk of occupational irritant or allergic dermatitis with extended use of gloves.
The SHEA Compendium recommends ensuring the appropriate glove use to reduce hand and environmental contamination. This involves using gloves for all contact with the patient and environment as indicated by standard and contact precautions during care of individuals with organisms confirmed to be less susceptible to biocides. It also includes educating healthcare personnel about the potential for self-contamination and environmental contamination when gloves are worn. Personnel should clean their hands immediately following glove removal. If handwashing is indicated and sinks are not immediately available, use an alcohol-based hand sanitizer and then wash hands as soon as possible. Finally, infection preventionists must educate and confirm the ability of healthcare personnel to don and doff gloves in a manner that avoids contamination.
Sickbert-Bennett emphasized to attendees that the key take-home message is that gloves are most often used as personal protective equipment to protect the wearer and when used for extended durations leads to increased environmental surface contamination and decreased hand hygiene.
The final topic that Sickbert-Bennett tackled was hand hygiene monitoring.
“ When we conduct hand hygiene compliance monitoring, the goal is to collect timely, meaningful data that will give us actionable feedback to help guide improvement,” she said.“ It’ s unlikely that any single data collection method is going to fulfill all your hand hygiene program needs, so the measurement methods that you choose should be ones that are executed in a way that enhances the culture of safety, results in credible and actionable data, and improves performance toward your facility’ s goals. Additionally, individuals who conduct hand hygiene observations should be recognized as valued team members and patient safety advocates.”
She recommended that attendees consult SHEA’ s Compendium to review the various types of hand hygiene monitoring and measurement, whether it’ s a direct covert observation, a direct overt observation, automated hand hygiene using technology, or remote video observation, for example.“ The Compendium describes the strengths, the weaknesses, and different considerations for the different types of monitoring methods.”
SHEA’ s recommendations say facilities should monitor adherence to hand hygiene, considering the advantages and limitations of each type of monitoring. To provide timely and meaningful feedback, facilities should provide feedback in multiple formats( verbal, written) and on multiple occasions( such as real-time or weekly). SHEA also advises debriefing managers as soon as possible after each direct covert observation sessions in a manner that preserves the observer’ s confidentiality. All data should have clear targets linked to actions that improve adherence.
Sickbert-Bennett emphasized,“ Monitoring is necessary to gauge performance, inspire improvement and report to external agencies but often does not accurately reflect reality or inspire improvement in hand hygiene behaviors, leading to some of the difficulties in just doing it.”
We have, for a number of years, used volunteer observers. We basically have an army of probably a couple hundred or more healthcare workers who have gone through a short training to learn how to be an observer.”— Matthew Linam, MD, MS
The SHEA townhall panelists shared how they monitor hand hygiene in their respective healthcare institutions.
“ We have, for a number of years, used volunteer observers,” said Matthew Linam, MD, MS, of Emory University.“ We basically have an army of probably a couple hundred or more healthcare workers who have gone through a short training to learn how to be an observer. We use a Red Cap tool that people can have on their phones with which to do the observations and we garner observations from essentially every inpatient and outpatient location in our hospital. I think we average about 3,000 observations a month.”
Erica Shenoy, MD, PhD, of Massachusetts General Hospital Brigham, noted that,“ The SHEA Compendium is a great document. We use that as the basis for our system’ s hand hygiene policy because it’ s very well written and accessible. We’ re in the process of system integration. About a year and a half ago or s we looked across all of our 14 institutions. Hand hygiene was kind of being done a little bit differently across the board, both in terms of who was doing the observations and how those were being recorded. It ranged from pen and paper to Red Cap, to apps, and even in our rehabilitation network, which is comprised of four facilities, there was an automated hand hygiene monitoring system. The first thing we did was create a hand hygiene policy and then we got everyone on a single app to record the observations with the exception of the post-acute-care
14 • www. healthcarehygienemagazine. com • sept-oct 2025