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Clean Hands Save Lives: A Systems Approach to Improving Hand Hygiene

April 2015
Executive Summary
The Center For Health Design
Hospital-Acquired Conditions, Infections, and Healthcare Reform
As discussed in the Healthcare Reform brief, various infections are included as part of the Hospital-Acquired Conditions (HAC) program and the related Hospital-Acquired Conditions Reduction program. In FY15, these include catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI). In FY16 they will also include surgical site infections following both colon surgery and abdominal hysterectomy. In FY17, the list will expand again to include MRSA Bacteremia and Clostridium difficile (C. diff). These represent two of the most challenging drug-resistant infections faced by healthcare organizations today, often referred to publicly as “superbugs.”


Hand hygiene is the single most important component of healthcare-associated infection prevention. Many such infections are now linked to healthcare provider reimbursement in the United States. However, maintaining and improving hand hygiene compliance has been an ongoing battle despite efforts on facility, organizational, national, and international levels. Based on a literature review, this executive summary recaps hand hygiene promotion efforts following four main strategies. Each strategy integrates environmental, organizational/operational, and personal elements.

  • Strategy 1: Increase knowledge/awareness through education. Such programs should be tailored to particular staff and include clearly articulated guidance, social influence, and leadership support.
  • Strategy 2: Provide real-time monitoring/reminders. Leverage new monitoring and communication technology, stakeholder engagement, and visual (or other) cues to direct attention to hand hygiene tasks during routine work.
  • Strategy 3: Make it easy to clean hands. Install hand hygiene facilities (e.g., sinks and gel dispensers) in convenient locations, and design processes more effectively to incorporate hand hygiene as an important step in the workflow and to maximize staff time in direct patient care.
  • Strategy 4: Improve hand cleanliness through environmental hygiene. A clean environment can reduce the risk of pathogen transmission by contaminated hands.

Increasingly, a systems approach is used to implement multiple strategies simultaneously to maximize the impact on hand hygiene and infection prevention. This approach may help healthcare organizations to enhance safety and improve viability.

Strategies to Improve Hand Hygiene
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