The Institute for Healthcare Improvement in its How-to Guide: Improving Hand Hygiene recommends a multidimensional approach (e.g., introduction of alcohol-based hand rub, and educational and behavioural initiatives) to improve compliance with hand hygiene guidelines in healthcare settings.25 The science supporting a multidimensional approach to hand hygiene is sufficiently established to be considered the standard and consist of four components:2,3,11
- HCP demonstrate knowledge
- Predicated on educational exposure, HCP understand the rationale for hand hygiene:
- Types of patient care activities that result in hand contamination.
- Relative advantages and disadvantages of handwashing and the use of alcohol-based hand rubs at the point of care
- Important role that contaminated hands play in transmission of healthcare-associated pathogens, including multidrug-resistant organisms.
- Morbidity and mortality caused by HAIs.
- HCP demonstrate competence
- Predicated on exposure to live demonstrations, video-presentations, and/or fluorescent dye-based training methods, HCP perform appropriate hand hygiene:
- Correct technique for handwashing, hand antisepsis, and surgical hand antisepsis
- Application of an appropriate volume of alcohol-based hand rub, or a plain or antiseptic soap.
- Institution enables staff
- Predicated on institutional commitment to good hand hygiene practices:
- Alcohol-based hand rub and gloves of various sizes are readily available to HCP near the point of use.
- Alcohol-based hand rub dispensers available in locations that are compliant with local and federal fire safety regulations.
- Established protocol with responsibility assigned for checking alcohol-based hand rub dispensers and glove boxes on a regular basis to ensure that (a) dispersers and glove boxes are not empty, (b) dispersers are operational, and (c) containers dispense the correct amount of the product.
- Evaluated the design and function of dispensers before selecting a product for use since poorly functioning dispensers may adversely affect hand hygiene compliance rates.
- Institution verifies competency of HCP and provides feed back
- Predicated on an established program to monitor that hand hygiene is performed and gloves are used appropriately by HCP as recommended by the CDC:
- Routinely using alcohol-based hand rub when hands are not visibly soiled.
- Washing hands with plain or antimicrobial soap and water when hands are visibly dirty or contaminated with proteinaceous material or with blood and other potentially infectious material.
- Wearing gloves when contact with blood or OPIM (all body fluids, excretions, secretions [except sweat]), mucous membranes, and nonintact skin could occur